Treatment of severe flexion deformity of the knee in children and adolescents using the Ilizarov technique. J Bone Joint Surg Br

Hopital d'Enfants Armand Trousseau, Paris, France.
The Bone & Joint Journal (Impact Factor: 3.31). 02/1996; 78(1):140-4.
Source: PubMed

ABSTRACT We have used the Ilizarov technique for severe flexion deformity of the knee in 11 patients (13 knees) between 1986 and 1994 and have followed them up for an average of 4.1 years. The age of the patients at operation ranged from 1.7 to 18.8 years. The femoral and tibial components were connected by two anterior hinges, medial and lateral, and two posterior distraction rods. The deformity was corrected to a femorotibial lateral shaft angle of less than 20 degrees. A permanent orthosis was applied after removal of the fixator. Fractures occurred in four patients and paralysis of the common peroneal nerve in another. There was a recurrence of the deformity in four patients. At the last review all patients were able to walk on their operated leg with or without an orthosis. We have found the Ilizarov method to be helpful in correcting severe fixed flexion deformity of the knee, with relatively few complications, but the basic principles of the method must be carefully followed.

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    • "In the light of our experience with the Ilizarov fixator, this method appears highly efficient in the progressive correction of lower limb length discrepancies and articular or bony angular deviations [11]. The aim of that study was to demonstrate the interest of the Ilizarov external fixator in the multistage conservative management of congenital tibial deficiencies. "
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    ABSTRACT: Congenital longitudinal deficiency of the tibia is a rare and often syndromic anomaly. Amputation is usually the preferred treatment option in complete absence of the tibia; however, a conservative management might be implemented in partial forms or in case of amputation refusal. Our experience with the Ilizarov fixator, convinced us this device was the best suited for progressive correction of lower limbs length discrepancies and articular or bone angular limb deformities (ALD). The aim of this study is to highlight the interest of the Ilizarov fixator in the multistage conservative treatment of congenital tibial deficiencies. A retrospective study was conducted in nine patients suffering from Type I or II congenital tibial deficiencies (Jones) and sequentially managed using the Ilizarov technique. The functional outcome after treatment completion was then clinically assessed. The different stages of correction were recorded for each individual patient. Patients were assessed at a mean follow-up of 18,3 years (4-32 years). The mean maximum knee flexion was 35 degrees (0 degrees -90 degrees ) in type I deficiencies and 118 degrees (90 degrees -140 degrees ) in type II deficiencies. One patient underwent amputation and a bilateral knee arthrodesis was performed in another case. Few series in the literature report a comparable length of follow-up period in the conservative management of severe congenital tibial deficiencies. In our study, the Ilizarov fixator provided satisfactory progressive corrections of severe congenital tibial deficiencies. Level IV therapeutic retrospective study.
    Orthopaedics & Traumatology Surgery & Research 10/2009; 95(6):431-6. DOI:10.1016/j.otsr.2009.04.017 · 1.26 Impact Factor
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    • "This technique may be indicated in severe periarticular retraction when the aim is to provide the child with a limb in extension to enable walking [2]. The progressive nature of the reduction enables continuous distension of capsule-ligamentary, tendinous and vasculonervous components [2]. The cutaneous retractions—–bands and webs, however extensive—–are also suppled, circumventing the need for covering or cutaneous expansion plasty. "
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    ABSTRACT: IntroductionVarious treatment options are in use to address severe knee flexion contractures in children. Their success depends on an adequate selection of the proper one applying to each individual anatomical situation.HypothesisApplied to limb deformity, the Ilizarov technique combines progressive correction, to joint structures flexibility restitution in case of severe knee flexion contracture. We review a continuous series of popliteal pterygium syndrome patients managed with this technique.Patients and methodsMedical records of eight children (11 knees), consecutively treated between 1986 and 2007, were reviewed. Knee flexion ranged from 40 to 120°. Contracture (> 90°) was extremely severe in 10 cases. Progressive correction was gained by Ilizarov external fixation. Complications during and following articular chain distraction-lengthening were noted. Follow-up ranged from 1 to 21 years.ResultsSurgical realignment was rendered particularly complex by the popliteal cutaneous band itself, partly responsible of the joint stiffness and sciatic nerve shortening. Deformities were corrected by the Ilizarov technique. Complete extension was obtained in all cases. In six cases, flexion contracture reccurrence required to repeat the correction, using the same technique, at a mean interval of 3–4 years. During follow-up, four evolutive partial posterior tibial dislocations and one complete dislocation were diagnosed, all associated with recurrence of the flexion contracture.Level of evidence: Level IV. Therapeutic Study.
    Orthopaedics & Traumatology Surgery & Research 05/2009; 95(3-95):196-201. DOI:10.1016/j.otsr.2009.01.004 · 1.26 Impact Factor
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    • "Ilizarov used a natural hinge or temporarily removed the hinge during correction to allow restoration of the normal joint position. Once subluxation of the joint is detected during correction, it can be reduced by means of the existing Ilizarov frame and addition of a pull construct, or change of position of hinges (Damsin and Ghanem 1996). However, our observations show that the subluxation may spontaneously reduce after removal of the fixation device. "
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    ABSTRACT: We used Ilizarov frames in 26 patients for correction of severe contractures in 10 knees and 19 ankles. All patients had good initial correction. 2 patients developed posterior subluxation of the knee and 2 patients developed anterior subluxation of the ankle. At a minimum of 3 years' follow-up, 11 contractures had recurred. All patients except 1 had persistent restriction of motion. Considering the final position, improvement of motion and complications, we obtained an excellent result in 1 patient, good in 13, fair in 11, and a poor result in 1. Better results were obtained in patients with posttraumatic contractures than with other etiologies. There were also better results in correcting equinus contracture of the ankle than in knee flexion contracture.
    Acta Orthopaedica Scandinavica 11/1996; 67(5):443-9. DOI:10.3109/17453679608996665
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