Joint contractures can occur primarily or most of the time secondary to neuromuscular imbalance.
The knee joint is the most commonly involved followed by the ankle joint.

A- Knee Contracture:
There are 2 types of knee contracture:

Knee extension contracture:
where the patient can not bend his knee. the knee is stiff in full extension. We need at least 80' of knee flexion to be able to function well. With extension contracture, there is difficulty in walking and in getting up from the sitting position. Most common causes are previous femoral fractures or thigh injury. It can occur after femur lengthening.
The treatment consists in a modified Judet Quadricepsplasty which is an open surgery of 3 hours, after which the patient is started on CPM machine that moves his knee continuously for 1-2 weeks. Patient should be able to regain at least 80' of flexion.

Knee flexion contracture:
The knee is fixed in bent position. Patient can not extend it. In severe cases he can not even sit on a chair. Open surgeries have lead to poor results and worsening of the problem because of severe soft tissue scarring. The ideal treatment is gradual distraction with the use of external fixator applied to the thigh and leg bones and connected with knee hinges. These hinges will allow knee motion and physical therapy during the process. The aim is to reposition the arc of motion of the knee so the patient can sit and walk. In motivated patient, improvement of the degrees of the arc of motion has been shown.

Clinical cases:

B- Ankle Contracture:
Neuromuscular diseases and injury commonly involved the ankle dorsiflexors resulting in loss of active dorsiflexion of the ankle ( patient can not pull up his ankle ). With time, the joint becomes stiff and the patient loses the passive dorsiflexion. The ankle is fixed in equinus; i.e the foot is pointing down. The gait of the patient becomes affected as he or she walks on the tip of the toes. In mild cases, lengthening of the Achilleus tendon that is the heel tendon may improve the situation but in severe cases, the only open surgical solution is multiple wedges osteotomy and ankle fusion ( devastating surgery). We have adopted the principle of soft tissue distraction to treat this condition. An external fixator is applied to the leg and foot bones and  used to gradually correct the deformity and pull  the foot up. Simultaneous distraction of the ankle joint will reverse the arthritic changes and allow cartilage remodeling.

Clinical cases:

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