Rectus femoris surgery for the correction of stiff knee gait in cerebral palsy: a systematic review and meta-analysis
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Search Strategy on MEDLIN Figure. Meta-analysis of the effect of distal rectus femoris transfer (DRFT) and after distal rectus femoris release (DRFR) on knee kinematic data: figure a MKEST after DRFT surgery ; figure b t-PKFGC after DRFT surgery ; figure c MKEST after DRFR surgery ; figure d t-PKFGC after DRFR surgery.
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Stiff Knee Gait (SKG) is very common in children with cerebral palsy (CP). It is characterized by decreased knee flexion during swing phase (SP). Source of this gait dysfunction is attributed to inappropriate rectus femoris activity during swing. The purpose of this systematic review was to determine outcomes of two surgical techniques: distal rectus femoris transfer (DRFT) and rectus intramuscular lengthening (RIL). The meta-analysis was conducted in compliance with the PRISMA statement. It was prospectively registered in the PROSPERO registry. Medline, Science Direct, Cochrane registry, Scopus and Pascal were searched. Studies were collected up to September 2018. Patients were children with cerebral palsy. Interventions had to include DRFT or RIL. Outcomes measures had to include pre-and postoperative knee kinematics from gait analysis. Methodological Index for Non-Randomized Studies (MINORS) was used to assess the methodological quality of the included studies. Study selection was independently performed by 2 reviewers (AJ & MT). Pre-and 1 year postoperative motion analysis data were extracted. Effect size was estimated by the standardized mean difference (SMD).