A conservative approach to quadricepsplasty: description of a modified surgical technique and a report of three cases.

Various techniques have been described for the treatment of soft tissue extension contracture of the knee. Some involve large exposures, and others can result in a permanent extensor lag. We describe a technique with limited exposure, avoiding transverse incisions in the rectus femoris. Through a midline incision, the extensor expansion is exposed. The rectus femoris is separated from the vastus medialis, lateralis, and intermedius to form a strap-like structure. Vastus intermedius is separated from the patella. If firm, careful manipulation of the knee is unsuccessful, the incisions are extended distally along both sides of the patella and patellar tendon, releasing the extensor mechanism from any underlying heterotopic bone, and further manipulation of the knee is performed. Postoperatively, a rehabilitation program is begun. A good outcome following this technique is described in 3 knees presenting with severe restriction of knee flexion. There were no wound complications and no residual extensor lag.