Appropriate classification, treatment of arthrogryposis may increase range of motion
Patients with arthrogryposis may experience increased knee arc and knee and hip range of motion with appropriate classification and treatment, according to results presented at the Limb Lengthening and Reconstruction Society Annual Scientific Meeting.
“The study looked at arthrogrypotic knees and hips which were either stiff in, for instance, flexion so that they did not straighten or they were straight and they did not flex; and in both cases, ... we were able to increase the arc of motion — get them from 0° to almost an average of 90° after treatment — and this avoided the use of an external fixator,” David Feldman, MD, director of spinal deformity and hip preservation at the Paly Institute and co-author of the study, told Healio.com/Orthopedics.
Feldman and colleagues classified 13 patients with arthrogryposis with knee contractures with or without hip contractures into three categories based on the type of knee contracture with a hip modifier: flexion contractures (type 1); extension contractures (type 2); and combined flexion and extension contractures (type 3). Treatments included posterior knee release and femoral shortening for type 1 contractures, quadsplasty and anterior release for type 2 contractures and both treatments for type 3 contractures. Researchers treated hip flexion and extension contracture at the same time.
Results showed 13 legs were classified as type 1, six legs were classified as type 2 and two legs were classified as type 3. Researchers found knee range of motion increased from approximately 48° to approximately 81° in the type 1 group, from approximately 29° to approximately 78° in the type 2 group and from 35° to 90° in the type 3 group. However, due to small sample size, researchers noted statistics were not calculated. Results showed a significant increase in hip range of motion in all types, from a mean of approximately 67° to a mean of approximately 88°.
Despite arthrogryposis being relatively common, according to Feldman more information is needed on overall long-term function, including how to maintain motion and function.
“I think there is a lot of research that needs to be done in terms of both clinical research and basic research on treating children,” Feldman said. “At what age do we treat them is a good question we do not have an answer to. Should we treat them very young or a little older?” – by Casey Tingle
Feldman D, et al. Improving knee range of motion in arthrogrypotic knee. Presented at: Limb Lengthening and Reconstruction Society Annual Scientific Meeting; July 13-14, 2018; San Francisco.
Disclosure: Feldman reports no relevant financial disclosures.