Treatment of fixed knee flexion deformity by anterior distal femoral stapling.
OBJECTIVE
The treatment of fixed knee flexion deformity through anterior distal femoral stapling has been investigated in only two studies so far, with promising results. The aim of the present study was to determine whether this technique might improve fixed knee flexion deformity in a series of growing children and adolescents with different conditions. Follow-up examinations were continued after staple removal in terms of a possible impairment of this deformity.


METHODS
We reviewed the medical records of all patients with fixed knee flexion deformity who had been treated by anterior distal femoral stapling at our institution. Twenty patients (37 knees) with a mean age of 12.7 years met the inclusion criteria (>12 months of follow-up; no additional procedures to correct fixed knee flexion deformity such as hamstring lengthening or posterior capsulotomy) and were evaluated in this study.


RESULTS
The mean fixed knee flexion deformity significantly improved from 21.4° (SD = 11.6) preoperatively to 7.0° (SD = 9.8) after a mean follow-up of 35.3 months. Young patients (<12 years) revealed superior improvement of this deformity, and especially children with distinct fixed knee flexion deformity of 30° or greater had benefit from early treatment. Impairment of flexion deformity was only seen in one patient (2 knees) after staple removal.


CONCLUSIONS
Our results demonstrate that anterior distal femoral stapling is an effective method for the treatment of fixed knee flexion deformity in growing children and adolescents. Rare complications, immediate mobilization, and a low recurrence rate after staple removal provide obvious advantages of this minimally invasive procedure.


METHODS
Retrospective therapeutic study, Level IV.
Department of Trauma-, Hand-, and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. aspiro@uke.uni-hamburg.de
Alexander S
AS
Spiro
Peggy
P
Stenger
Michael
M
Hoffmann
Eik
E
Vettorazzi
Kornelia
K
Babin
Sandra
S
Lipovac
Jan Philipp
JP
Kolb
Alexander
A
Novo de Oliveira
Johannes M
JM
Rueger
Ralf
R
Stuecker
D000293:Adolescent; D002648:Child; D005260:Female; D005269:Femur / Q000002:abnormalities* / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000002:abnormalities* / Q000601:surgery*; D008297:Male; D019637:Orthopedic Procedures; D017792:Surgical Stapling / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult