Knees

The knee motion is influenced by the muscular control of the quadriceps and hamstrings. Knee flexion con­tractures are a common occurrence at all neurologic levels, but are seen in a higher frequency in thoracic and high lumbar lesions.

Treatment is geared toward preventive strategies of stretching and standing. When all else fails, surgi­cal interventions are indicated. Contractures of greater than 30 degrees often require surgery. Aggressive posterior capsule release is used in thoracic and high lumbar lesions and soft tissue releases in lower lev­els (116). Recent techniques have evolved in the treat­ment of knee flexion contractures, such as the “guided growth” approach developed by Klatt and Stevens. By surgically placing anterior tension band plates, grad­ual correction of the deformity is achieved by the use of tension forces to guide bone development in grow­ing children (117). Knee hyperextension can be seen in the L3 level from unopposed contraction of the quad­riceps. Serial casting and capsule releases may be required. Abnormal gait patterns have been identified and include genu valgus. This can result in knee pain and may require more aggressive bracing as a preven­tative strategy.