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Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 12/2012

01.12.2012 | Knee

Treatment of fixed knee flexion deformity by anterior distal femoral stapling

verfasst von: Alexander S. Spiro, Peggy Stenger, Michael Hoffmann, Eik Vettorazzi, Kornelia Babin, Sandra Lipovac, Jan Philipp Kolb, Alexander Novo de Oliveira, Johannes M. Rueger, Ralf Stuecker

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 12/2012

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Abstract

Purpose

The treatment of fixed knee flexion deformity through anterior distal femoral stapling has been investigated in only two studies so far, with promising results. The aim of the present study was to determine whether this technique might improve fixed knee flexion deformity in a series of growing children and adolescents with different conditions. Follow-up examinations were continued after staple removal in terms of a possible impairment of this deformity.

Methods

We reviewed the medical records of all patients with fixed knee flexion deformity who had been treated by anterior distal femoral stapling at our institution. Twenty patients (37 knees) with a mean age of 12.7 years met the inclusion criteria (>12 months of follow-up; no additional procedures to correct fixed knee flexion deformity such as hamstring lengthening or posterior capsulotomy) and were evaluated in this study.

Results

The mean fixed knee flexion deformity significantly improved from 21.4° (SD = 11.6) preoperatively to 7.0° (SD = 9.8) after a mean follow-up of 35.3 months. Young patients (<12 years) revealed superior improvement of this deformity, and especially children with distinct fixed knee flexion deformity of 30° or greater had benefit from early treatment. Impairment of flexion deformity was only seen in one patient (2 knees) after staple removal.

Conclusions

Our results demonstrate that anterior distal femoral stapling is an effective method for the treatment of fixed knee flexion deformity in growing children and adolescents. Rare complications, immediate mobilization, and a low recurrence rate after staple removal provide obvious advantages of this minimally invasive procedure.

