Follow-up study after treatment of knee flexion contractures in spina bifida patients

Knee flexion contractures in spina bifida patients are seen in all levels o f paralysis. The majority is encountered in children with thoracolumbar les ions. Positional deformation, spinal reflex activity, fractures around the knee joint and a weak quadriceps are the main causes of the flexion deformi ty of the knee. One hundred and forty-five knee flexion contractures in 80 children have been treated between 1980 and 1995; 15 with unilateral contra cture, 65 with bilateral involvement. The age at the time of correction in 38 patients with thoracolumbar lesions was between 24 months and 11 years ( average, 7.7 years). In 42 patients with sacral or lumbosacral lesions, the age at the time of correction was between 10 and 19 years (average, 16.3 y ears). Associated surgery was mainly carried out on hip flexors, adductors and triceps surae. Complete posterior release was practiced in thoracolumba r lesions including posterior capsulotomy and release of the posterior cruc iate ligament. In lumbosacral lesions, the lengthened tendons are sutured t o prevent flexor weakness in the postoperative course. Vascular and neurolo gic structures are spared. Postoperative serial casts are helpful to achiev e full extension without vascular or skin troubles. The long-term results w ere very good in 59 patients with 106 knees, good in 16 patients with 29 kn ees, and unsatisfactory in 5 patients with 10 knees. Slow deterioration yea rs after surgery can be anticipated. The main causes are lack of personal i nitiative to stand and to walk, and obesity.