Change of function of the rectus femoris through medial transfer of its distal tendon. This procedure transforms a hip flexor and knee extensor into a hip and knee flexor. Thus the muscle acts as a hip flexor during the terminal stance phase and swing phase and as a knee flexor during the swing phase. This permits the foot to clear the ground and to improve the spastic gait.
Functional sequelae of a simultaneous spasticity of knee flexors and extensors causing a stiff gait. Isolated spasticity of rectus muscle with continuous muscle activity during stance and swing phase, recurvatum of the knee during the stance phase, limited flexion (<15°) of the knee during the swing phase and lack of clearance of the foot.
Pattern of global flexor spasticity. Loss of power of hip flexors. Paresis of quadriceps.
Isolation and detachment of the distal tendon of the rectus femoris. The tendon can be transferred either medially or laterally. For a medial transfer the tendon is sutured to the gracilis tendon which is detached as proximal as possible. This permits to displace the direction of pull behind the center of rotation of the knee. For a lateral transfer the tendon is sutured to the iliotibial tract.
In 94.8% of patients (n=137; 274 limbs) followed for a mean of 21 months (7 to 39 months) the results were good to satisfactory using the score of Gage. The Duncan-Ely test was negative in these patients. The gait was markedly improved. Important complications did not occur.
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Baumann JU, Roch HG. Ventrale aponeurotische Verlängerung des Musculus gastrocnemius. Operat Orthop Traumatol 1989;1:254–8.
Cottrell GW. Role of rectus femoris in spastic children. Proceedings: American Academy of Orthopaedic Surgery. J Bone Joint Surg [Am] 1963;45:1556.
Csongradi J, Bleck E, Ford WF. Gait electromyography in normal and spastic children, with special reference to quadriceps femoris and hamstring muscles. Develop Med Child Neurol 1979;21:738–48.
Gage JR. Surgical treatment of knee dysfunction in cerebral palsy. Clin Orthop Rel Res 1990;253:45–54.
Gage JR, Perry J, Hicks RR, et al. Rectus femoris transfer to improve knee function of children with cerebral palsy. Develop Med Child Neurol 1987;29: 159–66.
Hensinger RN. Meeting highlights. J Pediatr Orthop 1995;15:261–71.
Lai KA, Kuo KN, Andriacchi TP. Relationship between dynamic deformities and joint moments in children with cerebral palsy. J Pediatr Orthop 1988;8:690–5.
Lipton G, Miller F, Dias R, et al. The effects of rectus EMG patterns on the outcome of rectus femoris transfers. Gait and Posture 1996;4:167–208.
MRC-Skala, Aus: Cash’s textbook of neurology for physiotherapists, 4th ed. London: Faber and Faber. 1986.
Ounpuu S, Muik E, Davis RB, et al. Rectus femoris surgery in children with cerebral palsy. Part I: The effect of rectus femoris transfer location on knee motion. J Pediatr Orthop 1993;3:325–30.
Ounpuu S, Muik E, Davis RB, et al. Rectus femoris surgery in children with cerebral palsy. Part II: A comparison between the effect of transfer and release of the distal rectus femoris on knee motion. J Pediatr Orthop 1993;3:331–5.
Perry J. Distal rectus femoris transfer. Develop Med Child Neurol 1987;29:153–8.
Silfverskiöld N. Reduction of the uncrossed two joint muscles of the leg to one joint muscles in spastic conditions. Acta Chir Scand 1923;56:315–29.
Strayer LM. Recession of the gastrocnemius. J Bone Joint Surg [Am] 1950;32:671–6.
Sutherland DH. Larsen LJ, Mann R. Rectus femoris release in selected patients with cerebral palsy: a preliminary report. Develop Med Child Neurol 1975: 17:26–34.
Sutherland DH, Santi M, Abel MF. Treatment of stiff-knee gait in cerebral palsy: a comparison by gait analysis of distal rectus transfer versus proximal rectus release. J Pediatr Orthop 1990;10:433–41.
Vulpius O. Aus: Orthopädische Operationslehre, 3. Aufl. Stuttgart: Enke, 1924:216.
Waters RL, Garland DE, Perry J, et al. Stiff-legged gait in hemiplegia: surgical correction. J Bone Joint Surg [Am] 1979;61:927–33.
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Wenz, W., Döderlein, L. Rectus transfer in spastic diplegia. Orthop Traumatol 7, 203–211 (1999). https://doi.org/10.1007/BF03180939
- Rectus femoris muscle
- Tendon transfer
- Spastic diplegia
- Cerebral palsy