Judet's quadricepsplasty, surgical technique, and results in limb reconstruction

Quadricepsplasty has been described by Thompson and Judet to improve flexion in severely ankylosed knees. Judet's technique has potential advantages because it is less damaging to the quadriceps mechanism and addresses the problem of external fixator pin site tethering on the lateral side of the thigh. The outcome of Judet's quadricepsplasty was assessed in 10 consecutive patients who were treated with external fixation either as a primary treatment (three patients) or as a secondary treatment for nonunion or malunion (seven patients) in a limb reconstruction unit. The patients were reviewed and examined at a minimal followup of 20 months. Their average prequadricepsplasty flexion of 33 degrees was improved to 105 degrees in the operating room and to 88 degrees on final review after an average followup of 24 months. According to Judet's criteria, there were one fair, seven good, and two excellent results. Two patients had postoperative complications, one hematoma and one infection. A minimal extension lag (10 degrees ) developed in one patient. Judet quadricepsplasty successfully increases flexion range with minimum impairment of quadriceps function. Familiarity with this technique might lower the surgeon's threshold for considering quadricepsplasty in patients with severe knee ankylosis after severe femoral fractures and in particular after a prolonged period of external fixation.