Posterior Capsulotomy for the Treatment of Severe Flexion Contractures of the Knee

Heydarian, K; Akbarnia, Behrooz A.; Tabador, Khosrow

doi:10.1097/01241398-198411000-00009

Cited by 37 publications

(16 citation statements)

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“…He reported his results on 21 knees using medial and lateral incisions, passing a sponge through the wound tunnel for exposure, and stripping the capsule from the distal femur (Wilson 1929). Posterior capsulotomy also has been described using a posterior approach because of concern that medial and lateral incisions did not provide adequate exposure (Heydarian et al 1984). No complications in this series related to the surgical exposure used.…”

Section: Discussionmentioning

confidence: 96%

Treatment of knee contracture in cerebral palsy by hamstring lengthening, posterior capsulotomy, and quadriceps mechanism shortening

Beals¹

2001

Dev Med Child Neurol

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Results of surgery to correct fixed flexion contracture of the knee and improve voluntary knee extension in 39 knees in 20 children (11 females, 9 males; mean age 12 years 8 months, age range 5 to 20 years) with cerebral palsy were analyzed. All patients had neuromotor disease and 18 children had spastic diplegia or quadriplegia. All patients could initiate voluntary knee extension but lacked full passive extension. Five patients (10 knees) were free walkers with a mean motor severity index of 19 and mean fixed knee contracture of 20 degrees. Fifteen patients (29 knees) were not free walkers and 13 were wheelchair ambulators. They had a mean motor severity index of 8 and mean fixed knee contractures of 30 degrees. Surgical procedures included various combinations of hamstring lengthening and/or posterior capsulotomy to allow free passive knee extension, with or without quadriceps mechanism shortening, to enhance voluntary extension. The best results were in patients who had hamstring lengthening, posterior capsulotomy, and quadriceps mechanism shortening.

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Section: Discussionmentioning

confidence: 96%

Treatment of knee contracture in cerebral palsy by hamstring lengthening, posterior capsulotomy, and quadriceps mechanism shortening

Beals¹

2001

Dev Med Child Neurol

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“…Persistent fixed knee flexion deformity after adequate hamstring lengthening disrupts knee function in both stance and swing phases of the gait cycle. 6 Treatment options for the management of resistant or recurrent knee flexion deformity after hamstring lengthening in children with CP include (1) more aggressive soft tissue release (lateral hamstrings, posterior knee joint capsular release, knee cruciate ligament release, and quadriceps shortening), 7,8 (2) gradual extension using serial stretch casting or an external fixator, and (3) distal femoral extension osteotomy. 9 However, significant complications are associated with each of these treatment options.…”

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confidence: 99%

Effectiveness of Serial Stretch Casting for Resistant or Recurrent Knee Flexion Contractures Following Hamstring Lengthening in Children With Cerebral Palsy

Westberry¹,

Davids²,

Jacobs³

et al. 2006

Journal of Pediatric Orthopaedics

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A retrospective review of all cerebral palsy (CP) patients with resistant or recurrent knee flexion contractures treated with serial stretch casting was performed. The protocol consisted of sequential wedging (5 degrees per week) of fiberglass casts until maximum knee extension had been achieved. Measurements were made prior to the initiation of casting, at completion of the casting, and at 1 year after the casting. Forty-six subjects, with 75 involved extremities, met the study inclusion criteria. Mean age at the time of initiation of casting was 12.7 years. Using radiographic measurements, the mean initial degree of knee flexion contracture was -17.6 degrees. At the completion of casting, the mean knee flexion angle was -8.1 degrees. The mean duration of casting was 30 days. At 1 year after completion of the casting, the mean knee flexion angle was -12.2 degrees. Initial correction to within 10 degrees of full extension was achieved in 76% of extremities. Age less than 12 years and initial flexion contracture of less than -15 degrees were statistically significant factors related to maintenance of correction at 1 year. Complications included soft tissue compromise in 13 extremities (17%), transient neurapraxia in 9 extremities (12%), and tibial subluxation in 1 extremity (1%). Serial stretch casting was successful in correcting resistant knee flexion contractures in the majority of cases. Casting was less effective in teenagers and those with larger contractures. Complications were minimized by proper casting technique and controlled rate of correction.

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“…Distal release of the hamstring tendons followed by immobilization in a cast or brace has been advocated for adults 16 . Compared with treatment of contractures in children, treatment in adults is more frequently followed by cutaneous and vascular complications 16,17 as well as by recurrence of the contracture 18 .…”

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confidence: 99%

Treatment of Knee Flexion Contracture Due to Central Nervous System Disorders in Adults

Martin

Vialle

Denormandie

et al. 2006

The Journal of Bone & Joint Surgery

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Posterior Capsulotomy for the Treatment of Severe Flexion Contractures of the Knee

Cited by 37 publications

References 0 publications

Treatment of knee contracture in cerebral palsy by hamstring lengthening, posterior capsulotomy, and quadriceps mechanism shortening

Treatment of knee contracture in cerebral palsy by hamstring lengthening, posterior capsulotomy, and quadriceps mechanism shortening

Effectiveness of Serial Stretch Casting for Resistant or Recurrent Knee Flexion Contractures Following Hamstring Lengthening in Children With Cerebral Palsy

Treatment of Knee Flexion Contracture Due to Central Nervous System Disorders in Adults

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