title: Neurotomy of the rectus femoris nerve: Short-term effectiveness for spastic stiff knee gait: Clinical assessment and quantitative gait analysis.
abstract: Stiff knee gait is a troublesome gait disturbance related to spastic paresis, frequently associated with overactivity of the rectus femoris muscle in the swing phase of gait.
  
  
  
  The aim of this study was to assess the short-term effects of rectus femoris neurotomy for the treatment of spastic stiff-knee gait in patients with hemiparesis.
  
  
  
  An Intervention study (before-after trial) with an observational design was carried out in a university hospital. Seven ambulatory patients with hemiparesis of spinal or cerebral origin and spastic stiff-knee gait, which had previously been improved by botulinum toxin injections, were proposed a selective neurotomy of the rectus femoris muscle. A functional evaluation (Functional Ambulation Classification and maximal walking distance), clinical evaluation (spasticity - Ashworth scale and Duncan-Ely test, muscle strength - Medical Research Council scale), and quantitative gait analysis (spatiotemporal parameters, stiff knee gait-related kinematic and kinetic parameters, and dynamic electromyography of rectus femoris) were performed as outcome measures, before and 3 months after rectus femoris neurotomy.
  
  
  
  Compared with preoperative values, there was a significant increase in maximal walking distance, gait speed, and stride length at 3 months. All kinematic parameters improved, and the average early swing phase knee extension moment decreased. The duration of the rectus femoris burst decreased post-op.
  
  
  
  This study is the first to show that rectus femoris neurotomy helps to normalise muscle activity during gait, and results in improvements in kinetic, kinematic, and functional parameters in patients with spastic stiff knee gait.
authors.affiliation: Laboratoire d'Analyse du Mouvement, Pôle hospitalo-Universitaire de Médecine Physique et de Réadaptation, CHU de Nantes, 85 rue Saint Jacques, 44093 Nantes cedex, France; Université de Brest Inserm UMR 1101, Laboratoire de Traitement de l'Information Médicale, SFR ScInBioS, 5 avenue Foch, 29609 Brest, France. Electronic address: raphael.gross@chu-nantes.fr.
authors.forename: R
authors.initials: R
authors.lastname: Gross
authors.affiliation: Laboratoire d'Analyse du Mouvement, Pôle hospitalo-Universitaire de Médecine Physique et de Réadaptation, CHU de Nantes, 85 rue Saint Jacques, 44093 Nantes cedex, France.
authors.forename: J
authors.initials: J
authors.lastname: Robertson
authors.affiliation: Laboratoire d'Analyse du Mouvement, Pôle hospitalo-Universitaire de Médecine Physique et de Réadaptation, CHU de Nantes, 85 rue Saint Jacques, 44093 Nantes cedex, France; College of Health & Social Care, University of Salford, Allerton Building, Frederick Road Campus, Salford M6 6PU, United Kingdom.
authors.forename: F
authors.initials: F
authors.lastname: Leboeuf
authors.affiliation: Laboratoire d'Analyse du Mouvement, Pôle hospitalo-Universitaire de Médecine Physique et de Réadaptation, CHU de Nantes, 85 rue Saint Jacques, 44093 Nantes cedex, France.
authors.forename: O
authors.initials: O
authors.lastname: Hamel
authors.affiliation: Université de Brest Inserm UMR 1101, Laboratoire de Traitement de l'Information Médicale, SFR ScInBioS, 5 avenue Foch, 29609 Brest, France; Service de Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire de Brest, 5 avenue Foch, 29609 Brest, France.
authors.forename: S
authors.initials: S
authors.lastname: Brochard
authors.affiliation: Laboratoire d'Analyse du Mouvement, Pôle hospitalo-Universitaire de Médecine Physique et de Réadaptation, CHU de Nantes, 85 rue Saint Jacques, 44093 Nantes cedex, France.
authors.forename: B
authors.initials: B
authors.lastname: Perrouin-Verbe
mesh_terms: D000328:Adult; D003714:Denervation; D005260:Female; D005684:Gait; D020233:Gait Disorders, Neurologic / Q000503:physiopathology*; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000503:physiopathology*; D011446:Prospective Studies; D052097:Quadriceps Muscle / Q000294:innervation* / Q000503:physiopathology / Q000601:surgery; D016059:Range of Motion, Articular; D016896:Treatment Outcome
keywords: Neurotomy; Rectus femoris; Spastic paresis; Stiff-knee gait