Level of evidence

Retrospective therapeutic study, Level IV.
Literatur
1.
Zurück zum Zitat Abraham E, Verinder DG, Sharrard WJ (1977) The treatment of flexion contracture of the knee in myelomeningocele. J Bone Jt Surg [Br] 59:433–438 Abraham E, Verinder DG, Sharrard WJ (1977) The treatment of flexion contracture of the knee in myelomeningocele. J Bone Jt Surg [Br] 59:433–438
2.
Zurück zum Zitat Arnold AS, Anderson FC, Pandy MG, Delp SL (2005) Muscular contributions to hip and knee extension during the single limb stance phase of normal gait: a framework for investigating the causes of crouch gait. J Biomech 38:2181–2189PubMedCrossRef Arnold AS, Anderson FC, Pandy MG, Delp SL (2005) Muscular contributions to hip and knee extension during the single limb stance phase of normal gait: a framework for investigating the causes of crouch gait. J Biomech 38:2181–2189PubMedCrossRef
3.
Zurück zum Zitat Blount WP, Clarke GR (1949) Control of bone growth by epiphyseal stapling; a preliminary report. J Bone Jt Surg [Am] 31:464–478 Blount WP, Clarke GR (1949) Control of bone growth by epiphyseal stapling; a preliminary report. J Bone Jt Surg [Am] 31:464–478
4.
Zurück zum Zitat Delp SL, Arnold AS, Speers RA, Moore CA (1996) Hamstrings and psoas lengths during normal and crouch gait: implications for muscle-tendon surgery. J Orthop Res 14:144–151PubMedCrossRef Delp SL, Arnold AS, Speers RA, Moore CA (1996) Hamstrings and psoas lengths during normal and crouch gait: implications for muscle-tendon surgery. J Orthop Res 14:144–151PubMedCrossRef
5.
Zurück zum Zitat de Morais Filho MC, Neves DL, Abreu FP, Juliano Y, Guimarães L (2008) Treatment of fixed knee flexion deformity and crouch gait using distal femur extension osteotomy in cerebral palsy. J Child Orthop 2:37–43PubMedCrossRef de Morais Filho MC, Neves DL, Abreu FP, Juliano Y, Guimarães L (2008) Treatment of fixed knee flexion deformity and crouch gait using distal femur extension osteotomy in cerebral palsy. J Child Orthop 2:37–43PubMedCrossRef
6.
Zurück zum Zitat Devalia KL, Fernandes JA, Moras P et al (2007) Joint distraction and reconstruction in complex knee contractures. J Pediatr Orthop 27:402–407PubMedCrossRef Devalia KL, Fernandes JA, Moras P et al (2007) Joint distraction and reconstruction in complex knee contractures. J Pediatr Orthop 27:402–407PubMedCrossRef
7.
Zurück zum Zitat Gorman TM, Vanderwerff R, Pond M, MacWilliams B, Santora SD (2009) Mechanical axis following staple epiphysiodesis for limb-length inequality. J Bone Jt Surg [Am] 91:2430–2439CrossRef Gorman TM, Vanderwerff R, Pond M, MacWilliams B, Santora SD (2009) Mechanical axis following staple epiphysiodesis for limb-length inequality. J Bone Jt Surg [Am] 91:2430–2439CrossRef
8.
Zurück zum Zitat Klatt J, Stevens PM (2008) Guided growth for fixed knee flexion deformity. J Pediatr Orthop 28:626–631PubMedCrossRef Klatt J, Stevens PM (2008) Guided growth for fixed knee flexion deformity. J Pediatr Orthop 28:626–631PubMedCrossRef
9.
Zurück zum Zitat Kramer A, Stevens PM (2001) Anterior femoral stapling. J Pediatr Orthop 21:804–807PubMed Kramer A, Stevens PM (2001) Anterior femoral stapling. J Pediatr Orthop 21:804–807PubMed
10.
Zurück zum Zitat Marshall PD, Broughton NS, Menelaus MB, Graham HK (1996) Surgical release of knee flexion contractures in myelomeningocele. J Bone Jt Surg [Br] 78:912–916CrossRef Marshall PD, Broughton NS, Menelaus MB, Graham HK (1996) Surgical release of knee flexion contractures in myelomeningocele. J Bone Jt Surg [Br] 78:912–916CrossRef
11.
Zurück zum Zitat Mielke CH, Stevens PM (1996) Hemiepiphyseal stapling for knee deformities in children younger than 10 years: a preliminary report. J Pediatr Orthop 16:423–429PubMedCrossRef Mielke CH, Stevens PM (1996) Hemiepiphyseal stapling for knee deformities in children younger than 10 years: a preliminary report. J Pediatr Orthop 16:423–429PubMedCrossRef
12.
Zurück zum Zitat Moen T, Gryfakis N, Dias L, Lemke L (2005) Crouched gait in myelomeningocele: a comparison between the degree of knee flexion contracture in the clinical examination and during gait. J Pediatr Orthop 25:657–660PubMedCrossRef Moen T, Gryfakis N, Dias L, Lemke L (2005) Crouched gait in myelomeningocele: a comparison between the degree of knee flexion contracture in the clinical examination and during gait. J Pediatr Orthop 25:657–660PubMedCrossRef
