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Distal Rectus Femoris Tendon Transfer for the Correction of Stiff-Knee Gait in Cerebral Palsy
T. Dreher, MD1; F. Braatz, MD1; S.I. Wolf, PhD1; V. Ewerbeck, MD1; D. Heitzmann, MSc1; W. Wenz, MD1; L. Döderlein, MD2
1 Pediatric Orthopaedics and Foot Surgery, Department for Orthopaedic and Trauma Surgery, Heidelberg University Clinics, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany. E-mail address for T. Dreher: thomas.dreher@med.uni-heidelberg.de
2 Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauer Strasse 18, 83229 Aschau i. Chiemgau, Germany
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Based on an original article: J Bone Joint Surg Am. 2012 Oct 3;94(19):e142.

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2013 Mar 13;3(1):e5 1-18. doi: 10.2106/JBJS.ST.L.00030
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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.

Step 1: Positioning and Approach

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

Step 2: Preparation of the Rectus Femoris Tendon

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

Step 3: Preparation of the Gracilis or Semitendinosus Tendon for Transfer

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.

Step 4: Transferring the Gracilis Tendon to the Rectus Femoris Tendon

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.

Step 5: Tendon Tensioning and Suturing

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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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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