Some people have no problem with full extension during rehabilitation, but find that they are unable to regain full flexion.

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Early causes of problems with flexion might include:

  • adhesions in the suprapatellar pouch
  • adhesions in the capsular gutters on the side of the joint cavity adjacent to the sides of the tibia
  • adhesions in the capsular pouches in the same region but adjacent to the sides of the femur
  • adhesions under the quadriceps muscle in the region of the suprapatellar pouch
  • tight retinacular tissues to the sides of the patella, with limited side-to-side patellar mobility

Later causes of problems with flexion might include:

  • shortening of the quadriceps muscle
  • shortening of the patellar tendon
  • adhesion of the patellar tendon to the tibia
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