13.
Zurück zum Zitat Palocaren T, Thabet AM, Rogers K et al (2010) Anterior distal femoral stapling for correcting knee flexion contracture in children with arthrogryposis–preliminary results. J Pediatr Orthop 30:169–173PubMedCrossRef Palocaren T, Thabet AM, Rogers K et al (2010) Anterior distal femoral stapling for correcting knee flexion contracture in children with arthrogryposis–preliminary results. J Pediatr Orthop 30:169–173PubMedCrossRef
14.
Zurück zum Zitat Rueter K, Pierre M (1985) Energy cost and gait characteristics of flexed knee ambulation. In: Bunch WE, Keagy R, Knitter AE et al (eds) Atlas of orthotics, St Louis, CV Mosby pp 154–155 Rueter K, Pierre M (1985) Energy cost and gait characteristics of flexed knee ambulation. In: Bunch WE, Keagy R, Knitter AE et al (eds) Atlas of orthotics, St Louis, CV Mosby pp 154–155
15.
Zurück zum Zitat Spiro AS, Babin K, Lipovac S et al (2010) Anterior femoral epiphysiodesis for the treatment of fixed knee flexion deformity in spina bifida patients. J Pediatr Orthop 30:858–862PubMedCrossRef Spiro AS, Babin K, Lipovac S et al (2010) Anterior femoral epiphysiodesis for the treatment of fixed knee flexion deformity in spina bifida patients. J Pediatr Orthop 30:858–862PubMedCrossRef
16.
Zurück zum Zitat van Bosse HJ, Feldman DS, Anavian J, Sala DA (2007) Treatment of knee flexion contractures in patients with arthrogryposis. J Pediatr Orthop 27:930–937PubMedCrossRef van Bosse HJ, Feldman DS, Anavian J, Sala DA (2007) Treatment of knee flexion contractures in patients with arthrogryposis. J Pediatr Orthop 27:930–937PubMedCrossRef
17.
Zurück zum Zitat Westberry DE, Davids JR, Jacobs JM, Pugh LI, Tanner SL (2006) Effectiveness of serial stretch casting for resistant or recurrent knee flexion contractures following hamstring lengthening in children with cerebral palsy. J Pediatr Orthop 26:109–114PubMedCrossRef Westberry DE, Davids JR, Jacobs JM, Pugh LI, Tanner SL (2006) Effectiveness of serial stretch casting for resistant or recurrent knee flexion contractures following hamstring lengthening in children with cerebral palsy. J Pediatr Orthop 26:109–114PubMedCrossRef
18.
Zurück zum Zitat Williams JJ, Graham GP, Dunne KB, Menelaus MB (1993) Late knee problems in myelomeningocele. J Pediatr Orthop 13:701–703PubMedCrossRef Williams JJ, Graham GP, Dunne KB, Menelaus MB (1993) Late knee problems in myelomeningocele. J Pediatr Orthop 13:701–703PubMedCrossRef
19.
Zurück zum Zitat Wren TA, Rethlefsen S, Kay RM (2005) Prevalence of specific gait abnormalities in children with cerebral palsy: influence of cerebral palsy subtype, age, and previous surgery. J Pediatr Orthop 25:79–83PubMed Wren TA, Rethlefsen S, Kay RM (2005) Prevalence of specific gait abnormalities in children with cerebral palsy: influence of cerebral palsy subtype, age, and previous surgery. J Pediatr Orthop 25:79–83PubMed
20.
Zurück zum Zitat Wright JG, Menelaus MB, Broughton NS, Shurtleff D (1991) Natural history of knee contractures in myelomeningocele. J Pediatr Orthop 11:725–730PubMedCrossRef Wright JG, Menelaus MB, Broughton NS, Shurtleff D (1991) Natural history of knee contractures in myelomeningocele. J Pediatr Orthop 11:725–730PubMedCrossRef
21.
Zurück zum Zitat Zimmerman MH, Smith CF, Oppenheim WL (1982) Supracondylar femoral extension osteotomies in the treatment of fixed flexion deformity of the knee. Clin Orthop Relat Res 171:87–93PubMed Zimmerman MH, Smith CF, Oppenheim WL (1982) Supracondylar femoral extension osteotomies in the treatment of fixed flexion deformity of the knee. Clin Orthop Relat Res 171:87–93PubMed
Metadaten
Titel
Treatment of fixed knee flexion deformity by anterior distal femoral stapling
verfasst von
Alexander S. Spiro
Peggy Stenger
Michael Hoffmann
Eik Vettorazzi
Kornelia Babin
Sandra Lipovac
Jan Philipp Kolb
Alexander Novo de Oliveira
Johannes M. Rueger
Ralf Stuecker
Publikationsdatum
01.12.2012
Verlag
Springer-Verlag
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 12/2012
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-012-1915-8

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