Treatment Of Flexion Contracture Research Articles

Surgical Treatment for Patients with Post-traumatic Flexion Contracture of Proximal Interphalangeal Joint: Analysis of Various Affecting Factors.

Background: A flexion contracture (FC) of the proximal interphalangeal (PIP) joint can have a profound negative influence on daily activity. The outcomes of surgical release of the PIP joint in literature are based on small sample size studies done several decades ago. The aim of this study is to report the outcomes of surgical treatment for post-traumatic FC of the PIP joint and to identify factors that affect these outcomes. Methods: This single institute retrospective study included patients from 2000 to 2020. We only included patients with post-traumatic FC of the PIP joint. We evaluated the demographic characteristics, cause of FC, surgical approaches and the various procedures conducted. We surveyed postoperative complications. During the study period, we asked about their current symptoms and evaluated their operative outcomes as excellent, good, fair or poor through the phone. Results: The average FC recovery angle was 37.3°. The small finger was the most affected, and the most common cause of FC was a tendon laceration. The volar plate complex release was the most frequently conducted procedure. The FC improvement was positively correlated to the degree of preoperative FC. The more severe preoperative flexion-extension arc was presented, the more FC recovery was achieved after operation. Patients who underwent multiple procedures had a higher degree of preoperative FC, and better correction was achieved with multiple procedures than with a single procedure. The most critical complication was recurrence. Conclusions: We were able to obtain average 37.3° of extension by surgical treatment. The more severe the FC presented before surgery, the greater the need for multiple procedures, however, this resulted in a significant increase in joint extension. Nevertheless, caution should be exercised regarding recurrence and could occur even with an experienced surgeon. Level of Evidence: Level IV (Therapeutic).

Flexion contracture is a risk factor for knee osteoarthritis incidence, progression and earlier arthroplasty: Data from the Osteoarthritis Initiative.

Knee joint osteoarthritis (OA) is often accompanied by flexion contracture (FC), but the impact of FC on important outcomes across the spectrum of OA, such as the incidence, progression and need for total knee arthroplasty (TKA), is not well established. We evaluated whether the presence and/or severity of knee FC were risk factors for worse OA clinical outcomes, radiographic incidence and progression as well as time to TKA. We evaluated longitudinal 9-year data from the Osteoarthritis Initiative (OAI) database for 3 sub-cohorts: at-risk of knee OA (n=3284), radiographically established knee OA (n=1390), and low-risk controls (n=122). We classified knee FC as none, mild, moderate or severe based on knee extension at enrolment. Knee OA outcomes were extracted from the database. FC was present in 32.4% of knees. Participants with FC had increased knee OA incidence with joint space narrowing in the definition (corrected odds ratio 1.31 [95% confidence interval (CI) 1.04-1.64]). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores for pain, stiffness and function were worse with than without FC at nearly all times (p<0.001). Effect estimates were significant for all 3 WOMAC sub-scales comparing FC to no FC (pain: 0.15 [95% CI 0.02-0.28], stiffness: 0.11 [0.05-0.18], function: 0.49 [0.05-0.93]). Individuals with knee FC had higher Kellgren and Lawrence grade (effect size 0.31 [95% CI 0.25-0.37]) and were more likely to undergo TKA (corrected odds ratio 1.37 [95% CI 1.10-1.71]) than those without FC. All outcomes were worse with increasing FC severity. The presence of knee FC at enrolment was a risk factor for radiographic OA incidence including joint space narrowing, worse clinical outcomes, radiographic progression and the need for early TKA. Treatment of knee FC may represent an option across the OA spectrum. Further research is needed to evaluate the pathophysiology, joint structure alterations and longitudinal impact of treating FC in individuals with knee OA.

Treatment of flexion contracture of the knee joint in children with arthrogryposis: A literature review

Knee joint lesions are observed in 58%-90% of patients with arthrogryposis. Majority of these cases involved flexion contracture of the knee. Ambulation is possible with a deficit of knee extension of 15-20°. Currently there is no standardized treatment in global practice, which makes the treatment of this disease extremely challenging. Clinicians must take into account the degree of flexion contracture, segmental level of the spinal cord lesion, and the age of the child when considering treatment options. In this study, national and international literature relating to the clinical profile, classification, and conservative and surgical treatment of this condition were reviewed. The following treatments have been considered for this condition: casts, extensor osteotomy, arthrolysis of the knee, the use of external fixation devices, and hemi-epiphysiodesis. The high probability of relapse for flexion contracture of the knee joint in children with arthrogryposis has been described.

Application of continuous proximal sciatic nerve blockade in the treatment of flexion contractures after primary total knee arthroplasty.

Application of continuous proximal sciatic nerve blockade in the treatment of flexion contractures after primary total knee arthroplasty.

