Safety and efficacy of the modified Judet quadricepsplasty in patients with post-traumatic knee stiffness

Bidolegui, Fernando; Pereira, Sebastián; Pires, Robinson Esteves Santos

doi:10.1007/s00590-020-02802-3

Cited by 10 publications

(3 citation statements)

References 13 publications

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“…The most frequently used technique is the anterior release of the extensor apparatus, which was described by Judet et al in 1956 (45). The technique is surgically aggressive and employs a lateral approach that largely detaches the quadriceps from the femur and adjacent structures; therefore, the potential benefits should be weighed against possible complications (bleeding, infection, and recurrent stiffness) before employing the technique (46,47).…”

Section: Open Releasementioning

confidence: 99%

Complications of the surgical treatment of fractures of the tibial plateau: prevalence, causes, and management

2022

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Open reduction and internal fixation is the gold standard treatment for tibial plateau fractures. However, the procedure is not free of complications such as knee stiffness, acute infection, chronic infection (osteomyelitis), malunion, non-union, and post-traumatic osteoarthritis. The treatment options for knee stiffness are mobilisation under anaesthesia (MUA) when the duration is less than 3 months, arthroscopic release when the duration is between 3 and 6 months, and open release for refractory cases or cases lasting more than 6 months. Early arthroscopic release can be associated with MUA. Regarding treatment of acute infection, if the fracture has healed, the hardware can be removed, and lavage and debridement can be performed along with antibiotic therapy. If the fracture has not healed, the hardware is retained, and lavage, debridement, and antibiotic therapy are performed (sometimes more than once until the fracture heals). Fracture stability is important not only for healing but also for resolving the infection. In cases of osteomyelitis, treatment should be performed in stages: aggressive debridement of devitalised tissue and bone, antibiotic spacing and temporary external fixation until the infection is resolved (first stage), followed by definitive surgery with grafting or soft tissue coverage depending on the bone defect (second stage). Intra-articular or extra-articular osteotomy is a good option to correct malunion in young, active patients without significant joint damage. When malunion is associated with extensive joint involvement or the initial cartilage damage has resulted in knee osteoarthritis, the surgical option is total knee arthroplasty.

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Section: Open Releasementioning

confidence: 99%

Complications of the surgical treatment of fractures of the tibial plateau: prevalence, causes, and management

2022

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“…Studies have shown that conservative treatment such as MUA has been successful in more than half of patients with knee arthrofibrosis, thus avoiding surgical treatment. For patients without significant improvement in knee ROM after conservative treatment, further surgical treatment such as open arthrolysis, quadricepsplasty, mini-incision operation and arthroscopic arthrolysis can be performed [ 25 , 26 ]. Compared with open surgery, arthroscopic arthrolysis has the advantages of less tissue trauma, less postoperative pain, fewer complications, faster recovery and better outcome.…”

Section: Discussionmentioning

confidence: 99%

Topical administration of tranexamic acid reduces postoperative blood loss and inflammatory response in knee arthroscopic arthrolysis: a retrospective comparative study

