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Related Experiment Videos

The knee in arthrogryposis.

B Thomas, S Schopler, W Wood

    Clinical Orthopaedics and Related Research
    |April 1, 1985
    PubMed
    Summary

    Treating arthrogryposis multiplex congenita knee deformities often requires combined physical therapy, casting, and bracing. Surgery may be necessary for resistant cases, but recurrence is common, especially with early osteotomies.

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    Area of Science:

    • Orthopedics
    • Pediatric Orthopedics
    • Rehabilitation Medicine

    Background:

    • Arthrogryposis multiplex congenita (AMC) frequently presents with significant knee joint involvement, including contractures, instability, and recurvatum.
    • Knee deformities in AMC pose complex challenges for long-term management and functional recovery.
    • A substantial proportion of AMC patients require interventions for knee pathology.

    Observation:

    • This study retrospectively analyzed 104 patients with AMC treated between 1952 and 1982, focusing on 74 individuals with significant knee issues.
    • Treatment modalities encompassed nonoperative approaches (physical therapy, bracing, serial casting) and surgical interventions (releases, osteotomies, arthrodesis, disarticulation).
    • Follow-up periods ranged from two to twenty years, with an average of 11 years for surgically treated patients.

    Findings:

    • Nonoperative management, particularly prolonged casting and bracing alongside physical therapy, showed limited efficacy alone.
    • Surgical interventions were reserved for more severe or resistant cases and often required concurrent correction of other limb deformities.
    • Recurrence of knee deformity was a frequent outcome across various procedures, with posterior capsular release and hamstring tenotomy showing promise in growing children.
    • Osteotomies performed before skeletal maturity were associated with a high rate of recurrence.

    Implications:

    • Comprehensive, multi-modal treatment plans are crucial for managing AMC knee deformities.
    • Surgical timing and technique require careful consideration to minimize recurrence risk in pediatric patients.
    • Further research into optimizing surgical and nonoperative strategies for AMC knee deformities is warranted to improve long-term outcomes.

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