A Clinical Study on Treatment of Flexion Contractures of Knee by Distraction Technique

Flexion contracture of knee is a major disability and very often the patient has to resort to a walking aid for mobility. Many methods have been described to correct the deformity and include exercise, casting, traction, soft tissue release and osteotomies. Deformity correction by gradual distraction of soft tissues has been successfully used in the treatment of congenital talipes equinovarus (CTEV), finger flexion etc. by the application of simple distractor rods. The present study was undertaken to assess the usefulness of this technique in correcting the flexion contracture of knee. This was a prospective study conducted in the Department of orthopedics, Teerthanker Mahaveer Medical College and research centre, after obtaining clearance from the ethics committee. The study included a total of 22 patients out of which 13 were females and 9 were males. The mean age of patients was 19.5 years (range 14–33 years). Four patients had bilateral deformity. Flexion contracture ranged between 40 to 90 degrees with an average preoperative contracture of 70 degrees. Patients who had contractures more than 90 degrees were not included in the study. Diagnosis included post polio residual palsy (19 cases), post burn contracture (2 cases) and rheumatoid arthritis (1 case). In all the cases simple distractor was used whereby two Denham's pin were passed in the distal femur and two in the proximal tibia and distractor rods were applied on both the sides. After achieving correction the distractor was kept in place for another 4–5 weeks. Average fixator time was 15.3 weeks. Patients were followed up for an average of 2.3 years.

Torque Measures of Common Therapies for the Treatment of Flexion Contractures

Efficacy of knee flexion contracture treatment protocols is dependent on the torque applied to the joint, but to date, no published reports have evaluated the torque applied by the available treatment options. The purpose of this study was to measure the torque applied by physical therapists (PTs), home exercises, and mechanical therapy devices. An instrumented test leg recorded peak torque applied by 14 PTs performing knee extension mobilization, 2 home exercises, and 3 types of mechanical therapy (dynamic splint, static progressive stretch, and patient-actuated serial stretch). Physical therapists applied 68.0 N m, patient-actuated serial stretch mechanical therapy applied 53.0 N m, and the other therapies ranged between 4.6 and 12.4 N m. The reported torque values can be used to help improve the efficacy of flexion contracture treatment protocols.

Treatment of flexion contractures following burns in extremities

In order to release and cover defects in burn contractures over joints, several surgical procedures have been proposed. Skin grafting is easy to do, but it requires immobilization, and tends to contract again, different types of flaps without skin grafting are alternatives. These flaps have their specific indications, limitations and some disadvantages such as a bulky, unattractive appearance in donor or recipient sites, partial necrosis, and sometimes patients dissatisfaction. Considering these points, the authors proposed a new technique composed of a Y-V advancement in the middle and two scar releases proximal and distal to the joint which were covered with full thickness skin grafts. This seems to have some advantages in both case of technique and more patients satisfaction. In the current study, the authors presented their results with different methods of treatment, which they performed for burn flexion contractures in limbs. Ninety-one operations were performed in 74 patients, the method of reconstruction included skin grafting in 43 contractures, local flaps in 16, pediculated flaps in 11, and the new combined approach in 21 cases. Width of scar was one of the main factors for selection of choice option. This proposed technique is especially appropriate for scars which cover 10–60% of joint surface area. Advantages of this combined technique are coverage of joint area with a pretty normal skin flap, and enough scar lengthening due to combination of Y-V advancement and skin grafted released areas.

The Knee in Arthrogryposis Multiplex Congenita

Summary: The functional, radiological, and ambulatory status of 30 patients (58 knees) with arthrogryposis multiplex congenita (AMC) were analyzed after a follow-up of 1-36 years. The muscular imbalance presented in many of these patients corresponded well to the type of deformity. The primary treatment was nonoperative in most cases. In spite of the initial promising results, a significant number of patients underwent operation for residual symptoms. Treatment of flexion contractures seems to be more discouraging than the treatment of extension contractures. On the other hand, the risk for degenerative arthritis seemed to be elevated, especially in the extension-contracture group.

The Knee in Arthrogryposis Multiplex Congenita

The functional, radiological, and ambulatory status of 30 patients (58 knees) with arthrogryposis multiplex congenita (AMC) were analyzed after a follow-up of 1-36 years. The muscular imbalance presented in many of these patients corresponded well to the type of deformity. The primary treatment was nonoperative in most cases. In spite of the initial promising results, a significant number of patients underwent operation for residual symptoms. Treatment of flexion contractures seems to be more discouraging than the treatment of extension contractures. On the other hand, the risk for degenerative arthritis seemed to be elevated, especially in the extension-contracture group.

Treatment of flexion contractures and ankylosis of the knee joint with a distraction-contraction device

Insufficient effectiveness of the generally accepted conservative methods for eliminating persistent flexion contractures of the knee joint makes it necessary to switch from one method to another in the course of treatment up to the use of operations associated with bone resection.