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Endoscopic quadricepsplasty: A new surgical technique
C E Blanco1, H O Leon, T B Guthrie
1Orthopaedic Division, Hospital Hermanos Ameijeiras, Havana, Cuba.
Insights
This study introduces a novel endoscopic surgical technique to release quadriceps fibrosis, improving knee flexion in patients with severe scarring and ankylosis. The minimally invasive approach offers a promising alternative to open surgery, enhancing patient function and recovery.
Area of Science:
- Orthopedic Surgery
- Minimally Invasive Procedures
- Reconstructive Surgery
Background:
- Extra-articular fibrosis of the quadriceps to the femur can result from gunshot injuries, post-surgical scarring, or fractures, leading to knee ankylosis in extension.
- Patients with persistent knee stiffness despite intensive physiotherapy may require surgical intervention.
- Traditional open quadricepsplasty can be associated with significant complications.
Purpose of the Study:
- To present a new surgical subperiosteal endoscopic technique for releasing quadriceps fibrosis.
- To evaluate the efficacy and safety of this technique in patients with knee ankylosis due to extra-articular fibrosis.
- To compare outcomes with traditional open surgical methods.
Main Methods:
- A prospective case series of 26 male patients with knee ankylosis in extension due to extra-articular fibrosis.
- A novel subperiosteal endoscopic technique involving proximal extension of arthroscopic release through superior knee portals.
- Use of periosteal elevators and arthroscopic scissors to release adhesions beneath the quadriceps mechanism.
Main Results:
- All patients achieved satisfactory results at 2-year follow-up.
- Additional knee flexion gained ranged from 30 to 90 degrees post-procedure.
- Complications included deep vein thrombosis, scrotal edema, hemarthrosis, and reflex sympathetic dystrophy, generally less severe than open procedures.
Conclusions:
- The presented endoscopic subperiosteal technique is effective for releasing quadriceps fibrosis and improving knee function in patients with ankylosis.
- This minimally invasive approach allows for immediate aggressive rehabilitation and offers a viable outpatient alternative to open quadricepsplasty.
- The technique demonstrates a favorable safety profile with fewer and less severe complications compared to classic open procedures.
Abstract:
We present a new surgical subperiosteal endoscopic technique for the release of fibrosis of the quadriceps to the femur caused by gunshot injuries, postsurgical scarring, and fractures, that was developed at the Arthroscopy Group at Hospital Hermanos Ameijeiras in Havana, Cuba. The technique used is a proximal endoscopic subperiosteal extension of the usual arthroscopic intra-articular release of adhesions, using periosteal elevators and arthroscopic scissors placed through medial and lateral superior knee portals to release adhesions and bands of scar tissue beneath the quadriceps mechanism. The technique was used in a prospective case series of 26 male patients aged 19 to 22 years between February 1997 and March 1998 who presented with clinically and ultrasonically documented extra-articular fibrosis resulting in ankylosis of the knee in extension. Only patients who had reached a plateau in their aggressive physiotherapy program with no further progression in knee flexion for 3 months were selected. Those with joint instability, motion-limiting articular surface pathology, and muscle or neurologic injury were excluded. All patients had obtained satisfactory results at 2-year follow-up. The extra-articular release gained at final follow-up was between 30 degrees and 90 degrees of flexion in addition to that obtained at the completion of the standard intra-articular release. Complications included 1 case of deep vein thrombosis, 2 cases of scrotal edema, 5 cases of hemarthrosis, and 2 cases of reflex sympathetic dystrophy. We have found this technique useful in obtaining additional flexion and improved function in a difficult class of patients with ankylosis caused by extra-articular fibrosis of the quadriceps to the femur, allowing immediate aggressive rehabilitation and presenting a useful outpatient alternative with fewer and less severe complications than described with the classic open Thompson's quadricepsplasty.