Distal Femoral Extension Osteotomy for Knee Flexion Contracture in Patients with Arthrogryposis

DelBello, Damon A.; Watts, Hugh G.

doi:10.1097/01241398-199601000-00025

Cited by 48 publications

(6 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The effect of supracondylar extension osteotomy is neutralized at a rate of about 1° per month by rapid growth; recurrence has also been reported following frame distraction [13, 14]. …”

Section: Introductionmentioning

confidence: 99%

Guided growth for correction of knee flexion deformity: a series of four cases

MacWilliams¹,

Harjinder²,

Stevens³

2011

Strategies in Trauma and Limb Reconstruction

View full text Add to dashboard Cite

Fixed knee flexion deformity can present as an insidious and significant problem in diverse etiologies, most commonly in cerebral palsy. Traditional surgical intervention has included posterior capsulotomy and supracondylar femoral osteotomy, both of which carry significant associated morbidity and risks. In the skeletally immature patient, guided growth may be used to correct or substantially diminish the deformity. We are presenting our early experience encompassing four subjects who completed instrumented gait analysis both prior to and after distal femoral anterior guided growth (hemiepiphysiodesis). Changes in gait and function resulting from surgery in each individual are reported. Outcomes indicate improved knee range of motion and alleviation of crouch at the knee with secondary improvements in the ankle, hip and pelvis. Three subjects with initially slow gait velocity improved to within normal limits by demonstrating increased stride length. A measure of overall gait kinematics showed improvements in all limbs. Anterior guided growth (hemiepiphysiodesis) of the distal femur resulted in positive quantitative changes in all four patients, though degree and types of changes were variable in this small series. Encouraged by these findings, we now prefer guided growth to extension supracondylar osteotomy for the skeletally immature patient with fixed knee flexion deformity.

show abstract

“…The effect of supracondylar extension osteotomy is neutralized at a rate of about 1° per month by rapid growth; recurrence has also been reported following frame distraction [13, 14]. …”

Section: Introductionmentioning

confidence: 99%

Guided growth for correction of knee flexion deformity: a series of four cases

MacWilliams¹,

Harjinder²,

Stevens³

2011

Strategies in Trauma and Limb Reconstruction

View full text Add to dashboard Cite

show abstract

“…The ability to achieve an increased range of motion in patients with AMC and a functional range of motion has not been previously demonstrated in the literature [4,7,12]. Distal femoral extension osteotomies, which have had success in patients with cerebral palsy, have also been attempted in AMC [5,6,[14][15][16]. In AMC, the supracondylar osteotomies improved ambulation ability, but did not improve total range of motion and had issues with recurrence of the deformity [5,6,14].…”

Section: Discussionmentioning

confidence: 99%

“…Distal femoral extension osteotomies, which have had success in patients with cerebral palsy, have also been attempted in AMC [5,6,[14][15][16]. In AMC, the supracondylar osteotomies improved ambulation ability, but did not improve total range of motion and had issues with recurrence of the deformity [5,6,14]. That being said, there may be a role for the distal femoral supracondylar osteotomy in patients who are skeletally mature, have knee flexion >90 • and a mild amount of deformity (<20 • ).…”

Section: Discussionmentioning

confidence: 99%

“…Treatment of these contractures have included: non-operative therapy, osteotomies of the hips/knees, posterior releases of the knee and gradual soft-tissue lengthening with external fixation [4][5][6][7][8][9][10][11][12]. Historically it has been demonstrated that treatment can redirect the arc of motion in AMC; however, it has not been shown that treatment can actually increase the total arc of motion [4][5][6][7][8][9][10][11][12]. If a patient has a knee flexion contracture of 90 • with an arc of motion of 15 • , then redirection of this arc so that the patient can stand may actually take away their ability to sit.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Novel Approach to Improving Knee Range of Motion in Arthrogryposis with a New Working Classification

2021

View full text Add to dashboard Cite

Arthrogryposis multiplex congenita (AMC) is a rare condition defined as contrac-tures in multiple joints. Surgical interventions for severe knee flexion contractures have included posterior release, distraction and extension with external fixation and distal femoral extension osteotomies. These operations have been able to achieve knee extension, but not increase the range of motion. The purpose of this study was to review our experience with peroneal nerve decompression, posterior knee release and proximal femoral shortening. We retrospectively reviewed the medical charts and radiographs of all patients with a diagnosis of arthrogryposis who underwent aforementioned procedure. There were 39 patients with 73 knees included in the analysis with a mean follow-up of 21 months. The mean preoperative arc of motion was 45° and last followup arc of motion was 79° (p < 0.0001). The mean last followup flexion contracture was 8° (p < 0.0001). Additional subanalyses were performed on those with followup greater than 24 months and those with flexion contractures >60°; there were no differences found in these groups. This study demonstrates that it is possible to achieve a functional range of motion of the knees in patients with AMC while improving ambulatory function.

show abstract

“…Another option is to make a ventral closing wedge osteotomy of the distal femur, fixing it with a plate or with wires in the young child [9]. However, in the growing child, there is a recurrence rate of 1° per month.…”

Section: Flexion Contracture Of the Kneementioning

confidence: 99%

Management of the knees in arthrogryposis

Pontén

2015

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

Arthrogryposis is defined as limited range of motion in three or more joints in two or more body parts. This article will describe treatment options for the arthrogrypotic knee. In all types of arthrogryposis, and in both extension and flexion deformities, very early treatment is favorable. Just after birth, traction and mobilization followed by serial casting could often greatly improve the range of motion. In the hyperextended knee, surgical lengthening of the extensor apparatus may be needed. Flexion deformities could be improved with temporary physeal arrest of the anterior distal femur by fixing two-hole plates over the physis on both sides of patella. The plates will result in a constrained growth of the anterior physis, and thus a very slow extension of the knee, which will give the nerves and vessels time to adjust. Pterygium, webbing of the knee joint, is a special subgroup that in selected mild cases could be treated with extensive surgical release of the webbing and orthotics. Arthrogrypotic knees can be treated with early reduction and maintenance with orthotics.

show abstract

Distal Femoral Extension Osteotomy for Knee Flexion Contracture in Patients with Arthrogryposis

Cited by 48 publications

References 15 publications

Guided growth for correction of knee flexion deformity: a series of four cases

Guided growth for correction of knee flexion deformity: a series of four cases

Novel Approach to Improving Knee Range of Motion in Arthrogryposis with a New Working Classification

Management of the knees in arthrogryposis

Contact Info

Product

Resources

About