Arthrofibrosis of the knee following a fracture of the tibial plateau

Abstract

The aim of this study was to report the incidence of arthrofibrosis of the knee and identify risk factors for its development following a fracture of the tibial plateau. We carried out a retrospective review of 186 patients (114 male, 72 female) with a fracture of the tibial plateau who underwent open reduction and internal fixation. Their mean age was 46.4 years (19 to 83) and the mean follow-up was16.0 months (6 to 80). A total of 27 patients (14.5%) developed arthrofibrosis requiring a further intervention. Using multivariate regression analysis, the use of a provisional external fixator (odds ratio (OR) 4.63, 95% confidence interval (CI) 1.26 to 17.7, p = 0.021) was significantly associated with the development of arthrofibrosis. Similarly, the use of a continuous passive movement (CPM) machine was associated with significantly less development of arthrofibrosis (OR = 0.32, 95% CI 0.11 to 0.83, p = 0.024). The effect of time in an external fixator was found to be significant, with each extra day of external fixation increasing the odds of requiring manipulation under anaesthesia (MUA) or quadricepsplasty by 10% (OR = 1.10, p = 0.030). High-energy fracture, surgical approach, infection and use of tobacco were not associated with the development of arthrofibrosis. Patients with a successful MUA had significantly less time to MUA (mean 2.9 months; sd 1.25) than those with an unsuccessful MUA (mean 4.86 months; sd 2.61, p = 0.014). For those with limited movement, therefore, performing an MUA within three months of the injury may result in a better range of movement. Based our results, CPM following operative fixation for a fracture of the tibial plateau may reduce the risk of the development of arthrofibrosis, particularly in patients who also undergo prolonged provisional external fixation.

Arthroscopic Lysis of Adhesions for Treatment of Post-traumatic Arthrofibrosis of the Knee Joint

“…Moreover, Haller et al. 9 reported successful results when MUA was performed within 3 months of definitive fracture management. Given these findings, dynamic splinting, passive motion, or early manipulation protocols may be most effective when motion loss is treated early in the postoperative period.…”

Intra-articular implantation of collagen scaffold carriers is safe in both native and arthrofibrotic rabbit knee joints

“…1,2,3 In order to study the pathophysiology behind arthrofibrosis, animal models have been developed using the New Zealand White rabbit knee. 4,5 These models involve an intracapsular knee injury followed by Kirschner-wire (K-wire) immobilisation for eight weeks, and result in substantial contracture that resembles the human biomechanical, cellular, and molecular response to injury, with increased myofibroblasts and transforming growth factor beta (TGF-β) activity.…”

Sulfasalazine Resolves Joint Stiffness in a Rabbit Model of Arthrofibrosis

“…Fibrosis often develops after joint trauma or major surgical procedures such as total knee arthroplasty (TKA) and anterior cruciate ligament (ACL) reconstruction . Approximately, 3–10% of TKA patients are treated for arthrofibrosis, while 2–35% of ACL reconstruction patients and 14.5% of patients with knee intra‐articular fractures require intervention . The standard‐of‐care is limited to arthroscopic debridement, capsule‐release, and manipulating limbs under anesthesia.…”

“…2,3 Approximately, 3-10% of TKA patients are treated for arthrofibrosis, while 2-35% of ACL reconstruction patients and 14.5% of patients with knee intra-articular fractures require intervention. [4][5][6] The standard-of-care is limited to arthroscopic debridement, capsule-release, and manipulating limbs under anesthesia. While these procedures can partially restore joint mobility, 25% of patients suffer recurring fibrosis that necessitates multiple interventions.…”