Management of fixed flexion contracture in primary total knee arthroplasty: recent systematic review

Open Access

Review

Table 2

Description of studies using algorithms to correct flexion contracture, and the steps taken to correct this deformity.

Authors and year of publication	Different steps in the surgical algorithm
Chai et al. 2021 [22]	1. Frontal ligament balancing after osteophyte removal;
	2. Additional resection of distal femur up to 4 mm;
	3. Fusiform capsulectomy of posterior capsule.
Kim et al. 2017 [26]	1. Removal of osteophytes, release of the deep layer of the MCL and minimal release of the semimembranosus at its tibial insertion;
	2. Sacrifice of the PCL;
	3. Removal of posterior osteophytes and release of posterior capsule;
	4. Additional 2 mm distal femur resection.
Debette et al. 2014 [32]	1. Removal of osteophytes, release of the deep layer of the MCL and minimal release of the semimembranosus at its tibial insertion (varus knees) or release of the anterolateral capsule (valgus knees);
	2. Sacrifice of the PCL;
	3. Removal of posterior osteophytes and release of posterior capsule;
	4. Additional 2 mm distal femur resection;
	5. Additional tibial resection.
Meftah et al. 2012 [34]	1. Release the posteromedial capsule and PCL resection;
	2. Introduce a spacer to assess the superficial MCL, release the MCL using the pie crust technique;
	3. Manipulate with repeated valgus pressure while the spacer is in place, until 2–3 mm of “elastic flexibility” is achieved, with greater accepted laxity medially.
Su 2012 [12]	1. Frontal ligament balancing after osteophyte removal;
	2. Sacrifice of PCL;
	3 Additional resection of distal femur up to 6 mm; 4. Removal of posterior osteophytes and release of posterior capsule.
Scuderi and Kochhar 2007 [39]	1. Frontal ligament balancing after osteophyte removal;
	2. Sacrifice PCL (if flexion contracture >10°);
	3. Removal of posterior osteophytes and release of the posterior capsule;
	4. Additional resection of distal femur from 3 mm to 10 mm.
Bellemans et al. 2006 [40]	1. Frontal ligament balancing after osteophyte removal and additional 2 mm resection of the distal femur;
	2. Release of posterior capsule and gastrocnemius muscles;
	3. Additional distal femur resection up to 4 mm;
	4. Hamstring tenotomy.
Berend et al. 2006 [41]	1. Removal of osteophytes;
	2. Resection of distal femur;
	3. Release of PCL;
	4. Additional distal femur resection up to 4 mm, soft-tissue release.
Mihalko and Whiteside 2003 [44]	1. Release of posterior capsule;
Mihalko and Whiteside 2003 [44]	2. Additional resection of distal femur.
Whiteside and Mihalko 2002 [45]	1. Osteophyte removal and ligament balancing;
	2. Release of medial capsule in varus knees, followed by release of posterolateral capsule if necessary;
	3. Additional resection of the distal femur.
Firestone et al. 1992 [46]	1. Removal of osteophytes and foreign bodies;
	2. Additional resection of distal femur;
	3. Release of soft tissue in extension and flexion (posteromedial in varus knees, posterolateral in valgus knees).

MCL: medial collateral ligament; PCL: posterior cruciate ligament.

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