Quadricepsplasty: A sustained functional achievement in front of a deteriorated flexion gain

Methods

Nineteen cases of extension contracture were operated upon by modified technique of Judet quadricepsplasty, one female and eighteen males. Results were evaluated by HSSKF score as well as Judet criteria.

Purpose

The hypothesis is that recurrence of adhesions underneath the quadriceps leads to loss of some of the gained intraoperative flexion range.

Results

In this series, flexion range deteriorates but this was found to be statistically non significant on the functional score of the patients.     

改良股四头肌成形术与传统松解手术治疗膝关节伸直位强直的比较分析

目的比较改良股四头肌成形术与常规松解手术方法治疗膝关节伸直位强直的疗效。方法回顾性分析比较改良股四头肌成形术治疗膝关节伸直位强直与常规松解手术方法的疗效与并发症。结果改良股四头肌成形术治疗组的疗效明显优于常规松解手术方法组,并发症发生率明显低于常规松解手术方法组(P<0.05)。改良股四头肌成形术治疗组的满意率87.5%,术前平均伸屈膝关节0°～49°。术后平均随访16个月,平均伸屈膝关节可达0°～110°,未见继发血肿感染、髌前皮肤坏死及伸膝无力等并发症。结论改良股四头肌成形术治疗膝关节伸直位强直手术安全、疗效好、术后并发症少。     

Extreme stiff knee recurvatum following manipulation under anesthesia and botulinum neurotoxin injection

In this article we report a case of stiff, neglected extreme recurvatum knee deformity in a 17-year-old female. This is the first reported case in the literature of an acquired ligamentous stiff extreme knee recurvatum following manipulation under anesthesia and botulinum neurotoxin injection. Μodified Judet quadricepsplasty combined with Ilizarov external hinged frame fixation was implemented. This dual technique can be considered as a rational approach for such an extreme deformity as it stabilizes, progressively corrects, and prevents recurrence. A patellar tendon rupture caused by the increasing tension of the extensor mechanism following the correction was treated successfully using a cadaveric Achilles tendon allograft.     

缝匠肌在股四头肌成形术中的应用

目的　探讨解决部分伸直型膝关节僵硬,在股四头肌成形术后遗留伸膝无力,站立不稳,易跪倒等并发症。方法　1978 年～1997 年,在股四头肌成形术原切口上进行延长,游离缝匠肌,其止点不切断,移至髌骨前固定,加强伸膝装置力量,术后即刻进行膝关节被动、主动伸屈功能锻炼。结果　手术12 例,随访到9 例,随访时间9～25 个月,平均随访14个月。关节平均活动度,由术前15°增至102°,伸膝平均肌力,由术前Ⅱ级增至Ⅳ级。结论　缝匠肌前移手术加强了伸膝装置的力量,可解决膝关节伸直型僵硬、股四头肌成形术中伸膝肌力减弱,是一种较理想简便的方法     

股四头肌重建二种方法的比较及生物力学问题

随访１５０例股四头肌重建术，其中Ｇｕｏ绳肌替代股四头肌术１１２例，腹外斜肌加腹直肌替代股四头肌术３８例。分析、比较二种术式的疗效和着力情况，提出了股四头肌重建术应当注意的几个问题。证明：在力臂、肌截面积不变的情况下，作用力的大小取决于作用力线与关节轴线的夹角。角度越大，动力臂越大，越省力；当作用力线与关节轴线呈负角或有膝屈曲崎形时，负角越小、关节分力越小而伸膝分力越大。     

Effects of Judet Quadricepsplasty in the Treatment of Post‐traumatic Extension Contracture of the Knee

