Correction of Combined Flexed and Stiff Knee Gait in Spastic Diplegic Cerebral Palsy by Double Tendon Transfers Around the Knee as Part of Multilevel Surgery

Abstract

Background/Purpose: Flexed knee gait and stiff knee gait are common coexisting gait disturbances in children with cerebral palsy. We analyzed the effect of medial hamstring transfer and distal rectus transfer around the knee as part of multi-level surgery for this group of patient. Methods: Eleven lower limbs of six patients who received double transfer were retrospectively studied. Instrumented gait analysis were carried out before and a minimum of 2 years after operation. Results: Comparing the kinematic study before and after the operation, maximum knee extension in stance phase (MKES), total knee swing (TKS) and the time to maximum knee flexion in swing phase (TMKFS) showed statistically significant improvement (p <0.05). Hip extension in swing phase and hip extension power were maintained. The oxygen consumption during walking also decreased after operation (p <0.05). Conclusion: Double transfer around the knee can improve both flexed knee gait and stiff knee gait, without causing significant hip extension weakness.

Keywords

• cerebral palsy
• flexed knee gait
• stiff knee gait
• medial hamstring transfer
• distal rectus femoris transfer