When a contracture of the knee joint is considered severe. Knee contracture, knee contracture treatment

Knee contracture is one of the most common ailments associated with the functionality of the knee joints. Often this violation does not apply to diseases. Contracture is caused by damage or injury to the knee joints, as cicatricial changes lead to limitation motor activity and shortening of ligaments. Contracture of the knee joint requires mandatory diagnosis and subsequent treatment.

Causes of knee contracture

Contracture of the knee joint

Knee contracture is often caused by trauma to the joints and their subsequent deformation in front or behind.

The main factors provoking the appearance of contractures:

mechanical damage;
diseases associated with musculoskeletal system and its effect on the knees;
acute inflammation;
negative predisposition at the genetic level;
decreased elasticity of the knee muscles;
improper supply of impulses to the central nervous system.

The above factors threaten the development of knee contracture. Subsequently, temporary immobility of the joint leads to muscle contracture, as a result of which an active lifestyle becomes impossible.

Pathological disorders of the musculoskeletal system are manifested with mechanical damage. Serious injuries resulting from different reasons accompanied by contracture. To restore the previous functions of the joint, it is desirable to use immobilization for a certain period of time, since subsequently there is a risk of manifestation of pathological changes.

Symptoms of contracture

Severe knee pain

The symptomatology of contracture depends on the degree of pathological processes. Subsequently, the movements of the knee joint are limited more and more. The leg unbends - it bends differently than before the injury, and the restraining amplitude becomes more and more noticeable. Gradually, the leg is fixed in one position.

Temporary contractures are characterized by the manifestation of sharp pain. The chronic form of the pathological process becomes hardly noticeable, since a person may not complain of pain. The resulting stiffness leads to a sharp limitation of the possibilities regarding active image life. Often a sick person goes to the doctor after his gait changes.

The main symptoms of contracture:

swelling in the affected area;
violation of the support;
joint pain;
leg shortening;
curvature of the shape of the lower leg;
a feeling of an uncomfortable position of the leg, and therefore a manifestation of discomfort.

The above signs of contracture indicate deterioration physiological state, and additional symptoms determined by the presence or absence of the underlying disease.

Development of persistent contracture

Development of contracture of the knee joint

Persistent contracture may occur after 3 weeks of forced immobilization of the knee joint. Subsequently strength muscle tissue decreases at an accelerated rate. After a week and a half, the joint bag becomes less elastic, so the violations are fixed.

Persistent contractures traditionally include pathologies of a congenital form. Usually they appear when the structure of the leg is incorrect. For example, clubfoot in a child leads to impairments and limitations associated with motor functions.

The treatment of persistent contractures is always complex and it is mandatory to take into account all medical advice. The inactivity of the patient and deviations from the rehabilitation course worsen the condition of the sick person. Pathological processes develop faster if the straightening or bending of the leg occurs in a forced manner.

Failure to comply with medical instructions and avoiding the prescribed course of therapy threatens with a complete loss of mobility of the knee joint.

Diagnostics

X-ray is one of the main diagnostic methods.

The symptoms of contracture are characteristic, so it is not difficult to make a correct diagnosis. The main complaint is an incorrect range of motion of the knee joint, so the position of the leg becomes unsatisfactory. The study of the anamnesis of the disease determines the cause of the development of contracture and possible complications, after which the possibilities for the subsequent treatment course are determined.

The examination involves the mandatory measurement of the amplitude of active and passive movements in the knee joint. Diagnosis is aimed at studying the features of the motor function of the knee joint, after which the method of treatment (mobilization and the need for surgery) is determined, and the results of treatment are evaluated. The appearance of a crunch becomes an additional dangerous sign. Also undesirable are skin scars and increased muscle tone, shortening of the leg.

X-ray is one of the main diagnostic methods. This method determines the nuances of fusion of the femur and tibia, which leads to the formation of contracture and limitation of motor function.

Electromyography is often included in a number of diagnostic measures, as it allows you to determine the activity of the muscles.

Ultrasound, MRI determine the presence or absence of cicatricial and adhesive changes in the muscles and knee joints.

Thermal imaging study is aimed at identifying inflammatory processes in the knee joints and soft tissues of the knees.

Holding comprehensive examination reveals the cause of contracture of the knees.

Treatment of knee contracture

With the manifestation of flexion contracture of the knee joint, mandatory therapeutic measures are required, which are related to a conservative or operative direction. The method of treatment is determined by the doctor, taking into account the characteristics of the state of health and the need for immobilization.

If forced rest for the knee joint is required for three weeks, it is possible to limit conservative ways to restore motor functions, eliminate pain, improve blood circulation.

The main directions of conservative treatment:

physiotherapy procedures;
taking medications;
manual therapy;
massotherapy.

Reception medicinal products becomes mandatory, as they eliminate the inflammatory process and reduce cicatricial changes. Novocain and Lidocaine are prescribed as painkillers. It is desirable to use such preparations in the development of contracture of the knee joint according to a specially agreed scheme.

No less useful are physiotherapy procedures that have a positive effect on the inflamed knee joint.

Orthopedic bandages are used to improve the position of the leg and support the joint. The appointment of bandages is the responsibility of the doctor who selects special products for fixing the knees.

Therapeutic exercise is also becoming mandatory. Gymnastics is held under compulsory medical supervision. Gymnastic exercises are aimed at relaxing the muscles. If the knees are pinched and they cannot straighten up in the future, it is recommended to stop the lesson.

The doctor selects special gymnastics taking into account the following factors:

the degree of manifestation of the disease;
features of the physical condition;
age category of the patient.

It is advisable to perform a set of exercises to improve the condition of the knee joint and gain the desired muscle tone. Increased caution becomes mandatory. Correct performance of therapeutic exercises will restore the function of the leg. Regular training becomes useful, as they are aimed at restoring the previous motor and flexion-extensor function of the knee and ankle. Knee development is required in without fail, therefore exercise therapy is included in the complex of treatment.

If the knee joint continues to jam, mechanical therapy is required. These exercises are performed on special simulators. Training is carried out at the final stage of treatment to receive electrical stimulation.

Psychotherapeutic treatment is recommended for hysterical contracture. Such an approach to treatment is possible only after a preliminary consultation with a doctor and if the treatment methods used did not allow the knee joint to return to its previous functionality.

Operation

Arthroscopy of the knee

In severe cases, conservative treatment at home and stationary conditions becomes ineffective.

In this scenario, surgery is required to restore the shape of the knee joint and remove scar tissue. Usually, after the operation, the knee joint no longer wedges and the stiffness of movements is eliminated.

A preliminary examination is carried out and an accurate diagnosis is made in accordance with the ICD, after which an intervention is performed on the right or left knee. The operation becomes effective even with an initially poor prognosis, but the period and conditions of rehabilitation depend on the characteristics of the patient's state of health.

