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Objective: We sought to evaluate the association of low rectus femoris cross-sectional area (RFCSA) with hospital length of stay and poorer outcomes in patients undergoing cardiac surgery., Methods: A single right-leg RFCSA was measured with ultrasound preoperatively and baseline characteristics, clinical data, and outcomes recorded. Patients were categorized as low rectus femoris muscle size (lowRF) or normal rectus femoris muscle size (normalRF), if they were in the lowest quartile or not, respectively. All analyses were performed on both body surface area (BSA)- and sex-adjusted RFCSA., Results: One hundred eight-four patients had a RFCSA measured with a mean of 5.01 cm 2 (1.41 cm 2 ), and range of 0.71 to 8.77 cm 2 . When analyzing the BSA-adjusted RFCSA, we found the lowRF group had a longer hospital stay, 11.0 days [7.0-16.3] versus 8.0 days [6.0-10.0] for the normalRF group (P < .001), and a greater proportion of extended hospital stay (≥18.5 days) of 19.6% compared with 6.2% (P = .010). When the RFCSA was adjusted for sex, the lowRF group had a greater length of hospital stay, 9.0 days [7.0-14.5] versus 8.0 days [6.0-11.0] (P = .049). In both the BSA- and sex-adjusted RFCSA, the lowRF group suffered greater morbidity and were more likely discharged to a destination other than home. In multivariate analyses adjusting for European System for Cardiac Operative Risk Evaluation II, BSA-adjusted lowRF but not sex-adjusted lowRF was independently associated with log-transformed hospital length of stay. LowRF was not independently associated with increased major morbidity and death for both BSA and sex-adjusted RFCSA., Conclusions: Low RFCSA has a significant association with increased hospital length of stay, morbidity, and nonhome discharge in patients undergoing cardiac procedures., Trial Registry Number: ACTRN12620000678998., (Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Introduction: A shortened rectus femoris muscle has been associated with many different musculoskeletal problems. Assessing rectus femoris muscle length is commonly performed using the Modified Thomas Test. However, this test position is often difficult to assume and there are difficulties with reliably measuring rectus femoris length. A method that that uses an easier position to assume and could be more reliable would be beneficial to therapists. The purpose of this study was to determine observer agreement using a new test for assessment of rectus femoris length. A second purpose was to determine if those with anterior knee pain have different rectus femoris muscle length than those without anterior knee pain., Method: Fifty-three participants with and without anterior knee pain were enrolled. Rectus femoris muscle length was measured lying prone with the leg measured on the table while the non-measured leg was off the table in a position of 90° hip flexion. Rectus femoris muscle was lengthened by passively bending the knee until a firm end-feel. The angle of knee flexion was then measured. The process was then repeated after a brief rest period., Results: Observer agreement assessing rectus femoris length using this method showed "almost perfect" reliability for both intra- and inter-rater testing: intra-rater: ICC = .99, [CI 95 : .98-.99], inter-rater: ICC = .96, [CI 95 : .92- .98]. Agreement for the sub-sample of those with anterior knee pain (N=16) showed "almost perfect" reliability for intra-rater (ICC 1,1 = .98); [CI 95 : 0.94-.99] and inter-rater reliability (ICC 2,1 = 0.88); [CI 95 : 0.70 -.95]. No differences were noted in rectus femoris length between those without and those with anterior knee pain (t= 0.82, p> 0.01); [CI 95 : -7.8 -3.33]; (SEM = 1.3°; MDC=3.6°)., Conclusion: This new method of assessing rectus femoris length is reliable between and within raters. No differences were noted in rectus femoris length between those with anterior knee pain and those without., Competing Interests: The authors report no conflicts of interests.

