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Rectus managment in CP

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28 papers 0 to 25 followers Rectus transfer versus lengthening
By David Bennett Pediatric Orthopaedic Surgeon in the United States
Robert M Kay, Susan A Rethlefsen, John P Kelly, Tishya A L Wren
Fifty-six patients who underwent 94 distal rectus femoris transfers and pre- and postoperative gait analyses were retrospectively reviewed. The patients were divided into three groups based on pre- and postoperative Duncan-Ely tests. Group A (34 limbs) had positive tests both before and after surgery. Group B (46 limbs) had positive tests before surgery and negative tests after surgery. Group C (13 limbs) had negative tests both before and after surgery. One limb had a negative test before surgery and a positive test after surgery and was not included in any group...
January 2004: Journal of Pediatric Orthopedics
R Gross, F Leboeuf, O Rémy-Néris, B Perrouin-Verbe
We present the case of a 54 year-old man presenting with a right Brown-Séquard plus syndrome (BSPS) after a traumatic cervical spinal cord injury. After being operated on with selective tibial neurotomy and triceps surae lengthening because of a right spastic equinus foot, he developed a gait disorder at high speed. The patient complained about an instability of the right knee. Observational gait analysis exhibited an oscillating, flexion/extension motion of the right knee during stance, which was confirmed by gait analysis...
December 2012: Annals of Physical and Rehabilitation Medicine
N Lampire, N Roche, P Carne, L Cheze, D Pradon
BACKGROUND: In hemiparetic patients, rectus femoris spasticity is one of the main causes of reduced knee flexion in swing phase, known as stiff knee gait. Botulinum toxin is often used to reduce rectus femoris spasticity and to increase knee flexion during swing phase. However, the mechanisms behind these improvements remain poorly understood. The aim of this study was (1) to quantify maximal rectus femoris length and lengthening velocity during gait in ten adult hemiparetic subjects with rectus femoris spasticity and stiff knee gait and to compare these parameters with those of ten healthy subjects and (2) to study the effect of botulinum toxin injection in the rectus femoris muscle on the same parameters...
February 2013: Clinical Biomechanics
S Rethlefsen, V T Tolo, R A Reynolds, R Kay
To evaluate the outcome of hamstring lengthening and distal rectus femoris transfer, a retrospective study was performed comparing preoperative and postoperative gait analysis data from 16 children with neurologic involvement. Postoperatively, the timing of peak knee flexion during swing and the total arc of knee motion significantly improved. Hamstring range of motion and knee extension at terminal swing significantly improved, but stride length and gait velocity did not for the overall population. Patients who used braces postoperatively showed an improvement in stride length and velocity when wearing orthoses...
April 1999: Journal of Pediatric Orthopedics. Part B
E Guerado, V de la Varga
There are two main problems with muscle tendon lengthening: thinness created by the technical procedure weakens the tendon, and in short tendons, lengthening may not provide enough length for the amount of joint motion required. In proximal rectus femoris lengthening, the distal ends of the reflected and straight heads are sutured together. Using this technique, the tendon will not be thinned, and a later second lengthening is possible.
July 2001: Orthopedics
Garry E Gold, Deanna S Asakawa, Silvia S Blemker, Scott L Delp
We describe the magnetic resonance (MR) imaging appearance of the knee flexor and extensor tendons after bilateral rectus femoris transfer and hamstring lengthening surgery in five patients (10 limbs) with cerebral palsy. Three-dimensional models of the path of the transferred tendon were constructed in all cases. MR images of the transferred and lengthened tendons were examined and compared with images from ten non-surgical subjects. The models showed that the path of the transferred rectus femoris tendon had a marked angular deviation near the transfer site in all cases...
January 2004: Skeletal Radiology
Brian T Carney, Donna Oeffinger, Nicholas K Gove
The purpose of this study was to assess the sagittal knee kinematics of rectus femoris transfer without hamstring lengthening. A retrospective review of seventeen children (29 knees) was performed. Gait analysis was performed prior to surgery and repeated at a minimum of one year after surgery. Sagittal knee kinematics were analyzed. Stance minimum knee flexion increased 7 degrees; swing maximum knee flexion increased 5 degrees; and swing minimum knee flexion increased 5 degrees. The present study confirmed previously reported increases in swing maximum knee flexion...
