Secondary nerve lengthening to obtain full knee extension in popliteal pterygium syndrome

J Reconstr Microsurg. 2014 May;30(4):235-40. doi: 10.1055/s-0033-1354735. Epub 2014 Mar 28.

Abstract

Microsurgical nerve lengthening was performed in two siblings presenting a popliteal pterigium syndrome with a knee flexion contracture of 80 degrees. After the first attempt for nerve lengthening and knee extension elsewhere, a repeated lengthening was required due to continuing tip-toe walking and recurrent knee contracture at the age of 3 years. An extensive external and internal interfascicular microsurgical neurolysis resulted in a lengthening of the nerves. A full length of leg procedure had to be performed, inclusive of Achilles tendon lengthening to obtain a complete extension of the knee and a 90-degree ankle flexion. Maintaining the leg in a fully extended position was obtained with a dynamic splinting in the first month after the operation. When timing the operation we have to consider the importance of adequate precision of the microsurgical neurolysis, down to the identification of the Fontana bands, and the adequate postoperative splinting.

Publication types

  • Case Reports

MeSH terms

  • Abnormalities, Multiple
  • Child
  • Cleft Lip / physiopathology
  • Cleft Lip / rehabilitation
  • Cleft Lip / surgery*
  • Cleft Palate / physiopathology
  • Cleft Palate / rehabilitation
  • Cleft Palate / surgery*
  • Contracture / physiopathology
  • Contracture / rehabilitation
  • Contracture / surgery*
  • Eye Abnormalities / physiopathology
  • Eye Abnormalities / rehabilitation
  • Eye Abnormalities / surgery*
  • Fingers / abnormalities*
  • Fingers / physiopathology
  • Fingers / surgery
  • Gait*
  • Humans
  • Knee / innervation*
  • Knee / surgery*
  • Knee Joint / abnormalities*
  • Knee Joint / physiopathology
  • Knee Joint / surgery
  • Lower Extremity Deformities, Congenital / physiopathology
  • Lower Extremity Deformities, Congenital / rehabilitation
  • Lower Extremity Deformities, Congenital / surgery*
  • Male
  • Microsurgery
  • Nerve Block
  • Nerve Expansion / methods*
  • Plastic Surgery Procedures / adverse effects
  • Plastic Surgery Procedures / methods*
  • Postoperative Complications / physiopathology
  • Postoperative Complications / rehabilitation
  • Postoperative Complications / surgery*
  • Range of Motion, Articular
  • Reoperation
  • Siblings
  • Splints
  • Syndactyly / physiopathology
  • Syndactyly / rehabilitation
  • Syndactyly / surgery*
  • Time Factors
  • Treatment Outcome
  • Urogenital Abnormalities / physiopathology
  • Urogenital Abnormalities / rehabilitation
  • Urogenital Abnormalities / surgery*

Supplementary concepts

  • Popliteal Pterygium Syndrome