TRANSPLANTATION OF THE BICEPS FEMORIS FOR THE RELIEF OF QUADRICEPS FEMORIS PARALYSIS IN RESIDUAL POLIOMYELITIS

¹ The Shriners' Hospital for Crippled Children, and the Department of Surgery of Washington University.

I. In a series of sixty-three cases, transplantation of the biceps femoris forward to replace or to reenforce the quadriceps femoris was found to be a highly satisfactory procedure.

II. The operation should not be done in the presence of deformity of the knee or hip, in the absence of sufficient posterior support of the knee, or unless there is reasonable hope that mechanical support can be discarded.

III. The essential points to be observed in a well executed operation are:

1. Preparation of an adequate patellar bed into which the tendon is to be inserted.

2. Sufficient freeing of the biceps femoris muscle upward to insure the maximum obliquity of pull.

3. Suturing the tendon firmly to its new insertion under tension and with the knee and hip in full extension.

IV. The stage of muscle reeducation determines to a great degree the success or failure of the transplant. The important points to be remembered are:

1. Early institution of exercises, baking, and massage (third or fourth week).

2. Mechanical support of the transplant for at least a year.

3. Faithful daily exercises over a period of at least twelve to eighteen months directed at both extension and flexion of knee.

V. Complications and failures are for the most part avoidable if the cases are properly selected and the treatment properly carried out.

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