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

Abstract

Background: Arthrofibrosis is a known complication of total knee arthroplasty (TKA). Closed manipulation is the treatment of choice for arthrofibrosis within 90 days of TKA. Treatment for arthrofibrosis that has failed prior interventions remains controversial, and the role for arthroscopic lysis of adhesions has not been examined for late-presenting arthrofibrosis. Methods: A retrospective analysis of patients who underwent arthroscopic lysis of adhesions (LOAs) with manipulation for post-TKA arthrofibrosis was performed. Chart review included patient characteristics, time from TKA, prior interventions, and range of motion (ROM) data. Knee extension, flexion, and total ROM were recorded preoperatively, intraoperatively, and throughout follow-up. Knee ROM was compared at the different time intervals using Wilcoxon signed-rank tests. Results: A total of 13 patients (6 male and 7 female) with a mean age of 66.3 years were included. Average time since index TKA was 57.2 months (3.7-209.5). Ten of 13 patients had undergone prior interventions for arthrofibrosis, which included closed manipulation under anesthesia, open LOA, and revision arthroplasty. The mean preoperative knee flexion and extension values for the cohort were 76.5 ± 17.4 and À4.6 ± 6.1 degrees, respectively. Postoperative improvements in knee ROM were significant at all time points, with mean improvements of 17.2 ± 16.3 degrees at 1 week (P ¼ .022), 17.2 ± 13.2 degrees at 4 weeks (P ¼ .001), 19.2 ± 16.0 degrees at 8 weeks (P ¼ .004), and 25.2 ± 13.1 degrees at 12 weeks (P ¼ .005). No complications were recorded. Conclusions: Arthroscopic LOAs with manipulation achieves significant improvements in knee ROM for late-presenting arthrofibrosis after TKA.

Previous Extensor Mechanism Repair Is Associated With Increased Rates of Surgical Complications Following Total Knee Arthroplasty: A Propensity-matched Analysis

“…It is interesting that there was no increased risk of MUA in patients with a prior history of repair. One possible explanation is that these patients who present in the postoperative period with stiffness are presenting late enough (>12 weeks) that only an LOA has been shown to be effective per consensus opinion [ 18 ]. Another likely explanation is surgeons are less likely to perform an MUA on a patient with a history of an extensor mechanism repair in fear of compromising the extensor mechanism and will instead opt for an LOA.…”

Intra-articular celecoxib improves knee extension regardless of surgical release in a rabbit model of arthrofibrosis

“… 40 , 41 For these patients who fail MUA, arthroscopic or open lysis of adhesions has limited success. 42 , 43 Furthermore, these surgical options are not without risks of periprosthetic fracture or extensor mechanism disruption. 44 , 45 For these reasons, the discovery of a non-surgical treatment option for established contractures is important.…”

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

“…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.…”