Gradual distraction on hinged-based Ilizarov ring fixator to correct fixed flexion deformity of knee: description of the surgical technique
Keywords:Stiff knee, Flexure contracture, Ilizarov, Deformity correction, Knee arthrodesis, Osteotomy
Knee deformity in flexion is the most disabling deformity. Surgical correction can be attempted with soft tissue release, osteotomy, or both. However, acute correction can cause serious complications. Ilizarov technique has become an appealing alternative to open surgery, where skeletal traction is used to distract the joint gradually and steadily in order to reduce the risk of skin problems or neurovascular injuries. Two patients and three limbs, male aged 28-42 (mean=35 years) with severe fixed flexion deformity were corrected by a hinged-based Ilizarov ring fixator. Mean flexion of the knee was pre-operatively 86.66 degrees (80-90 degrees). The mean extension angle at the last follow-up was 168.3 degrees (165-170). The mean knee society score (KSS) was 44.3 (35-50), mean KSS functional score was 43.3 (0-65). One patient had satisfactory outcomes and could stand without walking aids and walks on extended knee with walking aids. Arthrodesis of knee or creating a stiff knee in the most extended position may be most effective for severe, fixed contractures.With the gradual, calculated distraction, the Ilizarov apparatus is an effective tool for treating severe cases of knee contracture.
Kwan MK, Penafort R, Saw A. Treatment for flexion contracture of the knee during Ilizarov reconstruction of tibia with passive knee extension splint. Med J Malaysia. 2004;59:39-41.
Guven M, Gholve PA, Blyakher A, Widmann RF. Case report: Juvenile Dermatomyositis with Bilateral Progressive Knee Flexion Contracture. Clin Orthop Relat Res. 2007;464:238-41.
Pujol N, Boisrenoult P, Beaufils P. Post-traumatic knee stiffness: Surgical techniques. Orthop Traumatol Surg Res. 2015;101(1):S179-86.
van Bosse HJP, Pontén E, Wada A, Agranovich OE, Kowalczyk B, Lebel E, et al. Treatment of the Lower Extremity Contracture/Deformities. J Pediatr Orthop. 2017;37:S16.
Damsin JP, Ghanem I. Treatment of severe flexion deformity of the knee in children and adolescents using the ilizarov technique. J Bone Joint Surg Br. 1996;78-B(1):140-4.
Hosny GA, Fadel M. Managing Flexion Knee Deformity Using a Circular Frame. Clin Orthop. 2008;466(12):2995-3002.
Herzenberg JE, Waanders NA. Calculating rate and duration of distraction for deformity correction with the Ilizarov technique. Orthop Clin North Am. 1991;22(4):601-11.
Nelson CL, Kim J, Lotke PA. Stiffness After Total Knee Arthroplasty. JBJS. 2005;87(1):264-70.
Solignac N, Vialle R, Thévenin-Lemoine C, Damsin JP. Popliteal pterygium knee contracture: Treatment with the Ilizarov technique. Orthop Traumatol Surg Res. 2009;95(3):196-201.
Herzenberg JE, Davis JR, Paley D, Bhave A. Mechanical distraction for treatment of severe knee flexion contractures. Clin Orthop. 1994;(301):80-8.
Guo B, Qin S, Zheng X, Zang J, Zhao W, Wu H. Ilizarov technique for severe knee flexion contracture in juvenile rheumatoid arthritis. J Orthop Transl. 2020;25:33-8.
Leonchuk SS, Novikov KI, Subramanyam KN, Shikhaleva NG, Pliev MK, Mundargi AV. Management of severe congenital flexion deformity of the knee using Ilizarov method. J Pediatr Orthop B. 2020;29(1):47-52.
Zhai J, Weng X, Zhang B, Peng H, Bian Y. Management of knee flexion contracture in haemophilia with the Ilizarov technique. The Knee. 2019;26(1):201-6.
Balci HI, Kocaoglu M, Eralp L, Bilen FE. Knee flexion contracture in haemophilia: treatment with circular external fixator. Haemophilia. 2014;20(6):879-83.
van Bosse HJP, Feldman DS, Anavian J, Sala DA. Treatment of Knee Flexion Contractures in Patients With Arthrogryposis. J Pediatr Orthop. 2007;27(8):930-7.
Makhdom AM, Cartaleanu AS, Rendon JS, Villemure I, Hamdy RC. The Accordion Maneuver: A Noninvasive Strategy for Absent or Delayed Callus Formation in Cases of Limb Lengthening. Adv Orthop. 2015;e912790.
Liu Y, Cai F, Liu K, Liu J, Zhang X, Yusufu A. Cyclic Distraction–Compression Dynamization Technique Enhances the Bone Formation During Distraction Osteogenesis. Front Bioeng Biotechnol. 2022;9:810723.