Submit Manuscript | http://medcraveonline.com Introduction Extension contracture or stiff knee is a complication of fracture femur, particularly in the supracondylar area. Adequate knee fexion may not be possible, if we dont’ do the proper exercises postoperatively. After a fracture in the femoral supracondylar region, some diffculty always remains in regaining a full range of motion. In most of our cases stiffness is due to the periarticular and intramuscular adhesions which prevent free gliding of the muscle fbres one upon another. If stiff knee is severe and not possible by conservative treatment by exercises the knee movement can be increased by Judet’s quadricepsplasty. The pathological abnormalities that limit knee fexion include. 1,2 1. Intra articular adhesions to complete arthofbrosis. 2. Capsular contracture. 3. Quadriceps muscle contracture and adhesions to bone. 4. Fascial contractures and 5. MCL contracture The treatment of knee extension contracture must therefore vary from simple arthroscopy to lyse adhesions to more extensive quadricepsplasty. Quadricepsplasty can be divided into distal and proximal types. Distal quadricepsplasty, such as the Thompson or V-Y types, should never be performed in adults because it leads to permanent knee extension lag. This may occur in children as well, but because the children are growing and retensioning their quadriceps muscle, it may recover. The best way of obtaining knee fexion is the Judet’s Quadricepsplasty. 1,2 This is a proximally based quadriceps muscle slide that addresses all the elements of the knee contracture. It was popularized by Letournel. The Judet’s quadricepsplasty is a stepwise release of the knee and quadriceps muscle. Each successive step determines whether one continues with the next step of the release depending on the amount of knee motion recovered. In our series Judet’s quadricepsplasty for stiff knee was done on 32 cases from January 2003 to January 2013 with proper postoperative management with CPM machine in an attempt to improve the knee range of motion. Materials and methods This study was conducted in NITOR (National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka) and BARI- ILIZAROV Orthopaedic Centre between January 2003 to January 2013. The mean age of the patient was 26 years (20-35 years) and the total number of patients were 32. All patients were male. All the patients developed stiff knee after periarticular knee fractures or Ilizarov application. We retrospectively reviewed the results of 32 cases of knee extension contracture managed with Judet’s quadricepsplasty during the last 10 years having a mean follow up of 24 months. Degrees of fexion of the operated knees preoperatively and at last follow up were recorded along with quadriceps strength, presence of extension lag and complications. Outcomes were classifed according to Judet’s criteria: 1. Excellent, if fexion was greater than 100°. 2. Good, from 80° to 100°. 3. Fair, from 50° to 80°. 4. Poor, if less than 50°. Surgical technique The incision is marked for the full length of the thigh from the rough line of the greater trochanter to the lateral aspect of the patellar tendon. During surgical intervention we must give imphasize with these following 5 steps: 1,3 Step-1 (Intra articular release): Under tourniquet, only the distal part of the incision is made to release the knee adhesions from the lateral side. MOJ Orthop Rheumatol. 2015;2(6):202‒206. 202 ©2015 Bari et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially. Judet’s Quadricepsplasty for Extension Contracture of the Knee (Stiff Knee) Volume 2 Issue 6 - 2015 Bari MM, 1 Shahidul Islam, 1 NH Shetu, 1 Wahidur Rahman, 2 Mahfuzer Rahman, 1 Mashiur H Munshi, 2 Golam Mostofa 1 1 Chief Consultant, Bari-Ilizarov Orthopaedic Centre,Visiting and Honored Prof., Russian Ilizarov Scientifc Centre, Russia 2 National Institute of Traumatology and Orthopaedic Rehabilitation, Bangladesh Correspondence: Mofakhkharul Bari, Chief Consultant, Bari- Ilizarov Orthopaedic Centre,Visiting and Honored Professor, Russian Ilizarov Scientifc Centre, Kurgan, Tel +88 01819 211595, Email Received: April 14, 2015 | Published: June 15, 2015 Abstract Between January 2003 to 2013 Judet’s Quadricepsplasty was performed on 32 stiff knees. The initial preoperative range of movement was 15° (range 10°-25°). Postoperative plaster immobilization was only for 1 day. The mean follow up period was 6 years (range 2-10 years). During our follow up the mean active flexion was 70° (range 60°-120°). Final outcome in knee movement was 90° (40°-175°). In our series six patients developed wound dehiscence which resolved after meticulous wound care and antibiotics. In our all the cases we believe that Judet’s Quadricepsplasty gives excellent result with proper postoperative care and CPM therapy. Keywords: Judet, Quadricepsplasty, Knee extension contracture MOJ Orthopedics & Rheumatology Research Article Open Access