股骨髌骨沟的解剖学定位及临床意义

目的：用三维放射图像和数字技术测量股骨的多种解剖学中心线来定位正常髌骨沟的位置。方法：在20根股骨干标本上确定并标记髌骨沟部位后，再进行冠状面、矢状面和水平面拍片，确定解剖轴、机械轴、经髁上轴和经内、外侧髁轴的位置。结果：这四条主要的轴线在冠状面和水平面上角度均值范围在11^。～16^。之间。在冠状面上，髌骨沟的准确定位几乎完全与经髁上轴线垂直，但变化范围很大。在测量的全部解剖轴线中，没有一条可作为确定髌骨沟确切位置的参考线。结论：(1)正常髌骨沟的解剖学定位比既往推测的具有更大的可变性。(2)股骨不适应这种可变性解释在膝关节置换术中与髌骨有关的并发症。     

髋骨弓状线的解剖学观测及其临床意义

目的 :为临床髋关节中心脱位内固定器的设计提供相关数据。方法 :测量 10 9套成人髋骨双侧弓状线的弧长 ,并计算出纵向弧度 ;用几何法测算出经弓状线三等分中点骨面的横向弧度 ;同时测量髋臼中心到弓状线的垂直距离。对所得结果用SPSS软件处理。结果 :男女弓状线弧长为 (5 7.71± 5 .5 9)mm、(5 2 .0 8± 6.2 7)mm ,纵向弧度为 61.41°± 11.86°和 67.42°± 11.94° ;男女弓状线横向弧度分别为前 111.16°±12 .3 7°和 111.14°± 2 1.0 9°、中 10 6.81°± 14 .60°和 10 9.5 8°± 16.5 0°、后 13 8.0 0°± 16.60°和 14 4.46°± 15 .2 1°。男女弓状线性别差异非常显著 (P <0 .0 1) ,同性别双侧差别不显著。结论 :弓状线周围测量的数据 ,可为设计更合适髋关节中心脱位内固定钢板 ,提供参数值。     

安装假体时股骨旋转定位轴线及相关角度的解剖学特征

背景:人工全膝关节置换过程中股骨假体旋转定位良好是置换成功的关键之一,与置换后关节功能密切相关。股骨髁各项解剖参数也非常重要,熟悉其各项数据能够合理截骨以及选择轴线,避免假体安装位置不佳导致全膝关节置换后关节功能障碍。目的:通过对股骨髁标本的解剖结构进行观察,测量股骨髁标本解剖参数及定位轴线之间的角度。方法:固定架固定共40例股骨骨性标本,观察内上髁及外上髁形态变化,测量股骨髁解剖参数,包括长度、宽度等;应用定位导向器于内外上髁之间穿克氏针固定,垂直股骨后髁轴截骨后以万能角度量角器测量股骨4条轴线——手术髁上轴、临床髁上轴、后髁轴、AP轴之间的相关角度关系。结果与结论:内上髁凹陷出现比例较低,约占所有标本比例总数的25%;股骨髁的高度与西方人相比差别不大,宽度与西方人相比差别较大。提示股骨髁宽度与西方人群差别较大,手术操作应充分注意;股骨髁内上髁凹陷出现比例不高,故参照髁上轴的后髁角定位只适用于部分人群;而AP轴较易定位,两条轴线与后髁轴线之间成角数值稳定,变异性较小,证实AP轴可做为股骨假体旋转定位的可靠标记。     

国人经股骨上髁轴的磁共振测量

目的 在MRI上研究股骨远端上髁解剖,为全膝置换术中定位外科经股骨上髁轴(STEA)及股骨假体大小设计提供可靠依据。 方法 对78侧正常成人膝关节行磁共振扫描,测量STEA宽度、STEA的骨性标志与膝关节后侧及远端关节线的距离,股骨远端内外上髁的前后径大小及股骨后髁角。 结果 STEA宽度在男性中为(79.55±4.90)mm,在女性中为(71.18±4.22)mm,股骨内上髁沟最低点、外上髁最凸点与膝关节后方关节线及远端关节线的距离与STEA宽度具相关性,股骨远端内外上髁的前后径大小与STEA宽度也具相关性,股骨后髁角为(4.22±2.07)°。 结论 国人股骨远端上髁解剖大小明显小于欧美国家人群,股骨远端内外上髁的前后径与STEA宽度成一定比例,STEA的骨性标志与膝关节后侧及远端关节线的距离可为定位STEA提供一定帮助,通过术中触摸或PCL定位STEA的可靠性差。     

