Thompson Quadricepsplasty Research Articles

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

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. 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. 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. 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 IV. See Instructions for Authors for a complete description of levels of evidence.

Judet's quadricepsplasty after total hip arthroplasty and Thompson's quadricepsplasty: A case report

Judet quadricepsplasty provides a gradual release of knee extension contracture occurring due to intrinsic and extrinsic reasons. We herein present a 68-year-old male patient with a fragmented right femur AO (arbeitsgemeinschaft für osteosynthesefragen) Type A3 fracture, which occurred because of an in-vehicle traffic accident 30 years ago. The fracture was fixed with an anterior plate-screw with open reduction, and knee extension contracture had developed after the operation. The distinctive features of this case include a previous, unsuccessful, ipsilateral V-Y quadricepsplasty, an ipsilateral total hip arthroplasty with anterior approach six months ago and a persistent extension contracture for over 30 years. Gradual releasing techniques, as described by Judet, were performed under general anesthesia and sterile conditions with the patient in supine position. Intraoperatively, two displaced screws were detected on the anterior femur, which had adhered to the vastus medialis muscle, and fibrosed. Adhesions were dissected and screws were removed. Before the release of the proximal adhesion of the rectus muscle, a forced external rotation of hip joint was performed to assure that adequate fibrotic tissue had formed on the anterior facet of the joint capsule to prevent anterior instability. Five recurrent knee joint effusions developed after surgery, which were aspirated by needle. Joint fluids were clear and there were no reproductions of any microorganisms. By the end of an uneventful, two-year follow-up period, final knee range of motion was 0-90 degrees. Loss of extension and extensor muscle power had entirely improved by 6 months. In a patient with hip prosthesis, provided that adequate fibrosis has formed on the anterior facet of the joint capsule, rectus release may not cause instability. In cases resistant to rehabilitation, if there is implant, fibrosis or hypertrophic callus which may cause irritation at any level of the knee extensor mechanism, we suggest their resection for a more even anterior cortex contour.

Excellent outcome with modified thompson quadricepsplasty for knee extension contracture: Case report and review of the literature

The daily life routine activities require a good range of knee motion, losing that after femur fracture is a common problem that can be triggered by extension contracture, flexion contracture, or combined contractures. This case report is about a 19-year-old male with unremarkable medical history who suffered from extension contracture with no flexion following a wrongly applied plate for distal femur fracture, which was treated successfully surgically by modified Thompson's quadricepsplasty after 21 months from the initial injury. The final outcome was no extension lag and 120° active flection. The aim of reporting this case was to increase the awareness about the modified Thompson's quadricepsplasty, which is an excellent solution to the debilitating extension contracture complication and present a review of the literature of this procedure. The aim of the literature review is to evaluate the correlation and the influence of the patient's age, the interval to quadricepsplasty after the initial trauma, preoperative knee range of motion, surgical approach, and the postoperative care on the outcome of Thompson's quadricepsplasty and its modifications for the treatment of posttraumatic knee contractures besides that, to answer the question: Is Thompson's quadricepsplasty an excellent procedure to treat knee extension contracture?

Editorial review on: Excellent outcome with modified thompson quadricepsplasty for knee extension contracture: Case report and review of the literature

Editorial review on: Excellent outcome with modified thompson quadricepsplasty for knee extension contracture: Case report and review of the literature

Prognostic Factors Affecting the Results of Modified Thompson Quadricepsplasty for the Treatment of Extension Contracture of the Knee.

Knee extension contracture is a disabling complication after fractures around the knee. In this study we aimed to study factors influencing the outcomes of quadricepsplasty for the treatment of traumatic knee extension contracture. We hypothesized that there is no factor influencing the final range of knee motion. In this retrospective study, we included 64 patients who underwent modified Thompson quadricepsplasty between 2008 to 2011 with a mean follow-up time of 36 months. The mean change in flexion was 66 degrees. Using Judet criteria, results were excellent in 41 patients (64%), good in 15 (23%), fair in 4 (6%) and poor in 4 (6%). Preoperative arc of flexion, duration of extension contracture, number of previous surgeries on the limb, and BMI of the patients were independently influencing the final flexion. Modified Thompson quadricepsplasty is associated with high number of excellent and good results especially when it is performed earlier in more severe contractures. Preoperative arc of flexion, interval between trauma surgery and quadricepsplasty, the number of prior surgeries, and BMI influence the outcomes of quadricepsplasty.

