Knee contracture is defined as ankylosis of the knee due to extra-articular, intra-articular or combined pathology. It may occur in extension or flexion alone or in flexion, external rotation and valgus position. Knee contracture in extension commonly occurs following fracture of femur or extensive soft tissue damage of anterior aspect of thigh, scarring or fibrosis of all or part of quadriceps mechanism, total knee replacement, chronic osteomyelitis of femur/sequelae of septic arthritis of knee. Various techniques described for treatment of extension contracture of the knee include gentle manipulation under anesthesia, quadricepsplasty and arthroscopic release of intra-articular adhesions. Flexion contracture of the knee is much more common than extension contracture. It is often complicated by subtraction and internal rotation of the tibia on the femur. Another recently recognized cause of ankylosis in flexion is fibrosis and contracture of retropatellar fat pad and associated structures that prevent the normal superior and inferior excursion of patella and hence the extensor mechanism. These can partially be corrected conservatively. The various measures like traction with balanced suspension, Buck’s extension and static or dynamic splints, successive correction casts and braces designed to extend the knee are of great value and can be used before surgery to make the operation less extensive and after surgery to increase the correction. Posterior capsulotomy and supracondylar femoral extension osteotomy are the important surgical procedures for knee contracture in flexion. Total knee arthroplasty after flexion contracture is difficult but it can be preformed successfully in this challenging and highly debilitated subset of patients, giving them marked improvement in quality of life.