Knee Burn Contracture Surgery in Pune: Straightening the Knee for Walking

What is a knee burn contracture?

The back of the knee (the popliteal area) folds every time the knee bends. Burns here, often from flames, hot liquids or contact with hot surfaces, heal while the person keeps the knee bent for comfort or lies curled up. The scar then shortens across the back of the knee and stops it from straightening.

Effects include:

• walking with a bent knee and a limp;
• tiredness and pain in the hip, back and the other leg;
• difficulty standing straight, climbing stairs, squatting or sitting cross-legged;
• in children, abnormal growth and positioning of the leg if untreated.

Who may benefit, and how is it assessed?

Release is considered when the knee cannot straighten enough to walk comfortably or when the scar cracks and breaks down. The surgeon measures how far the knee straightens, looks at the width and thickness of the scar, checks the pulses and nerve function in the foot, and may request X-rays to look at the joint. In long-standing contractures, the risk of stretching the nerve and vessels is carefully considered.

What are the treatment options?

Option	Suits	Points to consider
Stretching, night splints, positioning	Healing burns and early tightness	Prevents contracture; limited for established bands
Z-plasty	Narrow bands with healthy skin beside them	No donor site; lengthens the scar
Release with split-thickness graft	Broad scars	Needs careful splinting; can contract
Local flap	Exposed deep structures; areas needing durable skin	Thicker, more stable cover
Serial casts or splints after release	Long-standing contractures	Straightens the knee gradually, protecting nerves
External frame for gradual correction	Severe, long-standing contractures	Specialist technique over weeks

Grafting is explained under skin grafting surgery, and non-surgical scar care under burn scar treatment. Scars that also tighten the ankle or toes are covered under foot burn contracture surgery.

How is knee contracture release performed?

1. Anaesthesia: spinal or general anaesthesia, lying face down.
2. Release: the scar is cut across, or Z-plasties are raised, protecting the nerve and vessels that run deep behind the knee.
3. Straightening: the knee is extended as far as is safe.
4. Cover: the defect is grafted or covered with a flap.
5. Splinting: the leg is placed in a padded extension splint; serial casts may follow to gain more straightening gradually.

How should you prepare, and what should you ask?

• Continue stretching exercises before surgery.
• Arrange crutches or a walker and help at home.
• Plan several weeks of physiotherapy.

Questions to ask:

• How straight can my knee safely become in one operation?
• Will I need serial casts afterwards?
• Graft or flap: which suits my scar?
• When can I walk, drive and return to work?

What is recovery like?

Time	What to expect for most patients
Days 1-7	Leg raised in an extension splint; graft or flap checks
Weeks 1-3	Walking with support begins; dressings reduced
Weeks 3-8	Physiotherapy; serial splints or casts if needed
Months 2-6	Night splint; walking pattern improves; scar care

What are the risks?

• Recurrence of bending if splinting stops early.
• Partial graft or flap loss.
• Nerve stretch symptoms, such as tingling or weakness in the foot, after straightening.
• Wound breakdown in the knee crease.
• Stiffness of the knee joint from long-standing contracture.

Contact the team for numbness or weakness in the foot, a cold or pale foot, fever, or wound discharge.

What results can you expect?

Most people walk more upright and with less effort after release. Long-standing contractures may not reach full straightening, but walking and posture usually improve noticeably with therapy.

What happens if a knee burn contracture is left untreated?

A knee held bent by scar makes the leg functionally shorter, so the person dips with each step and leans on the hip and lower back to keep balance. Over years the hamstrings, the joint capsule and the nerve and vessels behind the knee shorten as well, and the joint can partly slip backwards. When both knees are affected, standing upright may become impossible, which is why this pattern is often released early rather than waiting for the scar to mature. Children who walk on a bent knee for long periods may develop growth and alignment problems in the leg. Lying face down for set periods, thigh-tightening exercises and a night extension splint can control mild tightness while the scar is active.

Common myths about knee burn contractures

• “A pillow under the knee helps the burn heal comfortably.” Resting with the knee propped bent lets the scar shorten in that position, so the leg is usually kept straight during rest.
• “Squatting and sitting cross-legged will stretch the scar behind the knee.” These positions fold the knee further and slacken the scar, while straightening exercises are what lengthen it.
• “A limp after a leg burn is only weakness and will pass.” A limp that persists with the knee unable to straighten should be assessed.
• “The knee should be pulled fully straight in one operation.” In long-standing cases the nerve and vessels have shortened, so straightening is often completed gradually after release.

What affects the cost of knee burn contracture surgery in Pune?

• Severity and duration of the contracture.
• Technique: Z-plasty, graft or flap, and any gradual correction.
• Hospital stay and anaesthesia.
• Splints, casts and physiotherapy.