Knee contracture

Knee contracture is a condition in which the knee joint is restricted in movement and cannot fully straighten or bend. It can be caused by a variety of factors such as disease, injury, inflammation or surgery. Knee contracture can limit the mobility of the knee and make it difficult to perform normal activities of daily living.

Examples of causes of knee contracture include:

1. Arthritis: Joint diseases such as rheumatoid arthritis or osteoarthritis can cause inflammation and degeneration of joint structures, resulting in limited knee movement.
2. Trauma: Injuries to the knee, such as a sprain or fracture, can damage the joint structures and cause contractures.
3. Surgery: Contracture can develop after knee surgery, especially if rehabilitation and physical therapy are not provided.
4. Inflammation: Inflammatory conditions or infections of the knee can lead to adhesions and restricted movement.
5. Prolonged lack of movement: Lack of physical activity or wearing a leg cast for an extended period of time can cause the muscles and ligaments of the knee to contract, which can also cause contractures.

Treatment of knee contracture depends on its cause and the degree of restriction of movement. It may include physical therapy, muscle and joint stretching, medication and in some cases surgery. The goal of treatment is to restore full mobility of the knee and improve the patient's quality of life.

Causes of the knee contracture

Here are some of the main causes of knee contracture:

1. Arthritis: Arthritis, such as rheumatoid arthritis and osteoarthritis, can cause inflammation of the joint and destruction of cartilage. This can lead to loss of mobility and contracture.
2. Trauma: Injuries to the knee, such as sprains, fractures, or sprains, can damage the structures of the joint and cause limitation of motion.
3. Surgical interventions: After knee surgery or placing a cast on the leg without further rehabilitation, contractures can develop.
4. Inflammatory Diseases: Diseases such as inflammatory arthritis can cause inflammation of the joints and adhesions that limit movement.
5. Prolonged lack of movement: If the knee remains immobile for an extended period of time, such as due to restricted movement or long-term wearing of a cast, muscles and ligaments can contract and limit movement.
6. Specific diseases: Some genetic or rare diseases can lead to knee contracture.

Knee contracture (flexion contracture) can develop after a variety of surgical procedures, including knee replacement and arthroscopy. Post-traumatic flexion contracture of the knee can occur as a result of injury or trauma.

1. Contractureafter knee arthroplasty: Contracture can develop after knee arthroplasty if the patient does not perform exercises to restore joint mobility. It can also be associated with scar tissue formation after surgery. Treatment for contracture after endoprosthetic knee replacement may include physical therapy, stretching and massage of the joint, and sometimes surgery may be required to remove the scar tissue.
2. Post-traumatic knee flexion contracture: This contracture can develop after a knee injury such as a fracture or tendon sprain. It is often characterized by limitation of knee flexion. Treatment includes physical therapy, exercises to restore mobility, and in some cases surgery to remove the cause of the contracture.
3. Knee contractureafter arthroscopy: Knee arthroscopy is a minimally invasive surgical procedure, but contracture can also occur afterarthroscopy. This can be due to scar tissue formation, inflammation, or limitation of joint mobility. Treatment depends on the cause of the contracture and may include physical therapy, joint stretching, and other rehabilitation techniques.

Symptoms of the knee contracture

Here are some common symptoms of knee contracture:

1. Limitation of motion: The main symptom of knee contracture is restriction of motion in the knee joint. The affected knee may not straighten completely or may have a limited range of motion.
2. Pain: Pain in the knee area may accompany the contracture, especially when trying to straighten the joint.
3. Muscle Spasms: Muscle spasms around the knee can occur as the body attempts to compensate for restricted movement.
4. Crunching and creaking: The knee may make a crunching or creaking sound when moving, which is due to damage to the joint structures.
5. Deformity: In some cases, the contracture can cause deformity of the knee, which is visible to the naked eye.

Knee joint contractures in children

Knee joint contractures can develop in children for a variety of reasons. A contracture is a restriction of movement in a joint due to a shortening of muscles, tendons, or ligaments. In children, knee joint contractures can be congenital (at birth) or acquired. Here are some of the possible causes of knee contractures in children:

1. Congenital contractures: Some babies may be born with congenital contractures that can affect the knee joints. These contractures may be related to genetic factors or develop during fetal development in the womb.
2. Prolonged immobility: If an infant or child is not allowed to move or remain immobile for long periods of time (e.g. Due to lack of exercise or limited mobility), contractures can develop.
3. Injury or surgery: Injury, surgery, or even long-term wearing of a cast after a fracture can lead to the development of a knee joint contracture.
4. Muscle or tendon disorders: Various diseases, such as muscular dystrophies or tendon disorders, can cause muscles to shorten and develop contractures.

