CORR Insights^®: Does Proximal Rectus Femoris Release Influence Kinematics In Patients With Cerebral Palsy and Stiff Knee Gait?

Excerpt

The distal rectus femoris transfer to the hamstring muscle is designed to address stiff knee gait in an ambulatory child with cerebral palsy. Patients with cerebral palsy who have problems walking on uneven ground—often needing a brace, or ambulatory aids such as a walker or crutches—typically are classified as level II or III patients on the Gross Motor Function Classification System (GMFCS) mobility assessment. Children with a stiff knee gait often fall during the day, and are observed to have compensatory gait accommodations of external rotation, ipsilateral circumduction, contralateral vaulting, or a combination of all of these. Treatment options for this disorder, prior to the introduction of the transfer, include proximal or distal lengthening of the rectus femoris. Most suggest that there is little improvement in the stiff knee component of gait in patients who had undergone these surgeries. As more research is performed on the rectus transfer, it is becoming apparent that this approach is not the panacea thought to eliminate stiff knee gait in all patients. This could be ascribed to undiagnosed underlying dystonia, increased scarring after the transfer, or not performing the procedure correctly. There still are authors who suggest that quality treatment of the stiff knee gait can be accomplished by performing a proximal rectus femoris release. Végvári and colleagues addressed this controversy in the current study. …