Atroscopic arthrolysis. The procedure involves cutting the adhesions to mobilize the knee joint.
Arthroplasty. The operation involves the installation of an implant, which is a replacement for the knee joint.
Tenotomy. The operation involves lengthening the tendon to eliminate pinched knee ligaments.
Capsulotomy. Inner part of the knee joint is opened so that the doctor can operate on the affected area of the knee.
Fibrotomy. The operation involves dissection of the knee muscles.
Orthopedic surgery. The bone is supposed to be cut.

The surgeon performs diagnostics to determine suitable type surgery that can help the patient. The child and adult may be interested in surgical intervention, as contracture different degrees severity is manifested in people of different ages. If the knees do not unbend, the operation is recommended to be done taking into account the preparation and further rehabilitation to restore the previous motor function. If there are violations in the future, it is recommended to use gels and ointments, massage and exercise therapy, since the combined approach to treatment increases muscle tone and improves blood circulation. Initially, it is recommended to understand why contracture appeared and how to prevent the development of related diseases as complications.

Knee contracture is a disease that leads to the risk of disability. The knees can sometimes jam or pinch, after which it is difficult to unbend them - bend, but only holding timely treatment prevents more serious treatments.

Rehabilitation after the appearance of the first signs of contracture becomes mandatory. A mixed approach to treatment, including a conservative and surgical method, is recommended in the last stages of the disease, since the end of the development of inflammation threatens with disability and a complete loss of motor function.

Stiffness in the knee joint is treated, but this requires mandatory interaction with the doctor.

Under the contracture of the knee joint, it is customary to understand the pathology of the lower part of the limb, which is characterized by limitation of flexion or extension. As a result of contracture, the range of motion is reduced. This condition is a widespread pathology of the musculoskeletal system, which leads to disability. The risk of this disease increases in athletes and people involved in heavy physical labor.

Classification

Given the cause of the appearance of pathology, 2 groups are distinguished: neurogenic and structural contractures of the knee joint. In each group, several types of contractures are distinguished.

Neurogenic contracture appears as a result of cerebral hemorrhages, paralysis or diseases of the central nervous system.
Structural contracture occurs when there is something that prevents the movement of the joint.

All passive or structural pathologies are classified depending on which tissue predominates in the contracture. In this regard, the following types are distinguished:

Myogenic or muscle contractures develop as a result of excessive physical activity, when chronic fatigue and muscle strain occur. The result is muscle shortening.
The appearance of dermatogenic contracture is due to the presence of skin scars after burns or inflammatory diseases.
Desmogenic contractures are characterized by wrinkling of the connective tissue membrane that covers the muscles and ligaments during chronic inflammation or after deep lesions.
Tendogenic or tendon contractures are the result of shortening of the tendons and appear when the joint is damaged or inflamed. As a result, adhesions are formed, and the limb segment acquires a forced position.
Arthrogenic or articular contractures are characterized by changes in the ligamentous apparatus of the joint. The appearance can be influenced by dystrophic and inflammatory processes in the joint.
Immobilization contractures develop as a result of prolonged immobilization.

The mobility of the knee joint can be limited in different directions: during flexion, extension, rotation, abduction or adduction of the limb.

Among the neurogenic contractures are:

Central neurogenic. Develop as a result of injuries, diseases of the brain and spinal cord.
Hysterical. May occur as a result of a sudden seizure.
Peripheral. They appear when peripheral nerves are damaged, which connect the central nervous system with muscles, tendons.

Depending on the etiology, congenital and acquired contractures are distinguished.

Congenital contracture develops as a result hereditary diseases. It can be congenital clubfoot, muscular torticollis, etc.
Acquired contracture appears due to scarring at the site of the damaged area. This is affected by injuries of a different nature, infectious or dystrophic damage to the joints.

Causes

In most cases, contracture of the knee joint is not included in the category certain diseases and pathology appears after damage or injury. The scar left after this can lead to limitation of motor activity, shortening of the ligament. Later, deformity of the knee joint occurs.

The factors provoking the appearance of contracture include:

Mechanical damage (trauma, burns, fractures, dislocations, etc.);
Diseases of the musculoskeletal system (arthrosis, arthritis, etc.);
Inflammatory processes;
hereditary predisposition;
Decreased elasticity of muscle tissue;
Damage to the central nervous system.

With temporary immobility of the joint, contracture can also develop.

Most often this pathological condition of the musculoskeletal system appears due to mechanical damage. Any serious injury resulting from various reasons accompanied by contracture. Immobilization is required to repair a damaged joint. With each week of immobilization, the strength in the muscles decreases. As a result, immobilization contracture leads to the development of pathology of varying degrees.

Symptoms

The main clinical manifestations of contracture are limitation of flexion and extension movements in the joint. Symptoms depend on the cause, severity and phase of the disease. The clinical course of flexion contracture is observed early, during inflammatory processes in the joint. The patient may find that knee flexion before and after the injury is markedly different.

Symptoms of knee contracture include:

Pain in the area of the injured joint;
puffiness;
Deformity of the knee joint;
support violation;
Curvature of the lower leg outward;
Uncomfortable position of the leg;
Shortening of the limb.

In addition to the above symptoms, other symptoms may also occur. They depend on the course of the underlying disease. If this pathology lasts for several weeks, then a qualified specialist can detect arthrotic processes in the knee.

Diagnostics

It is important to determine the pathology at the initial stage of the development of the disease. To do this, you should consult a doctor if you have these signs: unnatural position of the leg, soreness, discomfort during movement. A surgeon or orthopedist deals with the diagnosis and treatment of contracture of the knee joint.

For staging correct diagnosis the doctor examines the patient's leg and prescribes an x-ray of the damaged area. Use if necessary instrumental methods diagnostics: magnetic resonance imaging and computed tomography. These methods are usually used if there are changes in the muscles and ligaments.

In some cases, to clarify the diagnosis of "neurogenic peripheral contracture", it is necessary to consult other specialists - a neurologist, a neurosurgeon.

Treatment

For joint contracture, conservative or operational methods treatment.

Treatment can be carried out in a trauma center, traumatology department or surgery in a hospital setting. The method of treatment is selected taking into account the duration of immobilization. If the affected joint has been at rest for 3 weeks, then conservative treatment is prescribed. It involves a number of medical procedures and events.

The goal of conservative treatment is to restore impaired knee movements and eliminate pain, improve blood circulation in the joints. To achieve the result, the patient is assigned a set of measures, which include:

Physiotherapy procedures;
drug therapy;
manual therapy;
Therapeutic exercise;
Massage.

By using medicines you can eliminate the inflammatory process in the joint and reduce scarring. Novocain, Lidocaine are used as painkillers.

Various methods of physiotherapy ( mud applications, warm baths, electrophoresis, etc.) have a beneficial effect on the affected joint.

Orthopedic dressings are used to correct the position of the articular joint. They are used to limit the mobility of the affected joint.

Therapeutic gymnastics is aimed at relaxing the muscles and can be done at home or in the exercise therapy room with an instructor. He draws up an exercise plan taking into account the degree of manifestation of the disease, the physical condition and age of the patient. Exercises must be performed in combination to improve joint mobility, tissue elasticity and increase muscle strength.

