TREATMENT OF STIFF KNEE GAIT IN CHILDREN WITH CEREBRAL PALSY

Abstract

Objective: To evaluate the effectiveness of distal rectus femoris (RF) release versus transfer to treat gait abnormalities of the knee in ambulatory children with cerebral palsy.

Methods: Ninety-three children were included in this study. Thirty-two patients underwent RF transfer at a mean age of 11.8 years and sixty-one underwent distal RF release at a mean age of 12.5 years. Indications for surgery included RF contractures, abnormal RF activity during swing phase (EMG) and kinematic characteristics of stiff-knee gait. All patients had pre–and postoperative 3D gait analysis and EMG at one year follow up. To evaluate outcomes, patients were grouped by pre-operative knee kinematics (swing-phase peak knee flexion (PKF) < 50º or PKF > 50º occurring later than 77% of the cycle). All data was analyzed statistically.

Results: For the group of patients with PKF< 50º, this value increased significantly after RF transfer (p=.005) and after RF release (p=.03). Children with PKF later than 77% of the cycle also showed significant improvement after both procedures (p=.001; p=.02). All patients experienced a significant decrease of muscle contractures.

Discussion: According to the results of this study, both RF transfer and release brought significant results. We opt for distal RF release, since is technically easier, particularly when one-stage multilevel procedures are being performed.