Clinical trial NCT06251765: Clinical Results After Judet Quadricepsplasty for Post-traumatic Knee Stiffness
Official title: Clinical Results After Judet Quadricepsplasty for Post-traumatic Knee Stiffness: a Retrospective and Prospective Observational Study
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Knee Fractures
Stiffness of Knee, Not Elsewhere Classified
Keywords: arthromyolisis
Judet
post-traumatic
quadricepsplasty
Lead sponsor: Istituto Ortopedico Rizzoli
Sponsor class: OTHER
First posted: 2024-02-09
Enrollment: 20
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Patients who underwent Judet arthromyolisis for treatment of post-traumatic knee-stiffness

Brief summary: The Post-traumatic Extension Contracture of the Knee (PECK) is a common complication following knee traumas. It is characterized by a restricted Range of Motion (ROM), pain, and discomfort in the affected knee.

Various factors can cause PECK, primarily inflammation and scar tissue formation. The underlying inflammatory state leads to the development of scar tissue, which - when combined with immobilization - results in the progressive stiffness of the knee. Additionally, prolonged immobilization leads to muscle atrophy and, consequently, reduced mobility and increased rigidity.

All these conditions contribute to a limited ROM, making it challenging to perform various daily activities.

Sometimes conservative treatments can be effective, but surgery is often necessary to restore joint functionality and alleviate pain.

Historically, various surgical approaches have been proposed to address post-traumatic knee stiffness.

Open surgery is typically reserved for cases where arthroscopic adhesion release and manipulation under anesthesia have not been successful. Over the last century, various open surgical techniques have been proposed.

In particular, arthromyolysis according to Judet was first described in the 1950s by the French orthopedic surgeon Jacques Judet. This technique involves a series of incisions and soft tissue releases, allowing the surgeon to resolve the stiffness of the quadriceps tendon caused by trauma or prolonged immobilization.

Although effective in restoring knee joint functionality, arthromyolysis according to Judet is not without risks and potential complications. These include infection, massive bleeding, nerve and muscle-tendon injuries, and residual stiffness.

The purpose of this study is to analyze our case series related to arthromyolysis according to Judet for PECK. Clinical outcomes, complications, and patient satisfaction following this type of intervention will be evaluated.


Eligibility criteria: Inclusion Criteria:

1. Adult patients underwent surgical intervention for arthromyolysis according to Judet with modified surgical technique for knee stiffness from January 2008 to December 2019.
2. Patients with post-traumatic injuries (fractures treated surgically).
3. Patients with a minimum of 4 years of follow-up.
4. Completeness of clinical documentation.

Exclusion Criteria:

1. Patients who underwent surgical intervention for arthrolysis (both arthroscopic and non-arthroscopic) or arthromyolysis according to Judet with minimally invasive technique.
2. Patients who underwent surgery to address knee stiffness due to other causes (rigid prosthesis, limb lengthening, etc.).
3. Incomplete clinical documentation.

Primary outcomes:
measure: Range of Motion at follow-up
timeFrame: baseline time 0
Secondary outcomes:
measure: Intra-operative Range of Motion
timeFrame: baseline time 0
measure: Knee injury and Osteoarthritis Outcome Score
timeFrame: baseline time 0
measure: Tegner Activity Scale
timeFrame: baseline time 0
Other outcomes:
Locations:
city: Bologna
country: Italy
facility: IRCCS Istituto Ortopedico Rizzoli
Study officials:
References:
citation: Pujol N, Boisrenoult P, Beaufils P. Post-traumatic knee stiffness: surgical techniques. Orthop Traumatol Surg Res. 2015 Feb;101(1 Suppl):S179-86. doi: 10.1016/j.otsr.2014.06.026. Epub 2015 Jan 9.
citation: Luo Y, Li H, Mei L, Mao X. Effects of Judet Quadricepsplasty in the Treatment of Post-traumatic Extension Contracture of the Knee. Orthop Surg. 2021 Jun;13(4):1284-1289. doi: 10.1111/os.12950. Epub 2021 May 6.
citation: Bidolegui F, Pereira SP, Pires RE. Safety and efficacy of the modified Judet quadricepsplasty in patients with post-traumatic knee stiffness. Eur J Orthop Surg Traumatol. 2021 Apr;31(3):549-555. doi: 10.1007/s00590-020-02802-3. Epub 2020 Oct 13.