改良"叉"形钢板固定股骨髁部C1型骨折的生物力学评价

目的 :评价改良“叉”形钢板对股骨髁部C1型骨折固定的生物力学性能。方法 :18具新鲜股骨下段及胫骨上段标本随机分成 3组 ,均制成股骨髁部C1型骨折模型 ,A组 :用改良“叉”形钢板固定 ;B组 :用股骨塑形钢板固定 ;C组 :用GSH钉固定。分别在MTS试验机上进行纵向压缩试验和轴向扭转试验 ,测量标本的纵向压缩位移、横向分离位移和扭转角度。结果 :改良“叉”形钢板、GSH钉、股骨塑形钢板固定组的纵向压缩位移分别为 (0 .41± 0 .0 3 )、(0 .3 8± 0 .0 1)、(0 .81± 0 .10 )mm ;横向分离位移分别为 (0 .2 0± 0 .0 1)、(0 .19± 0 .0 1)、(0 .3 0± 0 .0 1)mm ;扭转角度为 1.62°± 0 .0 7° ,1.69°± 0 .0 6° ,4.2 6°± 0 .72°。改良“叉”形钢板和GSH钉固定明显优于股骨塑形钢板 ,具有显著性差异 (P <0 .0 1)。结论 :改良“叉”形钢板用于固定股骨髁部C1型骨折 ,具有良好的生物力学性能 ,是治疗股骨髁部C1型骨折的一种较理想的内固定器械。     

人体膝关节股骨后髁角度的MRI测量

背景：全膝关节置换过程中股骨假体旋转力线良好非常重要,研究显示后髁角度是确定力线的重要依据,后髁角度为股骨后髁轴与股骨手术髁上轴之间角度,MRI测量可清晰显示后髁软骨、外上髁突起及内上髁凹陷,从而保证测量数据的准确。 目的：测量保定北部地区人群中膝关节后髁角度,为临床实施全膝关节置换过程中确定股骨假体旋转力线提供影像学依据。 方法：应用核磁共振机对入选中青年人群膝关节进行扫描,取膝关节伸直中立位,扫描平面垂直于膝关节机械轴,选择T1像上最佳膝关节轴位平面,由两名观察者独自分析图像,通过Bravo viewer 6.0影像软件观察股骨内上髁存在率,画出股骨髁上轴线及后髁线并测量两条轴线之间角度,即股骨后髁角度。 结果与结论：入选人群男性股骨后髁角度为(2.73±1.28)°,女性股骨后髁角度为(2.35±1.37)°,不同性别间差异无显著性意义。提示MRI测量股骨后髁角具有较大优越性,人工全膝关节置换过程中髁上轴线变异性较小,可参照后髁角度定位安装股骨假体,避免膝关节置换后并发症发生。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

与内固定器设计有关的髋骨解剖学观测

目的:为临床髋关节中心脱位内固定器的设计提供相关数据。方法:测量109副成人髓骨双侧弓状线的弧长,并计算出纵向弧度;用几何法测算出经弓状线三等分中点骨面的横向弧度;同时测量髋臼中心到弓状线的垂直距离。对所得结果用SPSS软件处理。结果:男女弓状线弧长为57.71±5.59mm和52.08±6.27mm;纵向弧度为61.41±11.86°和67.42±11.94°;男女弓状线横向弧度分别为前111.16±12.37°和111.14±21.09°;中106.81±14.60°和109.58±16.50°;后138.00±16.60°和144.46±15.21°;男女臼心弓距为22.64±3.45mm和18.71±2.55mm。男女弓状线性差非常显著(P<0.01),同性别双侧差别不显著。结论:弓状线周围测量的数据,可为设计更合适髋关节中心脱位内固定钢板,提供参数值。     

