Quadricepsplasty for congenital dislocation of the knee and congenital quadriceps contracture

Abstract

Purpose We encountered problems with the Curtis and Fisher technique of quadricepsplasty for congenital quadriceps contracture, including wound dehiscence, insufficient lengthening of the quadriceps and instability of the knee. We modified the operative technique to address these three problems. We undertook this study to evaluate the results of the modified technique of quadricepsplasty to determine if we succeeded in overcoming these limitations of the original technique. Methods Twenty children (33 knees) underwent the modified Curtis and Fisher quadricepsplasty through a lateral incision; a long tongue of the rectus femoris was raised and the vasti mobilised without dividing the lateral retinaculae till the collateral ligaments. The children were followed up for a mean period of 63 months and evaluated. The healing of the wound, active and passive range of motion (ROM) of the knee, the stability of the knee, quadriceps power and knee function were assessed. Results Primary wound healing occurred in 32 of 33 knees. Adequate lengthening of the quadriceps sufficient to facilitate knee flexion to 90°was possible. Considerable improvement in the ROM was noted. In non-syndromic congenital dislocation of the knee (CDK), the quadriceps power was Grade 5, but minor degrees of extensor lag was noted. In a proportion of patients, minor degrees of joint instability was present. The majority of children were community walkers. The overall results were better in nonsyndromic CDK than in children with arthrogryposis, but differences of some variables were not significant. Conclusion The modifications to the original Curtis and Fisher technique overcame the specific problems they were expected to avoid.

Stepwise Lengthening of the Quadriceps Extensor Mechanism for Severe Obligatory and Fixed Patella Dislocators

“…However, V-Y quadricepsplasty has been associated with extensor lag and quadriceps weakness. 8 As previously discussed, cases of obligatory and fixed patellar dislocation involve contracture of the lateral extensor mechanism. Thus, we believe it is more logical in these cases to use a technique that preferentially lengthens the lateral extensor mechanism while leaving the medial quadriceps intact.…”

Surgical management of the congenital dislocation of the knee and hip in children presented after six months of age

“…Johnston CE defined the indication of the soft tissue lengthening for the treatment of the congenital dislocation of the knee [ 1 ] Different approaches to correct the congenital dislocation of the knee include minimal invasive technique, percutaneous surgery, needle tenotomy, traditional open lengthening of the quadriceps muscle [ 6 ], or modification of the quadricepsplasty [ 7 ].…”

“…All joints good outcome 3 (6) Good- 3, Poor-3 All three children were delivered prematurely. One knee operated 8 Abdelaziz T et al[ 3 ] 2011 7 7 (13) Outcome not mentioned 7 (13) Excellent-6, Good-5, Fair-2 CTEV-2 Calcaneo-valgus-4 Deep infection-3, Recurrent dislocation-3 Recurrent Genu valgum-2 All knees were operated 9 Johnston CE[ 1 ] 2011 8 8 (11) Severin:1A-1, 1B-1,2A-5 2B-1, 3-2, 4-1 8 (11) Excellent-3, Good-1, Fair-3, poor-4 Tibial growth arrest-1 Repeat hip open reduction-1 Additional hip surgery-2 Larsen syndrome-4 Idiopathic-2 Trisomy8-1 Diastrophic dislocation-1 10 Tercier S et al[ 7 ] 2012 17 17 All children became community walker 17 All children became community walker Better results in nonsyndromic cases 11 Current study 2020 24 24 (40) McKay rating Excellent-9, Good-16 Fair-13, Poor-2 24 (45) Passive knee flexion 101.33 degree, Mean knee extensor lag -4 degree CTEV-14, CVT-10 FFD knee-0.67 , Three hip joints subluxated at final follow-up Spontaneous reduction 5/8 hip joints N Number of children, n number of joints, CTEV congenital talipes equinovarus, CVT congenital vertical talus, AMC arthrogryposis multiplex congenita, MMC meningomyelocele …”

“…Forty-five knee joints (24 children) were treated by modified Curtis and Fischer quadricepsplasty [ 6 , 7 ]. Three modifications to the original technique were lateral incision instead of the midline, transverse division of rectus femoris at the musculotendinous junction, and preservation of both side retinacula and collateral ligaments.…”

Congenital Dislocation of the Knee - Apropos of Two Cases

“…Many surgical options are available according to the degree of deformity and age of the patient [5][6][7][8]. The variability of the approaches is the indicator that a universal solution is not yet accepted.…”