The exercises should be done carefully. The sooner the patient starts therapeutic exercises, the faster the limb will recover. It is important to perform exercises regularly and systematically for 20 minutes a day several times a week.

The use of force when performing therapeutic exercises is contraindicated. This can aggravate the situation and lead to rupture of the ligaments.

Physiotherapy exercises should be performed throughout the entire period of treatment. With regular implementation and compliance with all the doctor's recommendations, you can return to the ability to unbend and bend the knee joint.

There is another type of conservative treatment - mechanotherapy. This is a set of exercises that are performed using special simulators. This type of therapy is used for final stage convalescence.

Treatment of neurogenic contracture involves the use of electrical stimulation procedures in the presence of peripheral form. Spinal neurogenic pathology is treated by adhesive or cuff traction. With hysterical contracture, psychotherapeutic methods of treatment are used.

Sometimes, in severe cases, conservative methods do not help. Then the doctors resort to surgery. Thanks to the operation, it is possible to restore the shape of the joint, remove scar tissue.

In the treatment of contracture of the knee joint surgically can be used various options operations:

Arthroscopic arthrolysis. The procedure involves dissection of fibrous adhesions to mobilize the joint.
Arthroplasty or endoprosthetics. The operation is reduced to replacing the joint with an artificial implant. Joint restoration can also be carried out without prostheses.
Tenotomy. An operation in which the dissection and lengthening of the tendon is performed. It is used mainly for arthrogenic contractures.
Capsulotomy. The intervention involves opening the inside of the joint so that the doctor can get to the affected area.
Fibrotomy. The operation is to cut the muscles.
Osteotomy. Orthopedic surgery, which is aimed at eliminating the deformity by dissecting the bone.

The surgeon selects the operation taking into account the severity of the disease and the degree of damage to the knee joint.

The reason for the development of contracture is the defeat of various tissues, according to which there are several types of contractures:

structural (passive):
- arthrogenic;
- desmogenic;
- myogenic;
- dermatogenic;
neurogenic (active):
- central;
- peripheral;
- psychogenic.

Structural contractures

Structural contractures are called, in which the stiffness of the joint is due to mechanical causes: if free movement is prevented by some kind of physical interference caused by damage to the joint itself or its surrounding tissues.

Arthrogenic stiffness is caused by damage to the joints and articular surfaces of bones.

Desmogenic contractures are caused by damage to the ligamentous apparatus and fascia - connective tissue covers surrounding the muscles.

Myogenic contractures are associated with damage to muscle tissue.

The cause of dermatogenic stiffness is scars that tighten the skin.

Causal factors

The contracture of the knee joint is characterized by a rather complex mechanism development. The starting point for the onset of the disease can be the following factors:

inflammatory processes and injuries of the knee joint;
bone deformation due to arthritis or arthrosis;
decreased elasticity of the joint capsule and ligaments;
reduction in the length of the muscles, due to which the mobility of the constituent articular elements should be ensured.

Temporary immobility of the joint can lead to contracture

Depending on the factor that caused the pathological changes that led to contracture of the knee joint, the following types of stiffness are distinguished:

immobilization;
ischemic;
compensatory;
professional.

Signs of contractures

The joint can be fixed in an extended or flexed state, with rotation and abduction. The main types of disorders are flexion and extensor contractures of the knee joint.

Her combined view characterized by complete immobility of the affected area. This is the most severe complication, practically not amenable to conservative therapy.

Symptoms and Diagnosis

The development of a pathological process in which there is no flexion function of the knee is called "knee joint contracture". This disease is caused by cicatricial contraction of tendons, skin or muscles. Translated from the Latin "contractura" means contraction.

Contracture in the knee joint is accompanied by several symptoms:

acute pain syndrome;
limitation of joint mobility (no flexion function);
pathological changes in the tissues adjacent to the joint (tightening of tendons and muscles);
leg deformity;
limb shortening;
complete loss of joint mobility (without appropriate treatment).

The nature of the course of the disease and its symptoms depend on age category the patient and the stage in which the disease is located (acute or chronic form).

For staging accurate diagnosis doctor must prescribe full examination sick. To date, the diagnostic technique is diverse:

CT scan;
x-ray examination;
magnetic resonance imaging (MRI).

Contracture of the knee joint is a pathology of the knee in which it is impossible to fully bend or straighten the limb as a result of cicatricial contraction of the skin, tendons or muscle disease.

Contracture is Latin for contracture. The main symptoms of knee contracture are as follows: the mobility of the knee joint is sharply limited, because as a result of contraction in the adjacent soft tissues changes are taking place.

The patient experiences severe pain and eventually, if timely proper treatment is not carried out, contracture of the knee joint leads to its complete immobility.

The disease is characterized by a curvature of the lower leg and shortening of the limb, when you try to move the joint, acute pain pierces. The severity of symptoms depends on whether the disease is acute or chronic, the age of the patient, and a number of other factors.

Establishing an accurate diagnosis requires complete thorough examination sick. For this, modern medical technology diagnostics such as magnetic resonance imaging (MRI), computed tomography (CT) and radiography.

Painful sensations are often accompanied by deformation, the degree of which is noticeable even from the outside, and the stronger and longer it takes pathological process, the more pronounced the deformation. These are the main signs, but along with them are also observed:

The manifestation of certain symptoms always depends on the stage of contracture development. With a long course of the disease, even the appearance of arthrosis is possible.

During the initial diagnosis, which consists in a physical examination, the mobility of the joint is established. Subsequently, x-rays are ordered.

If scarring is noted on soft tissues, an MRI, CT or arthroscopy is additionally prescribed. Suspicion of neurogenic disorders entails adjustment of diagnostic measures, consultation of a neurosurgeon or neurologist may be necessary.

In hysterical forms of contracture, the patient is also referred to a psychotherapist.

The main symptom of knee contracture is the inability to bend or straighten the leg to the end. You may also experience:

swelling in the joint area;
decrease in the girth of the thigh, lower leg due to muscle atrophy;
visual shortening of the leg;
giving the leg an unnatural, forced position.

Depending on the cause that caused the contracture of the knee joint, limitation of mobility may be accompanied by pain, sensory disturbances.

Prognosis in treatment

In situations where physical exercise And medical preparations do not lead to the desired results, it is necessary to use a surgical method of treatment.

With the help of surgery, doctors lengthen the muscles; restore tendons (release them from healed tissues); perform osteotomy, transplantation and elimination of skin scars.

When the tendon is seriously damaged, the patient is implanted with tissues made of special plastic or canned, which easily take root in the body.

They also perform various corrective operations on bone tissues. For example, when the length of the limbs does not match, the shortened bone can be lengthened or, conversely, shortened.

Surgical intervention in the treatment of contracture of the knee joint is often combined with physiotherapy and balneotherapy.

Depending on the severity of the lesion, which is established by the above measures, treatment is prescribed. It can be operational or conservative.