Handheld ultrasound has great potential in resource-limited areas, and can improve healthcare for rural populations. Single-channel ultrasound has been widely used in many clinical ultrasound applications, and optical tracking is considered accurate and reliable. In this study, we developed a 10 MHz lead magnesium niobate-lead titanate (PMN-PT) dual-element ultrasound transducer combined with a miniature optical position tracker, and then measured the rectus femoris of the thigh, upper arm, and cheek muscles. Compared to single-element transducers, dual-element transducers improve the contrast of near-field signals, effectively reduce noise, and are suitable for measuring curved surfaces. The purpose of position tracking is to calculate the location of the ultrasound transducer during the measurement process. By utilizing positioning information, 2D ultrasound imaging can be achieved while maintaining structural integrity. The dual-element ultrasound scanner presented in this study can enable continuous scanning over a large area without a scanning width limitation. The custom-made dual-element ultrasound scanner has the advantage of being a portable, reliable, and low-cost ultrasound device, and is helpful in popularizing medical care for remote villages.

The present study aimed to determine the effect of elastic taping on soccer instep kicking kinematics. Fifteen male university soccer players performed maximal instep kicking with and without Y-shaped elastic taping on the skin surface of the rectus femoris muscle. Their kicking motions were captured at 500 Hz using a motion capture system. The thickness of the rectus femoris muscle was measured using an ultrasound scanner prior to the kicking session. The thickness of the rectus femoris muscle and kicking leg kinematics in both the conditions were compared. The thickness of the rectus femoris muscle increased significantly after elastic tape application. In conjunction with this change, kinematic variables of the kicking leg, such as peak hip flexion angular velocity and knee and foot linear velocities significantly increased. However, there was no change in the knee extension angular and hip linear velocities. The elastic tape application caused deformation of the rectus femoris muscle and improvement of the instep kicking performance. The study findings provide a new insight on the effect of elastic taping on dynamic sports performance, such as in soccer instep kicking.

Background: Cancer-related malnutrition is still unrecognized and undertreated in clinical practice. The morphofunctional assessment of disease-related malnutrition (DRM) is a new approach that focuses on evaluating changes in body composition and function. The aim of this study is to evaluate the prognostic value of classic and emerging assessment of malnutrition at 12-months survival in cancer patients., Methods: We conducted a prospective study on cancer outpatients. Bioelectrical impedance with phase angle (PhA), nutritional ultrasound by rectus femoris cross-sectional area (RFCSA), hand grip strength, and "Timed Up and Go Test" (TUG) were evaluated as predictors of mortality., Results: Fifty-seven patients were included. The non-survivors had lower PhA values than the survivors (4.7° vs. 5.4°; p < 0.001), and we had the same results with RFCSA 2.98 cm 2 /m 2 vs. 4.27 cm 2 /m 2 ( p = 0.03). Cut-off points were identified using the ROC (receiver operating characteristic) curves for PhA (≤5.6° cancer patients, ≤5.9° men, ≤5.3° women), RFCSA (≤4.47 cm 2 /m 2 cancer patients, ≤4.47° men, ≤2.73° women) and rectus femoris-Y-axis (RF-Y-axis; ≤1.3 cm cancer patients, ≤1.06 men, ≤1 women). In multivariate logistic regression analysis, we found that high PhA was significantly associated with a lower mortality hazard ratio (HR: 0.42 95% CI: 0.21-0.84, p = 0.014). Likewise, high RFCSA was associated with a decrease in mortality risk in the crude model (HR: 0.61 95% CI: 0.39-0.96, p = 0.031). This trend was also maintained in the adjusted models by the confounding variables., Conclusions: Low PhA and RFCSA values are significant independent predictors of mortality in cancer patients. These cut-off points are clinical data that can be used for nutritional assessment and the prediction of clinical outcomes.

