[Arthrolysis for chronic flexion deficits of the knee. An overview of indications and techniques of vastus intermedius muscle resection, transposition of the tibial tuberosity and z-plasty of the patellar tendon].
OBJECTIVE
Limitations to the range of motion of the knee reduce knee function and life quality. Flexion deficits inhibit using stairs and shoe closure, and may cause social deprivation. We present a pathophysiological concept of arthrolysis of the knee for flexion deficit. Our concept divides into intra- and extra-articular factors involving knee stiffness. Extra-articular problems can be located proximally in the quadriceps mechanism and distally in the patellar tendon.


RESULTS
The main proximal factor is fibrosis of the vastus intermedius muscle (MVI) which is treated by MVI-resection; the main distal factor is shortening of the patellar tendon which is treated by z-plasty of the this tendon or transposition of the tibial tuberosity. Intra-articular factors are adhesions and fat pad fibrosis. These conditions can be treated by arthroscopic or limited open arthrolysis and eventually z-plasty of the retinacula.


CONCLUSIONS
A strict postoperative protocol is obligatory for pain control and physiotherapy. In 19 cases treated with this algorithm there was a mean flexion gain of 26 degrees. The AOSSM subjective outcome score was excellent in ten and good in seven cases after a mean follow-up of 8.2 months. This treatment protocol allows improvement in flexion, even in difficult revision cases.
Freiling
D
D
Klinik für Unfall- und Wiederherstellungschirurgie, Henriettenstiftung, Hannover.
Galla
M
M
Lobenhoffer
P
P
D000844:Ankylosis / Q000601:surgery*; D001178:Arthroplasty / Q000379:methods*; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D018482:Muscle, Skeletal / Q000601:surgery*; D010027:Osteotomy / Q000379:methods; D017847:Patellar Ligament / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome