Arthroscopic Posteromedial Capsular Release

Dean, Chase S.; Chahla, Jorge; Mikula, Jacob D.; Mitchell, Justin J.; LaPrade, Robert F.

doi:10.1016/j.eats.2016.01.034

Cited by 15 publications

(23 citation statements)

References 11 publications

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“… 9 In comparison with isolated posteromedial capsulotomy, the advantages of applying our technique are symmetry and complete release of contracted structures. 7 Moreover, the posterolateral capsule is thicker than the posteromedial capsule, and releasing only the medial part may not be sufficient to restore full knee extension. This is why combined medial and lateral capsulotomy techniques were developed.…”

Section: Discussionmentioning

confidence: 99%

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Arthroscopic Complete Posterior Capsulotomy for Knee Flexion Contracture

Malinowski¹,

Góralczyk²,

Hermanowicz³

et al. 2018

Arthroscopy Techniques

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Knee flexion contracture is a clinically important complication that can be observed after trauma, after knee surgery, or as a result of osteoarthritis. When it is left untreated, knee shearing forces increase not only in the affected joint but also in the contralateral knee, leading to mechanical overload in both limbs. Conservative management is a first-line treatment option for extension deficits, but when it fails, surgical treatment is necessary. Open as well as arthroscopic techniques focus mainly on an anterior arthrolysis and a posterior capsular release. Until now, posterior capsulotomy involved either a medial posterior capsular release or medial and lateral posterior capsular releases. Our aim is to present the technique of arthroscopic complete posterior capsulotomy for knee flexion contractures.

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Section: Discussionmentioning

confidence: 99%

“… 3 , 4 , 5 , 6 Until now, an isolated medial posterior capsular release or medial and lateral posterior capsular releases have been described in the literature. 7 , 8 We present a safe and effective technique for arthroscopic complete posterior capsulotomy.…”

mentioning

confidence: 99%

Arthroscopic Complete Posterior Capsulotomy for Knee Flexion Contracture

Malinowski¹,

Góralczyk²,

Hermanowicz³

et al. 2018

Arthroscopy Techniques

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“…Athroscopicarthrolysis have been successfully used in treating patients with knee contracture after knee trauma, knee osteoarthritis, movement disorders and total knee arthroplasties (TKA) [27][28][29][30][31]. Good pain relief was generally reported after arthroscopic synovectomy and arthroscopic removal of the loose bodies.…”

Section: Discussionmentioning

confidence: 99%

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2016

BAOJORT

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“…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 . Thus, there is a need to develop approaches to augment these interventions.…”

mentioning

confidence: 99%

“…While these procedures can partially restore joint mobility, 25% of patients suffer recurring fibrosis that necessitates multiple interventions. [7][8][9][10] Thus, there is a need to develop approaches to augment these interventions.…”

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confidence: 99%

Sulfasalazine Resolves Joint Stiffness in a Rabbit Model of Arthrofibrosis

Atluri

Brouillette

Seol

et al. 2019

Journal Orthopaedic Research

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Joint stiffness due to fibrosis/capsule contracture is a seriously disabling complication of articular injury that surgical interventions often fail to completely resolve. Fibrosis/contracture is associated with the abnormal persistence of myofibroblasts, which over‐produce and contract collagen matrices. We hypothesized that intra‐articular therapy with drugs targeting myofibroblast survival (sulfasalazine), or collagen production (β‐aminopropionitrile and cis‐hydroxyproline), would reduce joint stiffness in a rabbit model of fibrosis/contracture. Drugs were encapsulated in poly[lactic‐co‐glycolic] acid pellets and implanted in joints after fibrosis/contracture induction. Capsule α‐smooth muscle actin (α‐SMA) expression and intimal thickness were evaluated by immunohistochemistry and histomorphometry, respectively. Joint stiffness was quantified by flexion‐extension testing. Drawer tests were employed to determine if the drugs induced cruciate ligament laxity. Joint capsule fibroblasts were tested in vitro for contractile activity and α‐SMA expression. Stiffness in immobilized joints treated with blank pellets (control) was significantly higher than in non‐immobilized, untreated joints (normal) (p = 0.0008), and higher than in immobilized joints treated with sulfasalazine (p = 0.0065). None of the drugs caused significant cruciate ligament laxity. Intimal thickness was significantly lower than control in the normal and sulfasalazine‐treated groups (p = 0.010 and 0.025, respectively). Contractile activity in the cells from controls was significantly increased versus normal (p = 0.001). Sulfasalazine and β‐aminopropionitrile significantly inhibited this effect (p = 0.005 and 0.0006, respectively). α‐SMA expression was significantly higher in control versus normal (p = 0.0021) and versus sulfasalazine (p = 0.0007). These findings support the conclusion that sulfasalazine reduced stiffness by clearing myofibroblasts from fibrotic joints. Statement of clinical significance: The results provide proof‐of‐concept that established joint stiffness can be resolved non‐surgically. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:629–638, 2020

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Arthroscopic Posteromedial Capsular Release

Cited by 15 publications

References 11 publications

Arthroscopic Complete Posterior Capsulotomy for Knee Flexion Contracture

Arthroscopic Complete Posterior Capsulotomy for Knee Flexion Contracture

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Sulfasalazine Resolves Joint Stiffness in a Rabbit Model of Arthrofibrosis

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