Objectives: Sarcopenia patients require more medical attention and caretaking. As such, early detection of sarcopenia and appropriate interventions are crucial for decreasing medical costs and meeting the challenges of aging populations. The aim of the present study was to develop a reliable and accurate model to estimate muscle mass using ultrasound-derived parameters from the rectus femoris (RF), referenced by dual-energy X-ray absorptiometry., Methods: Cross-sectional study was performed. The study patients were recruited by Taipei Veterans General Hospital (No. 2016-07-013C) between 2016 and 2019. A total of 91 community-dwelling adults (35 men and 56 women) were enrolled in this study. Ultrasound measurements of RF muscle thickness (MT), cross-sectional area (CSA), and muscle volume (MV) were performed in B-mode. Muscle strength and physical performance were also examined. Multivariate linear regression was used to build models for the prediction of appendicular skeletal muscle index (ASMI) based on MT, CSA, and MV values. The accuracy of ultrasound RF measurements for predicting sarcopenia was evaluated by using receiver operating characteristic (ROC) curve analysis., Results: The regression equations used for ASMI prediction (adjusted body mass index, sex, and leg length) had high precision and low error. Moreover, the MV model results were close to those of the CSA model and higher than those of the MT model. The ROC analysis showed that both MV and CSA had excellent discrimination when assessing sarcopenia (AUC = 0.83 and 0.81, respectively), whereas MT showed acceptable discrimination (AUC = 0.73)., Conclusions: Ultrasound-derived RF MV was accurate when predicting ASMI and diagnosing sarcopenia in community-dwelling adults., (© 2021 American Institute of Ultrasound in Medicine.)

Purpose: This study aimed to determine the validity of ultrasonographic measurement of the rectus femoris muscle (RFM) thickness as a screening tool for low appendicular muscle mass (ASM) to diagnose sarcopenia and to determine the cut-off point of RFM thickness in the Thai population., Patients and Methods: We enrolled 857 community-dwelling adults aged 60 years and older who were diagnosed with sarcopenia using the Asian Working Group for Sarcopenia-2019 algorithm. The RFM thickness was measured using ultrasonography and compared with bioelectrical impedance analysis (BIA) data. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were evaluated, and the area under the receiver operating curve (AUROC) was used to determine the accuracy of the test., Results: A total of 857 participants were included in the study. Overall, when the cut-off values of RFM thickness of ≤1.1 cm were used for male and ≤1 cm for female, the highest sensitivity for sarcopenia diagnosis was 90.9% and specificity was 92.2%. The PPV was 76.6, and the NPV was the highest at 97.3. The highest sensitivity for the diagnosis of severe sarcopenia was 92.5% and specificity was 97.4%. The AUROC of the cut-off point of RFM thickness for the diagnosis of sarcopenia was 0.92 (95% confidence interval [CI], 0.89-0.94); for severe sarcopenia, it was 0.95 (95% CI, 0.92-0.98)., Conclusion: Measuring RFM thickness using ultrasonography is a feasible and reliable screening test for sarcopenia, and the cut-off values of ≤1.1 cm for male and ≤1 cm for female showed the highest accuracy for confirming low ASM in the Thai population., Competing Interests: The authors declare that they have no conflicts of interest., (© 2022 Sri-on et al.)

We aimed to uncover which rectus femoris strain injury types affect regional activation within the rectus femoris. The rectus femoris has a region-specific functional role; the proximal region of the rectus femoris contributes more than the middle and distal regions during hip flexion. Although a history of strain injury modifies the region-specific functional role within the rectus femoris, it was not obvious which rectus femoris strain injury types affect regional activation within it. We studied 12 soccer players with a history of rectus femoris strain injury. Injury data were obtained from a questionnaire survey and magnetic resonance imaging. To confirm the region-specific functional role of the rectus femoris, surface multichannel electromyographic signals were recorded. Accordingly, eight legs had a history of central tendon injury, four had a history of myofascial junction injury, and four had a healed strain injury. When the injury was limited to the central tendon, the region-specific functional role disappeared. The region-specific functional role was confirmed when the injury was outside the central part. The neuromuscular function was also inhibited when the longitudinal range of the injured region was long. Our findings suggest that a central tendon injury with a long injury length impairs regional neuromuscular activation of the rectus femoris muscle.

