Abstract
Traumatic injuries to the knee are frequently complicated by extension contractures. The Judet Quadricepsplasty allows for controlled, sequential release of extrinsic and intrinsic knee contracture components while reducing the potential for iatrogenic quadriceps rupture. We document our institutions experience with this procedure and a systematic review of the current literature. We followed up on an elderly patient with posttraumatic flexion contracture that failed conservative management and underwent Judet Quadricepsplasty. Her knee range of motion improve dramatically from 20 degrees of flexion to 100 degrees of flexion. There was a residual extension lag of 5 degrees which did not impede on the patients daily activities. A review of the literature was performed and relevant data from 12 articles was extracted. The procedure was mainly performed in young adult males in most previous studies and the range of motion improvement ranged from 51° to 110°. Wound infections were the most common complication but otherwise other complications and severe extension lag were rare. The Judet Quadricepsplasty is a useful procedure for severe extension knee contractures that has failed conservative management in all age groups of patients. It is associated with significant increases in range of motion with low rates of complication or extension lag.Diagnostic IV
Highlights
Knee extension contractures are a common complication of severe trauma to the knee, in the supracondylar region
We performed a literature search of three databases, PubMed, Scopus and Web of Science, using the keywords, “quadricepsplasty”, “Judet Quadricepsplasty” which were subsequently matched with search terms “knee contracture”, “extension contracture”
Inclusion criteria included: (1) Randomized-controlled trials, longitudinal cohort and retrospective studies, (2) Assessment of surgical outcomes of Judet Quadricepsplasty in patients with knee contractures, (3) Full-text availability, (4) Manuscript written in English Language
Summary
Knee extension contractures are a common complication of severe trauma to the knee, in the supracondylar region. Thompson[2] and Judet[3] techniques of quadricepsplasty and their modifications have been described to correct recalcitrant cases of knee extension contractures. Thompson quadricepsplasty in adults has been shown to cause significant knee extension lag when quadriceps tendon lengthening is performed. Judet’s quadricepsplasty has been shown to have better outcomes and reduced occurrence of extensor lag as it allows for a controlled, sequential release of contracted components and a proximally based quadriceps muscle slide. Our study showcases this technique’s utility for elderly traumatic extension contractures and performs a systematic review of the literature. The authors had obtained the patient’s informed written consent for print and electronic publication of the case report and institutional review board approval was obtained for the purpose of the study
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