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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.
Summary
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.