Functional results of judet’s quadricepsplasty in the management of fixed flexion deformity of knee

Introduction: Prevalence of Fixed flexion deformity (FFD) of the Knee is more prevalent in Indian scenario due to prolonged immobilisation following indigenous method of treatment of fractures around knee. Quadricepsplasty has been described by Thompson and Judet to improve flexion in severely deformed knees. Judet's technique has potential advantages because it is less damaging to the quadriceps mechanism and addresses the problem of external fixator pin site tethering on the lateral side of the thigh. Methodology: This is a prospective study conducted in Omanthurar Multispecialty Hospital from 2013-2018. Patients presenting with FFD of any reason due to post op immobilisation or conservative management of the fractures around the knee are included in the study while patients with previous history of surgery to improve flexion deformity were excluded. All the patients were evaluated clinically to measure the available range of movement preoperative and Judets Quadricepsplasty was carried out in a standard fashion and intraoperative flexion range achieved is recorded and their function results at final follow-up is categorised based on Judet's criteria. Results: We included 32 patients into the study and the M: F ratio 1.42:1 with male preponderance. Etiology of the FFD being 18 patients due to indigenous management fractures around knee while 9 were due to external fixator for compound injuries and 5 due to post op immobilisation. Mean preoperative flexion was 33 o while intraop immediate mean flexion achieved was 112 o and flexion at final follow-up was 108 o. One case of superficial infection settled with antibiotics and one case required manipulation under anaesthesia to regain flexion which was lost in the initial follow-up since the patient was not adherent to the postop protocol. Mean follow up of the patients under study was 2.6 yrs (Range 2-5 yrs). Out of 32 cases we achieved 22 cases with excellent results and Good in 9 case and Fair in 1 case based on criteria by Judet. Conclusion: Judet's technique of Quadricepsplasty by disinsertion and muscle sliding is a useful technique in fixed flexion deformity of knee extension commonly seen in patients undergoing indigenous method of treatment and limb reconstruction surgery after a prolonged immobilisation of Knee due to conservative management of fractures around knee or application of external fixators.