Guided Growth for Correction of Knee Flexion Contracture in Patients with Arthrogryposis: Preliminary Results

Background. Knee flexion contractures frequently present in children with arthrogryposis and significantly alter kinematics of walking and reduce efficiency of ambulation or render it impossible. There are variety of surgical options for contracture correction, including entire soft-tissue release or its combination with Ilizarov ex-fix and supracondylar femoral osteotomy. Choosing of the most effective surgery is challenging because every method has limitations.Aim. To evaluate the treatment outcomes of knee flexion deformity correction by guided growth in patients with arthrogryposis.Materials and methods. A total of 12 patients (20 knee joints) with arthrogryposis who underwent anterior distal femoral hemiepiphysiodesis with 8 plates for knee flexion contracture correction were included in the study. The average age at surgery was 6.5 ± 0.5 (range, 4.3–9.6) years. Clinical and radiological methods were used with statistical analysis of the data.Results. The mean preoperative knee flexion deformity angle was 48.5° ± 4.04° (range, 20°–80°). After distal femoral hemiepiphysiodesis, a reduction of knee flexion contracture was observed in 17 (85%) patients during a follow-up period of 18–36 months. The average correction was 20° ± 2.67° (range, 0°–40°) (p < 0.05). The residual deformity angle was 28.5° ± 6.03° (range, 0°–60°). Patients with contractures up to 50° demonstrated the most significant correction (by 90% compared with the initial value) (p < 0.05). This group included patients with severe flexion contractures, treated by serial casting, combined with an extension devise before surgery, which contributed to a significant reduction of the contracture.Conclusion. Distal femoral hemiepiphysiodesis is an effective, safe, and reproducible surgical option for knee flexion contractures in patients with arthrogryposis. Combination with additional methods enables significantly reduction of knee flexion deformities from severe to moderate, thereby rendering treatment more effective with a shorter duration, which allows prompt improvement in ambulatory capacity.

Download Full-text

Non-Surgical Methods for Correction of Knee Flexion Contracture.

10.1055/s-0039-1682536 ◽

1977 ◽

Author(s):

D.C. Boone

Keyword(s):

Knee Flexion ◽

Flexion Contracture ◽

Physical Rehabilitation ◽

Functional Mobility ◽

Flexion Deformity ◽

Flexion Contractures ◽

Knee Flexion Contracture ◽

Surgical Methods ◽

Made In

Knee flexion contractures have presented problems for the physical rehabilitation of hemophilic patients. These deformities reduce the functional mobility of the patient and their presence increases the amount of energy which is expended in walking. Hinges which extend the knee and tend to desublux the tibia are incorporated in plaster cylinders. Daily adjustments are made in the extension and subluxation screws. Serial castings may be required when correcting a flexion deformity greater than 30-35 degrees. Maximum correction can be expected in two to three weeks. Maintenance of the corrected position is vital and is obtained through a sequence of cylinder and open-front castings. The extension desubluxation hinge and the open-front cylinder cast will be demonstrated and discussed.

Download Full-text

Reliability of Heel-Height Measurement for Documenting Knee Extension Deficits

The American Journal of Sports Medicine ◽

10.1177/03635465020300040501 ◽

2002 ◽

Vol 30 (4) ◽

pp. 479-482 ◽

Cited By ~ 15

Author(s):

Theodore F. Schlegel ◽

Martin Boublik ◽

Richard J. Hawkins ◽

J. Richard Steadman

Keyword(s):

Range Of Motion ◽

Knee Flexion ◽

Cruciate Ligament ◽

Flexion Contracture ◽

Height Measurement ◽

Height Difference ◽

Thigh Circumference ◽

Flexion Contractures ◽

Heel Height ◽

Knee Flexion Contracture

Background Heel-height difference has been used to detect subtle knee flexion contractures, but the effects of thigh circumference differences and patient positioning during testing have not been evaluated. Hypothesis Differences in thigh circumference measurements and whether the patient's patellae are on or off the examination table during heel-height difference measurement will not affect the accuracy of detecting knee flexion contracture. Study Design Prospective cohort study. Methods Bilateral knee range of motion, prone heel-height difference with the patellae on and off the table, and thigh circumference at 5 and 15 cm proximal to the proximal pole of the patella were measured by one investigator on 50 consecutive patients who had undergone unilateral anterior cruciate ligament reconstruction. Results A high degree of correlation was demonstrated between the heel-height difference and the standard range of motion measurement. Differences in thigh girth and patellar position did not statistically affect the accuracy of the heel-height difference as an indicator of knee flexion contracture. Conclusion Heel-height difference is a valid method of documenting knee flexion contractures. Compared with traditional goniometer assessment, this test is a more meaningful and easier way for detecting subtle knee flexion contractures of less than 10°.

Download Full-text