Purpose of the study: The anatomic, clinical and radiographic expression of congenital genu recurvatum corresponds to femorotibial subluxation. The clinical presentation can vary, ranging from an easily reducible subluxation to irreducible dislocation.

Material and methods: Fifty five patients (82 knees) were treated, mean age 2 days. Genu recurvatum was isolated (n=15 children), associated with hip dislocation or foot deformity (n=40 children), arthrogyrposis (n=10 children, or Larsen syndrome (n=3 patients). Were studied: anterior skin folds, anteroposterior femorotibial instability, joint range of motion at first exam and last follow-up. The Seringe classification was noted at birth: I – reducible (n=59 knees), II – difficult to reduce (n=12 knees), III – irreducible (n=11 knees). Mean follow-up was 4 years, 13 years, and 9 years for class I, II and III knees respectively. Orthopaedic treatment was performed in all cases with manipulations, braces, traction and plaster cast for at least 40 days. In the event of failure, a V/Y lengthening of the quadriceps was performed, associated with joint release.

Results: At the first exam, the skin folds were present in all cases in group I, 2/3 in group II, and absent in group III. Mean maximal flexion was 66, 43 and 17 respectively in groups I, II and III. The even operated knees were in group III. At last follow-up, the mean maximal flexion was 146, 124 and 77 respectively in groups I, II and III. Six knees presented anteroposterior instability in groups I, 3 in group II and 3 in group III. In group I, the final clinical outcome was good or very good in 55 knees (93%), fair in 4. In group II, good or very good outcome was noted in 8 knees (67%), fair in 3 (25%), and poor in 1 knee. In group III, outcome was faire in 4 (36%) and poor in 7 (64%). In this group, poor outcome corresponded to 86% of the operated knees.

Discussion: At the first exam, factors having the most unfavourable impact were: absence of an anterior skin fold, knee flexion < 50, irreducible femorotibial dislocation, and syndrome context. We emphasise the importance of adapted conservative treatment which, in our experience, provides the better clinical outcomes.

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.

Purpose of the study: The aim of this study was to evaluate the results of the repeated soft tissue release for recurrent postoperative idiopathic congenital talipes equinovarus. There is no real consensus on the appropriate therapeutic option.

Materials and Methods: Fifty two patients (74 feet) underwent revision surgery performed by our senior surgeon between 1974 and 2001. One, two or three soft tissue release procedures were performed on 59, 12 and 3 feet respectively. Mean age at the time of the revision surgery was 5.7 years (range 15m-14y). Triple deformity (varus, equinus, adductus) was found in 46 feet, while 28 feet had one dominant deformity. The operation consisted of complete release of the soft tissues in 26 feet and partial release in 48. Subtalar release was indicated in 21 feet. Lichtblau osteotomy was performed in 48 feet. The clinical and radiological outcome was assessed using the Ghanem and Seringe scores recorded before surgery and at last follow-up.

Results: Mean follow-up was 11 years (range 4–30). Complications included overcorrection in valgus (n=6) and recurrence (n=8). The anatomic correction was highly significant. Dorsoplantar X-rays show the improvements in the mean talocalcaneal divergence (18–21°), the mean talus-first metatarsal angle (reduced from 28° to 4°), and the calcaneus-fifth metatarsal angle (reduced from 20° to 2°). The average of tibiocalcaneal angle in lateral view increased from 1° to 10° and the average of calcaneal incidence from 6° to 9°. At last follow-up, outcome was considered as ‘excellent’ in 29% and ‘good’ in 42% of the cases. We had ‘fair’ results in 14 feet (19%) because of poor functional results in one third and anatomical defects in two-thirds of them. The outcome was considered ‘poor’ in seven feet (10%), which was due to significant anatomical defects. Triple arthrodesis was needed in seven feet after skeletal maturity.

Discussion and Conclusion. Repeated soft tissue release provides an effective means for correcting anatomical anomalies caused by recurrent postoperative talipes equinovarus. The mid-term results are however affected by functional limitations characterised by decreased range of motion and joint pain, particularly in ankle joint. Excessive subtalar release raises the risk of valgus overcorrection. A splint worn at night may be helpful for preventing the recurrence.

Aim: 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.

Patients & Methods: Thirty-nine children were included in this study. Thirty patients (55 limbs) underwent RF transfer at a mean age of 11.8 years. and nine (16 limbs) underwent distal rectus release at a mean age of 12.5 years. Indications for surgery included RF contracture and abnormal activity during swing phase in dynamic electromyography (EMG), whether with the presence of kinematic characteristics of stiff-knee gait or not. All patients had pre- and postoperative gait analysis and EMG. To evaluate functional outcomes, patients were grouped by pre-operative knee kinematics (normal; swing-phase peak knee flexion (PKF) < 50°; and peak knee flexion > 50° happening later than 77% of the cycle). All data was analyzed statistically.

Results: For the group of patients with PNF< 50°, this value increased significantly after rectus transfer (p=.005). Children with PNF> 50° and later than 77% of the cycle, showed significant improvement in timing after both procedures (p=.001; p=.02). When kinematic parameters were normal before surgery, they did not improved, although patients experienced a significant decrease of muscle contractures.

Conclusions: According to the results of this study, RF transfer would be the preferred procedure for those patients with preoperative swing-phase knee flexion < 50°. For the rest of patients, both procedures brought similar results. We opt for distal RF release since is technically easier, particularly when one-stage multilevel procedures are being performed.