Abstract
A female 11 years old, right knee stiffness since childhood. Able walking, but unable running, difficult sitting. Right knee Range of Motion 0-0-3°. Thigh muscle atrophy 2cm. Right lower limb axes well aligned. Rectus femoris muscle very tense, easy to feel under skin. Patella alta, 3 cm above normal position. Skin of anterior knee is in normality, but predictorily when flexion 120°, skin closure is impossible. Nerves and vessels are in normal condition. MRI shows severe contracture of Rectus Femoris. Vastus intermedius, lateralis and medialis are almost normal. Few adhesions inside the joint. Patellofemoral articulation smooth. First operation: placing a 300ml skin expander at prepatellar space, then inflate 300ml water by 10 times. Second operation: remove skin expander, lengthening Rectus Femoris 6 cm. Knee flexion 130°.Easy skin closure. 28th postoperative day, closed manipulation was performed under general anesthesia to achieve knee flexion 130°, then knee kept flexed for 2 hours. Knee flexion-extension was crucial exercise in longterm physical therapy. Last examination at 8th month postoperatively: almost normal walking, slight running, Knee Range of Motion 0-0-115°. By this case, presumable conclusion is skin expander may enhance the anterior coverage for the patients in knee liberation surgery
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