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[Treatment of extension contracture of the knee by quadriceps plasty (Judet procedure)].

Abstract：

OBJECTIVE:Knee flexion is increased by detachment of contracted quadriceps muscle from the pelvis and femur in combination with arthrolysis of the knee. INDICATIONS:Flexion contracture of the knee caused by extraarticular changes of quadriceps muscle (fibrosis, soft-tissue damage, infection, fracture). Failed intraarticular arthrolysis. Intraarticular treatment insufficient. CONTRAINDICATIONS:Isolated intraarticular fibrosis of the knee. Infection of the knee or the soft tissues. Soft tissue defects in the area of the incision. Noncompliance of patient. Neurologic reasons for flexion contracture. SURGICAL TECHNIQUE:Medial arthrotomy. Arthrolysis and resection of adhesions in the superior recess and lateral gutters. Incision of retinaculae preparing a lengthening. The vastus medialis muscle is dissected from the intermuscular septum from distal to proximal. The proximal third of the muscle is spared. The incision is now extended proximally and laterally. The vastus lateralis muscle is released from the intermuscular septum from distal to proximal. The insertion of vastus lateralis muscle is detached at the proximal femur. The conjoint tendons of rectus femoris muscle are released at the anterior inferior iliac spine. The knee is gradually flexed, residual adhesions are addressed. The proximal part of the vastus medialis has to be preserved since it covers the neurovascular supply of the quadriceps muscle. The knee is closed in flexion. The retinaculae are adapted as far as possible. Soft tissues and skin are closed in layers. POSTOPERATIVE MANAGEMENT:The patient in placed on a continuous passive motion device for 7 days under peridural anesthesia. Partial weight bearing with crutches is advised for 6 weeks, quadriceps training is started early to treat the active extension deficit. RESULTS:Our results reveal that operative treatment of complex flexion deficits lead to objective and subjective improvements. After 8.2 months, 17 of 19 patients had a mean gain of flexion of 26°. Subjectively 10 patients were highly satisfied and 7 were satisfied after operative treatment.

journal_name

Oper Orthop Traumatol

journal_title

Operative Orthopadie und Traumatologie

authors

Holschen M,Lobenhoffer P

doi

10.1007/s00064-013-0286-8

subject

Has Abstract

pub_date

2014-08-01 00:00:00

pages

353-60

issue

4

eissn

0934-6694

issn

1439-0981

journal_volume

26

pub_type

临床试验,杂志文章

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