Distal Rectus Femoris Tendon Transfer for the Correction of Stiff-Knee Gait in Cerebral Palsy

Distal rectus femoris tendon transfer is the standard surgical procedure for the treatment of stiff-knee gait in patients with cerebral palsy and is commonly performed during single-event multilevel surgery.

With the patient supine, make a 3 to 4-cm longitudinal incision 2 to 3 cm above the patellar proximal pole.

Separate the rectus femoris tendon from the vasti; avoid releasing the entire quadriceps at all cost.

Isolate the gracilis tendon proximally, release it from its muscle belly, and pull it out distally through a small incision at the pes anserinus insertion.

Insert a long tendon passer above the fascia and beneath the sartorius muscle belly from anterior to posterior to the mini-incision in the pes anserinus region to grasp and transfer the gracilis tendon to the anterior approach.

Weave the gracilis tendon into the released rectus femoris tendon with the interlacing technique described by Pulvertaft.

Various studies have demonstrated good initial results, with an improvement in peak knee flexion in swing phase and knee motion in swing phase, following distal rectus femoris tendon transfer.

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