- consider 90 deg of flexion in splint for 4 days, then begin CPM;
- need to start early motion;
- look for late varus collapse of knee;
- attempt to ambulate at 2-4 days, & consider FWB at 3-6 months;
- delayed union: persistent instability 3-4 mo after injury;
- more bone grafting may be necessary to salvage inadequate union;
- Accetable Alignment:
- saggital alignment of less than 5 deg antecurvatum or less than 10 deg of retrocurvatum is acceptable;
- frontal plane and rotational alignment of less than 5 deg is acceptable;
- Extension Contractures:
- more common w/ non surgical treatment;
- results from:
- intra articular adhesions;
- parapatellar adhesions;
- obliteration of the lateral gutters;
- obliteration of the suprapatellar pouch;
- fibrosis of vastus intermedius that ties down rectus femoris to the anterior aspect of femur;
- shortening of lateral and medial quad expansions;
- shortening of rectus femoris;
- quadricepsplasty, will release in sequence all pathologic adehesions and will provide most pts with age ROM of 5-90 degs;
- incision is made from a hands breadth below the trochanter to the knee joint, over the lateral side of the femur;
- intrinsic release:
- lateral capsulotomy;
- removal of adehesions from the lateral gutters, supra-patellar pouch, and undersurface of the patella;
- extrinsic release:
- release of vastus lateralis from the linea aspera;
- elevation of the vastus intermedius from the anterior femoral surface;
- post op: 3-4 months of rehab is required before maximum flexion is reached
A technique for freeing the extensor apparatus in cases of stiffness of the knee. Juedet R, Judet J, Lagrange J. Mem Acad Chir. 1956;82:944-947.
The results of quadricepsplasty on knee motion following femoral fractures.
The Judet quadricepsplasty for management of severe posttraumatic extension contracture of the knee. A report of a bilateral case and review of the literature.
Results of Judet Quadricepsplasty.
Quadriceplasty: the Judet technique and results in six cases.