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

Abstract

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.

Effects of Ankle Joint Motion on Pelvis-Hip Biomechanics and Muscle Activity Patterns of Healthy Individuals in Knee Immobilization Gait

“…Donald Neumann summarized the kinesiology of the hip and indicated that “a sufficiently strong and isolated bilateral contraction of any hip flexor muscle will either rotate the femur towards the pelvis, the pelvis (and possibly the trunk) towards the femur, or both actions simultaneously” [20]. The proximal part of the rectus femoris plays an important role in pelvic tilt and hip flexion [21]. As the knee joints were locked in both KAI and KI gait, and the hip angles did not present significant differences in the single support phase, therefore, the increased RF and RA activation could provide the power for more anterior pelvic tilt in KAI gait.…”

Distal rectus femoris surgery in children with cerebral palsy: Results of a Delphi consensus project

“…Various surgical approaches to stiff knee gait have been used over time, such as proximal or distal rectus femoris release and distal rectus femoris transfer (DRFT). 2 - 17 Computerized movement analysis data are often useful in the assessment of patients with stiff knee gait but there remains considerable variability in interpretation of underlying mechanisms and surgical decision-making.…”

Tendon release reduced joint stiffness with unaltered leg stiffness during gait in spastic diplegic cerebral palsy

“…Computerized gait analysis has been used for identifying more detailed changes in walking performance in CP patients before and after tenotomy [ 13 – 17 ]. Depending on the location of the surgery, tenotomy was found to help one or more of the following: decreased hip flexion contracture, increased knee extension during stance, decreased knee flexion during swing and decreased ankle plantarflexion throughout the gait cycle [ 13 – 16 ]. Since the different joints and muscles of the lower extremities work together to meet the varying mechanical and balance demands during different phases of gait, changing the tightness of one muscle may affect the actions of the other muscles, and thus the motions of the joints.…”