Evaluation of Thompson's quadricepsplasty results in patients with knee stiffness resulted from femoral fracture

Background:Posttraumatic and/or postsurgical knee stiffness is one of the orthopedic complications which is difficult to be treated and can affect individual's life negatively. The aim of this study is to investigate the results of quadricepsplasty in patients with knee stiffness resulted from femoral fracture.Materials and Methods:This is a cross-sectional study on all patients with femoral fracture which has caused knee flexion limitation referred to Kashani and Al-Zahra Hospitals in Isfahan from January 2010 to March 2013. The type and site of fracture, joint extension, and fracture fixation technique were recorded. Moreover, the range of motion (ROM) before surgery, under general anesthesia, and 3- and 6-month postoperation were measured.Results:Among the patients, 13 had a simple fracture (48%) and 14 had a segmental fracture (51.9%). Considering the fracture site, 11, 10, and 6 patients had femoral (40.74%), supracondylar (37.3%), and femoral supracondylar (22.2%) fractures, respectively. The fracture fixation was performed by the plate, external, and Wagner fixation techniques for 24 (88.9%), 2 (7.4%), and 1 (3.7%) patients, respectively. The mean ROM before operation, under general anesthesia, and 3- and 6-month postoperation were determined to be 33.15° ± 24.73°, 122.60° ± 10.22°, 99.63° ± 16.52°, and 100.74° ± 15.67°, respectively. The mean ROM value at various stages was not similar (P < 0.001). The mean changes in the ROM were 79.2° ± 24.6° and 62.1° ± 19.7° in the cases with simple and segmental fractures, respectively. The mean changes in the knee ROM were significantly higher in simple fractures in comparison with the segmental femoral fracture (P = 0.03).Conclusion:We found Thompson's quadricepsplasty may successfully increase the range of knee flexion in knee fracture and also regardless of quadriceps time.

Modified Judet Quadricepsplasty and Ilizarov Frame Application for Stiff Knee After Femur Fractures

Limited knee range of motion caused by posttraumatic arthrofibrosis after periarticular fracture remains a challenging problem. Traditionally, Judet or Thompson quadricepsplasty has been performed for severe stiff knee after distal femoral fracture. However, these procedures have a high rate of complications such as skin necrosis, wound dehiscence, and extension lag caused by long incisions and extensive surgery. The present study reports on a novel method that combines modified quadricepsplasty and the Ilizarov frame for management of severe stiff knee after metadiaphyseal fracture around the knee joints. This technique was applied in 10 patients over a 7-year period by one surgeon. The treatment resulted in improved knee range of motion without rebound phenomenon, which is a frequent problem when using either the Ilizarov frame or quadricepsplasty alone.

A Modified Thompson Quadricepsplasty for Extension Contracture Resulting From Femoral and Periarticular Knee Fractures

The lack of knee flexion is an increasingly recognized complication of femoral and periarticular knee fractures. This is a significant challenge for both surgeon and patients. This article reports the clinical outcomes of 40 knees in 40 patients who underwent a modified Thompson quadricepsplasty. They were 36 men and 4 women. We performed a modified Thompson quadricepsplasty for all patients without excision of vastus intermedius even in scarred cases. The definitive flexion gain was classified recording to Judet criteria; excellent defined as >100 degrees, good when >80 degrees and <99 degrees, fair when >50 degrees and <79 degrees, and poor when <50 degrees. Patients were operated on average 6.9 months +/- 3.6 months (range, 4-24 months) after first initial surgery. Average follow-up was 17.5 months (range, 12-24 months). According to Judet criteria, 9 patients (22.5%) achieved excellent, 27 patients (67.5%) good, 2 patients (5%) fair, and 2 patients (5%) poor. Final average flexion arc improvement was 65 degrees +/- 25.99 degrees with a range between 5 degrees and 100 degrees. Our complications included two cases (5%) of superficial infection and one case (2.5%) with patellar fracture. In patients who had preoperative extension lag, we did not achieve a significant improvement of the extension lag (p = 0.062). Modified Thompson quadricepsplasty is a promising procedure with satisfactory results. It provides significantly results if it is performed earlier and in more severe extension contracture.

Prognostic Factors of Modified Thompson Quadricepsplasty for the Stiff Knee

Purpose: This study evaluated the prognostic factors of modified Thompson quadricepsplasty for a stiff knee. Materials and Methods: From February 1987 to February 2007, 38 knees of 38 patients were managed with modified Thompson quadricepsplasty for a stiff knee. Thirty three males and 5 females were enrolled with a mean age of 36 years. The average follow-up duration was 92 months (range, 18 to 133 months). The most common cause of the stiff knee was a fracture around the knee in 33 cases. Multivariate logistic regression analysis was performed to evaluate the prognostic factors. Results: Multivariate analysis showed that the gain of ROM after surgery was negatively correlated with the ROM before surgery (p＜0.0001), and flexion contracture at the last follow up was positively correlated with the initial flexion contracture (p＜0.0001). Conclusion: In a stiff knee, modified Thompson quadricepsplasty should be considered as soon as possible if the patient cannot gain an acceptable ROM through conservative management. More improvement in the ROM can be obtained in those with a more severe limitation of motion.

