title: [Treatment of extension contracture of the knee by quadriceps plasty (Judet procedure)].
abstract: OBJECTIVE
  Knee flexion is increased by detachment of contracted quadriceps muscle from the pelvis and femur in combination with arthrolysis of the knee.
  
  
  METHODS
  Flexion contracture of the knee caused by extraarticular changes of quadriceps muscle (fibrosis, soft-tissue damage, infection, fracture). Failed intraarticular arthrolysis. Intraarticular treatment insufficient.
  
  
  METHODS
  Isolated intraarticular fibrosis of the knee. Infection of the knee or the soft tissues. Soft tissue defects in the area of the incision. Noncompliance of patient. Neurologic reasons for flexion contracture.
  
  
  METHODS
  Medial arthrotomy. Arthrolysis and resection of adhesions in the superior recess and lateral gutters. Incision of retinaculae preparing a lengthening. The vastus medialis muscle is dissected from the intermuscular septum from distal to proximal. The proximal third of the muscle is spared. The incision is now extended proximally and laterally. The vastus lateralis muscle is released from the intermuscular septum from distal to proximal. The insertion of vastus lateralis muscle is detached at the proximal femur. The conjoint tendons of rectus femoris muscle are released at the anterior inferior iliac spine. The knee is gradually flexed, residual adhesions are addressed. The proximal part of the vastus medialis has to be preserved since it covers the neurovascular supply of the quadriceps muscle. The knee is closed in flexion. The retinaculae are adapted as far as possible. Soft tissues and skin are closed in layers.
  
  
  METHODS
  The patient in placed on a continuous passive motion device for 7 days under peridural anesthesia. Partial weight bearing with crutches is advised for 6 weeks, quadriceps training is started early to treat the active extension deficit.
  
  
  RESULTS
  Our results reveal that operative treatment of complex flexion deficits lead to objective and subjective improvements. After 8.2 months, 17 of 19 patients had a mean gain of flexion of 26°. Subjectively 10 patients were highly satisfied and 7 were satisfied after operative treatment.
authors.affiliation: Sportsclinic Germany, Uhlemeyerstr. 16, 30175, Hannover, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Holschen
authors.forename: P
authors.initials: P
authors.lastname: Lobenhoffer
mesh_terms: D000328:Adult; D001178:Arthroplasty / Q000379:methods* / Q000534:rehabilitation*; D003131:Combined Modality Therapy; D003286:Contracture / Q000473:pathology / Q000601:surgery*; D004210:Dissection / Q000379:methods*; D005260:Female; D006801:Humans; D057913:Joint Capsule Release / Q000379:methods* / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
references.citation: Unfallchirurg. 2013 May;116(5):394-403
references.pmid: 23681486
references.citation: J Trauma Acute Care Surg. 2012 Feb;72(2):E77-80
references.pmid: 22439238
references.citation: Unfallchirurg. 2006 Apr;109(4):285-96
references.pmid: 16391934
references.citation: J Biomech. 1995 Nov;28(11):1265-79
references.pmid: 8522541
references.citation: J Biomech Eng. 2013 Aug;135(8):81002
references.pmid: 23719832
references.citation: Orthopedics. 1992 Sep;15(9):1081-5
references.pmid: 1437870
references.citation: J Surg Orthop Adv. 2013 Spring;22(1):36-41
references.pmid: 23449053
references.citation: J Bone Joint Surg Br. 2010 Feb;92(2):217-21
references.pmid: 20130311
references.citation: J Trauma. 2006 Aug;61(2):358-62
references.pmid: 16917451
references.citation: Clin Orthop Relat Res. 2003 Oct;(415):214-20
references.pmid: 14612648
references.citation: J Orthop Trauma. 2010 Nov;24(11):709-15
references.pmid: 20881636
references.citation: Mem Acad Chir (Paris). 1956 Nov 14-21;82(29-30):944-7
references.pmid: 13386942
references.citation: Knee. 2006 Aug;13(4):280-3
references.pmid: 16632365
references.citation: J Bone Joint Surg Br. 2000 Sep;82(7):992-5
references.pmid: 11041587
references.citation: Oper Orthop Traumatol. 2009 Dec;21(6):545-56
references.pmid: 20087716