PMC9823115_01
Ely's test showing normal knee flexion when the hip is flexed but extreme lack of knee flexion when the hip is extended.
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On physical examination, he had severe lack of knee flexion when his hip was extended (15 ) that improved to (120 ) when the hip was flexed (Fig. 1).
Plain x-ray shows no abnormalities but heterotopic ossification.
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Immediate improvement after the surgery which we successfully maintained with the continuum of physiotherapy.
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Tensor Fascia Lata which was fibrotic and scarred, the direct head of the rectus wasn't found, however, the reflected head was intact so we released it and got a slight improvement his hip was still tight in extension that further releases were necessary; first, we excised the bony prominence starting from the SAIS into the abductor's mass then we partially released the tensor fascia lata and the sartorius fascia while protecting the lateral femoral cutaneous nerve, then we lengthened the iliopsoas at the tendomuscular junction while protecting the femoral nerve. There were some fibrotic bands that we excised by electrocautery from the anterior surface of the hip capsule then major improvement was obtained (Fig. 3).