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Rectus Femoris to Gracilis Muscle Transfer With Fractional Lengthening of the Vastus Muscles: A Treatment for Adults With Stiff Knee Gait

S. Namdari, MD, is Orthopaedic Surgery Resident, Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
S.G. Pill, PT, MD, MSPT, is Orthopaedic Surgery Resident, Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania.
A. Makani, MD, is Orthopaedic Surgery Resident, Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania.
M.A. Keenan, MD, is Chief, Neuro-Orthopaedics Program, and Professor and Vice Chair for Graduate Medical Education, Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 3400 Spruce St, 2 Silverstein, Philadelphia, PA 19104 (USA).

Address all correspondence to Dr Keenan at: maryann.keenan{at}uphs.upenn.edu.

Background: Stiff knee gait, which may be seen in patients with upper motor neuron injury, describes a gait pattern with a relative loss of sagittal knee motion. It interferes with foot clearance during swing, often leading to inefficient compensatory mechanisms and ambulatory dysfunction. Distal rectus femoris muscle transfers and fractional lengthening of the vastus muscles have been performed in adult patients.

Objective: The purpose of this study was to describe a unique surgical technique and report on initial outcomes.

Design: A retrospective case-series study design was used.

Methods: The patients were adults with stiff knee gait due to stroke or traumatic brain injury who underwent distal rectus femoris muscle transfer with fractional lengthening of the vastus muscles. The patients (19 men and 18 women) had an average age of 51 years at the time of surgery. Lower-extremity examinations, clinical gait analyses, and satisfaction levels were recorded preoperatively and postoperatively.

Results: At a mean follow-up time of 10 months, 36 (97%) of the 37 patients were satisfied with their clinical and functional results, and the average Viosca score improved from 3.1 to 3.5.

Limitations: Limitations of the study include use of a retrospective design, lack of a control group, and limited quantitative measures of gait.

Conclusion: Distal rectus femoris muscle transfer and fractional lengthening of the vastus muscles were found to be a possible treatment for adults with stiff-knee gait caused by stroke or traumatic brain injury.

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