# Pediatric Hemophilic Arthropathy of the Knee: Treatment With Circular External Fixator and Intra-articular Injection of Platelet-Rich Plasma

## TL;DR

A 12-year-old boy with hemophilia A and knee flexion contracture was treated with a circular external fixator and platelet-rich plasma injections, showing improved joint function and pain relief.

## Contribution

This case report presents a novel combination of the Ilizarov technique and PRP injections for treating hemophilic knee contractures in pediatric patients.

## Key findings

- The Ilizarov technique improved knee flexion contracture over six weeks of distraction.
- PRP injections provided clinical and functional improvement in pain and joint function.
- More research is needed to establish a standardized protocol for this treatment approach in children with hemophilia.

## Abstract

There are limited reports about managing knee flexion contracture (KFC) due to hemophilic hemarthrosis with the Ilizarov technique and platelet-rich plasma intraarticular injection administration. This article aims to describe a case of KFC treated with a circular external fixator and intraarticular administration of platelet-rich plasma in a pediatric patient.

A 12-year-old male patient suffering from hemophilia A was being monitored by our department due to knee effusions. Extensive knee flexion contracture of the left knee was seen. The Ilizarov technique was chosen for surgical management of the worsening knee flexion contracture. The duration of distraction was six weeks. Due to localized pain and functional impairment, intra-articular administration of platelet-rich plasma (PRP) was applied twice, on the first month after the circular frame removal and at a six-month follow-up, with clinical and functional improvement.

Our clinical case report demonstrates that PRP intra-articular injections are likely to provide an improvement in pain and knee joint function, as well as joint hyperemia, even in the case of already established knee flexion contracture, which was managed with a circular distraction device. However, more studies regarding the Ilizarov technique and the PRP intraarticular administration are needed for a protocol to be established for the management of the hemophilic knee joint in the pediatric population.