How I do it: Selective femoral neurotomy.

BACKGROUND

Quadriceps spasticity is responsible for a gait disturbance characterized by stiff knee with reduced knee flexion during the swing phase. Selective Femoral Neurotomy induces long-term muscle relaxation via a decrease of the stretch reflex.

METHOD: Femoral nerve trunk is dissected just below the femoral crease. Motor branches to the rectus femoris and/or vastus intermedius muscles are identified using electrical stimulation combined with electromyographic recording, then partially sectioned according to an individualized preoperative chart. Postoperative rehabilitation is imperative for sustained gait improvements.

CONCLUSION

Selective Femoral Neurotomy (SFN) is a lesion-based, permanent surgical treatment of spastic stiff knee gait.