You

Yao

et al. 2023

BMC Musculoskelet Disord

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Background Knee arthroscopic arthrolysis serves as an effective treatment for knee arthrofibrosis. However, hemarthrosis is the most common complication in arthroscopic surgery, which has potential adverse effects on postoperative rehabilitation. The purpose of this study was to evaluate the effects of topical tranexamic acid (TXA) in knee arthroscopic arthrolysis. Methods A total of 87 patients with knee arthrofibrosis who underwent arthroscopic arthrolysis from September 2019 to June 2021 were eligible for this retrospective review. Patients in the TXA group (n = 47) received topical administration of TXA (50 mL, 10 mg/mL) at the end of the surgery, and patients in the control group (n = 40) received no TXA. The postoperative drainage volumes, hematologic levels, inflammatory marker levels, knee range of motion (ROM), visual analog scale (VAS) pain scores, Lysholm knee scores and complications were compared between the two groups. The curative effect of each group was calculated according to Judet’s criteria. Results The mean drainage volumes on postoperative day (POD) 1 and POD 2, and total drainage volume were significantly lower in the TXA group than in the control group (P < 0.001 for all). The TXA group had significantly lower postoperative CRP and IL-6 levels on POD 1 and POD 2, and at postoperative week (POW) 1 and POW 2 than the control group. The VAS pain scores in the TXA group were significantly lower on POD 1 and POD 2, and at POW 1 and POW 2 than those in the control group (P < 0.001 for all). Patients in the TXA group showed better postoperative ROM and Lysholm knee scores at POW 1 and POW 2. No patient had any complications such as deep venous thrombosis (DVT) or infection. The excellent and good rates of knee arthroscopic arthrolysis were comparable between the two groups at the sixth postoperative month (P = 0.536). Conclusions Topical administration of TXA in knee arthroscopic arthrolysis can reduce postoperative blood loss and inflammatory response, alleviate early postoperative pain, increase early postoperative knee ROM, and improve early postoperative knee function without increased risks.

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“…In this review, complication rates were found to be 17% and 24% for the Judet and Thompson cohorts, respectively. Complications include quadriceps tendon rupture, wound complications, and, most notably, extension lag 3,8,14,[27][28][29][30][32][33][34][35][36][37][38][39]41 . Permanent extension lag is an associated risk of quadricepsplasty, especially with the Thompson technique, where the rectus femoris is isolated from the rest of the quadriceps and may undergo lengthening 11,31,35,40,41 .…”

Section: Discussionmentioning

confidence: 99%

Thompson Versus Judet Techniques for Quadricepsplasty: A Systematic Review and Meta-analysis of Outcomes and Complications

Gutowski,

Hedden,

Johnsen

et al. 2024

JBJS Open Access

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Background: Quadricepsplasty has been used for over half a century to improve range of motion (ROM) in knees with severe arthrofibrosis. Various surgical techniques for quadricepsplasty exist, including Judet and Thompson, as well as novel minimally invasive approaches. The goal of this review was to compare outcomes between quadricepsplasty techniques for knee contractures. Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Available databases were queried for all articles on quadricepsplasty. Outcomes included postoperative ROM, outcome scores, and complication rates. Secondarily, we summarized rehabilitation protocols and descriptions of all modified and novel techniques. Results: Thirty-three articles comprising 797 patients were included in final analysis. Thirty-five percent of patients underwent Thompson quadricepsplasty, 36% underwent Judet, and 29% underwent other techniques. After Judet and Thompson quadricepsplasty, patients achieved a mean postoperative active flexion of 92.7° and 106.4°, respectively (p < 0.01). Complication rates after Judet and Thompson were 17% and 24%, respectively. Wound infection was the most frequently recorded complication after Judet, whereas extension lag predominated for Thompson. Conclusion: Both the Thompson and Judet quadricepsplasty techniques offer successful treatment options to restore functional knee ROM. Although the Thompson technique resulted in greater postoperative knee flexion compared with the Judet, the difference may be attributable to differences in preoperative flexion and time from injury to quadricepsplasty. Overall, the difference in flexion gained between the 2 techniques is comparable and clinically negligible. Level of Evidence: Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Safety and efficacy of the modified Judet quadricepsplasty in patients with post-traumatic knee stiffness

Cited by 10 publications

References 13 publications

Complications of the surgical treatment of fractures of the tibial plateau: prevalence, causes, and management

Complications of the surgical treatment of fractures of the tibial plateau: prevalence, causes, and management

Topical administration of tranexamic acid reduces postoperative blood loss and inflammatory response in knee arthroscopic arthrolysis: a retrospective comparative study

Thompson Versus Judet Techniques for Quadricepsplasty: A Systematic Review and Meta-analysis of Outcomes and Complications

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