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Rectus femoris transfer for children with cerebral palsy: long-term outcome
Aik Saw1, Peter A Smith, Yuddhasert Sirirungruangsarn
1Shriners Hospital for Children, Chicago, Illinois, USA.
Insights
Rectus femoris transfer improved knee flexion in cerebral palsy patients. However, long-term results showed a loss of knee extension, potentially requiring hamstring lengthening for optimal gait.
Area of Science:
- Orthopedics
- Pediatric Rehabilitation
- Biomechanical Engineering
Background:
- Cerebral palsy (CP) often causes stiff-knee gait, impacting mobility.
- Rectus femoris transfer is a surgical option to address this gait abnormality.
Purpose of the Study:
- To evaluate the long-term efficacy of rectus femoris transfer in children with CP and stiff-knee gait.
- To assess changes in knee motion, ambulatory status, and gait parameters post-surgery.
Main Methods:
- Gait analysis was performed preoperatively and at 1-year and long-term follow-up (average 4.6 years).
- Evaluated 38 limbs in 24 children, with 26 limbs in 18 patients completing final analysis.
- Functional ambulatory status was assessed using Hoffer's criteria.
Main Results:
- Significant improvements in swing-phase knee flexion (9.8°) and total knee motion (7.0°) at 1 year.
- Long-term follow-up maintained swing-phase flexion improvement but showed decreased total knee motion.
- A trend towards loss of knee extension during the stance phase was observed long-term.
Conclusions:
- Rectus femoris transfer effectively improves swing-phase knee flexion and foot clearance in CP.
- Long-term follow-up indicates a potential trade-off with reduced stance-phase knee extension.
- Consideration of hamstring lengthening may be necessary for patients developing excessive stance-phase knee flexion.
Abstract:
The purpose of this study was to evaluate the long-term results of rectus femoris transfer in cerebral palsy children with stiff-knee gait. Thirty-eight affected limbs in 24 children were evaluated preoperatively and 1 year postoperatively by gait analysis, with 26 limbs in 18 patients having final study, averaging 4.6 years postoperatively. Functional ambulatory status was evaluated based on Hoffer's criteria on ambulation. There were statistically significant improvements of 9.8 degrees in maximum swing-phase knee flexion and 7.0 degrees in total range of knee motion at 1 year, with a small loss of knee extension in stance. At final gait analysis, the improvement in the swing-phase knee flexion was maintained, but improvement in total range of knee motion was decreased. There were no significant changes in temporal parameters. Improvement in swing-phase knee flexion and foot clearance after rectus femoris transfer was associated with loss of knee extension at long-term follow-up. Hamstring lengthening in patients who develop excessive stance-phase knee flexion may be necessary.