Judet's Quadricepsplasty for Extension Contracture of the Knee (Stiff Knee)

Abstract

Between January 2003 to 2013 Judet's Quadricepsplasty was performed on 32 stiff knees. The initial preoperative range of movement was 15° (range 10°-25°). Postoperative plaster immobilization was only for 1 day. The mean follow up period was 6 years (range 2-10 years). During our follow up the mean active flexion was 70° (range 60°-120°). Final outcome in knee movement was 90° (40°-175°). In our series six patients developed wound dehiscence which resolved after meticulous wound care and antibiotics. In our all the cases we believe that Judet's Quadricepsplasty gives excellent result with proper postoperative care and CPM therapy. The treatment of knee extension contracture must therefore vary from simple arthroscopy to lyse adhesions to more extensive quadricepsplasty. Quadricepsplasty can be divided into distal and proximal types. Distal quadricepsplasty, such as the Thompson or V-Y types, should never be performed in adults because it leads to permanent knee extension lag. This may occur in children as well, but because the children are growing and retensioning their quadriceps muscle, it may recover. The best way of obtaining knee flexion is the Judet's Quadricepsplasty [1,2]. This is a proximally based quadriceps muscle slide that addresses all the elements of the knee contracture. It was popularized by Letournel. The Judet's quadricepsplasty is a stepwise release of the knee and quadriceps muscle. Each successive step determines whether one continues with the next step of the release depending on the amount of knee motion recovered.In our series Judet's quadricepsplasty for stiff knee was done on 32 cases from January 2003 to January 2013 with proper postoperative management with CPM machine in an attempt to improve the knee range of motion. Materials and MethodsThis study was conducted in NITOR (National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka) and BARI-ILIZAROV Orthopaedic Centre between January 2003 to January 2013. The mean age of the patient was 26 years (20-35 years) and the total number of patients were 32. All patients were male. All the patients developed stiff knee after periarticular knee fractures or Ilizarov application.We retrospectively reviewed the results of 32 cases of knee extension contracture managed with Judet's quadricepsplasty during the last 10 years having a mean follow up of 24 months. Degrees of flexion of the operated knees preoperatively and at last follow up were recorded along with quadriceps strength, presence of extension lag and complications. Surgical techniqueThe incision is marked for the full length of the thigh from the rough line of the greater trochanter to the lateral aspect of the patellar tendon. During surgical intervention we must give imphasize with these following 5 steps [1,3]:Step-1 (Intra articular release): Under tourniquet, only the distal part of the incision is made to release the knee adhesions from the lateral side.

Post traumatic knee stiffness managed by modified Judet’s quadricepsplasty - what we achieved by surgery

“…[5][6][7] Therefore a significant extension lag was observed. 4 A modified Thompson's approach was later developed, 5,8 in which two small parapatellar incisions and a lateral or antero lateral incision on the distal thigh were made to reduce problems with wound healing. Moreover the insertion of the vastus medialis at the patella was preserved.…”

“…In 1956, Judet proposed an alternative technique involving proximally based quadriceps muscle slide with stepwise release of knee and quadriceps. 3,4 We are presenting two cases of post traumatic knee stiffness treated with modified Judet's quadricepsplasty.…”

The judet quadricepsplasty for elderly traumatic knee extension contracture: a case report and review of the literature

“…Wound and surgical site infections were the most common complication of this procedure[4, 5, 7, 9, 11–13]. Most of the infections were superficial surgical site infections with deep infections in Belle man s and Masse’s case series originating from external fixator pin sites.…”

A case report of adult-onset Still’s disease of a patient presenting with the symptoms of intraparotid lymphadenopathy

“…The initial symptoms of the disease include arthritis, daily high fever, and skin rash [1]. The etiology of AOSD, which was first described by George F., is still unknown [2]; however, it is thought to be related to bacterial infections such as yersinia enterocolitica, mycoplasma pneumoniae [3] and viral infection, such as rubella [4]. The diagnosis is made by exclusion of infection, malignancy, and rheumatologic disorders.…”