Limited quadricepsplasty for contracture during femoral lengthening.
Extension contracture of the knee is a common complication of femoral lengthening. Knee flexion exercises to stretch the contracture with physical therapy can be effective but take a prolonged amount of time to work and place increased stress across the patellofemoral joint. We developed a minimal-incision limited quadricepsplasty surgical technique to treat knee extension contracture secondary to femoral lengthening and retrospectively reviewed 16 patients treated with this procedure. The mean age of the patients was 23 years. Range of motion of the knee and quadriceps strength were recorded preoperatively, after femur lengthening but before additional surgery, after quadricepsplasty, and at each followup. The mean femoral lengthening performed was 4.4 cm. We compared range of motion and time to regain knee flexion with those of historical controls. The minimum followup after quadricepsplasty was 6 months (mean, 38 months; range, 6-84 months). The mean range of motion was 129 degrees preoperatively, 29 degrees after the distraction phase of femoral lengthening, and 108 degrees after limited quadricepsplasty, and at final followup, the mean knee flexion was 125 degrees . There were no major complications. Limited quadricepsplasty improved knee flexion after a knee extension contracture developed secondary to femoral lengthening. In comparison to historical controls who did not have quadricepsplasty, the patients with limited quadricepsplasty had quicker return of knee flexion, although there was no difference in knee flexion achieved ultimately.


METHODS
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Khakharia
Saurabh
S
Institute for Limb Lengthening and Reconstruction, Limb Lengthening and Deformity Service, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY, 10021, USA.
Fragomen
Austin T
AT
Rozbruch
S Robert
SR
D000293:Adolescent; D000328:Adult; D001852:Bone Lengthening / Q000009:adverse effects* / Q000379:methods; D016022:Case-Control Studies; D002648:Child; D003286:Contracture / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005269:Femur / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D007870:Leg Length Inequality / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology; D011336:Probability; D052097:Quadriceps Muscle / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome