Managing Flexion Knee Deformity Using a Circular Frame

One-year follow-up study of serial orthotic treatment in two cases with arthrogrypotic syndromes who have bilateral knee flexion contractures

“…By using an orthosis for adequate periods and maintaining deformities at minimal degrees, less aggressive procedures can be realized. 14 In our study, the first case continued to use her orthosis 4-6 h a day for 6 months, and after 1 year, the range of motion in the knee joint was maintained. However in the second case who gave up using the orthosis, there was a recurrence in extension limitation.…”

“…10 Most physicians agree that surgery should be recommended when conservative management fails to treat the contractures. 10,14,15 However, some physicians believe that time should not be lost by conservative treatment and that the initial treatment should be surgical.…”

“…16 There are some studies in which the incidence of flexion contractures of the knee is as high as 90%, 10 and according to most researchers, conservative management of flexion contractures is more difficult than extension contractures. 14,15,17 In a study by Hosny and Fadel 14 , all patients with arthrogryposis were treated initially by physiotherapy and splintage which was successful in all except one patient in the extended-knee group, whereas only 7 of 26 knees responded to physiotherapy and splintage in the flexed-knee group. 14 In our study, the decrease in knee flexion contracture was up to 80% in both the cases.…”

“…14,15,17 In a study by Hosny and Fadel 14 , all patients with arthrogryposis were treated initially by physiotherapy and splintage which was successful in all except one patient in the extended-knee group, whereas only 7 of 26 knees responded to physiotherapy and splintage in the flexed-knee group. 14 In our study, the decrease in knee flexion contracture was up to 80% in both the cases. Also, our first subject could not achieve a long sitting position before treatment; with increase in knee extension, she could sit in the long sitting position and began to cruise.…”

“…3 Studies related with correction of knee flexion deformity usually compare results of surgical intervention. 10,14,17 Studies that investigate the effectiveness of conservative treatment in improving knee contractures are sparse. 15,17 Choice of treatment method depends on degree of deformity and level of ambulation.…”