Article

Spasticity of the rectus femoris (RF) is one of the possible causes of stiff knee
gait (SKG) in cerebral palsy. Musculoskeletal studies have shown that in SKG,
length and speed of the RF are affected. No evaluation had been made to quantify
the modifications of those parameters after surgery. The effect of this operation
on gait quality and on RF kinematics was assessed in this study in order to
identify kinematic patterns that may aid its diagnosis. For 26 transfers,
clinical gait analysis pre- and post-surgery was used to compute the Gait
Deviation Index (GDI) and Goldberg's index. The kinematics of the Original RF
path (ORFp) was studied before and after surgery. The expression ORFp was chosen
to avoid any confusion between this modeling parameter, whose computation was
unchanged, and the actual anatomical path that was modified by surgery. The gait
quality was improved (+18+/-12GDI) and there was an inverse relation between the
pre-operative GDI and its improvement. The Golberg's index was improved (88% of
the cases). The operation had a significant effect on the normalization of the
timings of maximum length and speed of the ORFp. The improvement of SKG was
correlated with the normalization of the timing of the ORFp's maximum length. The
global improvement of the gait quality and of the SKG was demonstrated. Some
parameters of muscular kinematics (RF length and velocity) have been
standardized, showing an effect of the transfer not only during the swing, but
also during stance. The premature timing of the ORFp peak length has been
identified as a prognostic factor of a successful surgical outcome.
CI - Copyright (c) 2011 Elsevier B.V. All rights reserved.

Langue : ANGLAIS