Tendon Transfer — Rectus Femoris Transfer to Medial Hamstrings

Children's Colorado / Center for Gait and Movement Analysis (CGMA) · CGMA Physical Therapy Team, Children's Colorado

Weight-Bearing

NWB x 4-6 weeks (long leg cast, knee flexed ~20 deg); CPM option (2-4 hr intervals, 6-8 hrs/day) instead of casts to minimize scarring

Key Restrictions

No forceful/resisted quad contraction x 6 weeks; no impact x 6 weeks; expect 12-15% quad strength reduction; sub-maximal (<50%) isometric quad allowed after day 8; avoid CPM exceeding 90 deg flexion

Timeline & Phases

Phase 1 (days 1-7): NWB, isometrics (glutes/hamstrings), ankle AROM; Phase 2 (days 8-21): sub-maximal isometric quad, SLR all planes; Phase 3 (day 22+): PROM then AROM after cast removal, slow treadmill gait, total LE strengthening (quads/hip flexion-extension), scar massage ~4-6 weeks; return to full activity ~3 months

Notes

Pediatric; indication is stiff knee gait (rectus femoris active in swing, knee flexion slope <160 deg/sec, delayed peak knee flexion, positive Ely test); distal RF inserted transferred to semitendinosus; Children's Colorado CGMA

Surgeon / Author

CGMA Physical Therapy Team, Children's Colorado

Published

June 2008