Background & Aims: Muscle mass is an important biomarker of survival from a critical illness; however, there is no widely accepted method for routine assessment of low muscularity at intensive care unit (ICU) admission. We hypothesize that ultrasound-based partial muscle mass assessments can reflect the trunk muscle mass. Therefore, we aimed to investigate whether ultrasound muscle mass measurements could reflect trunk muscle mass and identify patients with low muscularity., Methods: We performed a retrospective analysis of prospectively obtained ultrasound data at ICU admission. We included patients who underwent computed tomography (CT) imaging at the third lumbar vertebra (L3) within 2 days before and 2 days after ICU admission. Primary outcomes included the correlation between the femoral muscle mass measurements using ultrasound and the cross-sectional area (CSA) at L3 obtained by CT. Low muscularity was defined as a skeletal muscle index of 36.0 cm 2 /m 2 for males and 29.0 cm 2 /m 2 for females. Secondary outcomes included the correlation with the ultrasound measurements of the biceps brachii muscle mass and diaphragm thickness., Results: Among 133 patients, 89 underwent CT imaging, which included the L3. The patient mean age was 72 ± 13 years, and 60 patients (67%) were male. The correlation between the femoral muscle ultrasound and CT was ρ = 0.57 (p < 0.01, n = 89) and ρ = 0.48 (p < 0.01, n = 89) for quadriceps muscle layer thickness and rectus femoris muscle CSA, and these had the discriminative power to assess low muscularity, with the areas under the curve of 0.84 and 0.76, respectively. The ultrasound measurements of the biceps brachii muscle mass and diaphragm thickness were correlated with CT imaging [ρ = 0.57-0.60 (p < 0.01, n = 52) and ρ = 0.35 (p < 0.01, n = 79)]., Conclusions: Ultrasound measurements of muscle mass were correlated with CT measurements, and the measurements of femoral muscle mass were useful to assess low muscularity at ICU admission., Trial Registration: UMIN000044032 (retrospectively registered on April 25, 2021)., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2021 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Objectives: Muscle mass at admission is important to survive stroke, and stroke-induced sarcopenia is a serious problem because of its poor prognosis. Muscle mass measurement and monitoring are essential for appropriate rehabilitation and nutrition management. However, few reviews are available about the muscle mass measurement and monitoring after stroke., Material and Methods: Several methods are used to assess skeletal muscle mass in stroke, such as computed tomography (CT), ultrasound, bioelectrical impedance analysis, dual-energy X-ray absorptiometry, biomarkers, and anthropometrics. We summarized the current methods and clinical applications in stroke., Results: In stroke, a head CT is used to estimate muscle mass by measuring the temporal muscle. However, it can be conducted retrospectively due to radiation exposure. After stroke, limb muscle atrophy and diaphragm dysfunction are observed using ultrasound. However, ultrasound requires an understanding of the methods and skill. A bioelectrical impedance analysis can be used to assess muscle mass in patients after a stroke unless they have dynamic fluid changes. Dual-energy X-ray absorptiometry is used for follow-up after hospital discharge. Urinary titin N-fragment and serum C-terminal agrin fragment reflect muscle atrophy after stroke. Anthropometrics may be useful with limited resources., Conclusions: We summarized the features of each measurement and proved the recent evidence to properly measure and monitor skeletal muscle mass after stroke., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Ultrasonography (US) is a feasible and accessible method for the measurement of skeletal muscle mass. This technique presents acceptable intra-rater reliability; however, there are a few reports on its inter-rater reliability. Additionally, relative reliability should equally be inspected to determine the presence of systematic errors. Therefore, this study aimed to investigate the intra- and inter-rater reliabilities and absolute reliability of rectus femoris muscle thickness as measured using US., Methods: The participants included in our study comprised 12 healthy young men (26.5 ± 3.9 years. Rectus femoris muscle thickness was measured from the right side of the thigh using US by two trained physical therapists. Inter- and intra-rater reliabilities were determined using the intraclass correlation coefficient (ICC) (1, 1) and ICC (2, 1) methods, respectively. Absolute reliability was evaluated using Bland - Altman analysis. Additionally, we calculated the minimal detectable change at the 95% level of confidence (MDC 95 )., Result: According to the results of the Bland - Altman analysis, no fixed or proportional errors were present. The ICC (1, 1) was 0.95, and the ICC (2, 1) was 0.70. The MDC 95 values of rectus femoris thickness for the intra- and inter-rater reliabilities were 2.0 mm and 4.3 mm, respectively., Conclusions: In our study, intra- and inter-rater reliabilities were measured at "excellent" and "moderate" levels in the healthy individuals based on a previously defined scale. Moreover, we determined the measurement error for quantifying rectus femoris thickness. Therefore, the measurement of rectus femoris thickness using US could be considered applicable in clinical research.

