gms | German Medical Science

Temporary epiphysiodesis of the distal femur in the immature patient is an established method for correction of angular deformities or leg lenth differences. The anterior femoral stapling of fixed flexion deformities of the knee is firstly described 2001 by Stevens. The aim of this retrospective study was to introduce this method and evaluate our results.

Since 2002 we operated on 4 patients between 12 and 14 years with fixed flexion contractures using this technique. Diagnosis included spina bifida (n=2) and cerebral palsy (n=2). In all cases a dorsal release including a hamstring lengthening/capsulotom was done bevor. After an arthrotomy Blount staples are introduced medial and lateral of the femoral sulcus aiming in an anteroposterior direction. Range of motion and weight bearing started immediately.

The preoperative average fixed flexion deformity was 16° (10° - 30°). No complications were seen. The variety of underlying conditions and the individual growth patterns results in difference developments. Two patient experienced sufficient improvement (10°) by 5 month after stapling. Another patient with spina bifida experienced in a slow correction rate (5° in 5 month). Another boy with cerebral palsy shows no significant correction by 24 month after stapling.

In patients with neuromuscular disorders refractory fixed deformities of the knees results in crouch gait or even in an insufficient weight bearing. An extension supracondylar osteotomy may then be the last option after harmstring recession/lengthening and dorsal capsulotomy. In conclusion we believe that anterior femoral stapling of the distal femur is a minimally invasive and effective method, which can prevent an early femoral osteotomy.