Arthroscopic Lysis of Adhesions With Manipulation Under Anesthesia Versus Manipulation Alone in the Treatment of Arthrofibrosis After TKA: A Matched Cohort Study

Abstract

Arthrofibrosis following total knee arthroplasty (TKA) is a debilitating complication. Treatment options include physical therapy, manipulation under anesthesia (MUA), and arthroscopic lysis of adhesions (ALOA) with or without MUA. The authors studied 70 patients with arthrofibrosis after TKA treated with MUA or ALOA plus MUA. In this matched cohort study, 35 patients were treated with MUA and 35 patients were treated with ALOA plus MUA. Total knee arthroplasty followed by MUA was performed by 2 surgeons and TKA followed by MUA plus ALOA was performed by 1 surgeon at 1 institution. Electronic records were used to collect information and match cohorts based on age, sex, body mass index, diabetes mellitus, perioperative range of motion (ROM), and timing of the procedure for arthrofibrosis. The combination of MUA and ALOA yielded changes in ROM: a 72.7% increase 4 to 12 weeks after index TKA ( P =.032), a 50.0% increase 12+ weeks after TKA ( P =.032), and a 99.8% increase in patients with a pre-manipulation ROM of 0° to 60° ( P =.001). Manipulation under anesthesia yielded a 49.2% increase 4 to 12 weeks after TKA ( P =.161), a 27.0% increase 12+ weeks after TKA ( P =.161), and a 68.8% increase in patients with pre-manipulation ROM of 0° to 60° ( P =.084). Patients treated with ALOA plus MUA had greater increases in ROM ( P =.026) and final knee flexion ( P =.028) compared with those treated with MUA alone. Arthrofibrosis following TKA is a complication that often requires additional procedures. Traditionally, ALOA is added 3+ months from index TKA, when abundant scar formation has occurred. This study found a benefit to ALOA plus MUA compared with MUA alone, with the largest benefit in patients whose pre-manipulation ROM was 0° to 60°. [ Orthopedics . 2019; 42(3):163–167.]

Arthroscopic Lysis of Adhesions With Manipulation for Management of Late-Presenting Stiffness After Total Knee Arthroplasty

“…[23] Additional studies have also supported the role of arthroscopic LOAs in the stiff TKA [11,22,24,25]. Volchenko et al [26] performed a matched-cohort study of 70 total patients with post-TKA arthrofibrosis. One cohort was treated with a closed MUA alone and another with an arthroscopic LOA combined with MUA.…”

“…On average, patients in our study underwent arthroscopic LOA 57.2 months after their index TKA. The majority of prior studies which have investigated arthroscopic LOA with or without closed MUA for arthrofibrosis have included patients within 1 year from index TKA [11,[23][24][25][26]. Volchenko et al did report a diminished benefit of arthroscopic LOA þ MUA when performed later from index TKA; however, this was stratified at the 12-week postoperative mark [26].…”

“…Volchenko et al. [ 26 ] performed a matched-cohort study of 70 total patients with post-TKA arthrofibrosis. One cohort was treated with a closed MUA alone and another with an arthroscopic LOA combined with MUA.…”

“…One cohort was treated with a closed MUA alone and another with an arthroscopic LOA combined with MUA. They reported that the addition of an arthroscopic LOA resulted in a significantly improved percentage increase in knee ROM (49.1% vs 31.4%, P = .026) and final knee flexion (91.3 degrees vs 80.9 degrees, P = .028) [ 26 ]. In their systematic review of treatment of post-TKA arthrofibrosis, Fitzsimmons et al.…”

Stiffness after Primary Total Knee Arthroplasty

“…Arthroscopic lysis with MUA yielded changes in ROM: a 72.7% increase 4 to 12 weeks after index TKA (p = 0.032), a 50.0% increase 12+ weeks after TKA (p = 0.032), and a 99.8% increase in patients with a pre-manipulation ROM of 0-60 degrees (p = 0.001). MUA alone yielded a 49.2% increase 4 to 12 weeks after index TKA (p = 0.161), a 27.0% increase 12+ weeks after TKA (p = 0.161) and a 68.8% increase in patients with pre-manipulation ROM of 0 to 60 degrees [41]. Authors concluded arthroscopic lysis of adhesions plus MUA led to greater increases in ROM (p = 0.026) and final knee flexion (p = 0.028) compare with those treated with MUA alone.…”