title: [Rectus transfer in spastic diplegia].
abstract: OBJECTIVE
  Change of function of the rectus femoris through medial transfer of its distal tendon. This procedure transforms a hip flexor and knee extensor into a hip and knee flexor. Thus the muscle acts as a hip flexor during the terminal stance phase and swing phase and as a knee flexor during the swing phase. This permits the foot to clear the ground and to improve the spastic gait.
  
  
  METHODS
  Functional sequelae of a simultaneous spasticity of knee flexors and extensors causing a stiff gait. Isolated spasticity of rectus muscle with continuous muscle activity during stance and swing phase, recurvatum of the knee during the stance phase, limited flexion (<15(o)) of the knee during the swing phase and lack of clearance of the foot.
  
  
  METHODS
  Pattern of global flexor spasticity. Loss of power of hip flexors. Paresis of quadriceps.
  
  
  METHODS
  Isolation and detachment of the distal tendon of the rectus femoris. The tendon can be transferred either medially or laterally. For a medial transfer the tendon is sutured to the gracilis tendon which is detached as proximal as possible. This permits to displace the direction of pull behind the center of rotation of the knee. For a lateral transfer the tendon is sutured to the iliotibial tract.
  
  
  RESULTS
  In 94,8% of patients (n=137; 274 limbs) followed for a mean of 21 months (7 to 39 months) the results were good to satisfactory using the score of Gage. The Duncan-Ely test was negative in these patients. The gait was markedly improved. Important complications did not occur.
authors: Orthopädie II-Schwerpunkt Rehabilitations-medizin, Orthopädische Universitätsklinik Heidelberg, Schlierbacher Landstraße 200a, D-69118, Heidelberg. Wolfram.Wenz@urz.uni-heidelberg.de.
authors: W
authors: W
authors: Wenz
authors: Orthopädie II-Schwerpunkt Rehabilitations-medizin, Orthopädische Universitätsklinik Heidelberg, Schlierbacher Landstraße 200a, D-69118, Heidelberg.
authors: L
authors: L
authors: Döderlein
keywords: Cerebral palsy; Rectus femoris muscle; Spastic diplegia; Tendon transfer