Lengthening of knee flexor muscles by percutaneous needle tenotomy: Description of the technique and preliminary results

<div><p>Background</p><p>Knee flexion contractures occur frequently in non-ambulatory, aged persons and persons with central nervous system lesions, rendering positioning and nursing care difficult. There are often risks associated with surgical interventions.</p><p>Objective</p><p>To evaluate the effectiveness of percutaneous needle tenotomy to lengthen the knee flexor muscles and improve passive function.</p><p>Methods</p><p>This was a retrospective study of all patients who underwent percutaneous needle tenotomy between 2012 and 2014. Tenotomy was carried out in the semi-tendinosus, biceps femoris and gracillis muscles under local anesthesia. The procedure took no more than 40 minutes. Range of motion (ROM) was evaluated immediately post-operatively and 3 months later.</p><p>Results</p><p>Thirty-four needle tenotomies were carried out. Mean lack of knee extension was 94.2° (range 35–120°) pre-op, (range 15–90°; p<0.05) immediately post-op and 50.1° (range 10–90°; p<0.05) three months later, thus a mean increase of 44.1° knee extension (range 0–90°). All care and positioning objectives were achieved. There were no complications and procedure-related pain was rated as 3-4/ 10.</p><p>Conclusions</p><p>Needle tenotomy was well tolerated and yielded a significant increase in ROM with no unwanted effects. All objectives were achieved. This technique could be used in an ambulatory care setting or within institutions for severely disabled individuals.</p></div

Relationship between HO development and factors analysed.

<p>Relationship between HO development and factors analysed.</p

Item information curves of the nine items used for scoring the BBQ scale obtained by the parametric IRT model.

<p>Items 1, 8, 12 and 13 have a low power of information over the entire scale. These items contributed very little to the ranking of individuals. Conversely, the strongest informations power were observed for items 6 and 14. The minimal anonymized data set of the present study is available in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0186753#pone.0186753.s002" target="_blank">S2 Appendix</a>.</p

Operative delay for first HO excision in the case sample (‘recurrence”) and in the control sample.

<p>The upper and lower hinges indicate the 25^th and 75^th percentiles, the line in the box indicates the median.</p

Hip Medial Heterotopic Ossification (Brooker Class IV).

<p>Hip Medial Heterotopic Ossification (Brooker Class IV).</p

Main results of the multivariate analysis.

<p>Main results of the multivariate analysis.</p

Characteristics of case and control patients.

<p>Characteristics of case and control patients.</p

Flow chart.

<p>Flow chart.</p

Bland & Altman method representation of a bias in the test-retest reliability method to assess temporal stability between D1 and D7.

<p>A bias between the mean differences can be detected. Here the score calculated at the second visit is +1.24 higher.</p

Heterotopic ossification around the elbow in patients with burns.

<p>A and B: X-ray images of circumferential HO.</p