In particular, in some cases they are prescribed at the nearest emergency room, and in the orthopedic or traumatology department of the hospital. As there is an improvement in the mobility of the damaged joint, the patient can increase the load to the maximum allowable volumes so as not to aggravate the situation.

The main methods of conservative treatment:

physiotherapy, which includes shock wave therapy and electrophoresis;
massage and mechanotherapy;
correction of the position of the limb in a bloodless way using fixing devices and replaceable plaster bandages.

All these manipulations can also be accompanied by the use of so-called traditional medicine, for example, warm baths with the addition of spruce needles, pine needles or eucalyptus oil. This relieves muscle tension.

If conservative treatment does not give the desired result, it is necessary to resort to surgical intervention. It can be done by opening skin and open access to the injured joint, as well as using arthroscopy equipment.

During surgery, joint deformities, restoration of their surface, removal of scars and lengthening of muscle tissues are eliminated. With significant damage to the joints, arthroplasty is used.

In the postoperative period, a complex of restorative procedures is performed, including physiotherapy exercises, as well as physiotherapeutic procedures and massage, which are designed to improve the blood supply to regenerating tissues and increase muscle tone.

In the treatment of neurogenic contracture, considerable attention is paid to the underlying disease and the elimination of its side effects. With hysterical contracture, psychotherapeutic techniques are used.

In the case of the diagnosis of flexion contracture, the use of devices with weights and special splints, which help to straighten the limbs, gives a positive effect.

In all cases, the prognosis based on the results of treatment is determined by the success of the fight against the main diseases and the elimination of the causes that led to them. A significant role is played by the timeliness of the patient's appeal to specialized specialists, accurate and prompt diagnosis, as well as the correctness of the chosen treatment method.

Immobilization contractures with a short duration of the lesion have a positive prognosis, while with chronic manifestations, the prognosis is considered less favorable, due to the development primary disease and secondary lesions of nearby tissues.

The timeliness of treatment and the adequacy of treatment are the key to getting rid of this unpleasant disease.

The fight against contractures consists of four main points:

prevention of contractures by applying correctly applied dressings and their timely removal;
correction of contractures by orthopedic methods - elastic bands, twist, stage and plaster bandages, by surgery;
retention of the achieved position by a fixing bandage;
intermediate and especially subsequent.

During treatment, it is necessary to reasonably combine contracture correction, aimed at maintaining muscle tone, with surgical and spa measures. The active will of the patient and the skillful use of therapeutic exercises are of great importance.

In the event that the contracture cannot be cured by conservative methods, surgical intervention is performed. With its help, skin scars are eliminated, muscles, tendons are lengthened, they are released from scars, transplantation, osteotomy, and so on are performed.

In case the tendon is seriously damaged, tissues canned or made of special plastic are used, which take root well in the body.

Various corrective operations of bone tissue can be performed. Somehow, if the length of the limbs is not the same, an extra bone fragment is removed for shortening or, conversely, the shortened bone is lengthened.

Surgical removal of contracture of the knee joint should be combined with balneotherapy and physiotherapy.

Doctors pursue the goal - to relieve inflammation, pain and restore mobility to the joint. Modern medicine has succeeded in this.

The prognosis in the treatment of contracture fully depends on its type and degree of damage, on how much time has passed since its onset, on the age of the person suffering from it and on his condition, on the time from which treatment was started.

The sooner you start it, the more chances there are for positive response dynamics and, as a result, for complete healing.

In the treatment of knee contracture, preference is always given to conservative methods treatments such as:

the use of orthopedic dressings for mechanical correction of the position of the articular joint;
physiotherapeutic methods (mud therapy, paraffin baths, etc.);
exercise therapy - physiotherapy;
massage;
exercises on special devices and devices.

Physical therapy is used to treat contractures.

Exercise therapy for contracture has a number of features:

the sooner you start movement exercises, the higher the chances of a complete recovery of the limb;
no need to use violence physical therapy classes, since pain causes reflex muscle tension, and this may lead not to the elimination of contracture, but to its strengthening;
exercise therapy exercises should be done regularly, but not to overwork. When drawing up a program, the exercise therapy instructor must take into account the age of the patient, his condition and manifestations of the disease;
exercises must be performed systematically three to four times a day for twenty-five minutes;
in case of pathology of the knee joint, exercise therapy exercises should be performed with both legs so that all joints work, including absolutely healthy ones.

It is very important to remember that in the process of performing therapeutic exercises, any violent influence is strictly contraindicated. The use of brute force will lead to torn ligaments and even more trauma, which will only aggravate the disease.

The general method of exercise therapy throughout the course of treatment involves the division into several main stages:

Surgical operation for contracture is carried out only in the most extreme cases, When conservative therapy renders ineffective. Most often, the operation is performed using arthroscopic equipment, but can also be performed through open access.

The main purpose of surgery is to correct the shape of the articular surfaces, lengthen the muscles and remove scars. If the joint is too severely damaged, arthroplasty may be required.

When a contracture of the knee joint is detected, it is first necessary to diagnose and treat the underlying disease. The least favorable prognosis is in contractures caused by chronic, incurable diseases, but even in these cases, adequate treatment can restore the mobility of the knee joint, if not completely, then at least partially.

Drug treatment is prescribed depending on the cause that caused the contracture, and is aimed at eliminating this cause. Such treatment can prevent the development of contracture, however, stiffness, complicated by pathological changes in tissues, drugs do not eliminate.

Conservative treatment

Treatment begins with warming up - applying ozokerite or paraffin to the area of the knee joint.

Of the hardware methods of physiotherapy, the following are used:

electrophoresis or phonophoresis of lidase, potassium iodide, aminophylline;
shock wave therapy;
high-frequency centimeter (CMV) and decimeter (UHF) therapy;
electrical stimulation of the quadriceps femoris muscle with sinusoidal modulated current (SMT).

For resorption of adhesions, the introduction of oxygen into the joint bag can be used. To relieve muscle spasm, a therapeutic massage is prescribed.

To develop muscles and joints, physiotherapy exercises are used, including both passive (aimed only at muscle tension and relaxation) and active (including movements in the joint) exercises.

Gymnastics is carried out under the supervision of an instructor; after exercises, the leg can be fixed in the achieved position with the help of a fixing device.

Water exercises are also helpful. healing souls, therapeutic swimming.

In order to improve the condition of the joint after arthroscopy or injury, it is necessary to relieve inflammation and pain, restore mobility. Modern therapeutic techniques allow you to get rid of contracture without surgery.

Recovery time largely depends on the type and severity of the violation, the amount of time that has passed since the injury. The sooner treatment begins, the higher the chances of a full recovery.

For the development of the joint are used:

massage;
physiotherapy procedures (electrophoresis, thermal exposure, SWT).

Treatment at home involves the use of non-steroidal anti-inflammatory drugs and analgesics. In a hospital, hormonal agents are injected into the knee joint. They eliminate pain, increase muscle tone, slow down the process of tissue destruction.

Massage of the knee joint should be performed according to a specific pattern. An active effect is exerted on weakened muscles and a cautious one on those that are in an increased tone. First, soft movements are performed, then active ones. Only after a while, elements of resistance are introduced.

