Knee Flexion Contractures: Soft Tissue Correction With Monolateral External Fixation

James F. Mooney III, MD, L. Andrew Koman, MD, Winston-Salem, NC

J South Orthop Assoc. 2001;10(1) 

In This Article

Abstract and Introduction

We assessed the efficacy of progressive soft tissue distraction using monolateral external fixation in the management of severe knee flexion contractures. We prospectively evaluated 10 knee deformities in seven pediatric patients. After gradual distraction using the modified Orthofix Limb Reconstruction System (LRS), most recent functional status and knee range of motion were determined. This treatment was applied to 10 extremities in seven patients, ranging in age from 2 to 16 years. Diagnoses included arthrogryposis (4), sickle cell disease (1), previous sepsis (1), and congenital pterygium (1). Average preoperative flexion contracture was 80.5°. Each patient achieved full extension. There was one recurrence, despite bracing, which was managed with replacement of the fixator and soft tissue procedures. Management of knee flexion contractures using a monolateral fixator appears to be a viable alternative to extensive release or femoral osteotomy. Long-term follow-up will be essential to assess the overall risk of recurrence and complications.

Severe flexion contracture involving the knee is a major impediment to functional weight-bearing and ambulation. Such contractures are particularly common in pediatric patients in conjunction with arthrogryposis, but may be seen in congenital pterygium syndrome, sickle cell disease, sacral agenesis, and multiple other congenital and acquired conditions. Management of these deformities is extremely problematic.[1,2,3,4] The use of gradual correction with circular external fixation has been reported, and use of monolateral fixators has been mentioned briefly.[2,3] The purpose of this report is to review the use of an adaptation of the Orthofix LRS for the gradual correction of severe knee flexion contractures that limit patient function.

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