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Comparison of rectus femoris transposition with traditional transfer for treatment of stiff knee gait in patients with cerebral palsy

  • Original Clinical Article
  • Published:
Journal of Children's Orthopaedics

Abstract

Purpose

To assess the outcome of children with cerebral palsy following reposition of the distal rectus femoris tendon for treatment of stiff knee gait.

Methods

Children with cerebral palsy with stiff knee gait who underwent rectus femoris transfer were studied retrospectively. Inclusion criteria were cerebral palsy of diplegic or quadriplegic type, preoperative and 1 year postoperative three-dimensional motion analysis, and no other surgery except rectus femoris transfer at the time of study. The patients were separated into two groups: in group I, the rectus femoris was transferred to the distal medial hamstring tendons, either the gracilis or the semitendinosus; in group II, the distal tendon of the rectus femoris was transposed laterally and attached to the iliotibial band/intermuscular septum.

Results

Peak knee flexion during swing phase, total dynamic knee range of motion, knee range of motion during swing phase, and time to peak knee flexion during swing phase were all improved in both groups. Hip and pelvic kinematics were not influenced by the surgery. Velocity, stride length, and cadence were all improved following the surgery. There was no difference between the transfer group and the transposition group.

Conclusion

These findings suggest that distal transfer of the rectus femoris is effective in improving swing phase knee function by diminishing the mechanical effect of the dysphasic swing phase activity of the rectus femoris, not by converting the rectus femoris to an active knee flexor.

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References

  1. Gage JR, Perry J, Hicks RR, Koop S, Werntz JR (1987) Rectus femoris transfer to improve knee function of children with cerebral palsy. Dev Med Child Neurol 29(2):159–166

    Article  CAS  Google Scholar 

  2. Perry J (1987) Distal rectus femoris transfer. Dev Med Child Neurol 29(2):153–158

    Article  CAS  Google Scholar 

  3. Sutherland DH, Santi M, Abel MF (1990) Treatment of stiff-knee gait in cerebral palsy: a comparison by gait analysis of distal rectus femoris transfer versus proximal rectus release. J Pediatr Orthop 10(4):433–441

    Article  CAS  Google Scholar 

  4. Chambers H, Lauer A, Kaufman K, Cardelia JM, Sutherland D (1998) Prediction of outcome after rectus femoris surgery in cerebral palsy: the role of cocontraction of the rectus femoris and vastus lateralis. J Pediatr Orthop 18(6):703–711

    CAS  Google Scholar 

  5. Delp SL, Ringwelski DA, Carroll NC (1994) Transfer of the rectus femoris: effects of transfer site on moment arms about the knee and hip. J Biomech 27(10):1201–1211

    Article  CAS  Google Scholar 

  6. Miller F, Cardoso Dias R, Lipton GE, Albarracin JP, Dabney KW, Castagno P (1997) The effect of rectus EMG patterns on the outcome of rectus femoris transfers. J Pediatr Orthop 17(5):603–607

    Article  CAS  Google Scholar 

  7. Rethlefsen S, Tolo VT, Reynolds RA, Kay R (1999) Outcome of hamstring lengthening and distal rectus femoris transfer surgery. J Pediatr Orthop B 8(2):75–79

    CAS  Google Scholar 

  8. Saw A, Smith PA, Sirirungruangsarn Y, Chen S, Hassani S, Harris G, Kuo KN (2003) Rectus femoris transfer for children with cerebral palsy: long-term outcome. J Pediatr Orthop 23(5):672–678

    Article  Google Scholar 

  9. Ounpuu S, Muik E, Davis RB 3rd, Gage JR, DeLuca PA (1993a) Rectus femoris surgery in children with cerebral palsy. Part I: The effect of rectus femoris transfer location on knee motion. J Pediatr Orthop 13(3):325–330

    Article  CAS  Google Scholar 

  10. Ounpuu S, Muik E, Davis RB 3rd, Gage JR, DeLuca PA (1993b) 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 13(3):331–335

    Article  CAS  Google Scholar 

  11. Riewald SA, Delp SL (1997) The action of the rectus femoris muscle following distal tendon transfer: does it generate knee flexion moment? Dev Med Child Neurol 39(2):99–105

    Article  CAS  Google Scholar 

  12. Asakawa DS, Blemker SS, Gold GE, Delp SL (2002) In vivo motion of the rectus femoris muscle after tendon transfer surgery. J Biomech 35(8):1029–1037

    Article  Google Scholar 

  13. Asakawa DS, Blemker SS, Rab GT, Bagley A, Delp SL (2004) Three-dimensional muscle-tendon geometry after rectus femoris tendon transfer. J Bone Joint Surg Am 86-A(2):348–354

    Google Scholar 

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Acknowledgment

The authors thank Kaye Wilkins for the friendly assistance.

Author information

Authors and Affiliations

  1. Dana Children’s Hospital, Tel-Aviv Medical Center, Tel-Aviv, Israel

    Yoram Hemo

  2. Shriners Hospital for Children – Portland Unit, 3101 SW Sam Jackson Park Road, Portland, OR, 97239, USA

    Michael D. Aiona, Rosemary A. Pierce, Robin Dorociak & Michael D. Sussman

Authors
  1. Yoram Hemo
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  2. Michael D. Aiona
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  3. Rosemary A. Pierce
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  4. Robin Dorociak
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  5. Michael D. Sussman
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Corresponding author

Correspondence to Michael D. Sussman.

Additional information

No financial support was received for this study.

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Cite this article

Hemo, Y., Aiona, M.D., Pierce, R.A. et al. Comparison of rectus femoris transposition with traditional transfer for treatment of stiff knee gait in patients with cerebral palsy. J Child Orthop 1, 37–41 (2007). https://doi.org/10.1007/s11832-006-0002-4

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  • DOI: https://doi.org/10.1007/s11832-006-0002-4

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