Judet's arthromyolysis in the treatment of stiff knee in extension

After a brief historical review of the surgical treatment of long-established stiffness of the knee, and a discussion of the related indications, the authors describe the surgical technique used in their Division of the Rizzoli Institute. Basically, we use Judet's arthromyolysis, but we often perform, as an initial stage, medial arthrolysis without particular concern for the medial collateral ligament. Our results prove that this does not cause instability. Twenty-seven of the thirty knees in our series presented as sequelae of fractures of the femur where there had been complications, or in which immobilisation had been unduly prolonged. Analysis of the results shows that: a) average pre-operative flexion of 25 degrees was increased to 95 degrees, without sacrificing stability; b) section of the collateral ligaments does not cause long term instability; c) proximal disinsertion of the rectus femoris tendon may lead to loss of active extension, although this was always well tolerated; d) persisting pain is always due to the development of arthrosis; e) The age of the patient, the duration and aetiology of the stiffness have no effect on the results. The complications consisted of two cases of skin necrosis and one of infection, but these were quickly resolved and did not affect the end results.