Treatment of knee joint contractures in children depends on the cause and the degree of restriction of mobility. Usually, treatment involves physical therapy, massage, muscle strengthening exercises and, in some cases, surgery. It is important to see your doctor or pediatrician promptly if your child shows signs of knee joint contracture, so that treatment can begin as early as possible and prevent long-term mobility limitations.

Stages

The degree of knee contracture is determined based on the angle to which the joint cannot fully straighten.

The degrees of knee contracture can vary and are usually categorized as follows:

1. Complete contracture (100%): The joint is completely immobile and cannot straighten. The angle of flexion is 0 degrees.
2. Subluxation (less than 100%): The joint can move slightly but cannot fully straighten. The angle of flexion is more than 0 degrees but less than 180 degrees.
3. Moderate contracture: The angle of flexion is more than 45 degrees but less than 90 degrees.
4. Medium Contracture: The angle of flexion is more than 30 degrees but less than 45 degrees.
5. Mild contracture: The angle of flexion is more than 10 degrees but less than 30 degrees.

The flexion angle in this case is measured in relation to the joint in full extension (fully erect). The greater the flexion angle, the more severe the contracture.

Forms

Knee contractures can have different characteristics, depending on the limitation of motion and the degree of flexion or extension of the joint. Here are some types of knee contractures:

1. Complete contracture of the knee joint: In this case, the knee joint is completely restricted in movement and cannot straighten or straighten. This is the most serious type of contracture and can completely destroy the mobility of the joint.
2. Flexion contracture of the knee joint: In this contracture, the joint is limited in extension and cannot fully straighten. This can result in the leg being permanently bent at the knee.
3. Extensor contracture of the knee joint: In this contracture, the joint is limited in flexion and cannot fully bend. This can make the leg permanently straightened at the knee.
4. Mixed contracture of the knee joint: In some cases, the contracture may be combined, meaning the joint may be limited in both flexion and extension.

Diagnostics of the knee contracture

Diagnosing knee contracture involves a number of medical procedures and tests to determine the degree of restriction of mobility in the knee joint and to identify the underlying causes of the contracture. Here are the main techniques and procedures used in the diagnosis of knee contracture:

1. Physical Exam: The doctor will perform a visual examination of the knee and talk to the patient to identify symptoms that preceded the development of the contracture and other diseases or conditions that could be related.
2. Mobility measurement: The doctor may measure the angle of motion in the knee joint to determine the degree of restriction of motion. This may include measuring the angle of flexion and extension of the knee.
3. X-rays: X-rays may be taken to evaluate the joints, bones, and cartilage of the knee joint. This helps rule out other conditions such as arthritis or osteoarthritis.
4. Magnetic resonance imaging (MRI): MRI can be used to study soft tissues, ligaments, tendons and joint capsule in more detail. It can be useful in identifying the causes of contracture.
5. Arthroscopy: If the diagnosis is unclear or a more precise examination is needed, arthroscopy may be performed. During this procedure, a medical instrument with a camera is inserted into the knee joint through small incisions. This allows the doctor to directly visualize the condition of the joint and perform treatment manipulations.
6. Laboratory tests: Sometimes blood and synovial fluid from the knee joint may need to be analyzed to look for signs of inflammation or infection that may be associated with the contracture.

Differential diagnosis

The differential diagnosis of knee contracture involves identifying and distinguishing this condition from other conditions that may cause restriction of motion in the knee joint. Below are some conditions and diseases to consider in the differential diagnosis:

1. Arthritis: Different types of arthritis, such as rheumatoid arthritis, osteoarthritis, or septic arthritis, can cause joint inflammation and restricted movement in the knee joint. Patients with arthritis may also experience pain and inflammation.
2. Injury: Injuries to the knee, such as sprains, torn ligaments, fractures or abrasions, can cause pain and restriction of movement. In these cases, X-rays or other imaging may be needed to determine the damage.
3. Synovitis: Synovitis, an inflammation of the joint lining, can cause swelling and restriction of motion in the knee joint.
4. Hemarthrosis: Hemarthrosis, hemorrhage into the joint space, often occurs after an injury and can cause inflammation and pain in the knee.
5. Neuromuscular diseases: Someneuromuscular diseases, such as myodystrophy or cerebral palsy, can lead to restricted movement and deformity of joints, including the knee.
6. Childhood illnesses: Some childhood illnesses, such as cerebral palsy or arthrogryposis, can cause contractures of the joints, including the knee.

Treatment of the knee contracture

Treatment of knee contracture depends on its cause, degree and duration. Here are some treatments that can be applied:

1. Physical Therapy:

   • Regular exercise and stretching designed to improve the mobility of the knee joint and strengthen the surrounding muscles and ligaments.
   • Chiropractic care and massage can help relax muscles and tissues, helping to improve joint mobility.

