A Clinical Study on Treatment of Flexion Contractures of Knee by Distraction Technique

Flexion contracture of knee is a major disability and very often the patient has to resort to a walking aid for mobility. Many methods have been described to correct the deformity and include exercise, casting, traction, soft tissue release and osteotomies. Deformity correction by gradual distraction of soft tissues has been successfully used in the treatment of congenital talipes equinovarus (CTEV), finger flexion etc. by the application of simple distractor rods. The present study was undertaken to assess the usefulness of this technique in correcting the flexion contracture of knee. This was a prospective study conducted in the Department of orthopedics, Teerthanker Mahaveer Medical College and research centre, after obtaining clearance from the ethics committee. The study included a total of 22 patients out of which 13 were females and 9 were males. The mean age of patients was 19.5 years (range 14–33 years). Four patients had bilateral deformity. Flexion contracture ranged between 40 to 90 degrees with an average preoperative contracture of 70 degrees. Patients who had contractures more than 90 degrees were not included in the study. Diagnosis included post polio residual palsy (19 cases), post burn contracture (2 cases) and rheumatoid arthritis (1 case). In all the cases simple distractor was used whereby two Denham's pin were passed in the distal femur and two in the proximal tibia and distractor rods were applied on both the sides. After achieving correction the distractor was kept in place for another 4–5 weeks. Average fixator time was 15.3 weeks. Patients were followed up for an average of 2.3 years.

Of the 22 patients enrolled in the study 12 cases had excellent results, 6 had good results and 3 had poor results. One Patient was lost to follow up. In a single patient severe stretch pain warranted removal of distractor. This patient was later on managed by a supracondylar extension OSteiatomy. Two patients had recurrence of the deformity and were managed by orthotics alone. Pin tract infection was seen in 6 patients who were managed by daily cleaning and antibiotics. The treatment of knee flexion contracture is effective, simple, easy to apply, minimally invasive technique and has encouraging results. We recommend the use of this technique especially in a limited resource centre. To conclude, correction of knee flexion contracture deformity by gradual distraction is a minimally invasive, cost effective, and easy to perform method that gives good results especially in cases of PPRP.