Progressive Stretch-Load is a Principle Step in the Surgical Treatment of Burned Knee Contracture

A prospective study which includes 36 patients who presented with 43 post burn knee contractures was conducted over the period of three years from Oct.2003-Oct.2006. Their mean age incidence was 17 years. Patients with right sided contractures were 16, left sided 13 and bilateral contractures were present in 7. The F/M ratio was 1:2.2. The mean time elapse from the burn injury to the development of contracture was 2.3 years. The mean healing time was 72 days .The degree of the flexion contractures were classified according to range of joint motion limitations into mild (less than 60° ) moderate (60-90°) and sever (more then 90°). The surgical release procedures involved two stages; (1) Incising of the contracted scar with subsequent application of progressive stretch load (PSL) to the limb through incremental weight traction over extended period of time, until the knee joint is fully extended. (2) To cover the created defect by Split Skin Graft (SSG). The weight traction range was 2.25-8.50 kilograms. The mean duration of PSL application was 7 days. The mean hospital stays was11.5 days .The mean follow-up period was 14 months. The complication rate was five (13.88 %), three patients (8.33%) showed partial (10-15°) recurrence in the contracture angle. Two patients (5.55 %) developed popliteal ulcerating graft which required excision and skin graft in six months period. By using the PSL method 31 patients (86.11 %) had full range of movements in the knee joint, and resumed their work in 3 -4 months during post operative periods.