Myelomeningocele Knee Flexion Contracture: Posterior Capsulectomy and Hamstring Lengthening| Biomed Grid

Introduction: Knee flexion contracture is a common problem in Myelomeningocele patients. Disturb and limits walking abilities; promote Crouch Gait and increase energy cost, interfering with child´s walking efficiency. Several treatments have been proposed, the aim of our study is to evaluate the results obtained with posterior capsulectomy, hamstring lengthening and patellar tendon advancement. Materials and methods: A retrospective study was carried out in which we included all Myelomeningocele patients who underwent surgery for knee flexion contracture with posterior capsulectomy, hamstring lengthening and patellar advancement; between 2008 and 2016, with a minimum follow up of 1 year. Preoperative and postoperative goniometric measures were taken according to the methods described by Norkin and White. Clinical controls and regular follow-up were carried out throughout the follow-up. Results: 15 Patients (26 knee). 11 male patients (73.3%) and 4 females (26.6%), with an average age of 11.93 years. 11 of the patients were ambulators and 4 patients were non-ambulators. Mean flexion angle measured preoperatively was 41,07°, it decreases after surgery to a mean of 5,42°. All the patients had a postoperative flexion angle less than 15°. A statistically significant change was observed in the pre and postoperative angles. Conclusions: we believed that posterior capsulectomy, hamstring lengthening, and patellar tendon advancement is a good alternative for the treatment of knee flexion contracture in Myelomeningocele patients. We recommend the surgical release of flexion contracture, when this is greater than 15° and generates impediments to walking, standing, sitting positions or transfers