title: The functional effect of a distal rectus femoris tenotomy in adults with cerebral palsy.
abstract: The purpose of this study was to determine the effect of a distal rectus femoris tenotomy on function and gait in adults with cerebral palsy who had diminished knee flexion during swing. A stiff knee gait pattern is commonly seen in individuals with cerebral palsy and frequently leads to tripping and falling. Five subjects, 25-51 years, (34.6±10.3 years) participated in the study; each individual had the surgery after the age of 18. Four of the five subjects underwent bilateral distal rectus femoris tenotomies for a total of nine limbs being studied. Four of the five subjects had a single procedure of a distal rectus femoris tenotomy and one subject also had bilateral adductor tenotomies. All individuals underwent a pre-operative and post-operative, (3.28±1.6 years) three-dimensional gait analysis. Pre-operative gait revealed diminished peak knee flexion and out of phase rectus femoris activity with a quiet vastus lateralis during swing in all subjects. Significant findings after a distal rectus femoris tenotomy included: improved peak swing knee flexion, improved peak stance hip extension, and increased total knee excursion without loss in knee extension strength. During swing, knee flexion angle improved on average 11° which correlated with subjective report of less shoe wear, tripping, and falling due to improved clearance. In conclusion, a distal rectus femoris tenotomy should be considered a surgical option for adults with cerebral palsy and a stiff knee gait pattern to improve mobility, function, and quality of life.
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States. Electronic address: drefusl@hss.edu.
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Drefus
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States.
authors.forename: Melanie A
authors.initials: MA
authors.lastname: Buckland
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States.
authors.forename: Sherry I
authors.initials: SI
authors.lastname: Backus
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States.
authors.forename: Leon
authors.initials: L
authors.lastname: Root
mesh_terms: D000328:Adult; D002547:Cerebral Palsy / Q000150:complications* / Q000503:physiopathology*; D005260:Female; D005684:Gait; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007717:Knee / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D026741:Physical Therapy Modalities; D011184:Postoperative Period; D052097:Quadriceps Muscle / Q000503:physiopathology*; D011788:Quality of Life; D016059:Range of Motion, Articular; D011795:Surveys and Questionnaires; D058971:Tenotomy / Q000534:rehabilitation; D016896:Treatment Outcome
keywords: Adult; Cerebral palsy; Distal rectus femoris tenotomy; Orthopedics; Stiff knee gait