Rectus Femoris Distal Tendon Resection Improves Knee Motion in Patients With Spastic Diplegia
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Children with spastic diplegia frequently show excessive knee extension (stiff-knee gait) throughout swing phase, which may interfere with foot clearance. Abnormal rectus femoris activity is commonly associated with a stiff-knee gait. Rectus femoris transfer has been recommended to enhance knee flexion during swing. However, recent studies suggest the transfer does not generate a knee flexor moment but diminishes knee extension moment in swing and MRI studies show the transferred tendons can be constrained by scarring to underlying muscles. Thus, it is possible knee flexion would be improved by distal rectus release rather than transfer since it would not be adherent to the underlying muscles.
We therefore determined whether rectus femoris distal tendon resection improves knee ROM and kinematic characteristics of stiff-knee gait in patients with spastic diplegia.
Patients and Methods
We studied 45 patients who underwent rectus femoris distal tendon resection as a part of multilevel surgery. Rectus femoris procedures were indicated based on kinematic characteristics of stiff-knee gait. All patients were walkers and had a mean age at surgery of 13 years (range, 6–22 years). We obtained gait analyses before surgery and at mean 2-year followup. We based postoperative assessment on clinical evaluation and gait analysis data.
At followup, rectus femoris distal tendon resection was associated with improved knee ROM and timing of peak knee flexion in swing, and the absolute values of peak knee flexion became normal for those patients who showed abnormal preoperative values.
Kinematic parameters of stiff-knee gait improved after rectus femoris distal tendon resection. Given the preliminary nature of our report, we intend to study the same patients to assess outcomes at a longer followup.
Level of Evidence
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
- Asakawa, DS, Blemker, SS, Gold, GE, Delp, SL (2002) In vivo motion of the rectus femoris muscle after tendon transfer surgery. J Biomech. 35: pp. 1029-1037 CrossRef
- Asakawa, DS, Blemker, SS, Rab, GT, Bagley, A, Delp, SL (2004) Three-dimensional muscle-tendon geometry after rectus femoris tendon transfer. J Bone Joint Surg Am. 86: pp. 348-354
- Davids, JR, Õunpuu, S, DeLuca, PA, Davis, RB (2003) Optimization of walking ability of children with cerebral palsy. J Bone Joint Surg Am. 85: pp. 2224-2234
- Gage, JR, Perry, J, Hicks, RR, Koop, S, Werntz, JR (1987) Rectus femoris transfer to improve knee function of children with cerebral palsy. Dev Med Child Neurol. 29: pp. 159-166 CrossRef
- Gold, GE, Asakawa, DS, Blemker, SS, Delp, SL (2004) Magnetic resonance imaging findings after rectus femoris transfer surgery. Skeletal Radiol. 33: pp. 34-40 CrossRef
- Hemo, Y, Aiona, MD, Pierce, RA, Dorociack, R, Sussman, M (2007) Comparison of rectus femoris transposition with traditional transfer for the treatment of stiff knee gait in patients with cerebral palsy. J Child Orthop. 1: pp. 37-41 CrossRef
- Kadaba, MP, Ramakrishnan, HK, Wootten, ME (1990) Measurement of lower extremity kinematics during level walking. J Orthop Res. 8: pp. 383-392 CrossRef
- Moreau, N, Tinsley, S (2005) Progression of knee joint kinematics in children with cerebral palsy with and without rectus femoris transfers: a long-term follow up. Gait Posture. 22: pp. 132-137 CrossRef
- Õunpuu, S, DeLuca, P, Davis, R, Romness, M (2002) Long-term effects of femoral derotation osteotomies: an evaluation using three-dimensional gait analysis. J Pediatr Orthop. 22: pp. 139-145 CrossRef
- Õunpuu, S, Muik, E, Davis, RB, Gage, JR, DeLuca, PA (1993) Rectus femoris surgery in children with cerebral palsy. Part I. The effect of rectus femoris transfer location on knee motion. J Pediatr Orthop. 13: pp. 325-330 CrossRef
- Õunpuu, S, Muik, E, Davis, RB, Gage, JR, DeLuca, PA (1993) Rectus femoris surgery in children with cerebral palsy. Part II. A comparison between the effect of transfer and release of the distal rectus femoris on knee motion. J Pediatr Orthop. 13: pp. 331-335 CrossRef
- Palisano, R, Rosenbaum, P, Walter, S, Russell, D, Wood, E, Galuppi, B (1997) Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 39: pp. 214-223 CrossRef
- Perry, J (1987) Distal rectus femoris transfer. Dev Med Child Neurol. 29: pp. 153-158 CrossRef
- Riewald, SA, Delp, SL (1997) The action of the rectus femoris muscle following distal tendon transfer: does it generate knee flexion moment?. Dev Med Child Neurol. 39: pp. 99-105 CrossRef
- Saraph, V, Zwick, E, Zwick, G, Steinwender, C, Steinwender, G, Linhart, W (2002) Multilevel surgery in spastic diplegia: evaluation by physical examination and gait analysis in 25 children. J Pediatr Orthop. 22: pp. 150-157 CrossRef
- Saw, A, Smith, PA, Sirirungruangsarn, Y, Chen, S, Hassani, S, Harris, G, Kuo, KN (2003) Rectus femoris transfer for children with cerebral palsy: long-term outcome. J Pediatr Orthop. 23: pp. 672-678 CrossRef
- Sutherland, DH, Davids, JR (1993) Common gait abnormalities of the knee in cerebral palsy. Clin Orthop Relat Res. 288: pp. 139-147
- Sutherland, DH, Larsen, LJ, Mann, R (1975) Rectus femoris release in selected patients with cerebral palsy: a preliminary report. Dev Med Child Neurol. 17: pp. 26-34 CrossRef
- Sutherland, DH, Santi, M, Abel, MF (1990) Treatment of stiff-knee gait in cerebral palsy: a comparison by gait analysis of distal rectus femoris transfer versus proximal rectus release. J Pediatr Orthop. 10: pp. 433-441
- Waters, RL, Garland, DE, Perry, J (1979) Stiff-legged gait in hemiplegia: surgical correction. J Bone Joint Surg Am. 61: pp. 927-933
- Rectus Femoris Distal Tendon Resection Improves Knee Motion in Patients With Spastic Diplegia
Clinical Orthopaedics and Related Research®
Volume 470, Issue 5 , pp 1312-1319
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- 1. Service d’Orthopédie, Hôpital Robert Debré, 48 Boulevard Sérurier, 75019, Paris, France
- 2. Laboratoire d’analyse de la marche et du mouvement, Centre de rééducation fonctionnelle Bois-Larris, Croix Rouge Française, Lamorlaye, France