Article

The evidence in support of distal rectus femoris transfer (DRFT)
as part of
single-event multilevel surgery (SEMLS) is limited due to inconsistent outcome
reports and a lack of randomized studies. The purpose of this prospective
randomized trial was to establish whether the results of SEMLS without DRFT are
similar to those of a conventional approach that includes DRFT in the SEMLS. In
all, 32 children with spastic diplegia (GMFCS I-III) and an indication for DRFT
were recruited and randomized into a DRFT (15 children) and a NON-DRFT group (17
children) using a minimization method. During SEMLS, bilateral DRFT was performed
only in the DRFT group. Three-dimensional gait analysis and clinical examination
were performed before and 1 year after surgery. In both groups a significant
increase in range of motion during swing and knee flexion velocity were found,
which was significantly higher in the DRFT group. While peak knee flexion in
swing (pKFSw) was preserved in the DRFT group and significantly decreased in the
NON-DRFT group, pKFSw timing was significantly earlier in both groups. The
clinical relevance of the higher overall benefits in the DRFT group is limited,
considering that 33% of patients in this group did not benefit from the
procedure. Furthermore, 53% of the NON-DRFT patients did not undergo what proved
to be an unnecessary DRFT. Subgroup analysis showed benefits for patients with
decreased pKFSw, while those with severe flexed-knee gait (normal or increased
pKFSw) did not profit from DRFT. This may explain the inconsistent overall
results, and DRFT is therefore not recommended as a "prophylactic" procedure in
patients with severe flexed-knee gait.
CI - Copyright (c) 2012 Elsevier B.V. All rights reserved.

Langue : ANGLAIS