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 Pediatrics Test 4: Trauma/Infection/Neuromuscular
CME 1: January, February, March 2004
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The Journal of Bone and Joint Surgery (American) 86:348-354 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Three-Dimensional Muscle-Tendon Geometry After Rectus Femoris Tendon Transfer

Deanna S. Asakawa, PhD1, Silvia S. Blemker, MS3, George T. Rab, MD2, Anita Bagley, PhD2 and Scott L. Delp, PhD3

1 Room 224 Durand Building, Mechanical Engineering, Biomechanical Engineering Division, Stanford University, Stanford, CA 95305-4038. E-mail address: dasakawa{at}stanfordalumni.org
2 Motion Analysis Laboratory, Shriners Hospital for Children Northern California, 2425 Stockton Boulevard, Sacramento, CA 95817
3 Bioengineering Department, Stanford University, Clark Center, Room 5-348, 318 Campus Drive, Stanford, CA 94305-5450. E-mail address for S.L. Delp: delp{at}stanford.edu. E-mail address for S.S. Blemker: ssblemker{at}stanford.edu

Investigation performed at the Department of Mechanical Engineering, Stanford University, Stanford, the Shriners Hospital for Children Northern California, Sacramento, and the Veterans Affairs Palo Alto Health Care System, Palo Alto, California

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the National Institutes of Health. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Rectus femoris tendon transfer is performed in patients with cerebral palsy to improve knee flexion during walking. This procedure involves detachment of the muscle from its insertion into the quadriceps tendon and reattachment to one of the knee flexor muscles. The purpose of the present study was to evaluate the muscle-tendon geometry and to assess the formation of scar tissue between the rectus femoris and adjacent structures.

Methods: Magnetic resonance images of the lower extremities were acquired from five subjects after bilateral rectus femoris tendon transfer. A three-dimensional computer model of the musculoskeletal geometry of each of the ten limbs was created from these images.

Results: The three-dimensional paths of the rectus femoris muscles after transfer demonstrated that the muscle does not follow a straight course from its origin to its new insertion. The typical muscle-tendon path included an angular deviation; this deviation was sharp (>35°) in seven extremities. In addition, scar tissue between the transferred rectus femoris and the underlying muscles was visible on the magnetic resonance images.

Conclusions: The angular deviations in the rectus femoris muscle-tendon path and the presence of scar tissue between the rectus femoris and the underlying muscles suggest that the beneficial effects of rectus femoris tendon transfer are derived from reducing the effects of the rectus femoris muscle as a knee extensor rather than from converting the muscle to a knee flexor. These findings clarify our understanding of the mechanism by which rectus femoris tendon transfer improves knee flexion.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.


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