Gradual distraction for treatment of severe knee flexion contractures using the Ilizarov’s apparatus
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20193837Keywords:
Knee contractures, Flexion deformity, Gradual distraction, Ilizarov apparatusAbstract
Background: Knee flexion contractures result in a significant amount of functional disability due to reduced mobility and limb length discrepancy. Treatment options include non-surgical methods like serial casting, dynamic splinting and traction or surgical methods like osteotomies and soft tissue procedures. External fixation has emerged as a highly successful means of achieving controlled gradual correction of joint contractures with low rates of complications including recurrence. The aim of this study is to evaluate the functional outcome in terms of residual deformity and change in ambulatory status following correction using the Ilizarov’s apparatus.
Methods: 12 patients with knee flexion contractures ranging from 20°-70° underwent correction using the Ilizarov’s external fixator (IEF). The use of simple mathematic formulae enabled us to calculate and estimate the rate and duration of distraction. End results were assessed at one year by the residual contracture as: Excellent: 0-5°, Good: 6-15°, Fair: 16-30° and Poor: >30°.
Results: The functional assessment was graded as excellent in 7, good in 4 and fair in 1 out of 12 patients. All patients were independent ambulators and only 1 out of 12 patients required an additional orthosis for maintenance of the correction.
Conclusions: The IEF is a safe and precise modality even for the most complex contractures of the knee. Accurate placement of the hinges along the center of rotation of the knee avoids undue subluxation of the tibia during correction. In order to ensure a low rate of complications, it is imperative to have a detailed pre-operative plan and all principles of fixation should be meticulously adhered to.
References
Halar EM, Bell KR. Immobility. In: DeLisa JA, Gans BM (eds). Rehabilitation Medicine: Principles and Practice. Philadelphia, PA: Lippincott-Raven; 1988: 1015–1034.
Trudel G, Uhthoff HK, Brown M. Extent and direction of joint motion limitation after prolonged immobility: an experimental study in the rat. Arch Phys Med Rehabil. 1999;80:1542–7.
MacWilliams BA, Harjinder B, Stevens PM. Guided growth for correction of knee flexion deformity: A series of four cases. Strategies Trauma Limb Reconstruction. 2011;6:83-90.
Heydarian K, Akbarnia BA, Jabalameli M, Tabador K. Posterior capsulotomy for the treatment of severe flexion contractures of the knee. J Pediatr Orthop. 1984;4(6):700-4.
Vulcano E, Markowitz JS, Fragomen AT, Rozbruch SR. Gradual correction of knee flexion contracture using external fixation. J Limb Lengthen Reconstr. 2016;2:102-7.
Green WT, Wyatt GM, Anderson M. Orthoroentgenography as a method of measuring the bones of the lower extremities. J Bone Joint Surg Am. 1946;28:60–5.
Paley D, Herzenberg JE, Tetsworth K: Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am. 1994;25:425-65.
Herzenberg JE, Waanders NA. Calculating rate and duration of distraction for deformity correction with the Ilizarov technique. Orthop Clin North Am. 1991;22:601-11.
Paley D. Principles of Deformity Correction. New York: Springer; 2002.
Çakmak M, Şen C, Eralp L. Basic techniques for extremity reconstruction. New York: Springer; 2018.
Herzenberg JE, Davis JR, Paley D, Bhave A. Mechanical distraction for treatment of severe knee flexion contractures. Clin Orthop Rel Res. 1994;301:80-8.
Damsin JP, Ghanem I. Treatment of severe flexion deformity of the knee in children and adolescents using the Ilizarov technique. J Bone Joint Surg. 1996;78(1):140-4.
Balci HI, Kocaoglu M, Eralp L, Bilen FE. Knee flexion contracture in haemophilia: treatment with circular external fixator. Haemophilia. 2014;20(6):879-83.
Hosny GA, Fadel M. Managing flexion knee deformity using a circular frame. Clin Orthop Related Res. 2008;466(12):2995-3002.
