Rectus femoris transfer in children with cerebral palsy: evaluation of transfer site and preoperative indicators.

BACKGROUND: Rectus femoris transfer (RFT) is a treatment option for children with cerebral palsy (CP) who exhibit a stiff-knee gait pattern. The rectus femoris muscle is transferred to different sites to overcome problems such as tripping and falling. Indications for RFT often include preoperative decreased knee range of motion (KROM) during swing phase, reduced peak knee flexion in swing (PKFSW), abnormal rectus femoris firing patterns on electromyography recordings, and a positive Duncan-Ely test. This study investigated the effect of different RFT sites on kinematic outcome variables and evaluated the relationship between commonly used preoperative surgical indicators and postoperative changes in kinematics.

METHODS: Thirty-eight patients with CP, who underwent RFT, with preoperative and postoperative instrumented gait analyses, were evaluated and divided by transfer site: semitendinosus, sartorius, and gracilis. Preoperative and postoperative comparisons were made for 5 knee kinematic variables: range of motion (KROM), peak flexion at loading response, peak extension at terminal stance, PKFSW, and peak extension at terminal swing. Analysis was performed in accordance to different transfer sites and overall postoperative change.

RESULTS: When all limbs were analyzed together for the 5 outcome variables, it was found that patients experienced significant (P < 0.05) improvements in sagittal-plane kinematics in 3 of the outcome variables: KROM, PKFSW, and peak extension at terminal swing. Patients had a significant improvement in postoperative KROM when the preoperative KROM was less than 80% of normal. Electromyography pattern and Duncan-Ely test were not found to be useful indicators of surgical success.

CONCLUSION: The authors recommend RFT in children with CP who exhibit a stiff-knee gait, regardless of transfer site.

LEVEL OF EVIDENCE: Level 3.