Bone resection and ligament treatment for flexion contracture in knee arthroplasty

A retrospective study of 103 knees (88 patients) who had primary total knee arthroplasty with a flexion contracture ranging from 20 degrees to 60 degrees was done to tabulate the primary soft tissue structures released during surgery and to identify any residual deformity. The average flexion contracture preoperatively was 27.1 degrees +/- 8 degrees and postoperatively was 2.7 degrees +/- 3.4 degrees (range, 0 degrees -10 degrees ). The average followup was 70.4 months (range, 12-180 months). Only medial or lateral soft tissue balancing procedures were necessary to correct the flexion contracture in 37 knees (35.9%) and no medial or lateral release was necessary in 25 knees (24.3%), of which 16 had a balanced posterior cruciate ligament. The posterior capsule was released on the deformity side of the knee in 15 knees (14.6%) and on the opposite side of the deformity in seven knees (6.8%). The posterior cruciate ligament was balanced in 21 knees (20.4%) and was released in four knees (3.9%). For all knees in which the posterior cruciate ligament was released or balanced, it was done for excessive rollback and tightness in flexion and not for flexion contracture management. In two patients (2%) an additional 4 mm of distal femur was resected for a 45 degrees and a 25 degrees flexion contracture. The data suggest that a contracted collateral ligament is the most likely primary structure whose effective release allows correction of the flexion contracture in most cases.