2. Medications:

   • Anti-inflammatory medications (such as NSAIDs) can help reduce inflammation and soreness in the joint.
   • Hyaluronic acid or corticosteroid injections may provide temporary relief of symptoms.

3. Devices and Support:

   • Wear special orthotics, braces, splints, or bandages that can help maintain proper joint position and prevent additional mobility restrictions.

4. Surgical treatment:

   • In cases where the knee contracture is too severe and does not respond to conservative treatment, surgery may be necessary. Surgery may involve cutting the tendons or bands that limit the mobility of the joint (tendon release), or even replacing the joint.

5. Regular exercise and lifestyle:

   • Maintaining an active lifestyle and performing recommended exercises and stretches after treatment is complete to maintain mobility and prevent recurrence.

Treatment of knee contracture should be individualized and supervised by a physician and physical therapist. It is important to start treatment as early as possible to prevent further deterioration and to maintain maximum mobility in the knee joint.

Knee contracture rehabilitation, including therapeutic exercises, exercises and massage, can be a key component in restoring mobility and functionality to the joint. Here are some of these techniques:

Therapeutic gymnastics

Therapeutic exercises can be helpful for knee contractures, as they can help improve joint mobility and relax contracted muscles and ligaments. Here are some exercises that can be used for knee contractures:

1. Stretching the flexor muscles:

   • Lie on your back with your legs extended.
   • Gradually raise one leg, bending it at the knee and pressing it against your chest.
   • Hold your foot in this position for 20-30 seconds.
   • Repeat with the other leg.
   • Do this exercise several times for each leg.

2. Stretching the extensor muscles:

   • Sit in a chair with a straight back.
   • Lift one leg and gradually bend it at the knee, trying to touch your heel to your buttocks.
   • Hold your foot in this position for 20-30 seconds.
   • Repeat with the other leg.
   • Perform the exercise several times.

3. Active exercises with counter force:

   • Sit in a chair or on the floor with your legs stretched out in front of you.
   • Place your hands or a rubber band under your knees and resist bending or extending your knee.
   • Effort should be moderate and controlled.
   • Repeat 10-15 times for each leg.

4. Gradual increase in extension or flexion:

   • With the help of a physical therapist or rehabilitator, perform gradual movements to increase the mobility of the knee joint.

Exercises

Exercise plays an important role in treating and preventing knee joint contractures. Regular exercise can help maintain joint mobility and strengthen the surrounding muscles. Below are some exercises that may be helpful for knee joint contractures. However, before beginning any set of exercises, it is important to consult with your doctor or physical therapist to make sure they are appropriate for your particular situation.

1. Passive exercises: If you have limited movement in your knee joint, your physical therapist may perform passive exercises, including slowly and gently pulling your leg into a full straightened position. This can help stretch tendons and muscles and increase mobility of the joint.
2. Stretching exercises: Regularstretching exercises can help improve flexibility and mobility of the knee joint. For example, while sitting on the floor, extend your leg and try to reach your toe. Hold this position for 20-30 seconds and then switch to the other leg.
3. Muscle strengthening exercises: Strengthening the surrounding muscles, including the quadriceps and calf muscles, can help improve stability and support of the knee joint. Examples of exercises include leg raises in a seated position and dumbbell exercises.
4. Bike: Pedaling on a stationary bike or exercise bike can help strengthen muscles and improve knee mobility.
5. Swimming: Swimming and water exercises are great for improving joint mobility and strengthening muscles without putting stress on joints.
6. Walking: Walking and walking with the support of crutches or canes can help maintain knee mobility.
7. Physical therapy: Regular supervised physical therapy sessions can be effective in treating knee contractures.

Stretchingexercises: Stretching the muscles and ligaments around the knee joint can help restore full range of motion. Stretching may include stretching the thigh muscles, calf muscles, and ligaments of the knee.

Muscle strengthening exercises: Strengthening the surrounding muscles can help improve stability and support the joint. Exercises include various types of leg lifts, squats, and exercises with rubber bands.

Passive Exercises: A physical therapist can assist you with passive exercises, including manual knee extension and flexion to restore range of motion.

Massage

Massage can be helpful in treating and reducing knee contractures, especially when combined with other treatments such as physical therapy and stretching. Here are some ways that massage can be used to help with knee contractures:

1. Muscle relaxation: Massage can help relax tight muscles around the knee joint. This can reduce pain and promote easier mobility of the joint.
2. Improved circulation: Massage helps improve blood flow to the tissues, which can help repair and regenerate the tissues of the joint and surrounding structures.
3. Tissue Stretching: Massage with the right techniques can help stretch limiting tissues such as tendons and ligaments, which can help increase joint mobility.
4. Increasing Body Awareness: Massage can help the patient feel and become aware of their limitations in mobility and tension in the knee area, which can help with symptom management and improved self-awareness.
5. Maintaining the results of physical therapy: Massage can be an adjunct to physical therapy and can help maintain the results achieved during physical rehabilitation.

