Rectus femoris surgery for the correction of stiff knee gait in cerebral palsy: A systematic review and meta-analysis.

Autor: Josse A; Service de Chirurgie Pédiatrique, CHRU de Brest, 2, Avenue Foch, 29200 Brest, France. Electronic address: a.josse@hotmail.fr., Pons C; Service de Rééducation Fonctionnelle, CHRU de Brest, 2, Avenue Foch, 29200 Brest, France., Printemps C; Service de Chirurgie Pédiatrique, CHRU de Brest, 2, Avenue Foch, 29200 Brest, France., Chan-Waï-Nam J; Service de Chirurgie Pédiatrique, CHRU de Brest, 2, Avenue Foch, 29200 Brest, France., Affes H; Service de Chirurgie Pédiatrique, CHRU de Brest, 2, Avenue Foch, 29200 Brest, France., Brochard S; Service de Rééducation Fonctionnelle, CHRU de Brest, 2, Avenue Foch, 29200 Brest, France., Thépaut M; Service de Chirurgie Pédiatrique, CHRU de Brest, 2, Avenue Foch, 29200 Brest, France.
Jazyk: angličtina
Zdroj: Orthopaedics & traumatology, surgery & research : OTSR [Orthop Traumatol Surg Res] 2023 May; Vol. 109 (3), pp. 103022. Date of Electronic Publication: 2021 Jul 24.
DOI: 10.1016/j.otsr.2021.103022
Abstrakt: Introduction: Rectus femoris (RF) transfer was long the gold-standard treatment for stiff knee gait (SKG), but efficacy now seems less than that of distal RF release. The aim of the present study was to compare efficacy between the two. The study hypothesis was that both significantly improve 4 knee kinematic parameters at 1 year.
Patients and Method: A meta-analysis was performed, using PRISMA criteria, on the Medline, Science Direct, Cochrane Registry, Scopus and Pascal databases. Search was conducted up to March 1, 2020 by two authors (A.J & M.T). Study methodology was assessed on MINORS index. Inclusion criteria comprised patients with SKG, treated by RF transfer or distal release. Endpoints comprised: Peak Knee Flexion in swing phase (PKF SW ), Knee Range of Motion (KROM), time to Peak Knee Flexion (t-PKF GC ), and Maximum Knee Extension in stance phase (MKE ST ). Effect size was assessed on Standard Mean Deviation (SMD).
Results: A total of 695 studies were identified, 16 of which were included: 14 transfer, 5 release. Data were analyzed for 1,079 limbs in 768 patients. Only transfer improved PKF SW , with small effect size (SMD=0.29). The other three parameters were improved by both techniques, with moderate effect size.
Discussion: Results showed improved knee kinematics after RF transfer, but with small or moderate effect size. The effect of distal release on PKF could not be assessed, due to publication bias. The heterogeneity of studies and low levels of evidence call for caution in interpreting the present results.
Level of Evidence: III.
(Copyright © 2021. Published by Elsevier Masson SAS.)
Databáze: MEDLINE
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