Purpose <p>The objective of this study was to report our experience using ultrasound guidance for percutaneous needle quadricepsplasty in patients with arthrogryposis multiplex congenita and congenital knee dislocation.</p> Methods <p>We describe the anatomy, imaging protocol and optimization, procedural logistics, surgical technique, and patient clinical results of this procedure. The study sample was comprised of five pediatric patients with knee extension contractures and treated with ultrasound-guided percutaneous quadricepsplasty using an 18-gauge needle between 2022 and 2024.</p> Results <p>Nine knees (five patients) with knee extension contractures were evaluated. Range of motion increased to greater than 90 degrees after the US-guided percutaneous quadricepsplasty.</p> Conclusion <p>Large incisions can be avoided in the treatment of knee contractures using ultrasound-guided quadricepsplasty. A minimally invasive approach avoids the formation of tight scars which can become a deforming force or create significant contractures which can limit motion.</p> Graphical Abstract <p></p>