March 2006: Journal of Pediatric Orthopedics
Ilse Jonkers, Caroline Stewart, Kaat Desloovere, Guy Molenaers, Arthur Spaepen
Inappropriate activity of M. rectus femoris (RF) during swing is believed to contribute to stiff knee gait in cerebral palsy. This study used musculoskeletal modeling techniques to analyze rectus femoris musculo-tendon (MT) length and lengthening velocity during stiff knee gait in 35 children with diplegic cerebral palsy (CP). Duncan Ely test scores were used to categorize the patients into four groups with increasing levels of rectus femoris spasticity. Knee kinematics confirmed a significant reduction and delay of maximal peak knee flexion during swing in the patient groups compared to reference values...
February 2006: Gait & Posture
J R Gage
The prerequisites for normal gait are: (1) stability in the stance phase of gait, (2) clearance of the foot in the swing phase, (3) proper foot preposition in swing, and (4) an adequate step length. In the stance phase, the knee provides shock absorption and energy conservation; in the swing phase, it allows foot clearance. To accomplish these functions, the knee must extend fully in stance and flex approximately 60 degrees in swing. Consequently, balanced muscle action at the hip, knee, and ankle joints, combined with adequate acceleration from the hip flexor and triceps surae muscles, is essential...
April 1990: Clinical Orthopaedics and related Research
J R Gage, J Perry, R R Hicks, S Koop, J R Werntz
Stance phase stability and swing phase clearance, prerequisites for normal ambulation, often are lost in the gait of children with cerebral palsy. Lengthening of the hamstrings usually will improve stance-phase knee extension but will not greatly alter swing-phase knee flexion. This paper presents the outcome of transfer of the distal end of the rectus femoris in conjunction with hamstrings lengthening in 37 knees, and compares it with a control group of 24 knees in which only hamstrings lengthening was done...
April 1987: Developmental Medicine and Child Neurology
Susan A Rethlefsen, Galen Kam, Tishya A L Wren, Robert M Kay
The objective of this study was to identify the predictors of outcome of distal rectus femoris transfer in cerebral palsy. Preoperative and postoperative gait data for 81 patients were examined, focusing on knee flexion/extension range. Outcome was 'good' for 46 patients and 'poor' for 35. The poor outcome group had no improvement in knee range because of increased crouch postoperatively. Outcome was unrelated to quadriceps strength, crouch, velocity, or type of cerebral palsy. Gross Motor Function Classification System was predictive of outcome, with poor results in all level IV patients (P< or =0...
March 2009: Journal of Pediatric Orthopedics. Part B
M Ostádal, J Chomiak, P Dungl, O Adamec
PURPOSE OF THE STUDY: Cerebral palsy is a serious world-wide problem; its incidence ranges from one to five per thousand of live-born children and is much influenced by gestation age and birth weight. In orthopaedic treatment of lower extremity motor disorders, one of the options for contracture or deformity elimination and for stiff leg gait improvement is rectus femoris tendon transfer. The aim of this study was to evaluate the results of this surgical technique. MATERIAL AND METHODS: In the period from 1993 to 2003, 15 patients of both sexes, aged 5 to 13 years, were treated by the Gage method (22 operations) in our department...
December 2007: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
Kenan Koca, Cemil Yildiz, Yüksel Yurttaş, Serkan Bïlgïç, Hüseyin Ozkan, Mustafa Kürklü, Birol Balaban, Bülent Haznecï, Mustafa Başbozkurt
BACKGROUND: Our aim was to evaluate the outcomes of combined hamstring release and rectus transfer in children with crouch gait using physical examination and gait analysis. MATERIALS AND METHODS: A total of 19 patients (38 knee joints) with crouch were evaluated by static examination and computerized analysis with dynamic EMG. The Ely test was positive together with prolonged and increased activity in the rectus muscle bilaterally in all patients. These patients underwent hamstring release and rectus transfer...
