Treatment and rehabilitation of postburn extension contracture of the knee

TANG Jin-shu; XU Ming-huo; WU Wen-wen; HU Yuan; SHI Xiu-xiu; HOU Shu-xun

doi:10.3969/j.issn.2095-252X.2014.01.006

Abstract：Objective To investigate the methods of release surgery and postoperative rehabilitation of postburn extension contracture of the knee.Methods From June 2007 to December 2011, 11 patients with 16 postburn stiff knees were adopted, including 9 males and 2 females. Their mean age was 33.2 years old ( range; 19-54 years ), and the average stiffness period was 12.6 months ( range; 8-26 months ). The mean range of lfexion was ( 26.2±11.9 ) degrees preoperatively ( range; 5-50 degrees ). The Hospital for Special Surgery ( HSS ) knee function score was ( 55.8±6.9 ) points preoperatively ( range; 46-72 points ). Release surgery was performed in all stiff knees. The intra-articular adhesion was totally released, and the contractural and ifbrous vastus intermedius was cut off. The deep and superifcial fascias were freed to increase the skin ductility. More than 90 degrees of lfexion was observed in all the knees during the operation, and the reversed fascial lfap was used to suture the deep fascia in the position of lfexion of 90 degrees. The skin was sutured with subcutaneous tissues in situ, and skin transplantation was not performed. After the operation the knee joint was immobilized in the maximum lfexion position for 72 hours, and meanwhile the pre-patellar skin would not become pale or ischemic. All the patients actively started early rehabilitation. The skin coverage, range of motion and functional restoration of the joint were observed before and after the treatment. All the patients were followed up for a mean period of 25.7 months ( range; 18-36 months ).Results The range of lfexion was ( 122.2±11.0 ) degrees on average after the treatment, ( range; 110-135 degrees ), which was increased by 96.0 degrees when compared with that preoperatively (P<0.01 ). The range of lfexion was increased to meet the demand after the increase of skin elongation. The mean HSS knee function score was 97.5 points in the latest follow-up ( range; 93-100 points ), which was increased by 41.7 points when compared with that preoperatively (P<0.01 ). The knee function was obviously improved.Conclusions For the patients with postburn extension contracture of the knee, release surgery is a good choice with the contractural tissues released and the deep and superifcial fascias separated. However,skin transplantation is not performed. The short-term immobilization in the lfexion position and active rehabilitation after the operation may be the crucial measures to improve the skin elongation and the knee function.