Results of surgical treatment of quadriceps femoris/contracture in children

Abstract

Background: The child presenting with quadriceps femoris/contracture that is resistant to serial manipulation and plaster casting and the older child with a fixed contracture of the quadriceps is treated surgically at the African Inland Church-Cure International Children's Hospital. The surgery involves soft tissue release and lengthening of the quadriceps tendon. Open reduction of the knee and femoral osteotomy is done as indicated. Objective: To analyze the outcome of surgical treatment of quadriceps femoris contracture in children. Setting: AIC-CURE International Children's Hospital in Kijabe, Kenya. Methodology: This is a review of files of children in our hospital treated surgically for quadriceps fibrosis over a period of three years (January 2005 to December 2007). Results: There were fifty one cases of quadriceps fibrosis in thirty six patients treated surgically over the study period. Thirty one cases were excluded due to incomplete records or patients lost to follow-up. Consequently, the remaining twenty cases were analyzed. The pre-operative range of motion of the knee was grouped as follows: two cases had dislocated knees, three had hyperextension contractures, thirteen (0-30 degrees) and two (31-60 degrees). The final post-operative range of motion was grouped as follows: three (0-30 degrees), four (13-60 degrees), three (61-90 degrees), one (91-120 degrees) and nine (full range of flexion). Gain in flexion ranged from minus forty degrees to positive 140 degrees. The average gain in flexion was 94.7 degrees. Five patients underwent a second procedure to improve flexion. Soft tissue complications developed in four cases. Conclusion: Quadriceps femoris/contracture responds well to surgical treatment with an expected gain in flexion of 94.7 degrees. The commonest complication is skin breakdown.

Iatrogenic retractile quadriceps fibrosis within children in Benin: Epidemiological, clinical, therapeutical aspects

“…In cases, stiffness onset did not exceed 6 months, iterative mobilization of the knee (IMK) was done with general anaesthesia. [14] Beyond 6 months, the surgery was more suitable. [12,13] The MDQTPT lead to lateral and anterior skin incision and extraarticular quadricepsplasty without arthrolysis, based on an extension of the rectus femoris muscle flap with a distal muscle-tendon flap created with a vastus intermedius [ Figure 1].…”

Rat Model of Quadriceps Contracture by Joint Immobilization

“…Myogenic contracture occurs the early stage of joint contracture caused by muscles, fascia, and tendons [ 14 , 15 ]. Other findings include muscle atrophy and fibrosis [ 4 , 10 , 11 , 16 , 17 , 18 ]. Muscle fibrosis leads to a decrease in muscle elasticity [ 18 ], which lowers the muscle’s ability to return to its original length after being stretched [ 12 ].…”

Surgical treatment of injection-induced rectus femoris muscle contracture in a child: A case report

“…Quadriceps contracture leads to a stiff extended knee, with limited flexion depending on the severity of the contracture. Fibrosis and shortening of the muscle components, particularly the Vastus intermedius and Rectus femoris in the midline of the limb, contribute to the limitation of flexion [ 1 , 8 ].…”

“…Postoperative physiotherapy is essential to support surgical outcomes and facilitate patient rehabilitation [ 7 ]. Conversely, preoperative physiotherapy and manipulation have limited effectiveness, except in mild and early cases, and may even pose risks such as supracondylar fractures [ 8 ]. Generally, passive stretching and physiotherapy are unlikely to yield long-lasting improvements [ 4 ].…”

“…To mitigate this problem, the incision should not extend distal to the superior pole of the patella. In some cases, a Z-plasty of the skin may be necessary to alleviate tension [ 8 ]. In our case, an incision was made proximal to the anterolateral aspect of the right thigh, which effectively prevented tension and minimized the occurrence of this complication.…”