Name of the Procedure:

Quadricepsplasty (Bennett or Thompson type)

Summary

Quadricepsplasty is a surgical procedure aimed at improving the range of motion in the knee by releasing or lengthening the quadriceps muscles. This surgery is typically performed when the knee has become stiff and immobile due to injury, surgery, or conditions like arthritis.

Purpose

The main goal of quadricepsplasty is to restore knee flexibility and improve the patient's mobility. It addresses limited range of motion caused by scar tissue or muscle shortening, which can result from prolonged immobilization, trauma, or prior surgery.

Indications

• Severe knee stiffness or contracture.
• Limited range of motion in the knee that interferes with daily activities.
• Patients who have not responded adequately to non-surgical treatments such as physical therapy.
• Conditions like post-traumatic knee stiffness, arthrofibrosis, or extensive scarring.

Preparation

• Patients are generally advised to fast for 8-12 hours before the procedure.
• Medication adjustments may be necessary, particularly for blood thinners or other anticoagulants.
• Preoperative diagnostic tests may include imaging studies like X-rays or MRI scans, as well as routine blood tests.

Procedure Description

1. The patient is placed under general or regional anesthesia.
2. An incision is made over the knee to access the quadriceps muscle group.
3. The surgeon carefully releases any scar tissue or adhesions within the quadriceps.
4. The muscle tendons may be lengthened to improve the knee's range of motion.
5. The incision is closed with sutures or staples, and a sterile bandage is applied.

Duration

The procedure typically takes between 1 to 2 hours, depending on the extent of the muscle release required.

Setting

Quadricepsplasty is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Physical therapist (for post-operative care)

Risks and Complications

• Infection
• Bleeding or hematoma formation
• Damage to surrounding tissues or structures
• Delayed wound healing or scarring
• Deep vein thrombosis (DVT)
• Possible need for revision surgery

Benefits

• Improved knee flexibility and range of motion
• Enhanced mobility and ability to perform daily activities
• Relief from pain and discomfort associated with knee stiffness
• Potential for a better quality of life

Recovery

• Patients may need to stay in the hospital for 1-2 days post-surgery.
• Physical therapy typically begins soon after surgery to ensure optimal recovery.
• Pain management includes prescribed medications and ice packs.
• Full recovery can take several months, with gradual improvement in knee function.
• Follow-up appointments are essential to monitor progress and healing.

Alternatives

• Continued physical therapy and supervised exercise programs.
• Manipulation under anesthesia (MUA) to break up scar tissue without open surgery.
• Arthroscopic release: a minimally invasive procedure to remove scar tissue.

Pros:

• Non-surgical options typically have fewer risks and recovery time. ##### Cons:
• May not be as effective for severe or longstanding knee stiffness compared to open quadricepsplasty.

Patient Experience

• During the procedure, the patient will be under anesthesia and should not feel any pain.
• Post-procedure, patients may experience discomfort and swelling, which can be managed with pain relief medications.
• Physical therapy and mild exercises are crucial for effective recovery and regaining full knee function.
• Adherence to post-operative instructions will play a significant role in the success of the surgery.