Functional quadriceps reconstruction: 3D gait analysis, EMG and environmental simulator outcomes

Lo, S. , Childs, C., Mahendra, A., Young, P. and Carse, B. (2022) Functional quadriceps reconstruction: 3D gait analysis, EMG and environmental simulator outcomes. Journal of Plastic, Reconstructive and Aesthetic Surgery, 75(11), pp. 3924-3937. (doi: 10.1016/j.bjps.2022.08.009) (PMID:36117134)

Abstract

Object: Limited objective evidence exists on the benefits of functional muscle transfers following quadriceps resection in sarcoma. In particular, no studies have compared patients with functional transfers to those without. In this study, objective and subjective assessment was performed with 3D Gait analysis, Environmental simulator, Electromyography (EMG), and Patient Reported Outcomes. Methods: 34 patients at the Scottish Sarcoma Network Glasgow Centre/ Canniesburn Plastic Surgery Unit underwent quadriceps resection for sarcoma between 2009 – 2019, including 24 patients with functional reconstruction and 10 without. Both groups were equivalent for extent of quadriceps resection (2.58 versus 2.85 components, p=0.47). Primary outcome measure was 3D Gait Analysis and Gait Profile Score (GPS), and secondary outcome was TESS score. Ancillary analyses included environmental simulation with Motek CAREN system, and EMG of transferred muscles. Results: Outcomes measures were better in functional reconstruction patients compared to those without - GPS score 8.04 versus 10.2 (p=0.0019), and TESS score 81.85 versus 71.17 (p=0.028). Environmental simulator tasks found that functional reconstruction patients could complete activities of daily living including shopping and collision avoidance tasks, without significant slowing of their walking speed. Patients without a functional reconstruction could not complete weighted shopping tasks. EMG showed that transferred hamstrings co-activated with the ipsilateral rectus femoris during the gait cycle. Conclusions: These are the first objective data demonstrating superiority of muscle transfers for functional restoration in quadriceps resection versus patients without functional transfers. Critically, these also provide answers to patient oriented questions relating to recovery of function and activities of daily living.

• Item Type: Articles
• Additional Information: Funding: Beatson Cancer Charity Grant Award 17-18-117; Canniesburn Research Trust; Jean Brown Bequest.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Lo, Professor Steven
• Authors: Lo, S., Childs, C., Mahendra, A., Young, P., and Carse, B.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Journal of Plastic, Reconstructive and Aesthetic Surgery
• Publisher: Elsevier
• ISSN: 1748-6815
• ISSN (Online): 1878-0539
• Published Online: 06 August 2022
• Copyright Holders: Copyright © 2022 The Authors
• First Published: First published in Journal of Plastic, Reconstructive and Aesthetic Surgery 75(11): 3924-3937
• Publisher Policy: Reproduced under a Creative Commons License