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

Stiefel, E; McIntyre, Louis F.

doi:10.1016/j.eats.2017.03.001

Cited by 19 publications

(11 citation statements)

References 10 publications

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“…10 Although many factors may contribute to joint limitation, the development of post-traumatic arthrofibrosis or intraarticular scar tissue adhesions are considered to be the causes of joint stiffness. 1,9 This case report demonstrated improvement in active knee ROM following hydrodissection around the CPN and within the surrounding fibrotic tissues in a young male patient who had knee stiffness due to femur fracture and knee surgery.…”

Section: Discussionmentioning

confidence: 83%

“…Knee stiffness usually occurs after surgery and is associated with lower functional outcome scores, increased pain and decreased patient satisfaction. [1][2][3]9 After treatment of knee fracture; fasciotomy, extensor mechanism disruption, the need for more than two surgical procedures and on-going wound management are reported as the factors related with increased knee stiffness. 10 Although many factors may contribute to joint limitation, the development of post-traumatic arthrofibrosis or intraarticular scar tissue adhesions are considered to be the causes of joint stiffness.…”

Section: Discussionmentioning

confidence: 99%

“…15 A supervised physical therapy program should be started in the early postoperative period. 1,9 In order to strengthen and reinforce the results of hydrodissection procedure, a supervised physical therapy including stretching and ROM exercises was combined and significant improvement was achieved.…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound-Guided Hydrodissection Combined with Peripheral Nerve Block for the Treatment of Post-Traumatic Knee Stiffness

Atar¹,

Gürçay²,

Demir³

et al. 2020

J PMR Sci

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Knee plays an important role in the human movement. 1,2 Knee stiffness, in an another word a limitation in range of motion (ROM), is a potential complication after intra-articular or extra-articular injuries involving articular structures. It is primarily due to intra-and extra-articular fibrosis and scarring adhesions in the quadriceps-femoral apparatus. Patients with diabetes mellitus, poor compliance to exercise therapy, and joint immobilization are at an increased risk for forming knee stiffness. 1,3,4 OLGU SUNUMU CASE REPORT ABS TRACT Knee stiffness is an important complication of knee injury and commonly affects natural ambulation. We demonstrated a case of 29-year old male who presented with knee stiffness following femur fracture and knee surgery and underwent ultrasound-guided hydrodissection into the fibrotic tissues. The patient's history revealed an open reduction internal fixation surgery after femur fracture and graft surgery for the tissue defect in the popliteal region. Although the patient had a 2-month physical therapy program including range of motion (ROM), stretching and strengthening exercises, and underwent arthroscopic lysis of adhesions after while, the left knee ROM continued to be seriously limited. Ultrasound-guided hydrodissection procedure around fibrotic tissues and common peroneal nerve block were performed once a week, 4 times in total. The patient underwent a total of 20 training sessions including ROM, stretching and strengthening exercises. The improvement of the knee flexion from 60° to 70° and extension from-35° to-15° were detected. This case report demonstrates that ultrasound-guided hydrodissection combined with peripheral block is a minimally invasive and a safe method in the treatment of patients with joint stiffness after knee trauma/surgery.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

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Ultrasound-Guided Hydrodissection Combined with Peripheral Nerve Block for the Treatment of Post-Traumatic Knee Stiffness

Atar¹,

Gürçay²,

Demir³

et al. 2020

J PMR Sci

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“…For slight end-stage range-of-motion limitation, in which condition the joint is accessible by an arthroscope, arthroscopic release is easy to perform and effective. [1][2][3][4][5][6][7][8] However, for knee stiffness with concomitant severe extension and flexion limitation, there is no intra-articular space in which to place the arthroscope because of scar tissue filling (Fig 1) and structural obstruction. In this case, the classic mini-invasive quadriceps-plasty is difficult to perform because it is difficult to release the anteromedial (AM) side of the knee across the patellofemoral joint through the small proximal anterolateral (AL) incision without full extension of the knee.…”

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confidence: 99%

Arthroscopic Release of Severe Flexion- and Extension-Impeding Knee Stiffness With Inaccessible Joint

