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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 pr...

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Autores principales: Kundu, ZS, Sangwan, SS, Guliani, G, Siwach, RC, Kamboj, P, Singh, Raj
Formato: Texto
Lenguaje:English
Publicado: Medknow Publications 2007
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989525/
https://www.ncbi.nlm.nih.gov/pubmed/21139797
http://dx.doi.org/10.4103/0019-5413.37004
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author Kundu, ZS
Sangwan, SS
Guliani, G
Siwach, RC
Kamboj, P
Singh, Raj
author_facet Kundu, ZS
Sangwan, SS
Guliani, G
Siwach, RC
Kamboj, P
Singh, Raj
author_sort Kundu, ZS
collection PubMed
description 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.
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spelling pubmed-29895252010-12-07 Thompson's quadricepsplasty for stiff knee Kundu, ZS Sangwan, SS Guliani, G Siwach, RC Kamboj, P Singh, Raj Indian J Orthop Original Article 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. Medknow Publications 2007 /pmc/articles/PMC2989525/ /pubmed/21139797 http://dx.doi.org/10.4103/0019-5413.37004 Text en © Indian Journal of Orthopaedics http://creativecommons.org/licenses/by/2.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Kundu, ZS
Sangwan, SS
Guliani, G
Siwach, RC
Kamboj, P
Singh, Raj
Thompson's quadricepsplasty for stiff knee
title Thompson's quadricepsplasty for stiff knee
title_full Thompson's quadricepsplasty for stiff knee
title_fullStr Thompson's quadricepsplasty for stiff knee
title_full_unstemmed Thompson's quadricepsplasty for stiff knee
title_short Thompson's quadricepsplasty for stiff knee
title_sort thompson's quadricepsplasty for stiff knee
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989525/
https://www.ncbi.nlm.nih.gov/pubmed/21139797
http://dx.doi.org/10.4103/0019-5413.37004
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