Modified Posterior Soft Tissue Release for Management of Severe Knee Flexion Contracture

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.

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Recurrence of knee flexion contracture after surgical correction in children with cerebral palsy

International Orthopaedics ◽

10.1007/s00264-021-05035-z ◽

2021 ◽

Author(s):

Supitchakarn Cheewasukanon ◽

Phatcharapa Osateerakun ◽

Noppachart Limpaphayom

Keyword(s):

Cerebral Palsy ◽

Knee Flexion ◽

Flexion Contracture ◽

Surgical Correction ◽

Knee Flexion Contracture ◽

Children With Cerebral Palsy

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The influence of preoperative knee flexion contracture severity on short-term outcome of orthopedic surgery in ambulatory children with bilateral cerebral palsy

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04362-x ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Evelina Pantzar-Castilla ◽

Brian Po-Jung Chen ◽

Freeman Miller ◽

Jacques Riad

Keyword(s):

Cerebral Palsy ◽

Motor Function ◽

Surgical Procedures ◽

Orthopedic Surgery ◽

Knee Flexion ◽

Flexion Contracture ◽

Short Term ◽

Knee Flexion Contracture ◽

Group 2 ◽

Group 1

Abstract Background Indications and cutoff value of deformities to determine surgical procedures for flexed knee gait are not clear. The aim was to determine the influence of none or mild, and moderate preoperative knee flexion contracture on the improvement of gait after orthopedic surgery in children with bilateral cerebral palsy (CP). Methods Inclusion criteria; bilateral CP, Gross Motor Function Classification System level I-III, and pre- and post operative-gait analysis. The 132 individuals identified were categorized into 2 groups based on the severity of knee flexion contracture (group 1: none or less than 11°; group 2: greater than or equal to 11°), and then matched according to the exact same soft tissue and/or bony orthopedic surgical procedures performed. The indication for surgery was to prevent progressive development of knee flexion contracture and stance phase flexed knee gait. Pre- and postoperative physical examination and gait analysis data were analyzed retrospectively. Results Sixty (30 + 30) children, with mean age 10.6 years in each group, were included. The average follow-up time was 17 months. Gait Deviation Index (GDI) improved in group 1 from mean 66 (SD 19) to 74 (15), p = 0.004, and in group 2 from 60 (13) to 69 (15), p = 0.001. Knee flexion in stance improved in group 1 from 21.4 (16.1) to 12.1 (16.0) degrees, p = 0.002, and in group 2 from 32.2 (14.2) to 17.0 (15.9), p = 0.001. Step length improved in both groups, p = 0.017 and p = 0.008, respectively. Only in group 2 significant improvement was noted in walking speed, p = 0.018 and standing function, Gross Motor Function Measure (GMFM-D), p = 0.001. Knee flexion contracture decreased in group 1 from mean 4.6 (5.3) to 2.1 (8.3) degrees, p = 0.071 and in group 2 from 17.2 (4.9) to 9.6 (9.3), p = 0.001. There was no statistical difference between groups in pre-post improvement of GDI or other variables, except GMFM-D. Conclusions Relative mild to moderate preoperative knee flexion contracture does not influence the short-term improvement of gait after orthopedic surgery in children with bilateral CP.

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Intra-articular collagenase injection increases range of motion in a rat knee flexion contracture model

Drug Design Development and Therapy ◽

10.2147/dddt.s144602 ◽

2017 ◽

Vol Volume 12 ◽

pp. 15-24 ◽

Cited By ~ 4

Author(s):

Kayleigh Wong ◽

Guy Trudel ◽

Odette Laneuville

Keyword(s):

Range Of Motion ◽

Knee Flexion ◽

Flexion Contracture ◽

Knee Flexion Contracture ◽

Collagenase Injection

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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°.

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