Abstract
Purpose
The Judet’s technique of quadricepsplasty for an extension contracture of the knee joint offers the benefit of a sequential and controlled release of the intrinsic and extrinsic soft tissue constituents restricting the knee flexion. The main principle of our study was to analyze the clinical as well as functional outcome and to assess an extension lag following Judet’s quadricepsplasty for the knee extension contracture deformity.
Materials and Methods
This is a retrospective cohort study comprises of thirty three patients, operated for extension contracture with Judet’s quadricepsplasty with the mean follow-up was 30 months. Knee range of motion of the operated knee was recorded preoperatively and at 6, 12 and 24 month follow-up after the surgery. Judet’s criteria were used to evaluate the outcomes following the procedure.
Results
92.42° (range, 60°–110°) of knee flexion was achieved after an average follow-up of 24 months compared to preoperative knee flexion was 14.09° (range 5°–25°), reflecting a 74.69° average improvement in knee flexion. Twelve patients had excellent results, nineteen had good results as per Judet’s criteria but there were no patients with extension lag. The two patients with fair results had superficial wound infection which healed without any further surgical intervention.
Conclusions
Judet’s quadricepsplasty offers sequential release without extension lag of the knee joint. Patients with the knee extension contractures deformity can be successfully managed with the Judet’s quadricepsplasty to gain useful knee motion and function.
Similar content being viewed by others
References
Paley, D. (2000). Principles of deformity correction. Knee extension contracture. Orthopedics (pp. 563–567). Springer.
Warner, J. J. (1990). The Judet quadricepsplasty for management of severe post traumatic extension contracture of the knee; a report of a bilateral case and review of the literature. Clinical Orthopaedics Related Research, 256, 169–173.
Zubairi, A. J., Rashid, H., Rashid, R. H., Ali, M., & Hashmi, P. M. (2017). Outcome of Judet’s quadricepsplasty for knee contractures and the effect of local infiltration of epinephrine on reducing blood loss. Chinese Journal of Traumatology, 20(3), 147–150.
Bari, M. M., Islam, S., Shetu, N. H., et al. (2015). Judet’s quadricepsplasty for extension contracture of the knee (stiff knee). MOJ Orthopaedics Rheumatology, 2(6), 202–206.
Ali, A. M., Villafuerte, J., Hashmi, M., & Saleh, M. (2003). Judet’s quadricepsplasty, surgical technique, and results in limb reconstruction. Clinical Orthopaedics Related Research, 415, 214–220.
Ebraheim, N. A., DeTroye, R. J., & Saddemi, S. R. (1993). Results of Judet quadricepsplasty. Journal of Orthopaedic Trauma, 7(4), 327–330.
Persico, F., Vargas, O., Fletscher, G., & Zuluaga, M. (2018). Treatment of extraarticular knee extension contracture secondary to prolonged external fixation by a modified Judet quadricepsplasty technique. Strategies in Trauma and Limb Reconstruction, 13(1), 19–24.
Judet, R. (1959). Mobilisation of the stiff knee. Journal of Bone Joint Surgery [Br], 41B, 856–857.
Kukreja, M., Kang, J., Curry, E. J., & Li, X. (2019). Arthroscopic lysis of adhesions and anterior interval release with manipulation under anesthesia for severe post-traumatic knee stiffness: A simple and reproducible step-by-step guide. Arthroscopy Techniques, 8(5), e429–e435.
Thompson, T. (1944). Quadricepsplasty to improve knee function. Journal of Bone Joint Surgery, 26, 366–379.
Masse, A., Biasibetti, A., Demangos, J., Dutto, E., Pazzano, S., & Gallinaro, P. (2006). The Judet quadricepsplasty: Long-term outcome of 21 cases. Journal of Trauma, 61(2), 358–362.
Hesketh, K. T. (1963). Experiences with the Thompson quadricepsplasty. The Journal of Bone and Joint Surgery, 45B, 491–495.
Moore, T. J., Harwin, C., Green, S. A., Garland, D. E., & Chandler, R. W. (1987). The results of Quadricepsplasty on knee motion following femoral fractures. Journal of Trauma, 27(49–51), 17.
Nicoll, E. A. (1963). Quadricepsplasty. The Journal of Bone and Joint Surgery, 45B(483–490), 18.
Pick, R. Y. (1976). Quadricepsplasty: A review, case presentations, and discussion. Clinical Orthopaedics, 120, 138–142.
Oliveira, V. G., D’Elia, L. F., Tirico, L. E., Gobbi, R. G., Pecora, J. R., Camanho, G. L., Angelini, F. J., & Demange, M. K. (2012). Judet quadricepsplasty in the treatment of posttraumatic knee rigidity: Long-term outcomes of 45 cases. Journal of Trauma and Acute Care Surgery, 72(2), E77-80.
Daoud, H., O’Farrell, T., & Cruess, R. L. (1982). Quadricepsplasty. The Judet technique and results of six cases. Journal of Bone Joint Surgery British, 64, 194–197.
Judet, R., Judet, J., & Lord, J. (1959). Resultats du traitement des raideurs du genoupar arthrolise et disinsertion du quadriceps femoral. Memoir Academic Chair, 1, 645–654.
Manimaran, K. P., & Sathish, M. (2019). Functional results of judet’s quadricepsplasty in the management of fixed flexion deformity of knee. International Journal of Orthopaedics Science, 5(1), 468–471.
Hussein, R., Miles, J., Garlick, N., & Dowd, G. S. (2008). A conservative approach to quadricepsplasty: Description of a modified surgical technique and a report of three cases. The Journal of Knee Surgery, 21, 39–42.
Lee, D. H., Kim, T. H., Jung, S. J., Cha, E. J., & Bin, S. I. (2010). Modified Judet Quadricepsplasty and Ilizarov frame application for stiff knee after femur fractures. Journal of Orthopaedic Trauma, 24(11), 709–715.
Wang, J. H., Zhao, J. Z., & He, Y. H. (2007). A new treatment strategy for severe arthrofibrosis of the knee. Surgical technique. Journal of Bone Joint Surgery, 89(2), 93–102.
Alici, T., Buluç, L., Tosun, B., et al. (2006). Modified Judet’s quadricepsplasty for loss of knee flexion. The Knee, 13(4), 280–283.
Funding
No funding from any source is received for the study.
Author information
Authors and Affiliations
Contributions
RM: Contribution Patient selection, Performed Surgery. VkD: Contribution Study design, surgery assistant, manuscript proof reading. SJ: Contribution Study design, performed measurements, manuscript preparation.
Corresponding author
Ethics declarations
Conflict of interest
There are no conflicts of interests of any kind from the authors of the manuscript.
Ethical approval
Consent from all the patients was taken for the participation in the study and proper ethical committee approval is taken for the study and publication.
Informed consent
For this type of study informed consent is not required.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Mittal, R., Digge, V. & Jain, S. Judet’s Quadricepsplasty Technique Offers Excellent Functional Outcome Without an Extension Lag for Extension Contracture of the Knee: A Retrospective Cohort of 33 Patients. JOIO 56, 1913–1917 (2022). https://doi.org/10.1007/s43465-022-00696-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s43465-022-00696-3