股骨上段髓腔角度几何形态学研究

目的:为了设计符合大多数病人股骨髓腔形状的人工股骨柄,减少术后并发症,对股骨上段髓腔角度几何学形态进行了研究。方法:股骨标本共160根,每根标本分别拍照正位、侧位、45°内斜位和45°外斜位的X线片。对髓腔角度、颈干角、前倾角进行测量。结果:髓腔角度侧位∠1、∠2、∠3分别为13.9°±10.5°(0°￣52.0°)、10.0°±4.2°(0°￣22.0°)、7.6°±2.2°(2.0°￣15.0°);内斜位分别为30.8°±9.7°(3.0°￣57°)、7.1°±3.8°(0°￣17.0°)、5.3°±2.5°(0°￣40.0°);外斜位分别为49.2°±8.6°(0°￣62.0°)、4.5°±3.5°(0°￣16.0°)、3.7°±2.3°(0°￣10.0°)。股骨颈干角128.4°±7.0°,前倾角为9.4°±6.6°。结论:(1)股骨前倾角、颈干角国人数据差值较大;(2)人工髋关节设计的型号需多样化,型号齐全及部件配组是解决假体匹配关键问题之一;(3)在侧位片及双斜位片上,股骨髓腔呈现2个弯曲,上部弯曲向后,下部弯曲向前,呈“S”形,而不是直的;(4)髓腔的形态在侧位及双斜位片与正位不同,并非直筒形,假体柄的设计应有一定的弯曲角度,目前通用的直柄假体难以匹配。     

股骨远端旋转力线中的测量及其临床意义

目的:通过测量股骨外科上髁轴线、股骨前后轴线及其股骨后髁轴线之间的夹角,探讨全膝关节置换术中定位股骨假体旋转力线的方法。方法:75侧正常成人股骨标本,性别、年龄不详,数码相机拍摄股骨远端轴位片并输入个人电脑,在Photoshop7.0.1软件中测量股骨外科上髁轴线与股骨后髁轴线之间的夹角(股骨后髁角,PCA)及前后轴线的垂线与股骨后髁轴线的夹角(APA),行配对资料的t检验,比较两角度的差异。结果:PCA均值3.67°±1.62°(0.75°～5.90°),与西方人数据及国人影像学测量数据接近;APA均值3.50°±1.40°(1.34°～5.65°),与PCA差异无统计学意义(t=0.949,P=0.359),此两个角度均有较大的变异性。结论:术中仅通过测量PCL进行旋转力线的定位可能导致截骨不准确,通过PCL、APL进行双重定位可以提高手术操作精度。     

运用三维摄影测量桡骨腕关节面

目的 :测量桡骨腕关节面的形态 ,为临床手术提供理论依据。方法 :用三维摄影测量的方法对 4 0例成人桡骨腕关节面进行摄影 ,测量各关节面的倾角、曲率和弧度。结果 :桡骨腕关节面前倾角为 10 .58± 1.75度 ,内倾角为2 3.0 7± 2 .14度 ,冠状面曲率为 0 .158± 0 .0 2 8,矢状面曲率为 0 .134± 0 .0 2 2。冠状面弧长为 30 .2 8± 2 .2 7mm,矢状面弧长为 15.90± 1.2 1mm。结论 :此方法测量桡骨腕关节面形态 ,精确度高 ,适用于对不规则物体表面的测量 ,对临床手术具有指导性意义     

Automatic string generation for estimating in vivo length changes of the medial patellofemoral ligament during knee flexion

Modeling ligaments as three-dimensional strings is a popular method for in vivo estimation of ligament length. The purpose of this study was to develop an algorithm for automated generation of non-penetrating strings between insertion points and to evaluate its feasibility for estimating length changes of the medial patellofemoral ligament during normal knee flexion. Three-dimensional knee models were generated from computed tomography (CT) scans of 10 healthy subjects. The knee joint under weight-bearing was acquired in four flexion positions (0°–120°). The path between insertion points was computed in each position to quantify string length and isometry. The average string length was maximal in 0° of flexion (64.5 ± 3.9 mm between femoral and proximal patellar point; 62.8 ± 4.0 mm between femoral and distal patellar point). It was minimal in 30° (60.0 ± 2.6 mm) for the proximal patellar string and in 120° (58.7 ± 4.3 mm) for the distal patellar string. The insertion points were considered to be isometric in 4 of the 10 subjects. The proposed algorithm appears to be feasible for estimating string lengths between insertion points in an automatic fashion. The length measurements based on CT images acquired under physiological loading conditions may give further insights into knee kinematics.     

