• INTRODUCTION
    • 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.
  • RESULTS
    • 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
    • IndicationsContraindicationsPitfalls & Challenges.