Exists exercise therapy complex aimed at improving the condition of the joint in the presence of contractures. The legs are pulled to the stomach and begin to alternately bend them at the knees.

The bent limb is lowered to the floor, after which it is straightened. The bicycle exercise is performed first for one leg, then for the second.

It is useful to hold the bent leg on weight for a long time. The straightened limb is placed on the gymnastic ball and pressed on it.

After that, rotational movements of the lower leg are performed.

Squats are done with the ball between the legs. The same object is placed under the knees and they begin to put pressure on it with the heels.

Lying on its side, the leg is bent and lifted up. In the same position, the limb should be held on weight.

Lying on your stomach, bend both legs. In the same position, the straightened limb is raised.

All actions are performed at least 10 times. Classes should be held regularly, at least 1 time in 2 days.

The constant supervision of an experienced instructor is required.

Consequences of the disease

Without timely thoughtful treatment, contracture of the knee joint leads to its complete immobility. A disease that has reached this stage is treated exclusively by surgery, so at the first symptoms you should consult a doctor.

Any type of contracture, whether congenital or acquired, can end badly.

Running contracture does not allow the patient to move normally and leads to limb deformity, preventing a person from leading full life and reducing the possibility of physical activity to a minimum.

megan92 () 2 weeks ago

Tell me, who is struggling with pain in the joints? My knees hurt terribly ((I drink painkillers, but I understand that I am struggling with the effect, and not with the cause ...

Daria () 2 weeks ago

I struggled with my sore joints for several years until I read this article by some Chinese doctor. And for a long time I forgot about the "incurable" joints. So it goes

megan92 () 13 days ago

Daria () 12 days ago

megan92, so I wrote in my first comment) I will duplicate it just in case - link to professor's article.

Sonya 10 days ago

Isn't this a divorce? Why sell online?

Yulek26 (Tver) 10 days ago

Sonya, what country do you live in? .. They sell on the Internet, because shops and pharmacies set their margins brutal. In addition, payment is only after receipt, that is, they first looked, checked and only then paid. And now everything is sold on the Internet - from clothes to TVs and furniture.

Editorial response 10 days ago

Sonya, hello. This drug for the treatment of joints is really not sold through the pharmacy network in order to avoid inflated prices. Currently, you can only order Official site. Be healthy!

Sonya 10 days ago

Sorry, I didn't notice at first the information about the cash on delivery. Then everything is in order for sure, if the payment is upon receipt. Thank you!!

Margo (Ulyanovsk) 8 days ago

Has anyone tried traditional methods of treating joints? Grandmother does not trust pills, the poor woman suffers from pain ...

Andrew a week ago

What only folk remedies I didn't try, nothing helped...

Ekaterina a week ago

Tried to drink a decoction of bay leaf, no use, only ruined my stomach !! I no longer believe in these folk methods ...

Maria 5 days ago

Recently I watched a program on the first channel, there is also about this federal program to combat joint diseases spoke. It is also headed by some well-known Chinese professor. They say that they have found a way to permanently cure the joints and back, and the state fully finances the treatment for each patient.

Elena (rheumatologist) 6 days ago

Indeed, at the moment there is a program in which every resident of the Russian Federation and the CIS can completely cure diseased joints. And yes, indeed, Professor Park supervises the program.

There are two main types of contractures of the knee joint:

active, or neurogenic, contractures, in which the restriction of movement in the joint is caused by prolonged tonic tension of certain muscle groups resulting from pathological impulses in various parts of the nervous system; with prolonged existence, neurogenic contractures become persistent, passive due to secondary cicatricial-dystrophic changes in the muscles and joint capsule;

passive, or structural, contractures due to certain structural changes in local tissues; the vast majority of passive contractures are the result of damage to the bones that form the knee joint or other elements of the joint; less commonly, they form during prolonged immobilization of the joint or inflammatory processes in the lower limb.

Passive contractures are:

myogenic, caused by pathological changes in the muscles;

arthrogenic, caused by intra-articular disorders;

dermatogenic, or primary skin;

combined.

Depending on the deficiency of certain movements, contractures of the knee joint are divided into extensor, characterized by limited flexion of the lower leg, flexion and flexion-extensor, at which there is a restriction of both flexion and extension.

The cause of post-traumatic contractures are:

cicatricial changes in the muscles of the thigh and lower leg as a result of a bone fracture without damage to the knee joint;

violation of the anatomical relationships in the joint in case of its damage in the form of discongruence of the articular surfaces, bone obstacles, as well as cicatricial adhesions in the joint cavity and surrounding tissues;

cicatricial changes in the muscles and structural elements of the knee joint with a simultaneous fracture of the diaphysis of the femur or tibia and their articular ends;

cicatricial degeneration of the muscles of the thigh and lower leg, which developed as a result of the formation of a false joint, improperly fused fracture or osteomyelitis.

Biochemical, electromyographic and histological studies in contractures of the knee joint indicate significant changes in the joint itself and its surrounding muscles. The cause of the changes, in addition to dysfunction of the limb, is a direct trauma to the elements of the joint and muscles by a damaging agent or bone fragments, as well as an inflammatory process that develops as a complication during the healing of a fracture of the bones that form the knee joint.

The improvement of osteosynthesis in the treatment of fractures of the lower extremity has led to an improvement in the outcomes of severe injuries, but unsatisfactory results still occur in 7-38% of patients. Thus, the outcomes of femoral fractures are often unfavorable and cause persistent limitation of the function of the knee joint and non-union in 15-20% of the victims.

Diagnostics

The clinical picture of contractures of the knee joint is quite characteristic and is recognized without much difficulty. The main complaint of patients is a violation of the range of motion in the knee joint and a functionally unsatisfactory position of the lower limb. When studying the anamnesis of the disease, it is necessary to carefully find out the mechanism of injury and the complications that arose during the treatment.

An objective examination measures the amplitude of active and passive movements in the knee joint. At the same time, not only the amplitude of movements is measured, but also the deficiency of flexion and extension, as this affects the choice surgical tactics, method of mobilization of the knee joint and evaluation of treatment results. Palpation determines muscle tone and the condition of skin scars. Measure the relative and absolute shortening of the limb.

X-ray examination reveals the features of fusion of the femur and tibia, contributing to the formation of contracture, as well as violations of the congruence of the articular surfaces, preventing the full range of motion.

With EMG, the degree of decrease in the bioelectric activity of muscles on the side of damage is determined. Ultrasound and MRI can reveal formed scars and adhesions in the muscles and knee joint that impede movement.

Hidden foci of inflammation in the bones that form the knee joint and in soft tissues helps to detect thermal imaging.

Treatment

Non-surgical treatment of contractures of the knee joint is effective in initial stages their formation and consists in the use of closed manual redressing, staged plaster casts or orthoses. As a necessary measure, it is also used in the presence of contraindications to surgical intervention.