The pendulum test assesses quadriceps spasticity by dropping the lower leg of a relaxed patient from the horizontal position and observing limb movement. The first swing excursion (FS) decreases with increasing spasticity severity. Our recent simulation study suggests that the reduced initial swing results from muscle short-range stiffness and its interaction with reflex hyper-excitability. Short-range stiffness emerges from the thixotropic behavior of muscles where fiber stiffness upon stretch increases when the muscle is held isometric. Fiber stiffness might thus be higher during the first swing of the pendulum test than during consecutive swings. In addition, it has recently been suggested that muscle spindle firing reflects fiber force rather than velocity and therefore, reflex activity might depend on fiber stiffness. If this hypothesized mechanism is true, we expect to observe larger first swing excursions and reduced reflex muscle activity when the leg is moved rather than kept isometric before release, especially in patients with increased reflex activity. We performed the pendulum test in 15 children with cerebral palsy (CP) and 15 age-matched typically developing (TD) children in two conditions. In the hold condition, the leg was kept isometric in the extended position before release. In the movement condition, the leg was moved up and down before release to reduce the contribution of short-range stiffness. Knee kinematics and muscle activity were recorded. Moving the leg before release increased first swing excursion ( p < 0.001) and this increase was larger in children with CP (21°) than in TD children (8°) ( p < 0.005). In addition, pre-movement delayed reflex onset by 87 ms ( p < 0.05) and reduced reflex activity as assessed through the area under the curve of rectus femoris electromyography ( p < 0.05) in children with CP. The movement history dependence of pendulum kinematics and reflex activity supports our hypothesis that muscle short-range stiffness and its interaction with reflex hyper-excitability contribute to joint hyper-resistance in spastic CP. Our results have implications for standardizing movement history in clinical tests of spasticity and for understanding the role of spasticity in functional movements, where movement history differs from movement history in clinical tests., (Copyright © 2020 Willaert, Desloovere, Van Campenhout, Ting and De Groote.)

Injuries of the thigh muscles are among the most common sports injuries. In soccer they represent nearly 30% of all injuries. The rectus femoris muscle in particular is often exposed to injuries due to its anatomical features. Versatile treatment strategies and posttreatment procedures are described in the literature, which take the type and duration of the injury and the physical constitution of the patient into consideration. This article presents the case of a 28-year-old hobby football player who suffered a proximal avulsion of a tendon of the rectus femoris muscle during a football match. After persistent complaints over 2 months operative treatment was performed by anchor refixation of the tendon. During the follow-up at 6 weeks postoperatively, there was a very good functional result with good mobility and only slightly reduced strength with early full load and movement. The anamnesis revealed no deficits in the side to side comparison 1.5 years after the trauma.

