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.
What to Watch For
Pitfalls & Challenges