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

Type of lesion depending on the success of the tenotomy.

<p>Type of lesion depending on the success of the tenotomy.</p

Hip Medial Heterotopic Ossification (Brooker Class IV).

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

Demographic data and univariate analysis.

<p>Demographic data and univariate analysis.</p

Comparability between the two groups: TBI versus SCI.

<p>Comparability between the two groups: TBI versus SCI.</p

Sites of Heterotopic Ossification of Patients Undergoing Surgery for Central Nervous System Damage. Data are for Number of First Surgeries Performed.

<p>Sites of Heterotopic Ossification of Patients Undergoing Surgery for Central Nervous System Damage. Data are for Number of First Surgeries Performed.</p

Univariate Analysis of Time from Central Nervous System Damage Related to Heterotropic Ossification Recurrence.

<p>Univariate Analysis of Time from Central Nervous System Damage Related to Heterotropic Ossification Recurrence.</p

Sites of Heterotopic Ossification (HO) in Patients Undergoing Surgery After Central Nervous System Damage.

<p>Data are for Number of First Surgeries Performed.</p><p>TBI: traumatic brain injury; SCI: spinal cord injury; CA: cerebral anoxia; CNS: central nervous system.</p

Demographic Data for Patients Undergoing Surgery for Heterotopic Ossification After Central Nervous System (CNS) Damage.

<p>HO: Heterotopic Ossification; TBI: traumatic Brain Injury; SCI: Spinal Cord Injury; CA: Cerebral Anoxia; CNS: Central Nervous System.</p