[Transfer of the psoas tendon to the, at its origin detached, rectus femoris muscle in infantile cerebral palsy].

OBJECTIVES: Correction of flexion contracture of hip allowing an erect position while standing and walking. The gain in function helps to prevent a neurogenic dislocation of the coxofemoral joint.

INDICATIONS: In infants with cerebral palsy unable to straighten the body before they can stand or walk. In ambulatory spastic children and adolescents with bothersome hip flexion contracture.

CONTRAINDICATIONS: Severe retardation of motor development in patients with cerebral palsy in whom walking and standing cannot be anticipated. Marked spastic-dystonic muscle weakness.

SURGICAL TECHNIQUE: In general, soft tissue releases at hip and knee are performed at the same sitting. Anterior approach to the hip. Detachment of the sartorius from the anterior superior iliac spine and mobilization in a distal direction. Detachment of the rectus femoris from the anterior inferior iliac spine and retraction distally. Exposure of the femoral nerve in the lacuna musculorum. Exposure of the psoas and detachment from the lesser tuberosity. The tendon is mobilized in a proximal direction. Transfer of the rectus tendon on the divided psoas tendon. Reattachment of the sartorius or distal displacement into the fascia of the thigh.

RESULTS: A clinical and radiological follow-up of 71 bilaterally operated patients. A pertinent complete radiographic documentation was possible in all but 1 patient. 49.3% (n=35) of patients were able to walk preoperatively compared to 80.3% (n=57) at the time of follow-up. The average migration percentage according to Reimers amounted to 28.4% preoperatively; it had regressed to 18.2% at the time of follow-up. In none of the patients did a subluxation or dislocation occur.