Modified Judet quadricepsplasty leads to enhanced knee function in patients with post-traumatic stiffness: a case series of 19 consecutive patients at 10 years mean follow-up

Aims: Knee stiffness is common condition after high energy trauma, surgeries, leading to severe functional limitation in normal daily activities. Purpose is reporting clinical outcomes and detect complications at mean follow-up of 10 years after modified Judet quadriceplasty. Methods: Retrospective observational single center study was conducted, evaluating a 19 patients sample affected by post traumatic knee stiffness who underwent modified Judet quadricepsplasty from January 2008 to June 2023. Procedures were performed by same expert surgical team, patients followed same perioperative protocol. Patients were clinically evaluated using Judet criteria for final range of motion and five score (KOOS, WOMAC, Tegner-Lysholm, HSS KS, EQ-5D). Demographic characteristic, clinical history, pre intra and post operative knee flexion and possible complications by computerized medical records were detected. Results: Average definitive flexion was 100.7° (range 35°-140°) and flexion gain was 50.4° (range 5–100°). According to Judet's criteria, the result obtained by 10 patients could be classified as excellent (52.6%), 7 as good (36.8%), 1 as fair (5.3%) and at last in 1 as poor (5.3%). An extension lag was observed in 47% of cases, with 8.8° average value (range 2–20°); only 10.5% showed significant deficit (greater than 10°). There were four cases that required new arthromyolysis, four cases of perioperative complications and two long-term complications, mostly due to infection. Conclusion: Modified Judet quadricepsplasty is effective in improving knee function and mobility in patients with post-traumatic stiffness, resulting in a less aggressive invasive technique. Despite some risks, especially in severe cases, it remains a valuable surgical option when conservative treatments fail. Level of evidence: Level IV retrospective case series.