Indications for redressing are contractures of the knee joint 6 to 12 months old, with moderate intra-articular adhesions, with fractures that did not lead to anatomical changes joint. Contraindications include severe osteoporosis of the bones of the injured limb, the presence of ossifications in the joint and thigh muscles, incomplete consolidation of the fracture, and inflammatory changes in the tissues of the injured limb.

Redressation is performed under intravenous or mask anesthesia. When limiting flexion, the lower limb is placed on a ladder splint with a soft roller made of a sheet in the region of the popliteal fossa. With flexion contracture, a soft roller is placed under the heel. The assistant, applying pressure on the iliac bones, presses the patient's pelvis to operating table. The surgeon covers the patient's knee joint with one hand, the anterior surface of the leg in the lower third with the other, and carefully begins to make slow rocking movements. The applied force is determined by the subjective sensations of the surgeon and should never be excessive. In the presence of spring movements in the joint, redressing continues for 3-5 minutes until flexion and extension increase. In the presence of significant resistance of the periarticular tissues and the absence of springy movements, redressing is stopped. Sometimes, after achieving a slight increase in the amplitude of movements within 5-10 ° during redressing, the subsequent complex treatment, combining the methods of FTL, mechanotherapy and exercise therapy, provides a good functional result.

In the treatment of contracture with stage plaster bandages, a lining bandage is applied with pelvic ring. A few days later, it is circularly dissected in the area of the knee joint, excising a small wedge from the anterior or posterior surface, depending on the type of contracture. The lower leg is bent or unbent and the bandage is reinforced with plaster bandages. Depending on the rigidity and degree of contracture, such manipulations are performed several times. After removing the bandage, rehabilitation treatment is carried out, to prevent the recurrence of contracture, the joint is immobilized with an orthosis for the night.

Orthopedic orthoses for the treatment of contractures of the knee joint are equipped with a stepped closing hinge, which allows fixing the achieved angle of leg flexion. In some cases, they allow you to eliminate contracture, but it is more expedient to use them to consolidate the result achieved with other methods.

To eliminate flexion contracture, the Momsen twist was previously used - a stick was fixed to the splints on the thigh and lower leg with ropes, the twisting of which led to the extension of the lower leg.

The listed non-operative methods are used in conjunction with a wide range physiotherapy and water procedures, exercise therapy, mechanotherapy.

Operative treatment.

In 1917, leading experts, having conducted experiments, found out the role of the components of the quadriceps muscle in the formation of contracture of the knee joint and proposed various methods for its mobilization and plastics. Depending on the degree of contracture and the severity of structural changes in the knee joint and m. quadriceps, he recommended for mild contractures to perform arthrolysis with excision of cicatricial adhesions from the upper torsion and, less often, to cross the intermediate muscle. In more severe cases, it is necessary to mobilize the rectus muscle and cut off the medial and lateral vastus muscles from the patella. If these elements did not increase the range of motion, then the author resorted to a Z-shaped lengthening of the common tendon of the quadriceps muscle. Sutures were placed on the tendon and muscles in the position of leg flexion at an angle of 150-160°.

Operation Thompson

For the treatment of extensor contractures of the knee joint that developed after a fracture of the femur, Tompson proposed an operation, which he called plastic m. quadriceps. The main stages of the operation are the mobilization of the rectus muscle to unchanged areas while maintaining its continuity, excision of the scar-modified intermediate muscle, cutting off the tendons of the lateral and medial wide muscles from the patella. After mobilization of the heads of the quadriceps muscle, redressing is performed to break intraarticular adhesions and stretch the rectus muscle. If necessary, the scars from the joint and upper inversion are excised. With slightly altered wide muscles, the author recommended suturing them after mobilization to the rectus muscle, and in case of significant cicatricial degeneration, isolating them from the rectus muscle, creating new spaces from the subcutaneous fatty tissue. Preservation of the integrity of the rectus muscle allows not to immobilize in postoperative period and start developing movements in the knee joint from the first days.

Operation Judet

A fundamentally different operation was proposed by Judet et al. based on the distal movement of the proximal portions of the quadriceps muscle along the thigh, along with arthrolysis, tenolysis and myolysis. The Judet operation is performed with two incisions, which are performed separately for arthrolysis and mobilization of the quadriceps muscle. From a long outer incision from greater trochanter to the outer condyle of the femur, the lateral broad muscle is released from the intermuscular septum, the place of its attachment is separated from the greater trochanter, then the intermediate and outer broad muscles are mobilized by skeletonizing the femur. Thus, the lateral and intermediate muscles are separated from the femur throughout. The second medial parapatellar incision is performed for arthrolysis, dissection of adhesions in the torsion of the joint and separation of the distal portion of m. vastus medialis from the femur. The scar-modified quadriceps muscle is pulled together in the distal direction, bending the lower leg. After the operation, joint immobilization is not used. The Judet operation is traumatic, often accompanied by profuse bleeding, and has been used extremely rarely in recent years.

The methods of surgical treatment described above are used for true contractures of the knee joint resulting from cicatricial-dystrophic degeneration of the thigh muscles. If fractures penetrate the knee joint, then its stiffness is formed, characterized by small changes in muscle tissue and quite significant changes in the joint cavity and surrounding tissues. To restore the full range of motion in patients of this group, it is necessary to achieve maximum restoration of the congruence of the articular surfaces of the femur, tibia and patella, as well as joint torsion.

Arthrolysis of the knee joint

At extensor contracture skin incision is made from the outside or inside of the knee joint, taking into account existing skin scars and clinical and radiological data. After the skin incision, the wound edges, including the wide fascia, are dissected 2 cm inward and outward, the distal part of the rectus muscle is found and it is isolated from the surrounding scars in the proximal direction to unchanged areas. The intermediate muscle is not crossed, its mobilization is carried out together with the external or internal wide muscles hips. M. rectus femoris is carefully separated from other muscles. The knee joint and upper torsion are opened, scar tissues are excised from the upper torsion and joint cavity, ossificates are removed. In case of low standing of the patella or cicatricial degeneration of the patellar ligament, it is also mobilized. When an intraarticular fracture is fused with a displacement, a modeling resection of the condyles of the femur, tibia and patella is performed.

With flexion and flexion-extension contracture, to obtain a full range of motion, two semi-oval skin incisions are made from the inner and outer sides knee joint from the upper pole of the patella downward and backward to the level of the articular surface of the tibia 2-3 cm posterior to the collateral ligaments and rising proximally along the posterior or posterior outer surface hips. With the help of hooks and Buyalsky's spatula, they penetrate into the joint cavity and mobilize its anterior and posterior sections. Mobilization of the anterior sections is carried out in the same way as with extensor contracture. Mobilization of the posterior sections is carried out by excision of scar tissue, release of the posterior surfaces of the condyles of the femur and tibia and back parts capsules, thus forming a volvulus space. From the joint cavity, moving proximally along the posterior surface of the thigh with a raspator or spatula, the inner and outer heads are separated calf muscles from the point of attachment to the condyles of the femur. The lower leg is extended to 180°.

