Journal of Pediatric Orthopaedics - 2026-06-25 - Journal Article
Increased Knee Range of Motion Following Rectus Femoris Transfer Does Not Improve Walking Ability in Patients With Cerebral Palsy.
Morais Filho MC, Kawamura CM, Fujino MH, Lopes JAF, Saraiva AO
Topics
Key Takeaway
In 98 GMFCS I-III spastic diplegic CP patients, improved knee range of motion after rectus femoris transfer did not translate to improved FAQ walking ability (IG: -0.08 vs UG: +0.79, no significant difference).
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Summary
This study asked whether kinematic improvement in knee range of motion (KRM) after distal rectus femoris transfer (RFT) correlates with patient-reported walking ability in GMFCS I-III spastic diplegic CP. Ninety-eight patients from a 20-year gait lab database were stratified by KRM change (>1 SD improvement, unchanged, >1 SD reduction) and compared on FAQ scores, GDI, and kinematics. Despite significant reduction in minimum stance-phase knee flexion in the improvement group (IG: -14.32° vs UG: +4.78°, P<0.001), FAQ scores were not significantly different between groups (IG: -0.08 vs UG: +0.79).
Key Limitation
The FAQ is an ordinal scale with ceiling effects in higher-functioning GMFCS I-II patients, potentially masking real functional differences between groups.
Original Abstract
BACKGROUND
Rectus femoris transfer (RFT) outcomes in cerebral palsy (CP) are often analyzed using 3-dimensional gait analysis, but there is limited patient-reported data on this procedure. This study aimed to evaluate the relationship between changes in walking ability, measured by the Functional Assessment Questionnaire (FAQ), and knee range of motion (KRM) improvements following distal RFT in CP.
METHODS
Data from a gait laboratory database (January 2002 to April 2022) were reviewed. Patients with spastic diplegic CP classified as GMFCS levels I to III who underwent RFT with pre- and postoperative gait analyses were included. Ninety-eight patients met the criteria and were divided into 3 groups based on KRM changes post-RFT: (1) reduction (RG): decrease >1 SD, (2) unchanged (UG): changes within ±1 SD, and (3) improvement (IG): increase >1 SD. Demographics, kinematics, the Gait Deviation Index (GDI), and FAQ scores were analyzed and compared among groups.
RESULTS
Postsurgery, KRM decreased in 6 patients (6.1%), remained unchanged in 69 (70.4%), and improved in 23 (23.5%). RG was excluded from comparisons due to the small sample size. There were no significant between-group differences in age at surgery (UG: 14.32 y; IG: 14.32 y), follow-up duration (UG: 3.17 y; IG: 2.70 y), change in GDI (UG: +8.14; IG: +11.07), increase in peak knee flexion during the swing phase (UG: +6.44 degrees; IG: +7.34 degrees), or change in walking ability as measured by the FAQ (UG: +0.79; IG: -0.08). In contrast, minimum knee flexion during the stance phase decreased in IG (-14.32 degrees) and increased in UG (+4.78 degrees), with a significant between-group difference (P<0.001). The prevalence of surgical procedures performed concomitantly with RFT was similar between the UG and IG groups, except for surgical lengthening of the hip adductors, which was observed in 13% of patients in UG and 34.8% in IG (P=0.02).
CONCLUSIONS
Improvements in kinematic parameters alone may not predict patient-reported functional gains. In the present study, increased KRM after RFT was not associated with improved FAQ walking ability, as FAQ scores were similar regardless of whether KRM increased.
LEVELS OF EVIDENCE
Level III.