To assess the outcome of Quadricepsplasty in limb reconstruction for stiff knees, and to analyze the contributing factors.

Thirteen patients underwent quadricepsplasty over the last 11-years for severe extension contractures of the knee, in the Limb Reconstruction Service. Ten cases were posttraumatic treated with External fixation, and three were non-traumatic causes, with an average interval between injury and quadricepsplasty of 10 years (range, 2–55). Eight patients had leg lengthening with an average of 6.5cm (range, 3–14), with simultaneous deformity correction. Post-operatively all the patients had continued passive motion except one with a fused hip.

Two to six weeks post-operatively, nine patients necessitated manipulation under anesthesia due to noteable loss of movement.

Preoperatively the average flexion was 24°(10–40), which improved in the operating room to 98°. After an average follow up of 15 months post-operatively they lost a mean of 18° flexion, with a final flexion 80°. Three patients developed an extension lag of 10° post-operatively. Two had deep infection with unsatisfactory results. Using Judet’s classification, we had 8 (53%) excellent or good, 6 (40%) fair, and one poor (7%) result.

The unsatisfactory results were associated with deep infection, long fixator time and a long interval between injury and quadricepsplasty.

Quadricepsplasty provides good results for severe extension contraction of the knee. Judet’s technique of disinsertion and muscle sliding addresses the problem of pin site tethering on the lateral side of the femur. Since this procedure is not free of complications and always demands intensive postoperative rehabilitation, it should be reserved for patients with severe extension contraction.