To date, developed various methods treatment of extensor and flexion contractures of the knee joint using the Ilizarov and Volkov-Oganesyan hinge-distraction apparatus. By providing rigid fixation of the articular ends and maintaining a predetermined diastasis between them, the devices allow dosed forced flexion and extension in the knee joint and stretching of fibrous-changed tissues. However, the experience accumulated over the years shows that the use of devices complicates treatment, increases its duration, is accompanied by a number of specific complications and does not provide a significant improvement in outcomes compared to open joint mobilization. At present, most orthopedists have come to the conclusion that the closed application of the device is indicated mainly for the correction of flexion and extension contractures in terms of up to 6 months. At a later date hardware treatment must be combined with open mobilization of the knee joint.

Technique of applying a hinge-distraction apparatus.

The apparatus is applied to the extensor surface of the limb. The first moment of the operation is the passage of the axial pin through the top of the external epicondyle of the femur strictly perpendicular to the main plane of movement of the joint. Then, at an angle of 10-30° to it, through the diaphysis of the femur in the frontal plane, the spoke of the closing bracket is passed, and through the tibia, also in the frontal plane, 2 spokes of the rotary bracket. First of all, the axial spoke is pulled and fixed, then the spoke in the closing bracket on the thigh and on the end of the spoke in the swivel bracket on the lower leg. The repositioning frames with the threaded ends of the distractors fixed in them are attached to the swivel bracket. Thus, the proximal part of the joint is rigidly fixed on one side of the apparatus hinge, and the distal part, on the other.

2-3 days after the application of the apparatus, the development of movements in the joint begins: a slight distraction is created and, depending on the severity of the contracture, the range of motion is increased by 2-8° per day. After reaching the required range of motion, the hinge is unlocked so that the patient can move freely, but the apparatus is left for a few more days. Then the device is removed and rehabilitation treatment is carried out.

One of the most actual problems in surgery of contractures of the knee joint is the problem of preventing the formation of adhesions after secondary reconstructive operations on the quadriceps femoris muscle and the knee joint. Low-traumatic operations performed to mobilize the knee joint often lead to the formation of even coarser adhesions, which are the cause of contracture recurrence.

Various methods have been proposed to reduce or prevent the development of adhesions after knee mobilization:

the use of artificial gaskets made of synthetic materials;

the use of pads from biological tissues;

introduction medicinal substances into the joint cavity and under the quadriceps femoris muscle;

the use of enzymes and absorbable substances, the use of physical methods.

The use of a siloxane film is promising. After performing a mobilizing operation, it is placed between the heads of the quadriceps muscle or articular surfaces. After 2-3 weeks, the film is removed and rehabilitation treatment is continued.

Postoperative treatment

The operation is the first step in the treatment of contractures of the knee joint. Upon its completion, active drainage of the joint is carried out for 24-48 hours, a plaster splint is applied. With extensor contracture of the knee joint, immobilization is carried out at an angle of 140°, and with flexion-extensor contracture - at an angle of 175°. Giving a certain position, depending on the type of contracture, is necessary for the reorientation of tissues around the knee joint during their healing in the postoperative period. Short-term immobilization does not affect the restoration of the function of the knee joint and promotes the healing of the surgical wound.

Rehabilitation treatment is divided into three periods:

immobilization;

post-immobilization;

restorative.

The main tasks of the immobilization period are the normalization of the trophism of damaged tissues and the prevention of adhesions in the periarticular tissues. It includes the following activities: UHF from 2-3 days after surgery, exercise therapy for the muscles of the foot, lower leg and thigh.

In the post-immobilization period, which takes 3-4 weeks, rehabilitation treatment is aimed at stimulating regenerative processes in the operated tissues, preventing scarring, increasing muscle elasticity and improving the function of the operated limb. In this period, the complex of physiotherapeutic procedures is expanded: electrophoresis, ultrasound, ozocerite, massage. Increase the load during exercise therapy. One of the elements of a comprehensive postoperative treatment severe contracture is the redressing of the knee joint. It is produced on the 3rd or 4th week, while the adhesive process is not very pronounced.

IN recovery period to the above complex of postoperative rehabilitation means, it is necessary to add mechanotherapy on blocks and pendulum apparatuses with increasing loads, exercises on an exercise bike, and water procedures.

The correct choice of the method of postoperative treatment and continuity at various stages allows you to get favorable outcome and return the sick to work. The combination of non-operative methods of rehabilitation with operational ones, their adequacy in each specific case, significantly reduces the period of incapacity for work of patients and reduces disability.

Relate to contractures and fibrous ankylosis, and a dangling joint. We adhere to the definition of contracture that Mikulich gave it at the time. Contracture of the knee joint should be considered a partial or complete restriction of active, passive movements, excluding the condition in which true or fibrous adhesion of the articular ends occurs (which is called "ankylosis").

Causes and mechanism of deformation formation

The occurrence of persistent contracture of the knee joint has its own explanation. In connection with the peculiarities of the anatomical device, movements are made around many axes, and flexion is combined with sliding. Therefore, as well as due to the destruction of cartilage and cicatricial changes in the ligamentous apparatus during inflammatory processes, simultaneously with flexion, at first a small, then more pronounced subluxation of the lower leg back occurs. The most common flexion contractures of an arthrogenic nature are the most persistent if there is a subluxation in the joint, especially with tuberculous persecution. On the contrary, myogenic contractures proceed more favorably. Neuromyogenic contractures of the knee joint are observed more often after poliomyelitis, with Little's disease, and also with progressive myopathy. A rather persistent flexion contracture develops when the skin and fascia in the popliteal fossa are damaged or burned - dermato-desmogenic contracture.

Traumatic contractures of the knee joint can be caused by intraarticular or periarticular changes in bones and soft tissues. Contractures can be flexion and extensor. Reflex contractures often develop after injury.

Contractures in the extension position after injury to the hip and surrounding muscles are so persistent that they are very difficult to conservative treatment. A similar phenomenon is often observed in gunshot osteomyelitis of the thigh, when the limb long time is in a plaster bandage. Accordingly, in the knee joint there is no primary cause for persistent extensor contracture. It lies in the primary cicatricial changes in the extensor muscular and fascial apparatus. In the future, secondary changes occur in the capsule, tendon-ligament apparatus, cartilage and bones. The cause of contracture can also be primary changes in the muscles, for example, with myositis ossificans. Finally, in the knee joints, very persistent congenital contractures are observed in the extension position with recurvation or in the flexion position, for example, in arthrogryposis.

Symptoms of knee contracture

Symptoms and clinical course of contractures of the knee joints depend on the cause of their occurrence, the phase of the disease and the degree of anatomical disorders. Signs of flexion contracture appear very early in inflammatory disease joint. Initially, m and o develops - gene contracture as a reflex to pain in the joint. Such contracture is easily corrected and almost completely disappears in anesthesia. In the future, as destructive and cicatricial changes occur in the joint, the contracture becomes resistant and, in the presence of subluxation in the knee joint, becomes difficult to correct. In the study, the flexor muscles (mm. biceps femoris, semitendinosus, semimembranosus and deeper m. popliteus and head m. gastrocnemius) are sharply tense. On the anterior surface of the knee below the patella, a slight retraction is determined, which indicates a subluxation of the lower leg. The extensor group is in a state of atrophy (especially after injury). The patella is initially mobile, but as the angle of flexion approaches 90°, the movements of the patella can be difficult to determine. Active contractions of the quadriceps muscle prove that the patella is not soldered to the thigh. This is important for the subsequent restoration of muscle function.

