Surgical release of knee flexion contractures in myelomeningocele

The Journal of Bone and Joint Surgery. British Volume
P D MarshallH K Graham

Abstract

We report the results of a prospective study of the surgical release of 45 knee flexion contractures in 28 patients with myelomeningocele. The neurosegmental level was thoracic in ten patients, L1/2 in one, L3/4 in 11, and L5/S1 in six. In walkers the indication for surgery was a fixed flexion contracture impeding walking, and in non-walking patients it was a flexion contracture impeding transfers or sitting balance, or likely to do so with increasing deformity. The mean age at surgery was 6.4 years (3 to 21) and the mean period of follow-up 13 years (4 to 20). The mean knee flexion contracture before surgery was 39 (25 to 70) which improved to 5 degrees at maximum correction and to 13 degrees at latest follow-up. We conclude that surgical release of knee flexion contractures in myelomeningocele improves gait in all children who walk, particularly those with low lumbar lesions. Recurrence of knee flexion contractures after surgical release is most common in those with thoracic lesions who do not achieve independent walking.

Citations

Apr 23, 2008·Strategies in Trauma and Limb Reconstruction·Pedro Gutiérrez CarbonellJavier Roca Vicente-Franqueira
Feb 1, 1997·Trends in Neurosciences·S Wonnacott
Feb 5, 2003·Spine·Alvin H CrawfordKerry Crone
Nov 26, 2010·Journal of Pediatric Orthopedics·Alexander S SpiroRalf Stuecker
Dec 7, 2010·Clinical Orthopaedics and Related Research·Todd C MoenClaudia Kelp-Lenane
Feb 7, 2012·Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA·Alexander S SpiroRalf Stuecker
Oct 3, 2008·The Journal of Bone and Joint Surgery. American Volume·Kun Bo ParkHyun Woo Kim
Oct 27, 2009·Journal of Children's Orthopaedics·Vineeta T Swaroop, Luciano Dias

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