Extension contracture of knee is a disabling deformity in Indian population. The cause for the contracture may be congenital or acquired. The treatment for the contracted quadriceps is quadriceps release which is done either proximally or distally. The latter method is common and in adults it leaves quadriceps lag.

The method was originally described by Judet in 1932. It is modified and used in this series. It is a stepwise procedure :

Lateral release and joint adhesiolysis;

Medial release and joint adhesiolysis;

Rectus release;

Entire quadriceps slide from proximal to distal.

Thirty six patients with extension contracture of the knee have been undergone surgical release. There were 27 males and 9 females. 32 patients were adults and four were children. The aetilogy was post-traumatic in 31 out of which two were following epiphyseal injury. There were three cases of arthrogryposis, and one each of post osteomyelitic and post TKR. The age group ranged from 5 years to 45 years. Male:Female ratio was 27:9.

All patients were followed from minimum period of one year. One arthrogrypotic child developed skin necrosis which healed by secondary intention. Thirty-three patients achieved 0 to 120 degrees of ROM. Two of the arthrogrypotic patients obtained 0 to 60 and last patient had only 20. None of the patients had quadriceps lag. Judet quadricepsplasty has been demonstrated to be very effective in treating contractures of the knee.

Saggital plane deformities are difficult to treat and pose major challenge to orthopaedic surgeons and we are presenting short series of patients who have undergone the deformity correction with ring fixator.

Sixteen deformities in 15 patients were corrected during 1996 to 2004. The aetiology was congenital pterigium five cases, post traumatic seven cases, one each of polio, septic knee and post osteomyelitic sequelae. Nine patients had fixed flexion deformity, four had procurvatum and one had recurvatum and one patient had combined deformity.

All cases were analysed with adequate x-rays two level fixation above and below the apex of the deformity was done with the hinges placed at the apex of the deformity. The motor was provided perpendicular to the axis of the hinge. Bony correction was performed in eight cases and rest were corrected by soft tissue distraction. After achieving correction fixator was retained for a month or two to prevent recurrence.

Out of the eight cases of fixed flexion deformity (FFD) in nine knees, full correction was achieved in seven knees. One adult with septic knee was planned for correction of deformity and fusion which was completed in 4 months time. Out of five congenital pterigium three had full correction. One case had complete recurrence which was recorrected completely in the second attempt and the 5th case had residual 20 degree deformity. Knee deformity in PPRP patient underwent SC osteotomy with good correction of the deformity which compensated the quadriceps gait. Post traumatic FFDs were corrected fully. The bony deformities of tibia namely the procurvatum and recutvatum deformities were corrected fully. Average fixator time is 7 months.