Heart failure (HF) is often accompanied by skeletal muscle weakness and exercise intolerance, which are known as prognostic factors of HF. Comprehensive evaluation of physical function is important, but it is not commonly conducted because of the lack of equipment or appropriate expertise. Measurement of rectus femoris diameter (RFD) by ultrasound is convenient and noninvasive, but it has not been clarified that RFD could represent physical functions in HF patients. This study evaluated 185 consecutive HF patients and underwent assessment including RFD, grip power (GP), knee extension strength (KES), skeletal muscle index (SMI), nutrition status, cardiopulmonary exercise testing, and New York Heart Association (NYHA) functional class. RFD was related with NYHA class and significantly correlated with GP, KES, SMI, body mass index, pre-albumin level, geriatric nutritional risk index, and peak VO 2 (r = 0.631, 0.676, 0.510, 0.568, 0.380, 0.539, 0.527, respectively; p < 0.001). Multivariate regression analysis revealed that estimated glomerular filtration rate (β = 0.551) and RFD (β = 0.326) were predictive factors of peak VO 2 . Gender, age, brain natriuretic peptide level, left ventricular ejection fraction, and hemoglobin level were the other explanatory parameters. The cut off value of RFD for sarcopenia diagnosis was estimated as 15 mm (sensitivity = 0.767 and specificity = 0.808). RFD is a simple and useful marker which reflects skeletal muscle strength/volume, exercise tolerance, nutrition status, and NYHA class. It is also associated with sarcopenia in HF patients.

Background: Inguinal wound complications often cause postoperative morbidity and also mortality following vascular surgical interventions. The aim of this study was to report experiences and a comparison of the outcomes using rectus femoris muscle flaps (RFF) and sartorius muscle flaps (SMF)., Material and Methods: A retrospective study was performed at two locations of a cross-border vascular center and all muscle flap interventions performed at the two centers within the vascular surgery department were reviewed. Primary outcomes were muscle flap survival, graft salvage and major amputations., Results: A total of 44 RFFs were performed in 39 patients (mean age 67 years, 73% males) and 25 SMFs in 24 patients (mean age 64 years, 76% males). Wound infections were the most common indications for muscle flap reconstruction. At a mean follow-up of 24 months (±24) and 17 months (±20), respectively, comparable flap survival rates (91% vs. 84%), wound healing rates (72% vs. 83%), graft salvage (65% vs. 73%) and amputation rates (9% vs. 8%) were found., Conclusion: Muscle flap reconstruction is an effective way to cover groin defects resulting from deep wound infections after vascular surgery, achieving good results in a high-risk group of patients. No differences were found between SMF and RFF regarding amputation and graft loss. Both techniques can be safely performed, depending on the preference and experience of the surgical team. The RFF technique should be preferentially used to cover large tissue defects, whereas the SMF procedure can be preferred to cover smaller defects in the groin.

Effects of resistance training are well known to be specific to tasks that are involved during training. However, it remains unclear whether neuromuscular adaptations are induced after adjacent joint training. This study examined the effects of hip flexion training on maximal and explosive knee extension strength and neuromuscular performance of the rectus femoris (RF, hip flexor, and knee extensor) compared with the effects of knee extension training. Thirty-seven untrained young men were randomly assigned to hip flexion training, knee extension training, or a control group. Participants in the training groups completed 4 weeks of isometric hip flexion or knee extension training. Standardized differences in the mean change between the training groups and control group were interpreted as an effect size, and the substantial effect was assumed to be ≥0.20 of the between-participant standard deviation at baseline. Both types of training resulted in substantial increases in maximal (hip flexion training group: 6.2% ± 10.1%, effect size = 0.25; knee extension training group: 20.8% ± 9.9%, effect size = 1.11) and explosive isometric knee extension torques and muscle thickness of the RF in the proximal and distal regions. Improvements in strength were accompanied by substantial enhancements in voluntary activation, which was determined using the twitch interpolation technique and RF activation. Differences in training effects on explosive torques and neural variables between the two training groups were trivial. Our findings indicate that hip flexion training results in substantial neuromuscular adaptations during knee extensions similar to those induced by knee extension training., (© 2017 The Authors. Scandinavian Journal of Medicine & Science In Sports Published by John Wiley & Sons Ltd.)

