Document Type: RESEARCH PAPER

Authors

1 Orthopedic Research Center, Shahid Kamyab Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

2 Orthopedic Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Background: Knee extension contracture is a disabling complication after fractures around the knee. In this study we aimed to study factors influencing the outcomes of quadricepsplasty for the treatment of traumatic knee extension contracture. We hypothesized that there is no factor influencing the final range of knee motion.
Methods: In this retrospective study, we included 64 patients who underwent modified Thompson quadricepsplasty between 2008 to 2011 with a mean follow-up time of 36 months.
Results:The mean change in flexion was 66 degrees. Using Judet criteria, results were excellent in 41 patients (64%), good in 15 (23%), fair in 4 (6%) and poor in 4 (6%). Preoperative arc of flexion, duration of extension contracture, number of previous surgeries on the limb, and BMI of the patients were independently influencing the final flexion.
Conclusion: Modified Thompson quadricepsplasty is associated with high number of excellent and good results especially when it is performed earlier in more severe contractures. Preoperative arc of flexion, interval between trauma surgery and quadricepsplasty, the number of prior surgeries, and BMI influence the outcomes of quadricepsplasty.

Keywords

Main Subjects

1. Lee DH, Kim TH, Jung SJ, Cha EJ, Bin SI. Modified judet
quadricepsplasty and Ilizarov frame application for
stiff knee after femur fractures. J Orthop Trauma.
2010; 24(11):709-15.
2. Ali AM, Villafuerte J, Hashmi M, Saleh M. Judet’s
quadricepsplasty, surgical technique, and results in
limb reconstruction. Clin Orthop Relat Res. 2003;
415(1):214-20.
3. Dhillon MS, Panday AK, Aggarwal S, Nagi ON. Extra
articular arthroscopic release in post-traumatic stiff
knees: a prospective study of endoscopic quadriceps
and patellar release. Acta Orthop Belg. 2005;
71(2):197-203.
4. Ebrahimzadeh MH, Birjandi-Nejad A, Ghorbani S,
Khorasani MR. A modified Thompson quadricepsplasty
for extension contracture resulting from femoral
and periarticular knee fractures. J Trauma. 2010;
68(6):1471-5.
5. Rose RE. Judet quadricepsplasty for extension
contracture of the knee. West Indian Med J. 2005;
54(4):238-41.
6. Hahn SB, Choi YR, Kang HJ, Lee SH. Prognostic
factors and long-term outcomes following a modified
Thompson’s quadricepsplasty for severely stiff knees.
J Bone Joint Surg Br. 2010; 92(2):217-21.
7. Alici T, Buluc L, Tosun B, Sarlak AY. Modified Judet’s
quadricepsplasty for loss of knee flexion. Knee. 2006;
13(4):280-3.
8. Hahn SB, Lee WS, Han DY. A modified Thompson
quadricepsplasty for the stiff knee. J Bone Joint Surg
Br. 2000; 82(7):992-5.
9. Masse A, Biasibetti A, Demangos J, Dutto E, Pazzano
S, Gallinaro P. The judet quadricepsplasty: long-term
outcome of 21 cases. J Trauma. 2006; 61(2):358-62.
10. Judet R. Mobilization of the stiff knee. J Bone Joint
Surg. 1959; 41(B):856-7.
11. Thompson TC. Quadricepsplasty to improve knee
function. J Bone Joint Surg Br. 26(2):366-79.
12. Warner JJ. The Judet quadricepsplasty for management
of severe posttraumatic extension contracture of the
knee. A report of a bilateral case and review of the
literature. Clin Orthop Relat Res. 1990; 256(1):169-73.
13. Huang YC, Wu CC. Modified Thompson quadricepsplasty
to treat extension contracture of the knee after surgical
treatment of patellar fractures. Chang Gung Med J.
2007; 30(3):263-9.
14. Wang JH, Zhao JZ, He YH. A new treatment strategy for
severe arthrofibrosis of the knee. A review of twentytwo
cases. J Bone Joint Surg Am. 2006; 88(6):1245-50.
15. Judet R. Mobilization of the stiff knee. J Bone Joint
Surg. 1959; 41(B):856-7.
16. Ebrahimzadeh MH, Makhmalbaf H, Golhasani-Keshtan
F, Rabani S, Birjandinejad A.The International Knee
Documentation Committee (IKDC) Subjective Short
Form: a validity and reliability study. Knee Surg Sports
Traumatol Arthrosc. 2015 Nov;23(11):3163-7.

17. Moore TJ, Harwin C, Green SA, Garland DE, Chandler RW.
The results of quadricepsplasty on knee motion following
femoral fractures. J Trauma. 1987; 27(1):49-51.
18. Kim YM, Joo YB. Prognostic factors of arthroscopic
adhesiolysis for arthrofibrosis of the knee. Knee Surg
Relat Res. 2013; 25(4):202-6.