It is important to make sure that the massage is performed by an experienced massage therapist or physical therapist who is experienced in working with patients with knee contractures.

Thermal treatments

Thermal treatments can be part of the treatment package for knee contractures and can help improve joint mobility and relieve muscle tension. Here are some types of thermal treatments and their steps:

1. Heat therapy:

   • Hot compresses: Applying hot compresses to the knee joint area helps to relax the muscles and joints, improving blood circulation. This can be especially helpful before physical therapy and exercise.
   • Warming: Using aheating pad or hot gel can also provide warmth and relaxation to muscles and joints.

2. Cold therapy:

   • Ice compresses: Applying ice compresses to the knee joint area can help reduce swelling and inflammation, especially after intense exercise or physical activity.

3. Combined thermal treatments:

   • Combinationapproach: Sometimes a combination of heat and cold therapy is used at different points in the treatment depending on the patient's needs and stage of treatment.

4. Ultrasound therapy:

   • Ultrasound: Ultrasound therapy can be administered by a physical therapist. Ultrasound waves penetrate deep into the tissues and help reduce inflammation and improve joint mobility.

5. Paraffin baths:

   • Paraffin baths: This method involves immersing the knee in a paraffin bath, which helps improve blood circulation, relax muscles and moisturize the skin.

6. Infrared therapy:

   • Infrared heaters: The use of infrared heaters can provide heat that penetrates deep into the tissue layers and helps relax muscles.

The effectiveness of thermal treatments may depend on the extent of the contracture, its cause, and the individual needs of the patient.

It is important to understand that rehabilitation techniques should be individualized and supervised by a specialist such as a physical therapist or rehabilitation therapist. They can also adapt the rehabilitation program depending on the degree of contracture and the characteristics of the patient.

Prevention

Knee contracture prevention involves a number of activities that aim to keep this joint healthy and mobile. Here are some recommendations for preventing knee contracture:

1. Active lifestyle: Regular physical activity helps strengthen the muscles around the knee joint and keeps it mobile. Incorporate moderate exercise into your daily regimen, such as walking, swimming, bicycling, yoga or Pilates.
2. Muscle Strengthening: Strong thigh and calf muscles reduce stress on the knee joint and prevent it from overloading. Do exercises to strengthen your thigh and calf muscles, such as squats and leg raises.
3. Warming up and stretching: Warm up before physical activity to prepare your muscles and joints for exertion. Stretch after exercise to improve joint mobility.
4. Proper technique when exercising: If you exercise, pay attention to proper exercise technique and avoid putting undue stress on the knee joint.
5. Weight management: Excess weight can increase stress on the knee joints and contribute to the development of contractures. Maintain a healthy weight through a balanced diet and moderate physical activity.
6. Consistency in physical activity: It is important to maintain regular exercise and physical activity throughout your life to keep your joints healthy.
7. PreventiveMassage: Preventive massage can help relax muscles and improve circulation in the knee area.
8. Visiting a doctor: If you have joint diseases, injuries or knee pain, see a doctor in time for diagnosis and treatment.
9. Avoid excessive strain: When performing daily tasks or physical activity, make sure that the load on the knee joints is even and does not exceed their physiological capacity.
10. Maintain proper posture and knee position: When performing tasks involving prolonged sitting or standing, maintain proper posture and knee position to avoid overloading the joints.

Forecast

Army

Questions regarding whether a person with a knee joint contracture is considered fit for military service or disabled are decided in accordance with the law and medical expertise.

The condition of the knee joint, the degree of contracture, and the impact of the condition on the ability to perform military duties or daily life can vary greatly from case to case.

Disability

Usually, a medical evaluation is conducted to assess the degree of functional impairment and limitations caused by the knee contracture. The results of this examination may influence the decision to declare fitness for military service, to award disability, or to award social benefits.

It is important to keep in mind that the criteria and rules for medical examinations may vary from country to country and each case is considered individually. It is best to contact your country's medical experts or military service to get specific information and advice on your situation.

Literature

• Kotelnikov, G. P. Traumatology / edited by Kotelnikov G. P.., Mironov S. P. - Moscow : GEOTAR-Media, 2018.
• Treatment tactics for flexion contracture of the knee joint in children with arthrogryposis. Journal: Orthopedics, traumatology and reconstructive surgery of pediatric age. Mulevanova S.A., Agranovich O.E., 2016.