As the knee is extended, the ends Alectinib price of

the aponeurosis pull apart and the muscle fibres also glide apart. Aponeurosis on the lateral aspect of the biceps femoris is exposed and similarly incised as the knee is extended. In severe contractures, the gracilis tendon is also cut. Once the posterior capsule of the knee has been released, the popliteus tendon and posterior cruciate ligament are also released, after protecting the neurovascular bundle in the region and the peroneal nerve in particular. Postoperatively, a long leg plaster with ample soft padding over the posterior aspects of the knee is placed on the leg to bring the knee gradually into complete extension. Active, gentle physiotherapy is initiated 48 h after the drain has been removed. The posterior splint is removed for intervals after the eighth postoperative day. Intensive physiotherapy is started in the hospital

once the wound has healed and continued after the patient’s discharge. Physiotherapy, including stretching exercises, is advised three times a week during the first 2 months, and close observation for the first 6 months, postoperatively [9]. Soft tissue procedures (hamstring release) are often insufficient to gain full correction this website [10,11]. Also, mechanical distraction using external fixators are presented as an efficient way to correct deformity with such advantages as versatility and low risk of neuro-vascular complication [12]; it has its potential disadvantages including pin tract site bleeding and infection, rebound phenomena after frame 上海皓元医药股份有限公司 removal, decreased range of motion, subluxation and is time consuming. Supracondylar extension osteotomy of the femur is a procedure that can be used to correct severe deformity [13]. This method may have several disadvantages. It creates a secondary deformity (shortening and angulation) and my lead to abnormal joint-loading forces in ambulatory patients. It also makes the future total knee arthroplasty difficult by distorting anatomy of distal end of the femur. In spite of these flaws, acute correction of the deformity, improvement in the patient’s walking

in both unilateral and bilateral cases and increase in total arc of motion of the joint in some patients are important advantages of this procedure. On the other hand, correction of deformity decreases the rate of haemorrhage in the same joint and the other joints. Among different techniques reported for the femoral extension osteotomy, trapezoidal extension osteotomy has several advantages compared with other osteotomy techniques or soft tissue release operations. Acute correction of deformity, low probability of neurovascular damage, early rehabilitation and ambulation after operation because of rigid fixation of osteotomy, and ability to correct of any frontal plane deformity during the same are some of the reported benefits.