Rectus femoris transfer in multilevel surgery: technical details and gait outcome assessment in cerebral palsy patients.

INTRODUCTION In children with cerebral palsy the abnormal activity of the rectus femoris (RF) during the swing phase results in "stiff-knee gait". Transferring the RF to a knee flexor tendon improves this stiffness. The effect may be limited by adhesions from scar tissue or from angular deviations along the surgically created muscle tendon route. HYPOTHESIS The goal of this study was to assess the effect on gait of a single event multilevel surgery protocol, and provide a detailed description of the transfer technique. PATIENTS AND METHODS Forty-eight RF transfers were studied in 26 children and adolescents 12 ± 3 years old after a follow up of 25 ± 10 months. Quantified gait analysis was performed pre- and postoperatively to calculate spatiotemporal variables, 3D kinematics, the Gait Deviation Index (GDI) and a knee stiffness score (Goldberg index). A standardized surgical procedure was followed: RF release, gracilis tendon preparation as well as the transfer and suture techniques are described. RESULTS Step length improved. Gait velocity and cadence were not modified. Gait quality improved (+13 ± 11 GDI) with an inverse relationship between the preoperative GDI and its improvement. Improvement of the preoperative Goldberg index in 74% of the cases was due to modifications of knee ROM from toe-off to peak flexion (+7°), total knee ROM (+16°) and timing of peak knee flexion in percentage of swing (from 51 to 40% of swing). DISCUSSION The surgical protocol presented here is discussed in relation to the results. LEVEL OF EVIDENCE IV, retrospective study.