TR
EN
Knee capsulotomy for fixed knee flexion contracture
Abstract
Objectives: This study aimed to assess the results of knee capsulotomy for correcting fixed knee flexion contracture in children with cerebral palsy (CP).
Methods: Thirty-five children (20 boys, 15 girls; mean age 13.5±2.5 years) with CP underwent posterior knee capsulotomy for 59 knees. Eleven patients had diplegia, one patient had hemiplegia, and 23 patients had quadriplegia. There were two community ambulators (3 knees), 19 household ambulators (33 knees), and 14 nonambulators (23 knees). Posterior knee capsulotomy was combined with hamstring lengthening (50 knees, 84.8%), rectus femoris transfer (10 knees, 17%), Achilles tendon lengthening (12 knees, 20.3%), and posterior cruciate ligament release (eight knees, 13.6%). The mean follow-up was 3.5±1.7 years.
Results: Fixed knee flexion contracture significantly improved from 26.5±15.4 degrees to 17.0±15.5 degrees after posterior knee capsulotomy (p<0.0001). The mean improvement was 9.5 degrees. Popliteal angle significantly improved from 70.6±18.7 degrees to 48.2±19.9 degrees (p<0.0001). Ankle dorsiflexion did not differ significantly. At the end of follow-up, 38 knees (64.4%) had improved knee flexion contracture and 21 knees (35.6%) had recurrent flexion contracture (failure). Age and male gender were significantly associated with failure rate (adjusted odds ratio 0.78, 95% CI: 0.62-0.99 and 12.1, 95% CI: 2.37-61.7, respectively). Complications included transient sciatic nerve palsy in seven knees (11.9%), and wound dehiscence in two knees (3.4%). Revision was required in two knees (3.4%), and posterolateral corner reconstruction in one knee (1.7%).
Conclusion: Posterior knee capsulotomy is another option for the treatment of knee contracture in CP, resulting in a significant decrease in knee contracture with acceptable complications. However, failure rate is higher in boys, patients who are marginal ambulators, and in younger age group.
Methods: Thirty-five children (20 boys, 15 girls; mean age 13.5±2.5 years) with CP underwent posterior knee capsulotomy for 59 knees. Eleven patients had diplegia, one patient had hemiplegia, and 23 patients had quadriplegia. There were two community ambulators (3 knees), 19 household ambulators (33 knees), and 14 nonambulators (23 knees). Posterior knee capsulotomy was combined with hamstring lengthening (50 knees, 84.8%), rectus femoris transfer (10 knees, 17%), Achilles tendon lengthening (12 knees, 20.3%), and posterior cruciate ligament release (eight knees, 13.6%). The mean follow-up was 3.5±1.7 years.
Results: Fixed knee flexion contracture significantly improved from 26.5±15.4 degrees to 17.0±15.5 degrees after posterior knee capsulotomy (p<0.0001). The mean improvement was 9.5 degrees. Popliteal angle significantly improved from 70.6±18.7 degrees to 48.2±19.9 degrees (p<0.0001). Ankle dorsiflexion did not differ significantly. At the end of follow-up, 38 knees (64.4%) had improved knee flexion contracture and 21 knees (35.6%) had recurrent flexion contracture (failure). Age and male gender were significantly associated with failure rate (adjusted odds ratio 0.78, 95% CI: 0.62-0.99 and 12.1, 95% CI: 2.37-61.7, respectively). Complications included transient sciatic nerve palsy in seven knees (11.9%), and wound dehiscence in two knees (3.4%). Revision was required in two knees (3.4%), and posterolateral corner reconstruction in one knee (1.7%).
Conclusion: Posterior knee capsulotomy is another option for the treatment of knee contracture in CP, resulting in a significant decrease in knee contracture with acceptable complications. However, failure rate is higher in boys, patients who are marginal ambulators, and in younger age group.
Keywords
Details
Primary Language
English
Subjects
Health Care Administration
Journal Section
Research Article
Publication Date
May 13, 2009
Submission Date
March 7, 2014
Acceptance Date
-
Published in Issue
Year 2009 Volume: 43 Number: 2
APA
Woratanarat, P., Dabney, K., & Miller, F. (2009). Knee capsulotomy for fixed knee flexion contracture. Acta Orthopaedica et Traumatologica Turcica, 43(2), 121-127. https://izlik.org/JA42CN87ZC
AMA
1.Woratanarat P, Dabney K, Miller F. Knee capsulotomy for fixed knee flexion contracture. Acta Orthopaedica et Traumatologica Turcica. 2009;43(2):121-127. https://izlik.org/JA42CN87ZC
Chicago
Woratanarat, Patarawan, Kirk Dabney, and Freeman Miller. 2009. “Knee Capsulotomy for Fixed Knee Flexion Contracture”. Acta Orthopaedica et Traumatologica Turcica 43 (2): 121-27. https://izlik.org/JA42CN87ZC.
EndNote
Woratanarat P, Dabney K, Miller F (May 1, 2009) Knee capsulotomy for fixed knee flexion contracture. Acta Orthopaedica et Traumatologica Turcica 43 2 121–127.
IEEE
[1]P. Woratanarat, K. Dabney, and F. Miller, “Knee capsulotomy for fixed knee flexion contracture”, Acta Orthopaedica et Traumatologica Turcica, vol. 43, no. 2, pp. 121–127, May 2009, [Online]. Available: https://izlik.org/JA42CN87ZC
ISNAD
Woratanarat, Patarawan - Dabney, Kirk - Miller, Freeman. “Knee Capsulotomy for Fixed Knee Flexion Contracture”. Acta Orthopaedica et Traumatologica Turcica 43/2 (May 1, 2009): 121-127. https://izlik.org/JA42CN87ZC.
JAMA
1.Woratanarat P, Dabney K, Miller F. Knee capsulotomy for fixed knee flexion contracture. Acta Orthopaedica et Traumatologica Turcica. 2009;43:121–127.
MLA
Woratanarat, Patarawan, et al. “Knee Capsulotomy for Fixed Knee Flexion Contracture”. Acta Orthopaedica et Traumatologica Turcica, vol. 43, no. 2, May 2009, pp. 121-7, https://izlik.org/JA42CN87ZC.
Vancouver
1.Patarawan Woratanarat, Kirk Dabney, Freeman Miller. Knee capsulotomy for fixed knee flexion contracture. Acta Orthopaedica et Traumatologica Turcica [Internet]. 2009 May 1;43(2):121-7. Available from: https://izlik.org/JA42CN87ZC