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Neurotomy of the rectus femoris nerve : Short-term effectiveness for spastic stiff knee gait - Clinical assessment and quantitative gait analysis

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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
CI - Copyright (c) 2016 Elsevier B.V. All rights reserved.

Langue : ANGLAIS

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