{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T13:13:57Z","timestamp":1776777237194,"version":"3.51.2"},"reference-count":18,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T00:00:00Z","timestamp":1624492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Arthrogryposis multiplex congenita (AMC) is a rare condition defined as contrac-tures in multiple joints. Surgical interventions for severe knee flexion contractures have included posterior release, distraction and extension with external fixation and distal femoral extension osteotomies. These operations have been able to achieve knee extension, but not increase the range of motion. The purpose of this study was to review our experience with peroneal nerve decompression, posterior knee release and proximal femoral shortening. We retrospectively reviewed the medical charts and radiographs of all patients with a diagnosis of arthrogryposis who underwent aforementioned procedure. There were 39 patients with 73 knees included in the analysis with a mean follow-up of 21 months. The mean preoperative arc of motion was 45\u00b0 and last followup arc of motion was 79\u00b0 (p &lt; 0.0001). The mean last followup flexion contracture was 8\u00b0 (p &lt; 0.0001). Additional subanalyses were performed on those with followup greater than 24 months and those with flexion contractures &gt;60\u00b0; there were no differences found in these groups. This study demonstrates that it is possible to achieve a functional range of motion of the knees in patients with AMC while improving ambulatory function.<\/jats:p>","DOI":"10.3390\/children8070546","type":"journal-article","created":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T23:22:14Z","timestamp":1624576934000},"page":"546","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Novel Approach to Improving Knee Range of Motion in Arthrogryposis with a New Working Classification"],"prefix":"10.3390","volume":"8","author":[{"given":"David S.","family":"Feldman","sequence":"first","affiliation":[{"name":"Paley Advanced Limb Lengthening Institute, St. Mary\u2019s Hospital, West Palm Beach, FL 33407, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Troy J.","family":"Rand","sequence":"additional","affiliation":[{"name":"Paley Advanced Limb Lengthening Institute, St. Mary\u2019s Hospital, West Palm Beach, FL 33407, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron J.","family":"Huser","sequence":"additional","affiliation":[{"name":"Paley Advanced Limb Lengthening Institute, St. Mary\u2019s Hospital, West Palm Beach, FL 33407, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,6,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1016\/j.ejmg.2014.03.008","article-title":"Arthrogryposis (multiple congenital contractures): Diagnostic approach to etiology, classification, genetics, and general principles","volume":"57","author":"Hall","year":"2014","journal-title":"Eur. J. Med. Genet."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1002\/bdra.20738","article-title":"Prevalence of multiple congenital contractures including arthrogryposis multiplex congenita in Alberta, Canada, and a strategy for classification and coding","volume":"88","author":"Lowry","year":"2010","journal-title":"Birth Defects Res. Part A Clin. Mol. Teratol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e531","DOI":"10.1097\/BPO.0000000000001322","article-title":"Predicting Ambulatory Function Based on Infantile Lower Extremity Posture Types in Amyoplasia Arthrogryposis","volume":"39","author":"Donohoe","year":"2019","journal-title":"J. Pediatr. Orthop."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1097\/00003086-199404000-00014","article-title":"Mechanical distraction for treatment of severe knee flexion contractures","volume":"301","author":"Herzenberg","year":"1994","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1097\/01241398-199601000-00025","article-title":"Distal femoral extension osteotomy for knee flexion contracture in patients with arthrogryposis","volume":"16","author":"DelBello","year":"1996","journal-title":"J. Pediatr. Orthop."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.rbo.2013.10.005","article-title":"Analysis on the results from percutaneous extensor osteotomy of the distal femur in patients with amyoplasia","volume":"49","author":"Moreira","year":"2014","journal-title":"Rev. Bras. Ortop."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1302\/0301-620X.78B1.0780140","article-title":"Treatment of Severe Flexion Deformity of the Knee in Children and Adolescents Using the Ilizarov Technique","volume":"78-B","author":"Damsin","year":"1996","journal-title":"J. Bone Jt. Surg. Br. Vol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1097\/01241398-198411000-00009","article-title":"Posterior Capsulotomy for the Treatment of Severe Flexion Contractures of the Knee","volume":"4","author":"Heydarian","year":"1984","journal-title":"J. Pediatr. Orthop."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1097\/BPO.0b013e3181653bde","article-title":"The Utility of Knee Releases in Arthrogryposis","volume":"28","author":"Ho","year":"2008","journal-title":"J. Pediatr. Orthop."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1007\/s12306-012-0218-z","article-title":"Management of knee deformities in children with arthrogryposis","volume":"96","author":"Lampasi","year":"2012","journal-title":"Musculoskelet. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1097\/BPO.0b013e3181d07593","article-title":"Anterior Distal Femoral Stapling for Correcting Knee Flexion Contracture in Children with Arthrogryposis\u2014Preliminary Results","volume":"30","author":"Palocaren","year":"2010","journal-title":"J. Pediatr. Orthop."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1097\/bpo.0b013e3181594cd0","article-title":"Treatment of Knee Flexion Contractures in Patients with Arthrogryposis","volume":"27","author":"Feldman","year":"2007","journal-title":"J. Pediatr. Orthop."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"137","DOI":"10.2106\/00004623-197355010-00014","article-title":"Functional Ambulation in Patients with Myelomeningocele","volume":"55-A","author":"Hoffer","year":"1973","journal-title":"J. Bone Jt. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1097\/BPO.0b013e3181f5a0c8","article-title":"Ambulation Gains After Knee Surgery in Children with Arthrogryposis","volume":"30","author":"Yang","year":"2010","journal-title":"J. Pediatr. Orthop."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"271","DOI":"10.2106\/JBJS.I.00316","article-title":"Distal Femoral Extension Osteotomy and Patellar Tendon Advancement to Treat Persistent Crouch Gait in Cerebral Palsy: Surgical Technique","volume":"91","author":"Novacheck","year":"2009","journal-title":"J. Bone Jt. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1097\/BPO.0b013e31824b29d7","article-title":"Distal Femoral Osteotomy Using the LCP Pediatric Condylar 90-Degree Plate in Patients with Neuromuscular Disorders","volume":"32","author":"Rutz","year":"2012","journal-title":"J. Pediatr. Orthop."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1097\/01241398-198909010-00020","article-title":"Femoral Shortening in Correction of Congenital Knee Flexion Deformity with Popliteal Webbing","volume":"9","author":"Saleh","year":"1989","journal-title":"J. Pediatr. Orthop."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"55","DOI":"10.2106\/JBJS.16.00304","article-title":"Reorientational Proximal Femoral Osteotomies for Arthrogrypotic Hip Contractures","volume":"99","author":"Saldana","year":"2017","journal-title":"J. Bone Jt. 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