This study investigated the age-related differences in shear moduli of the rectus femoris muscle (RF), the lateral head of the gastrocnemius muscle (LG) and the soleus muscle (SOL) using shear wave ultrasound elastography. Thirty-one young individuals and 49 elderly individuals volunteered for this study. The shear modulus of RF was determined at 50% of the thigh length, and those of LG and SOL were determined at 30% of the lower leg length. RF and LG shear moduli were significantly higher in young individuals than in elderly individuals, but there was no age-related difference in SOL shear modulus. From the standpoint of an index reflecting muscle mechanical properties, it is suggested that the lower muscle shear moduli of RF and LG are the reason for the decreased explosive muscle strength in the lower extremity and the increased risk of falls for elderly individuals., (Copyright © 2015 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)

Electromechanical delay (EMD) was described as a time elapsed between first trigger and force output. Various results have been reported based on the measurement method with observed inconsistent results when the trigger is elicited by voluntary contraction. However, mechanomyographic (MMG) sensor placed far away on the skin from the contracting muscle was used to detect muscle fiber motion and excitation-contraction (EC) coupling which may give unreliable results. On this basis, the purpose of this study was to detect EMD during active muscle contraction whilst introducing an ultrafast ultrasound (US) method to detect muscle fiber motion from a certain depth of the muscle. Time delays between onsets of EMG-MMG, EMG-US, MMG-FORCE, US-FORCE, and EMG-FORCE were calculated as 20.5 ± 4.73, 28.63 ± 6.31, 19.21 ± 6.79, 30.52 ± 8.85, and 49.73 ± 6.99 ms, respectively. Intrarater correlation coefficient (ICC) was higher than MMG when ultrafast US was used for detecton of the Δt EMG-US and Δt US-FORCE, ICC values of 0.75 and 0.70, respectively. Synchronization of the ultrafast ultrasound with EMG and FORCE sensors can reveal reliable and clinically useful results related to the EMD and its components when muscle is voluntarily contracted. With ultrafast US, we detect onset from the certain depth of the muscle excluding the tissues above the muscle acting as a low-pass filter which can lead to inaccurate time detection about the onset of the contracting muscle fibers. With this non-invasive technique, understanding of the muscle dynamics can be facilitated.

Objectives: Change of function of the rectus femoris through medial transfer of its distal tendon. This procedure transforms a hip flexor and knee extensor into a hip and knee flexor. Thus the muscle acts as a hip flexor during the terminal stance phase and swing phase and as a knee flexor during the swing phase. This permits the foot to clear the ground and to improve the spastic gait., Indications: Functional sequelae of a simultaneous spasticity of knee flexors and extensors causing a stiff gait. Isolated spasticity of rectus muscle with continuous muscle activity during stance and swing phase, recurvatum of the knee during the stance phase, limited flexion (<15(o)) of the knee during the swing phase and lack of clearance of the foot., Contraindications: Pattern of global flexor spasticity. Loss of power of hip flexors. Paresis of quadriceps., Surgical Technique: Isolation and detachment of the distal tendon of the rectus femoris. The tendon can be transferred either medially or laterally. For a medial transfer the tendon is sutured to the gracilis tendon which is detached as proximal as possible. This permits to displace the direction of pull behind the center of rotation of the knee. For a lateral transfer the tendon is sutured to the iliotibial tract., Results: In 94,8% of patients (n=137; 274 limbs) followed for a mean of 21 months (7 to 39 months) the results were good to satisfactory using the score of Gage. The Duncan-Ely test was negative in these patients. The gait was markedly improved. Important complications did not occur.