Neurotomy of the rectus femoris nerve: Efficiency in spastic stiff knee gait. Clinical assessment and quantitative gait analysis

Abstract

To present the efficacy of the neurotomy of the rectus femoris muscle in the treatment of stiff-knee gait in patients with unilateral spastic paresis. – Design: intervention study (before-after trial) with an observational design. – Setting: university hospital. – Participants: ambulatory patients with unilateral spastic paresis of spinal or cerebral origin ( n = 7) with spastic stiff-knee gait. – Intervention: a selective neurotomy of the rectus femoris nerve (motor branch of the femoral nerve). – Main outcome measures: functional parameters (functional ambulation classification and maximal walking distance), clinical measurements (spasticity, Ashworth scale and Duncan-Ely test, muscle strength-Medical Research Council scale), and quantitative gait analysis parameters (spatio-temporal data, kinematics of stiff-knee gait, knee kinetics, and rectus femoris dynamic EMG) were assessed before and 3 months after rectus femoris neurotomy. Compared with preoperative values, there was a statistically significant increase in maximal walking distance, gait speed, and stride length at 3 months post-op. All kinematic parameters associated with stiff-knee gait were improved, and the average early swing phase knee extension moments were decreased. The duration and amplitude of the rectus femoris burst were decreased post-op. This study brings the first evidence that rectus femoris neurotomy is effective in decreasing the swing-phase overactivity of the RF, with positive impact on kinetics, kinematics, spatiotemporal parameters and walking function in patients with spastic stiff knee gait.