ObjectiveTo investigate the clinical outcomes and the affecting factors of Judet''s quadricepsplasty on the stiffness of post‐traumatic knee flexion.MethodsA retrospective survey was analyzed from June 2015 to October 2018. A total of 15 patients (eight males, seven females; mean age, 48.27 years) with extension contracture of the knee were treated by Judet''s quadricepsplasty. All cases were injuries induced by fracture trauma. The mean interval between the initial procedure and quadricepsplasty was 56.2 months (range, 13–276 months). The knee range of motion (ROM) was assessed with a goniometer. The results of the procedure were analyzed by measuring the degrees of flexion of the operated knees at different time points (before, immediately after, and late postoperatively). We evaluated Hospital for Special Surgery (HSS) score, Judet''s criteria, change in the degree of knee flexion, and complications.ResultsAll patients were followed up for 14 to 47 months, with an average of 31.53 months. The degree of flexion increased from 23.33° (range, 10°–50°) preoperatively to 107.33° (range, 100°–125°) intraoperatively, followed by a slight fall in the range of flexion in the late postoperative period, which reached an average of 95.33° (range, 60°–115°) in the last follow‐up. The knee joint function was assessed according to the Judet''s criteria, eight cases (53.33%) achieved excellent results, six (40%) good, one (6.67%) fair, and zero (0.00%) poor results at final follow‐up. The long‐term excellent and good rate was 93.33%. The range of flexion of the knee during operation and at the last time of follow‐up was better than that before surgery (P < 0.001). The final flexion was significantly lower than that measured at immediate postoperative (P < 0.001). The mean postoperative HSS score for the entire group was 93.73 (range, 89–96). Fifteen excellent results were obtained according to the HSS knee score. Skin infection was seen in one patient (6.67%). There were no complications such as deep sepsis, intraoperative rupture of the quadriceps tendon, fracture of the lateral femoral condyle, skin dehiscence.ConclusionJudet quadricepsplasty is an effective method to treat knee extension contracture and improve knee range of motion (ROM). It should be performed by an experienced orthopaedic surgeon and followed by physiotherapy with continuous passive motion (CPM). The knee ROM obtained with the surgery has an excellent long‐term effect.     

Patellar dislocation due to iatrogenic quadriceps fibrosis: results of operative treatment in 54 cases

Objective

To evaluate the clinical and functional results of a surgical treatment of patellar dislocation whose etiology was iatrogenic quadriceps fibrosis in children.

Materials and methods

A prospective study was undertaken from February 2004 to December 2009. The study included 54 pediatric patients (56 knees) that had developed dislocation of the patella after repeated intramuscular injections of antibiotic(s) into the quadriceps muscle. There were 11 males (20.4 %) and 43 females (79.6 %). The patients’ mean age at surgery was 7 years, 9 months (range 6 years, 4 months to 12 years, 6 months). A complete history of each patient was recorded. The affected knees were evaluated preoperatively and postoperatively on the basis of the symptoms, signs, and roentgenographic findings. Patellar dislocation was classified according Bensahel’s criteria. All patients had a three-part surgical procedure that combined capsulorrhaphy, quadricepsplasty, and transfer of the vastus medialis oblique to the superior border of the patella.

Results

There has been no poor postsurgical result or recurrence so far; we have noted an ugly scar in nine knees (16.1 %), limitation of the knee flexion in five knees (8.9 %), and loss of extension of 5 °–20 ° in four knees (7.1 %). Overall, we attained excellent results in 39 knees (69.7 %), good results in 13 knees (23.2 %), and fair results in four knees (7.1 %).

Conclusion

In our cases of pediatric dislocation of the patella caused by iatrogenic quadriceps fibrosis, the introduced three-part surgical procedure has shown great success in restoring the realignment mechanism of the patella. The technique is simple, safe, and effective in skeletally immature children.     

Quadricepsplasty for congenital dislocation of the knee and congenital quadriceps contracture

Purpose

We encountered problems with the Curtis and Fisher technique of quadricepsplasty for congenital quadriceps contracture, including wound dehiscence, insufficient lengthening of the quadriceps and instability of the knee. We modified the operative technique to address these three problems. We undertook this study to evaluate the results of the modified technique of quadricepsplasty to determine if we succeeded in overcoming these limitations of the original technique.

Methods

Twenty children (33 knees) underwent the modified Curtis and Fisher quadricepsplasty through a lateral incision; a long tongue of the rectus femoris was raised and the vasti mobilised without dividing the lateral retinaculae till the collateral ligaments. The children were followed up for a mean period of 63 months and evaluated. The healing of the wound, active and passive range of motion (ROM) of the knee, the stability of the knee, quadriceps power and knee function were assessed.

Results

Primary wound healing occurred in 32 of 33 knees. Adequate lengthening of the quadriceps sufficient to facilitate knee flexion to 90° was possible. Considerable improvement in the ROM was noted. In non-syndromic congenital dislocation of the knee (CDK), the quadriceps power was Grade 5, but minor degrees of extensor lag was noted. In a proportion of patients, minor degrees of joint instability was present. The majority of children were community walkers. The overall results were better in non-syndromic CDK than in children with arthrogryposis, but differences of some variables were not significant.

Conclusion

The modifications to the original Curtis and Fisher technique overcame the specific problems they were expected to avoid.