Article

Although several studies have reported on the outcomes of rectus femoris transfer (RFT),
few have investigated the multiple factors that could
affect the results. Therefore, we evaluated the outcomes of RFT and analyzed
factors that influence improvement and annual change in knee motion after surgery
in patients with cerebral palsy (CP). METHODS: We reviewed ambulatory patients
with CP who were followed up after they had undergone RFT as part of a
single-event multilevel surgery (SEMLS) and who had undergone preoperative and
postoperative three-dimensional (3D) gait analysis between January 1995 and
December 2012. Relevant kinematic values, including peak knee flexion, knee range
of motion, and timing of peak knee flexion in the swing phase and gait deviation
index (GDI) score,
were the outcome measures. Improvements in rate of angle and
GDI score were adjusted by multiple factors such as sex, Gross Motor Function
Classification System (GMFCS) level, anatomic type of CP, and concomitant
surgeries as the fixed effects, and follow-up duration, laterality, and each
subject as the random effects, all of which was performed using a linear mixed
model. RESULTS: A total of 290 patients (487 limbs) and 612 3D gait analysis (2-4
per patient) results were finally included in this study. At 2 years after RFT,
estimated mean peak knee flexion (1.2 degrees , p=0.005), estimated mean knee
range of motion (10.7 degrees , p<0.001), and estimated mean GDI score (7.3,
p<0.001) increased significantly. Peak knee flexion in the swing phase occurred
5.4% earlier after surgery compared with that at baseline (p<0.001). In serial
postoperative gait analyses, peak knee flexion in the swing phase occurred 0.8%
earlier per year in patients with GMFCS level I or II (p=0.021). CONCLUSIONS: RFT
as part of a SEMLS was effective in treating stiff knee gait. In serial
postoperative gait analyses, patients with GMFCS level I or II showed better
prognosis than those with level III with regard to timing of peak knee flexion in
the swing phase. LEVEL OF EVIDENCE: Prognostic level IV.
CI - Copyright (c) 2014 Elsevier B.V. All rights reserved.

Langue : ANGLAIS