A mini-invasive procedure for treating arthroŞbrosis of the knee

Objective: The aim of this study was to introduce the results of a novel mini-invasive operative techniquecomprising mini-incision release,"pie-crusting" lengthening of the quadriceps extensor, and arthroscopic lysis in severe arthroŞbrotic knees.Methods: From 2010 to 2014, 17 patients (12 males and 5 females with a mean age of 44 years (range, 19e62 years)) with severely arthroŞbrotic knees were treated with this operative technique. The meanfollow-up duration was 23 months. The knee range of motion (ROM) was assessed with a goniometer.The functional outcomes were evaluated according to the Hospital for Special Surgery (HSS) score andJudet's criteria.Results: The ROM signiŞcantly improved from 29.7(range, 7e56) preoperatively to 127(range, 120e136) at theŞnal follow-up in all patients (p < 0.001). According to Judet's criteria, all patients achievedexcellent results (ROM> 100). The HSS score was improved from 70 points (range, 60e85 points)preoperatively to 91 points (range, 84e98 points) (p < 0.001) at the Şnal follow-up. No extension lag,skin necrosis, quadriceps weakness, wound dehiscence or quadriceps tendon rupture occurred.Conclusions: Mini-invasive quadricepsplasty-associated arthroscopic lysis and manipulation of the knee inflexion is simple and easy and should be considered as a legitimate treatment for arthroŞbrosis of the knee.© 2016 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V. This isan open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

___

Thompson TC. Quadricepsplasty. Ann Surg. 1945;121:751e754.

Judet J, Judet R, Lagrange J. Technic of liberation of the extensor apparatus in knee stiffness. Mem Acad Chir (Paris). 1956;82:944e947.

Oliveira VG, D'Elia LF, Tirico LE, et al. Judet quadricepsplasty in the treatment of posttraumatic knee rigidity: long-term outcomes of 45 cases. J Trauma. 2011. http://dx.doi.org/10.1097/TA.0b013e3182159e0a.

Ebrahimzadeh MH, Birjandi-Nejad A, Ghorbani S, Khorasani MR. A modiŞed Thompson quadricepsplasty for extension contracture resulting from femoral and periarticular knee fractures. J Trauma. 2010;68:1471e1475. http:// dx.doi.org/10.1097/TA.0b013e3181bdcdec.

Oliveira VG, D'Elia LF, Tirico LE, et al. Judet quadricepsplasty in the treatment of posttraumatic knee rigidity: long-term outcomes of 45 cases. J Trauma Acute Care Surg. 2012;72:E77eE80.

Nicoll EA. Quadricepsplasty. J Bone Jt Surg Br. 1963;45:483e490.

Ebraheim NA, DeTroye RJ, Saddemi SR. Results of judet quadricepsplasty. J Orthop Trauma. 1993;7:327e330.

Bellemans J, Steenwerckx A, Brabants K, Victor J, Lammens J, Fabry G. The Judet quadricepsplasty: a retrospective analysis of 16 cases. Acta Orthop Belg. ;62:79e82. Hahn SB, Lee WS, Han DY. A modiŞed Thompson quadricepsplasty for the stiff knee. J Bone Jt Surg Br. 2000;82:992e995.

Ali AM, Villafuerte J, Hashmi M, Saleh M. Judet's quadricepsplasty, surgical technique, and results in limb reconstruction. Clin Orthop Relat Res. 2003;415: e220. http://dx.doi.org/10.1097/01.blo.0000093913.26658.9b.

Wang JH, Zhao JZ, He YH. A new treatment strategy for severe arthroŞbrosis of the knee. A review of twenty-two cases. J Bone Jt Surg Am. 2006;88:1245e1250. http://dx.doi.org/10.2106/JBJS.E.00646.

Liu KM, Liu S, Cui Z, Han X, Tang T, Wang A. A less invasive procedure for posttraumatic knee stiffness. Arch Orthop Trauma Surg. 2011;131:797e802. http://dx.doi.org/10.1007/s00402-010-1223-z.

Mayr HO, Stohr A. Arthroscopic treatment of arthroŞbrosis after ACL recon- struction. Local and generalized arthroŞbrosis. Oper Orthop Traumatol. ;26:7e18. http://dx.doi.org/10.1007/s00064-013-0264-1.

Magit D, Wolff A, Sutton K, Medvecky MJ. ArthroŞbrosis of the knee. J Am Acad Orthop Surg. 2007;15:682e694.

Lee DH, Kim TH, Jung SJ, Cha EJ, Bin SI. ModiŞed judet quadricepsplasty and Ilizarov frame application for stiff knee after femur fractures. J Orthop Trauma. ;24:709e715. http://dx.doi.org/10.1097/BOT.0b013e3181c80bb9.

Steinfeld R, Torchia ME. Arthroscopically assisted percutaneous quad- ricepsplasty: a case report and description of a new technique. Arthroscopy. ;14:212e214. Liu HX, Wen H, Hu YZ, Yu HC, Pan XY. Percutaneous quadriceps tendon pie- crusting release of extension contracture of the knee. Orthop Traumatol Surg Res. 2014;100:333e335. http://dx.doi.org/10.1016/j.otsr.2013.12.023.

Sprague NR, O'Connor RL, Fox JM. Arthroscopic treatment of postoperative kneeŞbroarthrosis. Clin Orthop Relat Res. 1982;166:165e172.

Dhillon MS, Panday AK, Aggarwal S, Nagi ON. Extra articular arthroscopic release in post-traumatic stiff knees: a prospective study of endoscopic quadriceps and patellar release. Acta Orthop Belg. 2005;71:197e203.

Blanco CE, Leon HO, Guthrie TB. Endoscopic quadricepsplasty: a new surgical technique. jars.2001.24062. http://dx.doi.org/10.1053/

Burge JR, Sanchez HB, Wagner RA. Quadriceps and patellar tendon pie-crusting as a treatment for limitedflexion in total knee arthroplasty. Am J Orthop (Belle Mead NJ). 2014;43:E83eE88.