“…To avoid injuring the VMO attachment, the media vastus intermedius tendon was exposed at 40–50 mm proximal and 10 mm lateral to the patella. Pan et al [16, 22] reported that pie‐crusting release for the treatment of extension contractures of the knee achieved satisfactory results within a short‐term follow‐up period. This procedure includes percutaneous release of the extraarticular adhesive quadriceps tendon and arthroscopic joint debridement.…”
Section: Discussionmentioning
confidence: 99%
“…Although the pie‐crusting technique was a modified technique that maintains the integrity of the quadriceps, it was associated with poor visibility of the surgical field and failure to locate quadriceps adhesions. Shang et al [22] reported the use of pre‐operative sonographic examination to improve the accuracy of adhesion detection.…”
“…To avoid injuring the VMO attachment, the media vastus intermedius tendon was exposed at 40–50 mm proximal and 10 mm lateral to the patella. Pan et al [16, 22] reported that pie‐crusting release for the treatment of extension contractures of the knee achieved satisfactory results within a short‐term follow‐up period. This procedure includes percutaneous release of the extraarticular adhesive quadriceps tendon and arthroscopic joint debridement.…”
Section: Discussionmentioning
confidence: 99%
“…Although the pie‐crusting technique was a modified technique that maintains the integrity of the quadriceps, it was associated with poor visibility of the surgical field and failure to locate quadriceps adhesions. Shang et al [22] reported the use of pre‐operative sonographic examination to improve the accuracy of adhesion detection.…”
“…Several authors have proposed techniques to treat extensor contractures without the need for open surgery, such as the quadriceps pie-crusting technique associated with an arthroscopic technique (48,49,50). Endoscopic quadricep release has also been proposed (42,51,52,53).…”
Open reduction and internal fixation is the gold standard treatment for tibial plateau fractures. However, the procedure is not free of complications such as knee stiffness, acute infection, chronic infection (osteomyelitis), malunion, non-union, and post-traumatic osteoarthritis.
The treatment options for knee stiffness are mobilisation under anaesthesia (MUA) when the duration is less than 3 months, arthroscopic release when the duration is between 3 and 6 months, and open release for refractory cases or cases lasting more than 6 months. Early arthroscopic release can be associated with MUA.
Regarding treatment of acute infection, if the fracture has healed, the hardware can be removed, and lavage and debridement can be performed along with antibiotic therapy. If the fracture has not healed, the hardware is retained, and lavage, debridement, and antibiotic therapy are performed (sometimes more than once until the fracture heals). Fracture stability is important not only for healing but also for resolving the infection.
In cases of osteomyelitis, treatment should be performed in stages: aggressive debridement of devitalised tissue and bone, antibiotic spacing and temporary external fixation until the infection is resolved (first stage), followed by definitive surgery with grafting or soft tissue coverage depending on the bone defect (second stage).
Intra-articular or extra-articular osteotomy is a good option to correct malunion in young, active patients without significant joint damage. When malunion is associated with extensive joint involvement or the initial cartilage damage has resulted in knee osteoarthritis, the surgical option is total knee arthroplasty.
“… 1 , 2 Such hidden adhesions may present both intra-articularly and between quadriceps muscle parts and surrounding tissues. 1 , 2 , 17 However, if the extension contracture persists after arthroscopic LOA, the quadriceps is usually the main remaining source of knee flexion deficit, which is confirmed by effectiveness of quadricepsplasty in such cases. 1 Fig 8 Proposed workflow for knee extension contracture treatment.…”
Section: Discussionmentioning
confidence: 94%
“… 1 , 8 , 16 , 18 , 19 However, in the recent years, less invasive modification of quadricepsplasty, so-called pie-crusting quadricepsplasty was developed. 10 , 11 , 17 This procedure is routinely finished with MUA in order to stretch the prepared quadriceps. This is the next step in proposed workflow for knee extension contracture treatment, where PBS technique may be used instead of a traditional MUA ( Fig 8 ).…”
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