Many authors describe that tenotomy and elongation of the tendons at origin of rectus femoris muscle have caused postoperative recurrence inevitably from rectus type of quadriceps contracture. Therefore, instead of these operations, it is suggested to cut the contracted rectus femoris muscle at both venter and origin or to resect scarred rectus femoris completely. In latter case, whole thigh reveal operative scars exist more largely, and that many problems produce about the functional recovery of muscular strength after operation. However, when we can obtain the method to prevent recurrence by the operation adopted at origin of rectus femoris muscle, it may be effective for the improvement of treatment results of this disease.
Forty-seven limbs in 46 patients who were treated by tenotomy at the origin of rectus femoris muscle were examined to study cause and prevention of postoperative recurrence of the quadriceps muscle according to follow-up for sixteen years.
From the results obtained, it is considered that ;
1) The relationship between the duration of postoperative physiotherapy and recurrence is recognized.
2) Recurrence shows two sort of types, one appears slowly in parellel with the stage of growth at the whole length of lower extremity (A), and the other appears more rapidly (B).
The former does not produce the functional of lower extremity so high, on the contrary, the latter shows remarkable disorders as the state before operation.
3) Postoperative treatment was carried out with using the dynamic brace which is able to release the section of stump, and is able to do muscle strengthening exercise after operation, to examine the relation between postoperative treatment and treatment results. The results obtained as follows ;
(i) All patients who abandoned postoperative treatment within one year after operation recurred and developed again the functional disorder of lower extremity.
(ii) The others who have continued the treatments precisely over two years kept the condition of recurrence slow.
4) The cause of postoperative recurrence might be due to the two factors, which were relative shortening of muscle for femur which was resulted from the delayed growth with scarred muscle and re-contracture of muscle which was produced by re-adhesion between stumps.
The author believes that “A-type” of recurrence is caused by relative shortening, and “B-type” is caused by re-contracture of muscle. Such postoperative recurrence as produces the functional disorders of lower limb is due to the re-contracture of muscle.
5) In case of tenotomy at origin of rectus femoris muscle, the so-called “recurrence” with functional disorder of lower limb can be prevented by postoperative treatment continued over two years after operation.
View full abstract