Injection-Induced Quadriceps Contracture Treated with Distal Quadricepsplasty: A Case Series

Quadriceps contracture is a condition of shortening and fibrosis of the quadriceps muscle, resulting in restriction of various ranges of flexion of the knee. It commonly affects the children's age group who are immunized through the intramuscular route. Intramuscular immunization remains a potential cause of the problem, among other causes. Sound evaluation and surgical release of contracture are warranted in cases where conservative management with physiotherapy has failed to provide pain-free and adequate knee movements for routine activities.

Subjects with post-immunization contracture were treated by open quadriceps release with Z-plasty of the rectus femoris and fractional lengthening of the vastus intermedius with knee immobilization 3 weeks post-surgery, followed by quadriceps physiotherapy for range of movement exercises as tolerated by the patient. Follow-up was done at 3, 6, 12, and 24 weeks. Pre- and post-knee ranges of motions were compared.

Immediate post-release knee flexion range was significantly improved, attaining an acceptable range of flexion nearly about 12 weeks for routine outdoor activities. No complication was reported apart from a few degrees of extensor lag.

Distal procedure with Z-plasty and fractional lengthening can be considered a fair technique of addressing quadriceps contracture with minimal complications and a good anticipated outcome.