Gait and Posture 6 (1997) 137–146 Rectus femoris transfer — Gracilis versus Sartorius Chin Youb Chung 1 , Jean Stout, James R. Gage * Motion Analysis Laboratory, Gillette Children’s Hospital, 200 East Uniersity Aenue, St. Paul, MN 55101, USA Accepted 2 January 1997 Abstract In order to determine the effectiveness of a new technique of rectus femoris transfer and to compare the effectiveness between the two transfer sites (gracilis versus sartorius), we evaluated the results of pre- and post-operative gait analyses in 46 limbs in 35 cerebral palsy patients who had been treated with the rectus femoris transfer either to the gracilis (gracilis group) or to the sartorius (sartorius group). Preoperatively, there were no significant differences between the two groups in any of the parameters measured. Post-operatively there were significant improvements in stride length, dynamic knee range of motion (ROM), knee angle at initial contact, and maximum knee extension in stance in both groups (P 0.05). The improvement of dynamic knee ROM was more significant in the gracilis group (11.3 degrees) than in the sartorius group (5.0 degrees). Postoperatively maximum knee flexion in swing increased significantly in the gracilis group (P 0.05), but not in the sartorius group. Overall results indicated that the transfer of the rectus femoris to the gracilis by the technique currently used was better than that to the sartorius. © 1997 Elsevier Science B.V. Keywords: Cerebral palsy; Rectus femoris transfer; Gait analysis 1. Introduction The loss of selective motor control, weakness, ago- nist/antagonist muscle imbalance and the spasticity as- sociated with cerebral palsy (CP) produce an impediment to normal gait and the function of lower extremity joints. Loss of knee function, in particular, contributes to a stiff-kneed gait pattern and results in limited flexion/extension knee motion in stance and a restricted arc of motion during swing [2,7 – 9,17,21 – 23]. Treatment to optimize knee function, therefore, is di- rected at reducing knee flexion forces during stance and augmenting sagittal plane motion in swing. Since rectus femoris (RF) transfer was suggested as a means of restoring knee motion during swing, surgical treatment of knee dysfunction in CP has emphasized the treat- ment of the RF [7,8,15 – 18,21]. Sutherland [21] reported that distal RF transfer was superior to proximal RF release in two significant ways: (1) overall knee flexion/ extension range was better in the transfer group, and (2) the transfer group achieved peak knee flexion earlier in swing phase when it was most needed. Gage [8] has described the following specifications and prerequisites for rectus femoris transfer. 1. Hamstring contractures must be corrected and the knee must be able to come to full extension in mid-stance. 2. The foot must be plantargrade and stable in stance. Valgus and/or varus deformities of the foot must either be correctable through bracing or be surgically corrected. 3. In order to generate a moment arm adequate to maintain knee extension in mid-stance and terminal stance, the foot must be in the line of progression (Fig. 1). Minor degrees of malrotation of 10 degrees or less, particularly if they are dynamic, can be accepted. * Corresponding author. Tel.: 612 2293840; fax: 612 2293833. 1 Present address: Department of Pediatric Orthopedic Surgery, Seoul National University Children’s Hospital, 28 Yongon-dong, Chongro-gu, Seoul, 110-744 Korea. Tel.: 82 02 7602878; fax: 82 02 7410546. 0966-6362/97/$17.00 © 1997 Elsevier Science B.V. All rights reserved. PII S0966-6362(97)01116-8