Relationship of the posterior femoral axis of the “kinematically aligned” total knee arthroplasty to the posterior condylar,transepicondylar, and anteroposterior femoral axes

BackgroundA recent proposed modification in surgical technique in total knee arthroplasty (TKA) has been the introduction of the “kinematically aligned” TKA, in which the angle and level of the posterior joint line of the femoral component and joint line of the tibial component are aligned to those of the “normal,” pre-arthritic knee. The purpose of this study was to establish the relationship of the posterior femoral axis of the “kinematically aligned” total knee arthroplasty (TKA) to the traditional axes used to set femoral component rotation.MethodsOne hundred and fourteen consecutive, unselected patients with preoperative MRI images undergoing TKA were retrospectively reviewed. The transepicondylar axis (TEA), posterior condylar axis (PCA), antero-posterior axis (APA) of the trochlear groove, and posterior femoral axis of the kinematically aligned TKA (KAA) were templated on axial MRI images by two independent observers. The relationships between the KAA, TEA, APA, and PCA were determined, with a negative value indicating relative internal rotation of the axis.ResultsOn average, the KAA was 0.5° externally rotated relative to the PCA (minimum of − 3.6°, maximum of 5.8°), − 4.0° internally rotated relative to the TEA (minimum of − 10.5°, maximum of 2.3°), and − 96.4° internally rotated relative to the APA (minimum of − 104.5°, maximum of − 88.5°). Each of these relationships exhibited a wide range of potential values.ConclusionsUsing a kinematically aligned surgical technique internally rotates the posterior femoral axis relative to the transepicondylar axis, which significantly differs from current alignment instrument targets.     

内侧髌股韧带重建治疗复发性髌骨脱位疗效观察

目的探讨内侧髌股韧带重建治疗复发性髌骨脱位的临床效果。方法回顾性分析湖北省荆州市中心医院2017年1月至2019年6月通过关节镜辅助下内侧髌股韧带双束重建治疗的29例复发性髌骨脱位患者的临床资料。其中,男10例,女19例,年龄14.0~29.5岁,平均19.4岁。测量TT-TG距离、髌骨倾斜角,计算Caton指数。术前、术后通过Kujala、Lysholm评分评价膝关节功能。结果所有患者均获得随访,随访时间12~36个月,术前TT-TG距离均小于20 mm、髌骨倾斜角小于20°,Caton指数0.9~1.1。所有患者术后均未见脱位复发,术前术后Kujala评分分别为(51.32±5.52)分、(82.45±3.38)分;术前、术后Lysholm评分分别为(53.25±5.85)分、(89.65±4.75)分;术前、术后髌骨倾斜角为13.15°±1.67°,6.94°±1.47°。差异均具有统计学意义(P<0.05)。结论关节镜辅助下内侧髌股韧带双束重建治疗无严重骨性异常的复发性髌骨脱位,操作简单,疗效确切,并发症少,近期随访无复发,可以显著提高膝关节功能。     

Patellar mobility and lower limb kinematics during functional activities in individuals with and without patellar tendinopathy

Study designCase-control.ObjectiveTo examine whether patients with patellar tendinopathy (PT) display greater patellar mobility and different lower body kinematics than patients without PT.BackgroundPT is a common overuse condition of the patellar tendon that can cause pain and impair function. Subjects with overuse knee problems display different hip and knee functional mechanics, specifically valgus collapse. Patellar hypermobility has not been specifically studied as a possible risk factor for PT.Methods11 patients with PT and 11 controls without PT, age 18 to 40, were studied. Using a patellofemoral arthrometer (PFA), maximal lateral and medial patellar displacement was measured. 3-D motion analysis was performed to determine lower extremity joint motions during single-leg step down and drop vertical jump tests.ResultsPatients with PT had significantly increased lateral patellar mobility compared to controls (12.21 ± 3.33 mm vs. 9.19 ± 1.92 mm, P = .017). PT patients showed significantly greater peak hip adduction with both drop vertical jump (2.7° ± 6.3° vs. -5.6° ± 4.2°; P = .003) and step down (17.0° ± 3.8° vs. 12.5° ± 4.4°, P = .024). PT patients demonstrated increased peak ankle external rotation with drop vertical jump (−21.1° ± 5.9° vs. −14.8° ± 5.5°, P = .023) and step down (−15.6° ± 5.5° vs. −9.0° ± 6.0°, P = .017).ConclusionsPatients with PT exhibit increased lateral patellar mobility, hip adduction, and ankle external rotation. The effects of increased patellar mobility deserve further study in the development, management, and prevention of PT.     

