Service de Chirurgie Pédiatrique, CHRU de Brest, 2, Avenue Foch, 29200 Brest, France.
Service de Rééducation Fonctionnelle, CHRU de Brest, 2, Avenue Foch, 29200 Brest, France.
Orthop Traumatol Surg Res. 2023 May;109(3):103022. doi: 10.1016/j.otsr.2021.103022. Epub 2021 Jul 24.
Rectus femoris (RF) transfer was long the gold-standard treatment for stiff knee gait (SKG), but efficacy now seems less than that of distal RF release. The aim of the present study was to compare efficacy between the two. The study hypothesis was that both significantly improve 4 knee kinematic parameters at 1 year.
A meta-analysis was performed, using PRISMA criteria, on the Medline, Science Direct, Cochrane Registry, Scopus and Pascal databases. Search was conducted up to March 1, 2020 by two authors (A.J & M.T). Study methodology was assessed on MINORS index. Inclusion criteria comprised patients with SKG, treated by RF transfer or distal release. Endpoints comprised: Peak Knee Flexion in swing phase (PKF), Knee Range of Motion (KROM), time to Peak Knee Flexion (t-PKF), and Maximum Knee Extension in stance phase (MKE). Effect size was assessed on Standard Mean Deviation (SMD).
A total of 695 studies were identified, 16 of which were included: 14 transfer, 5 release. Data were analyzed for 1,079 limbs in 768 patients. Only transfer improved PKF, with small effect size (SMD=0.29). The other three parameters were improved by both techniques, with moderate effect size.
Results showed improved knee kinematics after RF transfer, but with small or moderate effect size. The effect of distal release on PKF could not be assessed, due to publication bias. The heterogeneity of studies and low levels of evidence call for caution in interpreting the present results.
III.
股直肌（RF）转移术长期以来一直是僵硬膝关节步态（SKG）的金标准治疗方法，但现在其疗效似乎不如远端 RF 松解术。本研究的目的是比较两种方法的疗效。研究假设是两种方法都能在 1 年内显著改善 4 个膝关节运动学参数。
采用 PRISMA 标准，对 Medline、Science Direct、Cochrane 注册中心、Scopus 和 Pascal 数据库进行了荟萃分析。由两位作者（A.J 和 M.T）于 2020 年 3 月 1 日进行了搜索。研究方法学采用 MINORS 指数进行评估。纳入标准包括：SKG 患者，接受 RF 转移或远端松解术治疗。终点包括：摆动相峰值膝关节屈曲度（PKF）、膝关节活动范围（KROM）、达到峰值膝关节屈曲度的时间（t-PKF）和站立相最大膝关节伸展度（MKE）。采用标准均数差（SMD）评估效应量。
共确定了 695 项研究，其中 16 项被纳入：14 项转移术，5 项松解术。对 768 例患者的 1079 条肢体进行了数据分析。只有转移术改善了 PKF，其效应量较小（SMD=0.29）。其他三个参数均得到了两种技术的改善，效应量中等。
结果显示 RF 转移术后膝关节运动学得到改善，但效应量较小或中等。由于发表偏倚，无法评估远端松解术对 PKF 的影响。研究的异质性和低水平证据呼吁在解释本研究结果时谨慎行事。
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