[Report on the Diagnosis and Treatment of Muscular Contracture. The Ad Hoc Committee of the Japanese Orthopaedic Association of Muscular Contracture]

Muscular contracture due to repeated intramuscular injections raised urgent questions from the medico-legal standpoint when a large number of children with quadriceps contracture was found in Yamanashi Prefecture in 1973. In 1975, the Japanese Orthopaedic Association formed an Ad Hoc Committee on Muscular Contracture to investigate the diagnosis and treatment of this particular condition. Since then, the Committee has studied the symptomatology, diagnosis, natural history, orthotic and operative treatment of quadriceps, deltoideus and gluteus contractures. The results have been reported annually to the Japanese Orthopaedic Association, and guidelines for diagnosis and treatment have been made available to its members. Quadriceps contracture can be classified into three types: the rectus femoris, vastus, and mixed types. The rectus femoris type represents 80 to 90 per cent of cases with quadriceps contracture, while the vastus type is quite rare. In both the rectus femoris and mixed types, operative treatment is suggested when the knee flexion is limited to 30 degrees or less in the prone position. Transverse division of the rectus femoris at the muscle belly is the standard operative procedure recommended for the rectus femoris type and gives very satisfactory results in most cases. In the mixed type, an additional division of the scarred portion of the vasti is needed. The ideal age for such procedures is near or after the end of growth. The vastus type is difficult to cure, but to improve the condition to a certain extent an operation is suggested when the knee flexion is limited to 45 degrees or less in the supine position. The operative procedure recommended is either release of the affected vasti at their insertion to the patella or Z-lengthening of the common tendon of the quadriceps. In deltoideus contracture, the Committee proposed a scoring system for evaluating the severity with the grade of abduction contracture and the opposite shoulder test as parameters. A score of 5 points or more indicates operative treatment. The operative procedure recommended is release of both the acromial part and the anterior fibers of the spinal part of the deltoideus. The ideal age for this procedure is 12 years or older. A dent produced by the operation distal to the acromion, however, has to be regarded as a cosmetic complication. To avoid this complication, advancement of the severed fibers of the deltoideus from the scapular spine to the acromion is needed. Such an advancement procedure is suitable for children of 14 or 15 years of age and leaves the natural round contour of the shoulder intact.(ABSTRACT TRUNCATED AT 400 WORDS)