Surgery combined with continuing post operative stretching and management for knee flexion contractures in cases of multiple sclerosis - a report of six cases

Abstract

Contractures are a common complication of advanced multiple sclerosis. In consequence the care load is increased. Sitting in the wheelchair becomes difficult if not impossible and there is a high risk of pressure sores due to inadequate weight distribution. The greatest impedance to care and maintenance was thought to be the bilateral knee flexion contractures and unilateral hip adduction contracture frequently found in the severely paralysed MS patient. It was postulated that release of contracture would ease the care load and management. Comfort and quality of life would improve as a result. Surgery to release the bilateral knee flexion contracture was combined with passive stretching to associated contractures in an attempt to improve the physical condition. A routine regimen of maintenance was introduced postoperatively and continued indefinitely. A comparison of postoperative method to increase range using continuous passive motion (CPM) and plaster of Paris (POP) serial splinting was carried out. The results of the six reported cases show a markedly increased range of movement at the knee, a reduction in care load and an improved sitting posture postoperatively which was maintained when reassessed at nine months. Little difference between the postoperative regimens of CPM and POP fixation was found.