Lengthening of knee flexor muscles by percutaneous needle tenotomy: Description of the technique and preliminary results.

Abstract

Knee flexion contractures occur frequently in non-ambulatory, aged persons and persons with central nervous system lesions, rendering positioning and nursing care difficult. There are often risks associated with surgical interventions.To evaluate the effectiveness of percutaneous needle tenotomy to lengthen the knee flexor muscles and improve passive function.This was a retrospective study of all patients who underwent percutaneous needle tenotomy between 2012 and 2014. Tenotomy was carried out in the semi-tendinosus, biceps femoris and gracillis muscles under local anesthesia. The procedure took no more than 40 minutes. Range of motion (ROM) was evaluated immediately post-operatively and 3 months later.Thirty-four needle tenotomies were carried out. Mean lack of knee extension was 94.2° (range 35-120°) pre-op, (range 15-90°; p<0.05) immediately post-op and 50.1° (range 10-90°; p<0.05) three months later, thus a mean increase of 44.1° knee extension (range 0-90°). All care and positioning objectives were achieved. There were no complications and procedure-related pain was rated as 3-4/ 10.Needle tenotomy was well tolerated and yielded a significant increase in ROM with no unwanted effects. All objectives were achieved. This technique could be used in an ambulatory care setting or within institutions for severely disabled individuals.