A modified Thompson quadricepsplasty for the stiff knee

Abstract

Patients and MethodsBetween March 1987 and March 1997, 20 modified Thompson quadricepsplasties were performed by one of the authors (SBH). The mean age of the patients was 37 years (18 to 64). There were 18 men and two women. In 17, the procedure followed a fracture of the femur. Of the remaining three, two had achondroplasia and stiffness resulting from femoral lengthening by the Ilizarov method, and one had suffered poliomyelitis. The mean interval between the initial operation and quadricepsplasty was 28 months (14 to 60). The mean flexion contracture was 7.0° (0 to 30) with active flexion to 50.0° (5 to 80). The mean range of movement was thus 43.0° (5 to 80). The mean follow-up was 35 months (24 to 52). The range of movement of the knee was measured at each visit by the surgeon who had performed the operation (SBH) using a goniometer with 30 cm movable arms and a scale marked in 1° increments. The stationary arm of the goniometer was placed parallel to the long axis of the femur along a line extending from the greater trochanter to the lateral condyle, and the movable arm was placed parallel to the long axis of the fibula, between the head of the fibula and the lateral malleolus.The final results were assessed by Judet's criteria: 8 excellent, if flexion was greater than 100°; good, from 81° to 100°; fair, from 50° to 80°; and poor, if less than 50°. Operative technique. Medial and lateral parapatellar incisions were used for arthrolysis (Fig. 1a). The knee was then flexed and if inadequate flexion was obtained, an anterolateral or lateral incision in the distal two-thirds of the thigh was performed to release adhesions around the quadriceps muscle (Fig. 1a). The tensor fascia lata was divided transversely in the distal thigh. Vastus lateralis was isolated from rectus femoris and released close to its patellar insertion (Fig. 1b). Vastus medialis was released from rectus femoris by stripping with a finger (Fig. 1b). Rectus femoris was freed from vastus intermedius and from the anterior surface of the femur and upper pole of the patella (Fig. 2a). In four cases in which a satisfactory range of flexion had not been achieved at this stage, Z-plasty of rectus femoris was performed to lengthen the tendon (Fig. 2b). The procedures were carried out using a tourniquet, and the wound was closed over suction drainage. The tourniquet was released, and the appearance of the skin flap was checked, while the

The Judet Quadricepsplasty: Long-Term Outcome of 21 Cases

“…3 However, several authors reported severe residual extension lag in a number of patients when adopting this procedure. [4][5][6][7][8][9] This lag was related to the weakening of the extensor apparatus of the knee.…”

Arthrofibrosis of the Knee after Tibial Spine Fracture in Children: A Report of Two Complicated Cases

“…Extension contracture of the knee is far less common than flexion contracture. Surgical approaches for extension contracture include arthroscopic release and/or quadricepsplasty [9,[15][16][17][18]. Flexion contracture can be treated with serial long leg casts with increasing knee extension, open or arthroscopic surgical release with hamstring lengthening, and/or external fixation devices [19].…”

“…After an initial trial of physical therapy, surgical management was offered for his severe knee extension contracture. A modified Thompson quadricepsplasty [9] was performed. The vastus medialis obliqus (VMO) and vastus lateralis were released from the rectus femoris, the vastus intermedius was released from the overlying rectus femoris and from the underlying femur, and a lateral parapatellar release was performed through the anterior incision.…”

The Iliotibial Band Transfer Restores Extensor Function after Quadricepsplasty for Knee Stiffness

“…Several methods of quadricepsplasty have been described such as the Thompson and Judet techniques and their modifications [22] [23], and Proximal release in the early stage and distal release in the late stage are the recommended treatments [24]. Distal quadricepsplasty such as the Thompson or V-Y Flaps, should not be performed in adults because it leads to significant permanent knee extension lag, especially when lengthening of the quadriceps tendon is required [22] [23].…”

“…This extension lag may occur in children as well, but because children are growing and constantly retensioning their quadriceps muscle, it may recover [25]. The preferable way of obtaining knee flexion is the Judet quadricepsplasty [23] [26]. This is a proximally based quadriceps muscle slide that addresses all elements of knee contracture.…”