It is very important to determine whether there is pain with a residual range of motion or whether the remaining limited movements are painless. In the first case, the inflammatory process should be considered incomplete; with painless movements, it can be assumed that the process is in the phase of remission. Of course, other data (X-ray, erythrocyte sedimentation reaction) should also be taken into account.

Special mention should be made of extensor contracture of the knee after long-term use plaster cast. At the same time, not only persistent contracture in the joint, but there is also severe atrophy of bones, cartilage, and changes in the capsule and ligaments appear, which predetermines the prognosis.

Forecast

The prediction should be made depending on the main suffering of the knee joint.

When creating different positions at the moment of fixation, an important physiological role the so-called sliding tissue in the movement of the limbs. Early movements preserve the viability of the sliding tissue, prolonged fixation destroys this tissue.

Given the predominance of the extensor muscle group of the thigh over the flexors, it is necessary to prevent the occurrence of extensor contracture, in which it soon loses its physiological value. adipose tissue located under the tendon of the quadriceps muscle. Struggling with extensor contracture is much more difficult than with flexion contracture.

Fresh traumatic contracture usually disappears after the cause is removed, which often lies in a meniscal injury or intra-articular fracture, especially eminentia intercondylaris tibiae.

Treatment of knee contracture

The fight against contractures consists of four main points:

prevention of contractures by applying correctly applied dressings and their timely removal;
correction of contractures by orthopedic methods - elastic bands, twist, stage and plaster bandages, by surgery;
retention of the achieved position by a fixing bandage;
intermediate and especially subsequent.

During treatment, it is necessary to reasonably combine contracture correction, aimed at maintaining muscle tone, with surgical and spa measures. The active will of the patient and the skillful use of therapeutic exercises are of great importance.

Forced redress under anesthesia is rarely used, especially in inflammatory processes, persistent consequences of trauma and severe forms congenital deformity; redressing with a fixed patella is also completely unacceptable.

The skin traction method combined with therapeutic gymnastics often useful in traumatic contractures.

The use of "twist" and staged plaster casts is proven method treatment of severe contractures of the knee joint of inflammatory and traumatic origin.

Scar excision and skin grafting. after burns and traumatic injuries often formed extensive scars that restrict movement. Simply cutting the scar is not enough. In such cases, the scars that restrict movement are excised, the contracture is corrected (it is not always possible to do this at the same time), and skin grafting is performed, most often with the help of a free or pedicled flap. The limb is fixed, maintaining the corrected position. After engraftment of the flap, they begin to move early.

Fasciotomy. Dissection of the fascia sometimes gives favorable results. So, with flexion contracture of the knee, not due to changes in the joint, oblique dissection of the broad fascia along the outer surface of the thigh in its lower third makes it possible to correct the contracture to some extent. Sometimes it is necessary to supplement this operation with flexor tenotomy.

Tenotomy. Myotomy. These operations are used more often for contractures of the knee joint. The open method of tenotomy has an advantage over the closed one. In many cases, instead of a simple dissection, tendon lengthening is used.

neurotomy. In the presence of spastic contracture, neurotomy or neurotomy with myotomy is done.

Tendon transplant. This operation is applied after the contracture has been corrected in a conservative way.

Capsulotomy. With flexion contracture of the knee joint, a capsulotomy is performed.

Wilson capsulotomy. An incision is made 12-14 cm long along the outer surface of the thigh and knee joint. Expose tractus iliotibialis, tendon m. biceps femoris. Tractus iliotibialis is dissected in a Z-shape 5 cm above the level of the joint. tendon m. biceps femoris is isolated and separated from the head of fibula n. peronaeus communis, which goes behind the head of the fibula, is isolated and pulled off with a strip of gauze.

After dissection of the tendon, the joint capsule is exposed and dissected at the level of the posterior surface of the femoral condyle. Using an elevator, the capsule is separated from the back of the thigh. The incision is led up over the outer condyle of the thigh, the outer head m. gastrocnemius and produce a subperiosteal dissection of the capsule 6 cm above the joint line, as well as medially to the midline of the thigh.

The second incision is made of the same length above the inner condyle of the thigh from the place of attachment of the adductors down 3 cm below the joint space of the knee joint. Here they also dissect back department capsules. A large napkin is pulled through the tunnel formed by the external and internal incision, the knee is bent, and with the help of the napkin, the entire back surface of the thigh is exposed at the level of the joint. In addition, tissues are dissected behind, which prevent the extension of the joint.

Finally, with the help of careful manipulation, an attempt is made to correct the contracture of the knee. After reaching full extension, check the condition of the nerve, produce a thorough hemostasis. The ends of the tendon m. biceps femoris are connected with catgut. The skin is sutured tightly. A plaster cast is applied, which is dissected from the lateral and medial surfaces immediately after the plaster is applied. After a week, leave the rear tire and proceed to cautious movements. By the end of the month, a splint is prescribed and the load is allowed.

Arthrolysis, consisting in arthrotomy, excision of fibrous adhesions and mobilization of the joint, gives a small range of motion.

Chaklin method. With extensor contracture of the knee joint, the following surgical technique is used. The quadriceps tendon is exposed by a medial incision, it is dissected in a Z-shape, the quadriceps muscle is freed from scars, the upper and lateral torsion of the joint, as well as adhesions are dissected, and the altered menisci are removed. The limb is gradually bent. When the flexion is brought to an angle of 110°, then some diastasis is obtained between the ends of the tendon. The distance between the ends of the tendon of the quadriceps muscle is replaced by a duplication of the wide fascia of the thigh. Here, covering the defect, the sartorius muscle is transplanted, the end of which is strengthened on the patella. The capsule and muscle are sutured with catgut sutures. Make a deaf seam of the skin. A back plaster splint is applied for 3-4 weeks, then galvanization and massage are prescribed. At first, the patient should walk in a splint.

Joint resection. This operation with painful contractures gives a reliable ankylosis and is indicated mainly for manual workers.

Arthroplasty for arthrogenic contractures of non-tuberculous origin gives satisfactory results with well-preserved muscles.

Prevention

Contracture prevention is the foundation of orthopedic surgery. In early forms of inflammation, as well as in injuries of the knee joint, the creation of rest conditions in a splint or plaster cast prevents the occurrence of contractures. But prolonged fixation can lead to the formation of a persistent extensor contracture.

It is especially important to prevent contracture in the aftermath of trauma, chronic inflammatory processes (tuberculosis, rheumatism) and in the aftermath of poliomyelitis.

The article was prepared and edited by: surgeon