Considerations in determining the severity of burn scar contractures with focus on the knee joint.

Scar contractures are a common complication after burn injuries. These contractures are characterized by impairment of joint mobility, leading to risk for limitations during daily activities, and restrictions in participation in society. Qualifying its severity is not well established in burn care. This study therefore examined different approaches to determine the severity of limited mobility in the knee joint due to a scar contracture. To determine the severity of burn scar contractures development of the knee over time, the following approaches were analyzed: prevalence, the degree of limitation, ability to perform basic daily activities, and the need for reconstructive surgery. Range of motion data of the knee joint were extracted from a 12-month prospective multicenter cohort study in the Netherlands. Based on prevalence, mean degree of limitation, and the classification based on mathematical division, limitations in knee flexion would be seen as giving most problems. On the other hand, when classified in terms of impact on function, limitations in extension were found to be giving most problems, although flexion limitations interfered slightly longer with the basic activities standing, walking, and climbing stairs. Depending on the chosen approach, the severity of burn scar contractures is projected differently. Interpreting the severity of a burn scar contracture of the knee, preferably should be based on a function-based classification system of the degree of ROM impairment, activity limitations and participation restrictions in society. Because that does justice to the real impact of burn scar contracture for the individual burn survivor.