Distal rectus femoris transfer.

A major concern in the management of children with cerebral palsy is crouch gait with its excessively flexed knee and hip stance. Earlier, attention was given to the flexed hip and it was assumed that the rectus femoris, as an active component of the quadriceps, contributed an unwanted effect. Proximal surgical release of the rectus from its attachment on the ilium was recommended. However, dynamic electromyographic records of 45 children with cerebral palsy demonstrated that the rectus more commonly was active in the swing phase, and such an approach is appropriate only when electromyography confirms that rectus function is occurring in stance. The recording technique must be capable of differentiating rectus femoris action from that of the underlying vasti, which surface electrodes are not able to do. Past experience indicates that routine inclusion of a proximal rectus femoris release (without confirmation that the muscle's action was limited to stance) resulted in the patient having a stiff-legged gait. Hence the actions of the rectus femoris need closer attention.