Summary

The modified Judet quadricepsplasty technique allows recovery of the articularity and functionality of the knee joint even in severe post-traumatic stiffness cases while reducing the surgical invasiveness compared to the original one

Abstract

BACKGROUNDS
Knee stiffness is a common condition following high energy trauma or surgeries, leading to severe functional limitation in daily activities. Although several surgical techniques are described in the literature, invasiveness and potential complications remain limitations. This clinical trial aims to report clinical outcomes and detect complications at a mean follow-up of 10 years after modified Judet quadricepsplasty.

Materials And Methods

A retrospective observational single center study was conducted to evaluate, both in outpatient and telemedicine settings, a sample of 19 patients affected by post traumatic knee stiffness surgically treated from January 2008 to June 2023.
Inclusion criteria were: a) age > 18 years old b) post-traumatic knee stiffness c) arthromyolysis surgery according to the modified Judet surgical technique d) a minimum of 1 year of follow-up.
Exclusion criteria were:
a) arthrolysis surgery or arthromyolysis using different surgical techniques b) knee stiffness due to cause different from traumatic one.
All patients underwent modified Judet quadricepsplasty performed by the same three expert surgeons. This technique differs from the original because an additional medial parapatellar approach is not performed to carry out the arthrolysis and the origin of vastus lateralis and rectus femoris are not dissected.
All patients followed the same postoperative protocol.
Clinical evaluation was conducted using Judet criteria for final range of motion and five clinical score (KOOS, WOMAC, Tegner-Lysholm, HSS KS, EQ-5D). Demographic characteristics, clinical history, pre-, intra-, and post-operative knee flexion, and possible complications were documented through computerized medical records.

Results

The average final knee flexion was 100.7° (35°-140°) and average flexion gain from the preoperative of 50.4° (5°-100°).
According to Judet's criteria, at the last follow-up, the result obtained by 10 patients could be classified as excellent (52.6%), 7 as good (36.8%), 1 as fair (5.3%) and at last in 1 as poor (5.3%).
In 9 cases (47%) was observed an extension lag, the mean value was 8.8° (range 2°-20°), but with significative deficit (>10°) in only 10.5% of all sample.
Univariate analysis did not show a significant impact of independent variables on the gain in flexion between preoperative and final follow-up measurements.
The average total WOMAC score was 19.5% (0-69.8%). Mean value of HSS-KS was 81.7 (64.9-97). Mean result of Tegner-Lysholm score was 73.7 (31-100). Total KOOS score showed an average value of 60.5% (22-87%). Finally, the mean EQ-5D score was 0.66 (-0.074 +1.000) and the EQ-5D VAS scale average value of 71.2 (15-100).
4 patients required a new arthromyolysis to improve flexion previous reached. There were 4 cases of perioperative complications (a patellar tendon detachment, hematoma, bleeding, surgical site infection) and 2 long-term complications (chronic osteomyelitis, infection).

Conclusion

The modified Judet quadricepsplasty has proven effective in improving knee function and mobility in patients with post-traumatic knee stiffness thereby enhancing quality of life. This less invasive technique, performed by expert surgeons, requires early and rigorous postoperative rehabilitation for long-term success. Despite some risks, especially in severe cases, it remains a valuable surgical option when conservative treatments fail.