We retrospectively reviewed the results of joint distraction and reconstruction in complex knee contractures in 6 patients with 9 knees. The circular Ilizarov fixator was used in all cases. Extensor mechanism alignment with frame in situ was performed in 4 cases and alignment of mechanical axis of the lower limb was done in 2. All patients had a mean total arc of movement of 79 degrees before operation; however, this was nonfunctional because of the degree of flexion contracture. Three of the 6 patients were nonambulant before surgery. After joint distraction and reconstruction, mean total arc of movement remained unchanged, but this was more functional with improvement in the mobility status. At an average follow-up of 53 months, the mean flexion contracture was 100 degrees (range, 0-70 degrees), with further flexion possible up to 90 degrees (range, 60-120 degrees). Four patients had no recurrence. All 6 patients were ambulant with or without orthosis. Rebound phenomenon with loss of achieved correction was observed in 2 patients. Four patients were quite satisfied with results of surgery. Realignment of the extensor mechanism and mechanical axis is an important part that needs to be addressed in flexion contractures of the knee. Proper preoperative planning and staged procedures reduce the risk of recurrence. A treatment protocol is proposed to help in planning and further management.