Development of Knee Function After Hamstring Lengthening as a Part of Multilevel Surgery in Children with Spastic Diplegia

Dreher, Thomas; Végvári, Dóra; Wolf, Sebastian I.; Geisbüsch, Andreas; Gantz, Simone; Wenz, W; Braatz, Frank

doi:10.2106/jbjs.j.00890

Cited by 128 publications

(122 citation statements)

References 40 publications

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“…This group difference remained at the 1-year followup for mean pelvic tilt, but at long-term evaluation no significant difference between the two groups was found. The pelvic tilt increased slightly in both groups after surgery and this increase should be seen mainly as the result of concomitant hamstring lengthening in many patients in both groups [5]. Therefore, the proximal rectus release did not prevent anterior pelvic tilt from increasing, corroborating the findings of McMulkin et al [16].…”

Section: Discussionsupporting

confidence: 81%

“…It is believed to cause or aggravate increased anterior pelvic tilt. DRFT is commonly performed to correct stiff knee gait, however variable outcomes have been reported [5,18,20,30]. A proximal rectus femoris release was done to eliminate rectus function at the pelvic level and to influence knee motion but was found to be less effective than DRFT.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the patients in our two study groups had several additional procedures (eight procedures per subject on average; Table 1) as part of single-event multilevel surgery. Some concomitant procedures affect knee kinematics, such as hamstring lengthening, which improves knee motion in the long term [1,5]. Hamstring lengthening may increase anterior pelvic tilt [5], since the hamstrings stabilize the pelvis and lengthening may lead to insufficiency.…”

Section: Discussionmentioning

confidence: 99%

“…Some concomitant procedures affect knee kinematics, such as hamstring lengthening, which improves knee motion in the long term [1,5]. Hamstring lengthening may increase anterior pelvic tilt [5], since the hamstrings stabilize the pelvis and lengthening may lead to insufficiency. However, hamstring lengthening was done in a nearly equal number of patients in both groups.…”

Section: Discussionmentioning

confidence: 99%

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Does Proximal Rectus Femoris Release Influence Kinematics In Patients With Cerebral Palsy and Stiff Knee Gait?

Végvári

Wolf

Heitzmann

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Stiff gait resulting from rectus femoris dysfunction in cerebral palsy commonly is treated by distal rectus femoris transfer (DRFT), but varying outcomes have been reported. Proximal rectus femoris release was found to be less effective compared with DRFT. No study to our knowledge has investigated the effects of the combination of both procedures on gait. Questions/purposes We sought to determine whether an additional proximal rectus release affects knee and pelvic kinematics when done in combination with DRFT; specifically, we sought to compare outcomes using the (1) range of knee flexion in swing phase, (2) knee flexion velocity and (3) peak knee flexion in swing phase, and (4) spatiotemporal parameters between patients treated with DRFT, with or without proximal rectus release. Furthermore the effects on (5) anterior pelvic tilt in both groups were compared. Methods Twenty patients with spastic bilateral cerebral palsy treated with DRFT and proximal rectus femoris release were matched with 20 patients in whom only DRFT was performed. Standardized three-dimensional gait analysis was done before surgery, at 1 year after surgery, and at a mean of 9 years after surgery. Basic statistics were done to compare the outcome of both groups. Results The peak knee flexion in swing was slightly increased in both groups 1 year after surgery, but was not different between groups. Although there was a slight but not significant decrease found the group with DRFT only, there was no significant difference at long-term followup between the groups. Timing of peak knee flexion, range of knee flexion, and knee flexion velocity improved significantly in both groups, and in both groups a slight deterioration was seen with time; there were no differences in these parameters between the groups at any point, however. There were no group differences in spatiotemporal parameters at any time. There were no significant differences in the long-term development of anterior pelvic tilt between the groups. Conclusions The results of our study indicate that the short-and long-term influences of adding proximal rectus femoris release on the kinematic effects of DRFT and on pelvic tilt in children with cerebral palsy are negligible.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Does Proximal Rectus Femoris Release Influence Kinematics In Patients With Cerebral Palsy and Stiff Knee Gait?

Végvári

Wolf

Heitzmann

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…The strength of the GGI is that it reduces the large gait analysis dataset into a single index. It continues to be used to evaluate clinical populations such as adults with spinal cord and brain injury [2], patients treated for central nervous system tumors [3], and children and young adults with cerebral palsy [4][5][6]. It has also been used to assess the reliability of instrumented gait analysis [7] and sensitivity of other gait indices [8].…”

Section: Introductionmentioning

confidence: 99%

Application of the Gillette Gait Index, Gait Deviation Index and Gait Profile Score to multiple clinical pediatric populations

McMulkin¹,

MacWilliams²

2015

Gait & Posture

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Gait Evaluation for Patients with Cerebral Palsy

White

Augsburger

2020

Orthopedic Care of Patients With Cerebral Palsy

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Development of Knee Function After Hamstring Lengthening as a Part of Multilevel Surgery in Children with Spastic Diplegia

Abstract: The results of the present study are crucial for the prognosis of knee function after hamstring lengthening as a part of multilevel surgery. Recurrence and possible overcorrection should be considered in treatment planning.

Cited by 128 publications

References 40 publications

Does Proximal Rectus Femoris Release Influence Kinematics In Patients With Cerebral Palsy and Stiff Knee Gait?

Does Proximal Rectus Femoris Release Influence Kinematics In Patients With Cerebral Palsy and Stiff Knee Gait?

Application of the Gillette Gait Index, Gait Deviation Index and Gait Profile Score to multiple clinical pediatric populations

Gait Evaluation for Patients with Cerebral Palsy

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