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

Abstract

BackgroundKnee 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.ObjectiveTo evaluate the effectiveness of percutaneous needle tenotomy to lengthen the knee flexor muscles and improve passive function.MethodsThis 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.ResultsThirty-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.ConclusionsNeedle 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.

Flexor tenotomies for the treatment of bilateral wrist contracture after traumatic brain injury: A case report

“…Schnitzler, et al performed a retrospective study treating knee flexion contracture with percutaneous needle tenotomy for tendon lengthening. 16 Overall, the treatment was well tolerated with significantly increased range of motion. Another study evaluated flexion contractures after total knee arthroplasty and found success with bone resection and subsequent posterior capsule and collateral ligament release.…”

“…A few studies have reported on surgical treatments for flexor tendon contracture, especially in the knee. Schnitzler, et al performed a retrospective study treating knee flexion contracture with percutaneous needle tenotomy for tendon lengthening 16 . Overall, the treatment was well tolerated with significantly increased range of motion.…”

Percutaneous Lengthening with an Intramuscular Needle of the Gastrocsoleus Complex Improves Critical Ankle Kinematic Values in Resistant Pediatric Equinus: A Pilot Study

“…Percutaneous soft tissue lengthening with an intramuscular needle has been previously described in the treatment of other diseases, such as Dupyutren's contracture of the hand [12], tendinitis [13,14], epicondylitis [15], and congenital talipes equinovarus [16,17], as well as for muscle contractures at different locations [18][19][20][21]. However, we are not aware of any publication describing the application of this technique in pediatric patients with equinus ankle.…”