Anterior femoral stapling.

Knee flexion deformity has an adverse effect on stride length and cadence, resulting in an inefficient and often uncomfortable gait. The purpose of this study was to introduce anterior stapling of the distal femur as a method to treat mild to moderate fixed flexion deformity of the knee. The authors undertook stapling in 28 patients (47 knees) with flexion deformities resulting from a variety of underlying conditions, including spina bifida, cerebral palsy, SCIWORA, and skeletal dysplasia. The preoperative clinical evaluation included assessment of hamstring contracture, fixed knee flexion deformity, and gait pattern. The technique is minimally invasive, requires no immobilization, and allows immediate resumption of bracing and physical therapy as needed. Preoperative fixed flexion deformities were typically 10 degrees -25 degrees (maximum 45 degrees ), decreasing to 0 degrees -11 degrees after surgery. Except for one patient who extruded a staple within the first postoperative month, there were no complications. The authors conclude that stapling is well tolerated and provides an excellent alternative to osteotomy in the immature patient by allowing gradual correction of fixed flexion deformities via growth manipulation.