Minimally Invasive Quadricepsplasty

Abstract

A modification of range of motion of the knee can significantly change a patient's quality of life. In general, range of motion of 0° to 125° is adequate for most activities of daily life. The rate of knee arthrofibrosis after ligament reconstruction is reported to be between 0% and 4%; after tibial fracture due to high-energy trauma, the rate is about 7%, with an undetermined incidence after limb lengthening. The purpose of this study was to describe a modification of the operative technique of Judet. We describe minimally invasive quadricepsplasty in 4 steps, aiming to obtain an end result with an arc of movement of at least 120° to 130°. We believe that our technique is a good option for the treatment of the stiff knee, having low morbidity and being an easy method to perform.

Fig 1

(A) The patient is placed in the supine decubitus position, and a 6-cm-long median incision is made extending proximally from the superior pole of the patella. (B) In the first step, by use of a blunt curved dissection scissor, a parapatellar lateral and medial arthrotomy is made by incising the lateral and medial retinaculum (yellow dotted arrows), from the top of the patella down the lower pole (right knee).

Fig 2

Isolation of rectus femoris in a left knee. Once the rectus is isolated, the vastus intermedius tendon is transected adjacent to its patellar insertion.

Fig 3

Once the rectus is isolated, the vastus intermedius tendon is transected (blue line) adjacent to its patellar insertion with a scalpel; right knee.

Fig 4

In the fourth step, subcutaneous adhesions around the anterior and lateral aspect of the thigh are released with a blunt scissor (yellow dotted arrows); left knee.

Fig 5

Adhesions on knee: patella (1), suprapatellar pouch and patellofemoral compartment (2), rectus femoris (3), and subcutaneous adhesions (4).

Fig 6

With the hip in 90° of flexion, gentle manipulation of the knee in flexion (arrows) is made until maximum flexion is achieved. The surgeon should remember to leave the hip in flexion to avoid complications due to excessive tension on the quadriceps; left knee.

Fig 7

In the last step, closure of the skin is performed with heavy nonabsorbable sutures such as Ethibond; right knee.

Fig 8

A femoral catheter is left in the operated leg, on the same side as the procedure, for continuous femoral nerve analgesia for at least 24 hours; left leg.