The functional effect of a distal rectus femoris tenotomy in adults with cerebral palsy

•Improved peak swing knee flexion (11°) correlated with less tripping and falling.•Improved peak hip extension (6°) during stance.•Increased knee excursion correlated with improved climbing of stairs and curbs.•A distal rectus femoris tenotomy is a surgical option for stiff knee gait in adults with CP.

The purpose of this study was to determine the effect of a distal rectus femoris tenotomy on function and gait in adults with cerebral palsy who had diminished knee flexion during swing. A stiff knee gait pattern is commonly seen in individuals with cerebral palsy and frequently leads to tripping and falling. Five subjects, 25-51 years, (34.6 ± 10.3 years) participated in the study; each individual had the surgery after the age of 18. Four of the five subjects underwent bilateral distal rectus femoris tenotomies for a total of nine limbs being studied. Four of the five subjects had a single procedure of a distal rectus femoris tenotomy and one subject also had bilateral adductor tenotomies. All individuals underwent a pre-operative and post-operative, (3.28 ± 1.6 years) three-dimensional gait analysis. Pre-operative gait revealed diminished peak knee flexion and out of phase rectus femoris activity with a quiet vastus lateralis during swing in all subjects. Significant findings after a distal rectus femoris tenotomy included: improved peak swing knee flexion, improved peak stance hip extension, and increased total knee excursion without loss in knee extension strength. During swing, knee flexion angle improved on average 11° which correlated with subjective report of less shoe wear, tripping, and falling due to improved clearance. In conclusion, a distal rectus femoris tenotomy should be considered a surgical option for adults with cerebral palsy and a stiff knee gait pattern to improve mobility, function, and quality of life.