Quadricepsplasty in arthrogryposis (amyoplasia): long-term follow-up

Abstract

Eight patients with arthrogryposis multiplex congenita (amyoplasia type) (11 knees) with knee hyperextension deformity underwent quadricepsplasty and were analyzed during an average follow-up period of 11 years and 2 months. The results were clinically analyzed based on gait pattern, range of movement, and orthotic requirements. Joint congruency was evaluated by radiography according to the Leveuf Pais classification. A satisfactory result was the correction of the deformity, articular congruency, sufficient range of movement, adequate gait pattern and no need for orthosis. A satisfactory outcome occurred in five of the eight patients (eight knees). We considered an unsatisfactory result when any of these conditions occurred. Our experience demonstrated that the quadricepsplasty corrected the hyperextension deformity of the knee joint, improved function, gait pattern, and maintained the muscle power of the quadriceps.

Muscle and joint function in children living with arthrogryposis multiplex congenita: A scoping review

“…Quadricepsplasty was performed mostly to correct extension contractures, and in some cases flexion contractures as well (Borowski et al, ; Ho & Karol, ). Fucs et al () and Ghoreishi et al () reported improved knee passive flexion from a preoperative mean of 1.09 and 4.09° to a post‐surgery mean of 67.30 and 70° with final quadriceps strength of grade 4 or 5 after a follow‐up ranging between 2 years and 17.11 years after quadricepsplasty. Other procedures included hamstring and gastrocnemius lengthening, soft‐tissue release and hamstring transfer with no specific results reported for them (Fassier et al, ; Hahn, ; Ho & Karol, ; Van Bosse et al, ; Yang et al, ).…”

“…Hall et al () reported that among 135 children with Amyoplasia, 87 had knee flexion contractures and 16 had knee extension contractures. Knee dislocations or subluxations were found in eight studies (Bharucha et al, ; Binkiewicz‐Glinska et al, ; Borowski et al, ; Fucs, Svartman, de Assumpcao, & Lima Verde, ; Ghoreishi, BirjandiNejad, & Hallaj Moghadam, ; Kroksmark et al, ; Sud et al, ). Ayadi et al () reported an agenesis of the patella and displacement of the patella was reported in two studies (Binkiewicz‐Glinska et al, ; Borowski et al, ).…”

“…Ten studies used radiography to assess the position of the knee. Of these studies, DelBello and Watts () measured the angle of the physis and the shaft of the femur on lateral radiograph and found a mean of 2° of flexion preoperatively on 12 patients with a mean age of 2.9 years and Fucs et al () noted five knees with recurvatum and six subluxated knees using Leveuf and Pais' radiographic classification. Ultrasound was used in two studies to assess the position of the patella in younger patients as unossified patella are not visible on radiographs (Binkiewicz‐Glinska et al, ; Borowski et al, ) and to measure the size of the patella, the cartilaginous femoral sulcus angle (CSA) and the osseous femoral sulcus angle (OSA) of the femoral groove (Borowski et al, ).…”

“…Fassier et al () found that early casting combined with PT was sufficient to correct deformities in 13 of 20 knees. Fucs et al () and Ghoreishi et al () reported that 6 months of manipulation and casting for hyperextended knees did not give successful results. Post‐surgery casting lasting 3 to 10 weeks was mentioned in eight studies (Fucs et al, ; Ghoreishi et al, ).…”

Quadricepsplasty for congenital dislocation of the knee and congenital quadriceps contracture

“…We have not encountered tibial fractures, we have never had to resort to tendon grafting and in no instance did we have to re-operate a child. Restoration of knee motion entailed a very short period of supervised physiotherapy in this series, without having to resort to repeated manipulations under general anaesthesia every 3-4 days, as recommended by Fucs [21]. The overriding advantage of a single-event surgery over repeated general anaesthetics in an infant cannot be over-emphasised.…”