Lateral patellar maltracking due to trochlear dysplasia: A computational study

BackgroundThe study focuses on the influence of trochlear dysplasia on patellar tracking related to patellar instability.MethodsKnee extension against gravity and dual-limb squatting were simulated with seven models representing knees being treated for recurrent instability. Trochlear depth was altered to represent lateral trochlear inclination (LTI) values of 6°, 12° and 24°. Repeated measures analyses compared patellar lateral shift (bisect offset index) across different LTI values. Peak bisect offset index during extension and squatting was correlated with patella alta (Caton–Deschamps index) and maximum lateral position of the tibial tuberosity.ResultsBisect offset index varied significantly (p < 0.05) between different LTI values at multiple flexion angles throughout simulated knee extension and squatting. Average bisect offset values were 1.02, 0.95, and 0.86 for LTI = 6°, 12°, and 24°, respectively, at 0° of flexion for knee extension. The strongest correlation occurred between peak bisect offset index and lateral position of the tibial tuberosity for knee squatting with LTI = 6° (r² = 0.81, p = 0.006). The strength of the correlation decreased as LTI increased. Caton–Deschamps was only significantly correlated with patellar tracking for LTI = 24° during knee squatting.ConclusionsA shallow trochlear groove increases lateral patellar maltracking. A lateral tibial tuberosity in combination with trochlear dysplasia increases lateral patellar tracking and the risk of patellar instability. Patella alta has relatively little influence on patellar tracking in combination with trochlear dysplasia due to the limited articular constraint provided by the trochlear groove.     

纽扣式缝合在固定髌骨粉碎性骨折游离软骨块中的应用*

目的 探讨纽扣式缝合在固定髌骨粉碎性骨折游离软骨块中的应用及临床疗效。方法 使用纽扣式缝合技术辅助固定髌骨粉碎性骨折游离软骨块患者15例,术后影像学评估骨折复位,临床采用患膝关节活动度和Böstman髌骨骨折功能评分评估关节功能。结果 15例患者均获得6 ～ 18个月随访,术后伤口均愈合良好,X线平片及膝关节CT检查骨折对位、对线良好,关节面平整。术后6个月随访X线片显示骨折均骨性愈合,未见骨块脱落及创伤性关节炎; 术后6个月膝关节活动度屈曲平均为（128.00±5.39）°（116° ～ 135°）,伸平均为（2.00±1.31）°（-2° ～ 6°）; Böstman髌骨骨折功能评分平均为29分,其中优13例,良2例,优良率为100%。结论 纽扣式缝合能有效固定髌骨骨折中的游离软骨块,术后可早期行康复功能锻炼,未见游离骨块脱落,临床疗效满意。     

Patellar resurfacing has minimal impact on in vitro tibiofemoral kinematics during deep knee flexion in total knee arthroplasty

BackgroundWhile patellar resurfacing can affect patellofemoral kinematics, the effect on tibiofemoral kinematics is unknown. We hypothesized that patellar resurfacing would affect tibiofemoral kinematics during deep knee flexion due to biomechanical alteration of the extensor mechanism.MethodsWe performed cruciate-retaining TKA in fresh-frozen human cadaveric knees (N = 5) and recorded fluoroscopic kinematics during deep knee flexion before and after the patellar resurfacing. To simulate deep knee flexion, cadaver knees were tested on a dynamic, quadriceps-driven, closed-kinetic chain simulator based on the Oxford knee rig design under loads equivalent to stair climbing. To measure knee kinematics, a 2-dimensional to 3-dimensional fluoroscopic registration technique was used. Component rotation, varus-valgus angle, and anteroposterior translation of medial and lateral contact points of the femoral component relative to the tibial component were calculated over the range of flexion.ResultsThere were no significant differences in femoral component external rotation (before patellar resurfacing: 6.6 ± 2.3°, after patellar resurfacing: 7.2 ± 1.8°, p = 0.36), and less than 1° difference in femorotibial varus-valgus angle between patellar resurfacing and non-resurfacing (p = 0.01). For both conditions, the medial and lateral femorotibial contact points moved posteriorly from 0° to 30° of flexion, but not beyond 30° of flexion. At 10° of flexion, after patellar resurfacing, the medial contact point was more anteriorly located than before patellar resurfacing.ConclusionDespite the potential for alteration of the knee extensor biomechanics, patellar resurfacing had minimal effect on tibiofemoral kinematics. Patellar resurfacing, if performed adequately, is unlikely to affect postoperative knee function.     

