[Distal rectus femoris tendon transfer in cerebral palsy patients].

Purpose of the Study: Cerebral palsy is a serious world-wide problem; its incidence ranges from one to five per thousand of live-born children and is much influenced by gestation age and birth weight. In orthopaedic treatment of lower extremity motor disorders, one of the options for contracture or deformity elimination and for stiff leg gait improvement is rectus femoris tendon transfer. The aim of this study was to evaluate the results of this surgical technique.
Material and Methods: In the period from 1993 to 2003, 15 patients of both sexes, aged 5 to 13 years, were treated by the Gage method (22 operations) in our department. The indication for surgery was excessive spasticity of the femoral quadriceps muscle at the beginning of the swing phase of the gait cycle. The spastic syndromes included quadruparesis in seven patients, diparesis in seven patients and hemiparesis in one patient. After surgery, a circular plaster cast was applied for 4 weeks. Following immobilization, all patients received a short-term inpatient and long-term outpatient physical therapy. They were followed- up for 1 to 10 years and gait improvement was analyzed on the basis of three criteria in the swing phase: quality of the initial swing, frequency of tripping over the toe and the degree of knee flexion. The results were evaluated on a 1-to-4 scale (best to worst), categorizing the patients into four groups.
Results: The first, second and third categories included eight, five and two patients, respectively. None of the patients was placed in the fourth category. Surgery did not increase the initial range of inner hip rotation. Patients with milder forms of cerebral palsy (diparesis and hemiparesis) achieved better results.
Conclusions: Our results showed that distal rectus femoris tendon transfer significantly improved knee flexion during the swing phase of the gait cycle. The prerequisite for a good outcome of surgery is a pre-operative potential for passive knee extension and stable function of the other lower extremity joints. Key words: cerebral palsy, surgical treatment, quadriceps tendon transfer.