Tendon Transfer — Rectus Femoris Transfer with Distal Femoral Extension Osteotomy

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

Weight-Bearing

NWB x 3 weeks; partial WB weeks 3-6 per MD; CPM option; healing 6-8 weeks

Key Restrictions

No forceful/resistive quad contraction x 6 weeks; no impact x 6 weeks; no knee flexion beyond 90 deg x 3 weeks (uncasted); minimize fall risk; expect 12-15% quad strength reduction; spasticity complications on cast removal

Timeline & Phases

Phase 1 (days 1-7): NWB (WB for transfers only with immobilizers if needed), pain management, safe transfers, hip/ankle PROM/AAROM/AROM, isometrics; Phase 2 (days 8-21): full passive knee extension, 90 deg flexion; Phase 3 (days 22-42): progressive WB, ground reaction AFOs, full knee ROM, scar massage, e-stim; Phase 4 (week 7+): gait re-training, full LE ROM, total LE strengthening (quads/hip flexion-extension/hamstrings), functional balance, return to pre-op

Notes

Pediatric; combined procedure (PT03 + PT23); indication is stiff knee gait with fixed knee flexion contracture; RF transferred to semitendinosus AND anterior femoral wedge removed; CPM option; Children's Colorado CGMA

Surgeon / Author

CGMA Physical Therapy Team, Children's Colorado

Published

June 2008