Overview

Knee ankylosis can vary in severity but to have functional range, patients need to be able to bend their knee more than 90 degrees. Knee ankylosis can have many underlying causes but eventually results in the contracture of the quadriceps muscle. Therefore, to be able regain range of motion, the quadriceps muscle needs to be released from its origin at the top of the femur. The Judet Quadricepsplasty technique involves releasing the knee and quadricep muscles in order to improve range of motion and function. This release is usually preformed from the knee, up the leg, along the entire femur on the anterior side all the way up to the hip joint.

Indications / Candidacy

Knee ankylosis is stiffness of the joint as a result of injury or disease. Patients with this condition may find that their pain and discomfort is worse in the morning and more intense after periods of inactivity. This can also cause compensatory pains in other joints, as the knee does not bend properly for function. In children, this can be used to treat underlying congenital or habitual patella problems. Judet quadricepsplasty has the advantage of achieving better range of motion, maintaining better strength in the leg and having less complications than other types of quadriceplasties.

Good Candidates for Judet Quadricepsplasty may have:

  • Minimal range of motion at the knee joint
  • Diagnosed ankylosis
  • Pain and discomfort at the knee and surrounding areas
  • Limited function due to joint stiffness and range of motion
  • Limited function at the knee after trauma, injury, or illness
  • Previous fractures of the distal femur
  • Congenital knee problems or patellar instability

Treated Conditions

The Canadian Limb Lengthening Center offers a team of experienced surgeons, nurses and physiotherapists that make patients feel supported throughout their entire treatment process. Our ability to treat complex orthopedic conditions with a holistic approach gives our patients the best possible outcomes. We pride ourselves in providing highly specialized, expert care. To learn more about Knee ankylosis follow the link below:

Condition

Knee ankylosis

Surgical Technique

Patients require an epidural anaesthesia for this procedure as they will require the use of a continuous passive motion (CPM) machine immediately post-operatively.

  1. A long curvilinear incision is made starting from the patellar tendon and then curving to the lateral side of the leg all the way up to the hip.
  2. The patella and surrounding tissue are freed allowing the patella to be lifted off the femoral condyles
  3. Intra-articular release of adhesions surrounding the knee joint is performed
  4. Release of fibrous tissue (thickened or scarred tissue) affecting the quadricep muscles is then performed in a very careful manner, sequentially going up the leg as needed, making sure to stay above the periosteal layer of the bone.
  5. Care is taken to protect the femoral nerve as the approach goes higher towards the hip
  6. Once the quadriceps muscle is entirely lifted off the femur anteriorly, the vastus lateralis and rectus are released from their origin which allows the entire quadriceps muscles to slide down the bone.
  7. This usually allows the knee to bend fully and range of motion is restored
  8. Drains are placed and the incision is closed
  9. The patient is placed immediately in a CPM (continuous passive motion) machine to keep the knee moving from 0-120 degrees for 3-5days (23/24hrs a day)

Results

As a result of undergoing Judet Quadricepsplasty surgery, patients have improved flexion at the knee joint. This is true of patients who experience severely ankylosed knees as well. With minimum impairment of quadriceps function Judet quadricepsplasty successfully increases range of motion. With this, we see improvements in gait function, and decreased pain and discomfort in other joints as well. Patients report increased satisfaction during occupational and leisure activities, which improves their quality of life and confidence.

Preop ROM

6 months follow up

Potential Complications

As with any surgical procedure, Judet Quadricepsplasty can have difficulties and complications. In most cases, our team of specialists can address these concerns without compromising the end results or outcome. Complications and side effects may include:

  • Infection
  • wound healing problems (including seromas)
  • Damage to nearby nerves
  • Blood clot
  • Loss of range of motion over time
  • Muscle weakness

Pre-Operative Care

  • An extensive medical history will be taken during your initial assessments
  • It is recommended that you stay active and eat a healthy diet prior to any operation
  • Certain medications and vitamins may need to be stopped several weeks before
  • Discuss all medications and over the counter drugs with your surgeon
  • Use a calendar or agenda to organize your pre and post appointment dates
  • Make arrangements for personal care givers

Post-Operative Care

  • Swelling can be controlled using Ice packs
  • Pain medications can be used to help control any discomfort
  • Patients remain in hospital for 3-5 days with an epidural anasthesia to help alleviate pain and allow for aggressive physical therapy that includes knee flexion exercises and passive motion in a CPM machine 23/24 hours a day
  • The patient then continues using the CPM machine at home for 6 weeks (16hours a day) and continues seeing a physiotherapist several times a week
  • Patients can be full weight bearing but need to use crutches for support due to weakness in the quadricep muscle during first 6 weeks.

Follow-ups after surgery

  • Patients are seen at post-operative week one for dressing change
  • When the drains no longer produce any fluid, they can be removed, usually within 5-10 days post operatively
  • Supervised physiotherapy is performed three times weekly
  • Due to the extensive incision, the wound can take a long time to heal and regular follow ups are needed to ensure proper healing.
  • Once the wound is healed, patients attend regular follow up appointments every 6 weeks

Case studies

5 year old girl with habitual dislocation of the knee
48 year old man with knee ankylosis

AM I A CANDIDATE?

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Highly specialized expert care at CLLC

At the Canadian Limb Lengthening Centre we offer complex deformity correction and limb lengthening surgeries performed by experienced surgeons with the most up to date technologies. When it comes to your care, and treatment of deformity and limb length discrepancy, our surgeons have extensive training and experience.

LW