Background: Studies concerning adult patients with spastic flexion
contracture of the knee are rare. Such patients frequently have cutaneous and
vascular complications as well as recurrence of the contracture after
treatment. We present a strategy consisting of simultaneous correction of all
deformities of both lower limbs, distal hamstring releases, and application of
femorotibial external fixation when extension of the knee is limited by
excessive posterior soft-tissue tension.
Methods: A consecutive series of fifty-nine patients (ninety-seven
knees) between the ages of twenty-one and seventy-seven years received
surgical treatment for a flexion contracture of the knee secondary to
neurological impairment. The flexion contracture was bilateral in thirty-eight
patients. Preoperatively, the mean flexion contracture angle was 69° and
the mean passive range of motion was 61°. The contracture was corrected,
through medial and lateral approaches, with distal hamstring lengthening. A
posterior capsulotomy was performed in thirty-five knees. Full extension of
thirty-four knees was achieved intraoperatively. In seventy-seven knees,
partial correction was maintained with a unilateral external fixator, and
passive and active mobilization was performed four times daily after temporary
removal of the spanning external fixator rod.
Results: At the time of final follow-up, ranging from one to five
years postoperatively, the mean residual flexion contracture was 6.2°.
Forty-five knees had complete extension, and thirty-nine knees had a residual
flexion contracture of <10°. No recurrence of the flexion contracture
or instability was noted in any knee at the time of follow-up. There were four
cutaneous complications but no vascular or neurological complications.
Conclusions: We believe that our surgical strategy for correction of
fixed knee flexion contracture in adult patients is safe and effective. The
correction improves nursing care and sitting posture, facilitating the upright
position of patients who are unable to walk, and improves walking ability for
patients who are able to walk.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.