Zhao¹

2021

Arthroscopy Techniques

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“…Manipulation under anesthesia (MUA) and lysis of adhesions (LOA) are well-described procedures in the arthroplasty and trauma literature. 15,20,30,31 Both procedures afford patients improved range of motion (ROM) should they experience arthrofibrosis. MUA is often performed within 12 weeks of the index procedure in order to address stiffness, although the appropriate timing is debated in the literature.…”

mentioning

confidence: 99%

Manipulation Under Anesthesia With Lysis of Adhesions Is Effective in Arthrofibrosis After Sulcus-Deepening Trochleoplasty: A Prospective Study

Carstensen

Feeley

Diduch

2019

Orthopaedic Journal of Sports Medicine

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Background: Sulcus-deepening trochleoplasty has been established as an effective treatment for patellar instability due to trochlear dysplasia. However, arthrofibrosis is a known complication following trochleoplasty, which may require manipulation under anesthesia (MUA) with or without lysis of adhesions (LOA) to increase the knee range of motion (ROM), especially flexion. Purpose: To prospectively follow patients for ROM improvements and subsequent complications after undergoing MUA with or without LOA in the setting of sulcus-deepening trochleoplasty. Study Design: Case series; Level of evidence, 4. Methods: A total of 76 knees with severe trochlear dysplasia were prospectively enrolled and underwent sulcus-deepening trochleoplasty, with a mean (±SD) follow-up of 32.5 ± 19.3 months. Concomitant procedures included medial patellofemoral ligament reconstruction, lateral retinacular release, and tibial tubercle osteotomy. Physical examination including ROM and findings of recurrent patellar instability were collected for all patients. Arthrofibrosis was defined as active and passive flexion less than 90° within 3 months of surgery combined with a plateau in progress with physical therapy. Paired-samples and independent-samples t tests were used. A P value less than .05 was considered significant. Results: A total of 62 knees met inclusion and exclusion criteria and were included in the study. Of these patients, 11 experienced arthrofibrosis as a complication and underwent MUA within 3 months of their index procedure. Of these 11 patients, 9 subsequently underwent arthroscopic LOA following MUA because acceptable ROM could not be achieved with manipulation alone. Patients with arthrofibrosis had a premanipulation mean ROM that was significantly different from those without arthrofibrosis (77.3° ±18.6° vs 133.3° ± 12.7°, respectively; P < .001). In the arthrofibrotic group, postoperative ROM increased significantly after MUA and/or LOA compared with the preoperative ROM (127.3° ± 12.5° vs 77.3° ± 18.6°, respectively; P < .001). ROM in the arthrofibrotic group after MUA/LOA was not significantly different from that in the nonarthrofibrotic group (flexion, 127.3° ± 12.5° vs 133.3° ± 12.7°, respectively; P = .156). No complications from the MUA or LOA were reported at subsequent follow-up visits. Conclusion: When indicated in the setting of severe trochlear dysplasia, sulcus-deepening trochleoplasty is a treatment for disabling recurrent patellar instability with a known complication of arthrofibrosis. Initiation of postoperative physical therapy within 3 days of surgery may reduce the incidence of arthrofibrosis. If arthrofibrosis is encountered after a sulcus-deepening trochleoplasty, MUA without LOA is not as effective as when following other procedures of the knee, whereas MUA with LOA is an effective procedure likely to result in ROM and patient outcome scores similar to those of a nonarthrofibrotic knee after the same procedure. Both MUA and LOA appear to be safe based on the limited number of patients in this study without complication.

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

Cited by 19 publications

References 10 publications

Ultrasound-Guided Hydrodissection Combined with Peripheral Nerve Block for the Treatment of Post-Traumatic Knee Stiffness

Ultrasound-Guided Hydrodissection Combined with Peripheral Nerve Block for the Treatment of Post-Traumatic Knee Stiffness

Arthroscopic Release of Severe Flexion- and Extension-Impeding Knee Stiffness With Inaccessible Joint

Manipulation Under Anesthesia With Lysis of Adhesions Is Effective in Arthrofibrosis After Sulcus-Deepening Trochleoplasty: A Prospective Study

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