Background: The rational of rectus femoris tendon transfer is to use a spastic rectus femoris tendon as a knee flexor during swing phase of gait cycle. However, the concept of the rectus femoris tendon transfer has been challenged by the evidence of scar tissue formation along the transferred tendon route.
Objective: Examine the surgical technique for rectus femoris tendon transfer to the sartorius at the index procedure and report the findings at the anchoring site during the re-exploration.
Methods: Three knees were examined in two patients with spastic cerebral palsy who developed recurrent flexion contracture at 18 months after the rectus femoris tendon to sartorius surgery. They underwent femoral shortening procedures and re-exploration at the rectus femoris tendon to sartorius transfer site simultaneously to correct flexion contracture. The transferred tendon route was examined. The anchoring site at the sartorius was manually tested. The follow-up period after the re-exploration procedure ranged from 7-60 months (mean: 37 months).
Results: All three rectus femoris tendons were in a straight line, and glided smoothly on the new route with minimal scar tissue formation. The anchoring site at the sartorius was well healed, and the knee flexion was observed upon manual testing. Degree of knee flexion contracture ranged from 15 to 35 degrees (mean: 27 degrees) before re-exploration procedure. It was 5 to -5 degrees (mean: 0 degree) at the recent follow-up. All patients maintained their ambulatory status.
Conclusion: The present technique for rectus femoris tendon to sartorius transfer gave a straight-line transfer over smooth gliding path and provided a secure anchoring site. It converted the function of the transferred tendon from a knee extensor to a knee flexor and created minimal scar formation with smooth gliding path.
Anongnart Sirisabya, Tanteera Tooptakong and Noppachart Limpaphayom
In 1975, King Chulalongkorn Memorial Hospital (KCMH) in Bangkok, Thailand, published data on common orthopedic problems in neonates.
To determine the more recent incidence of these conditions and to compare the results with those reported 40 years ago by KCMH. The data were also compared with a recent report from Siriraj Hospital.
We reviewed medical records of newborn infants from 2012 to 2016, all of whom were born in KCMH with deformities of upper and lower extremities or other birth-related injuries. The cases were grouped according to International Classification of Diseases, 10th edition. The incidence of common neonatal orthopedic problems was calculated as cases per 1,000 live births and compared, using a chi-squared test, with the earlier data from KCMH and with the data recently reported by Siriraj hospital.
Of the 24,825 live births, 54% were male and 46% were female. The average birth weight was 3,052.2 ± 516.1 g (range, 535–5,320 g) for infants. The most common deformity was postural clubfoot, followed by calcaneovalgus and hip dysplasia, with incidences of 1.37, 0.93 and 0.52 per 1,000 live births, respectively. The incidence of calcaneovalgus, metatarsus adductus, and clubfoot was lower than in the 1975 study and in the report from Siriraj. In all 3 studies, the incidence of birth-related injury was similar and clavicular fracture was the most common, with a rate of 1.3/1,000 live births.
The incidence of common neonatal orthopedic problems varies among institutions. Birth-related injury is a major challenge. The results may be utilized as updated data and as a starting point for parental education.