Patello-femoral contact area and compressive force after anteromedial displacement of tibial tuberosity in amputated knees

Contact force and contact area in the patello-femoral joint was biomechanically analyzed using seven amputated legs. The knees were fixed firmly to the experimental apparatus and 300 N of tension was applied to the quadriceps tendon. Total contact force was measured using pressure-sensitive film, and the ratio of the contact area to the patellar joint surface (%) was measured using hydrophilic vinyl polysiloxane impression material. At a Q-angle of 0° with no advancement, 10 mm and 20 mm advancement of the tibial tuberosity, the total contact force on the patello-femoral joint at a knee flexion of 45° was 266±55 N, 191±58 N and 146±58 N, respectively. The total contact force became smaller as the advancement of the tibial tuberosity changed to 5, 10, 15 and 20 mm. Especially, the total contact force with Q-angle of 0° and anterior advancement of 15 and 20 mm was significantly smaller than that with no advancement. With a Q-angle of 0°, the contact area of the patello-femoral joint at 10 mm advancement was the greatest, occupying 30.1±9.9% of the whole patellar joint surface. The mean contact pressure with Q-angle of 0° and anterior advancement of 10 mm was smaller than that with all other positions, but there was no significant difference. In this experiment, combined anterior and medial displacement of the tibial tuberosity reduced the contact force in the patello-femoral joint of the amputated legs, and an advancement of 10 mm achieved optimal reduction of force and the greatest contact area.     

髌下深囊形成的解剖学基础

目的通过尸体解剖和活体测量,研究髌下深囊的形成,为滑膜的分化及非遗传性滑液囊形成的预防提供依据。方法对成年人尸体膝关节标本进行解剖,显露髌韧带、关节腔、髌下深囊、髌下脂肪垫等结构。活体及骨标本观察并测量相关的数据。结果尸体测量结果显示,膝关节伸位时,髌下深囊长0.9~1.1 cm,最宽处0.5 cm,高0.3~0.5 cm,髌韧带长度为4.7~4.8 cm;膝关节屈位时（45°）,髌下深囊长0.8~1.0 cm,最宽处0.8 cm,高0.4~0.5 cm。活体测量结果膝关节伸位时,髌骨下缘与胫骨粗隆的距离为4.5~4.8 cm,屈位时（145°）为9.0~9.5 cm。结论髌下深囊的形成是因为髌韧带与胫骨之间长期摩擦诱导的结果。     

Tibial tubercle proximalization as quadriceps lengthening in treating severe habitual patellar dislocation in adults

BackgroundTo describe a novel ‘four-in-one’ procedure – including tibial tubercle proximalization, extensive lateral release, tibial tubercle medialization, and medial patellofemoral ligament reconstruction – for treating severe habitual patellar dislocation (HPD) in adults, and to report its early clinical outcomes.MethodsThirteen patients (13 knees) with severe primary HPD received this procedure. Results of the physical examinations, including apprehension tests and patellar tracking throughout full range of motion, were recorded pre-operatively and at final follow-up. Radiological assessments included standard anteroposterior view, true lateral view at 30° knee flexion, axial views of the patellofemoral joint at both 30° and maximum angle of knee flexion, and computed tomography scans at full knee extension pre-operatively and at final follow-up. Subjective patellofemoral functions were evaluated with the Kujala functional score before the index procedure and at final follow-up visit.ResultsAll 13 patients were followed for an average period of 35.5 months (range, 25–49). After the index ‘four-in-one’ procedure no patient reported reoccurrence of patellar dislocation at the final follow-up visit. Radiographically, there was a statistically significant improvement in the congruence angle from 75.2 ± 16.3° pre-operatively to ? 7.2 ± 5.4° postoperatively (P < 0.01) and in the lateral patellofemoral angle from ? 66.3 ± 8.3° pre-operatively to 6.3 ± 2.6° postoperatively (P < 0.01). The average pre-operative Kujala functional score was 41.4 and average postoperative score was 94.9 (P < 0.05).ConclusionThe novel ‘four-in-one’ procedure effectively treated HPD in adults with severe quadriceps contracture.