Thompson's quadricepsplasty for stiff knee

Background:Stiffness of the knee after trauma and/or surgery for femoral fractures is one of the most common complications and is difficult to treat. Stiffness in extension is more common and can be reduced by vigorous physiotherapy. If it does not improve then quadricepsplasty is indicated. The present study was undertaken to evaluate the results of Thompsons quadricepsplasty.Materials and Methods:Twenty-two male patients (age range 20-45 years) with posttraumatic knee stiffness following distal femoral fractures underwent Thompson's quadricepsplasty where knee flexion range was less than 45°. The index injury in these patients was treated with plaster cast (n=5), plates (n=3), intramedullary nailing (n=3) and external fixator for open fractures (n=9). Thompson's quadricepsplasty was performed in all the patients using anterior approach, with incision extending from the upper thigh to the tibial tubercle. Release of rectus femoris from underlying vastus intermedius and release of intraarticular adhesions were performed. After surgery the patients needed parenteral analgesia for three days and then oral analgesics for three weeks. Active assisted knee mobilization exercises was started on the first postoperative day. Continuous passive motion machine was used from the same day. Supervised physiotherapy was continued in hospital for six weeks followed by intensive knee flexion and extension exercise including cycling at home for atleast another six months.Results:Out of 22 patients, 20 had excellent to good results and two patients had poor results using criteria devised by Judet. One poor result was due to peroperative fracture of patella which was then internally fixed and hence the flexion of knee could not be started immediately. There was peroperative avulsion of tibial tuberosity in another patient who finally gained less than 50° knee flexion and hence a poor result.Conclusion:Thompsons quadricepsplasty followed by a strict and rigourous postoperative physiotherapy protocol successfully increases the range of knee flexion.

Judet quadricepsplasty for extension contracture of the knee

Extension contracture of the knee is a well known complication of severe femoral fractures, especially in the supracondylar region. Traditional management by the Thompson quadricepsplasty may result in a variable return of knee flexion and the possibility of significant extension lag. The Judet technique of quadricepsplasty offers the advantages of a controlled, sequential release of the intrinsic and then the extrinsic components limiting knee flexion and a reduced potential for iatrogenic quadriceps rupture or extension lag. The modified Judet quadricepsplasty has definite advantages over the Judet technique since it usually involves less soft tissue dissection and consequently less blood loss.

Thompson Quadricepsplasty in Ankylosis of the Knee Joint

Thompson Quadricepsplasty in Ankylosis of the Knee Joint

A modified Thompson quadricepsplasty for the stiff knee.

Between March 1987 and March 1997, we performed a modified Thompson quadricepsplasty on 20 stiff knees and followed the patients for a mean of 35 months (24 to 52). After the operation, the knee was immobilised in flexion and periodically extended. At the final follow-up, the mean active flexion was 113.5 degrees (75 to 150). The final mean gain in movement was 67.6 degrees (5 to 105). One patient had a deep infection which resolved after wound care and intravenous antibiotics. The modified Thompson quadricepsplasty with appropriate postoperative care can give good results.

A modified Thompson quadricepsplasty for the stiff knee

Between March 1987 and March 1997, we performed a modified Thompson quadricepsplasty on 20 stiff knees and followed the patients for a mean of 35 months (24 to 52). After the operation, the knee was immobilised in flexion and periodically extended. At the final follow-up, the mean active flexion was 113.5° (75 to 150). The final mean gain in movement was 67.6° (5 to 105). One patient had a deep infection which resolved after wound care and intravenous antibiotics. The modified Thompson quadricepsplasty with appropriate postoperative care can give good results.

The Judet Quadricepsplasty for Management of Severe Posttraumatic Extension Contracture of the Knee

Extension contracture of the knee is an increasingly recognized complication of severe femur fracture. Traditional management by Thompson quadricepsplasty may result in a variable return of knee flexion and the possibility of significant extension lag. The Judet technique of quadricepsplasty offers the advantages of a controlled, sequential release of the components limiting knee flexion and a reduced potential for iatrogenic quadriceps rupture or extension lag. Judet quadricepsplasty corrected severe bilateral extension contractures with excellent results at 17 months postoperatively in a 29-year-old man.

A Follow-up Study of Quadricepsplasty for the Stiff Knees

Since 1976, the Knee mobilization procedures have been performed upon 12 cases of stiff knees due to fractures of the femur and patella. Operative method was Thompson's quadricepsplasty or Kono's method. The average of flexion of the stiff Knees was 52 degrees pre-operatively, and 97 degrees post-operatively, so that the range of 45 degrees was obtained. The best improvement of flexion of the stiff knees was obtained by six weeks post-operatively suggesting importance of early physiotherapy. The post-operative follow-up examination showed that only two patients were able to squat and sit in Japanese style, but almost all patients were satisfied with improvement of the activity of daily living.

A Follow-up Study of Quadriceps Contracture

This study is based on the analysis of the results of 21 operated quadriceps contractures from 1954 to 1975.There were 13 proximal tenotomies of rectus tendon, 2 excisions of the scar in the muscle, 1 Thompson's quadriceps plasty, and 5 proximal tenotomies of rectus tendon with tendon transfer.The results of proximal tenotomy tends to the recurrence, but the results of proximal tenotomy with tendon transfer are satisfactory.

Quadricepsplasty

Seven patients were treated by the Thompson quadricepsplasty with marked improvement in knee-flexion. This procedure has much to offer active patients who are prepared to co-operate in the after-treatment.

EXPERIENCES WITH THE THOMPSON QUADRICEPSPLASTY

Ten cases of Thompson's quadricepsplasty for stiffness of the knee after thigh injuries are discussed, with particular reference to points in the operation and after-treatment.