This illustration shows adhesions in the suprapatellar pouch, deep to the muscle group of the quadriceps. But adhesions can also form between the muscle heads making up the quads.
Quadricepsplasty after arthrofibrosiss
When the quadriceps muscles become disabled by arthrofibrosis, scarring may occur around the vastus intermedius head of the quadriceps and in the suprapatellar pouch as well as in the 'anterior interval' under the patellar/quadriceps tendon.
Adhesions are sticky strands that form between tissue layers in response to inflammation, where the body tries to heal neighbouring inflamed tissues by drawing them together. Arthrofibrosis is more advanced process where adhesions become replaced inappropriately with connective tissue, locking down a joint making movement difficult and painful.
Peer-reviewed papersQuote from peer-reviewed paper:
"...the treatment of a severely arthrofibrotic knee represents a dilemma faced by orthopaedic surgeons...."
Citation: Xu H, Ying J. A mini-invasive procedure for treating arthrofibrosis of the knee. Acta Orthop Traumatol Turc. 2016 Aug;50(4):424-8. doi: 10.1016/j.aott.2016.06.006. Epub 2016 Jul 15. PMID: 27423809; PMCID: PMC6197392.
The procedure of quadricepsplasty
There are two types of procedure called quadricepsplasty - distal and proximal. In adults it is usually the proximal or Judet procedure that is performed - a stepwise procedure where after each surgical step the knee is evaluated to see if range of movement has improved.
Adhesions of the capsule are first released, then the rectus muscle is cut and the whole quadriceps released from the underlying bone, together with release of the fascial soft tissues holding tissues together.
Distal quadricepsplasty is called Thompson's quadricepsplasty and is a paediatric procedure not appropriate for adult knees.
Peer-reviewed papersQuote from peer-reviewed paper:
Judet's quadricepsplasty "...allows the surgeon to limit the procedure at any phase once adequate flexion is obtained thus preventing further soft tissue dissection and potential risk of greater extensor lag from over release....."
Citation: Ding BTK, Khan SA. The judet quadricepsplasty for elderly traumatic knee extension contracture: a case report and review of the literature. Biomedicine (Taipei). 2019 Sep;9(3):21. doi: 10.1051/bmdcn/2019090321. Epub 2019 Aug 27. PMID: 31453802; PMCID: PMC6711318.
Rehabilitation after quadricepsplasty
Early rehabilitation after quadricepsplasty focuses on continuous passive motion with a CPM machine.
Peer-reviewed papersQuote from peer-reviewed paper:
"...modification of range of motion of the knee can significantly change a patient's quality of life. In general, range of motion of 0° to 125° is adequate for most activities of daily life...."
Citation: Dos Santos Cerqueira F, T Araújo Motta GA, Rocha de Faria JL, Perez da Motta D, Dos Santos Cerqueira F, Adolphson F. Minimally Invasive Quadricepsplasty. Arthrosc Tech. 2019 Feb 25;8(3):e343-e347. doi: 10.1016/j.eats.2018.11.005. PMID: 31019888; PMCID: PMC6472174.
Forum discussions
- Help - Non union osteotomy/Judet Quadriceplasty
A spiral of surgical complications, with a Judet quadricepsplasty to remove adhesions.