July 2009: Ortopedia, Traumatologia, Rehabilitacja
Bjørn Lofterød, Terje Terjesen, Ingrid Skaaret, Ann-Britt Huse, Reidun Jahnsen
BACKGROUND: There is still some debate regarding the role of 3-dimensional gait analysis in routine preoperative evaluation of children with cerebral palsy. The aim of this prospective study was to evaluate to what extent introduction of 3-D gait analysis changes preoperative surgical planning. METHOD: Before gait analysis, 60 ambulatory children aged 10 (4-18) years with spastic cerebral palsy had a specific surgical plan outlined, based on clinical examination by orthopedic surgeons...
February 2007: Acta Orthopaedica
Noelle Moreau, Suzanne Tinsley, Li Li
The purpose of this study was to compare long-term outcomes of multi-level surgery with and without rectus femoris transfer (RFT) in a group of children with cerebral palsy. Forty-one subjects with a diagnosis of cerebral palsy were divided into a RFT group (28 subjects with 50 sides) and non-RFT group (13 subjects with 22 sides). The study protocol included pre-operative gait analysis, multi-level orthopedic surgical intervention, one year post-operative gait analysis, and three year or greater post-operative gait analysis...
October 2005: Gait & Posture
N Khouri, E Desailly
INTRODUCTION: In children with cerebral palsy the abnormal activity of the rectus femoris (RF) during the swing phase results in "stiff-knee gait". Transferring the RF to a knee flexor tendon improves this stiffness. The effect may be limited by adhesions from scar tissue or from angular deviations along the surgically created muscle tendon route. HYPOTHESIS: The goal of this study was to assess the effect on gait of a single event multilevel surgery protocol, and provide a detailed description of the transfer technique...
May 2013: Orthopaedics & Traumatology, Surgery & Research: OTSR
Timothy A Niiler, James G Richards, Freeman Miller
Cerebral palsy (CP) patients exhibit a wide range of functional responses to specific surgical interventions. The variability associated with surgical outcomes within this patient population precipitates the need to determine the functional effects in advance of the surgery. Pilot studies have indicated that the application of statistical models towards predicting functional outcomes of surgery produces clinically meaningful results. The purpose of this study was to evaluate the influence of pre-operative kinematic parameters in conjunction with concurrent surgeries on rectus transfer (RT) outcomes...
June 2007: Gait & Posture
J H Patrick
Two novel operations for cerebral palsy are described. Both procedures, originally proposed and performed by Gage, have been advocated as biomechanically more effective than previous procedures in achieving the objectives of eliminating hip and knee contractures in cerebral palsy. Description of the operative technique and the rationale of use are stated to assist the operator.
1996: Journal of Pediatric Orthopedics. Part B
Dinesh Thawrani, Thierry Haumont, Chris Church, Larry Holmes, Kirk W Dabney, Freeman Miller
BACKGROUND: Stiff knee gait is common among children with ambulatory cerebral palsy (CP). When surgery is indicated, rectus femoris transfer as a primary treatment enhances knee range of motion, reduces time to peak knee flexion, increases peak knee flexion, and reduces toe drag. QUESTIONS/PURPOSES: We determined whether (1) distal rectus femoris transfer improved knee range of motion, time to peak knee flexion, peak knee flexion, and toe drag in children with CP diagnosed with stiff knee gait; and (2) patients in some subgroups (eg, those with relatively high knee range of motion compared with those with low knee range of motion before rectus femoris transfer) had greater improvement in these parameters...
May 2012: Clinical Orthopaedics and related Research
Thomas Dreher, Sebastian I Wolf, Michael Maier, Sébastien Hagmann, Dóra Vegvari, Simone Gantz, Daniel Heitzmann, Wolfram Wenz, Frank Braatz
BACKGROUND: The evidence for distal rectus femoris transfer as a part of multilevel surgery for the correction of stiff-knee gait in children with spastic diplegic cerebral palsy is limited because of inconsistent outcomes reported in various studies and the lack of long-term evaluations. METHODS: This study investigated the long-term results (mean, nine years) for fifty-three ambulatory patients with spastic diplegic cerebral palsy and stiff-knee gait treated with standardized distal rectus femoris transfer as a part of multilevel surgery...
October 3, 2012: Journal of Bone and Joint Surgery. American Volume
2014-09-25 04:57:00
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