Both arthroscopic and open posterior knee capsulotomy are effective in terms of extension recovery and functional improvement—systematic review

Abstract

Purpose To assess the recovery of extension and improvement in functional scores after an arthroscopic or open posterior knee capsulotomy in the setting of an extension deicit. Methods A systematic search of articles published between 1980 and 2020 was performed in the MEDLINE/PubMed database, EMBASE/Ovid database and Web of Science database. The inclusion criteria consisted of patients with primary extension deicits > 5° who underwent an arthroscopic or open posterior knee capsulotomy. The assessed outcomes were preoperative and postoperative range of motion and functional outcome scores. Randomized controlled trials, cohort studies and case series with a follow-up longer than 6 months were included. The risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool for case series. The certainty of evidence was assessed using the GRADE approach. Results Of 226 records identiied through database searching, 7 studies were included in the inal analysis. The outcomes of 107 patients with a mean age of 34.1 (range 15-63) years were available. In all the included studies, a posterior capsulotomy resulted in the restoration of knee extension to normal or nearly normal values (mean postoperative extension deicit: 0.4-4.2 degrees) with a signiicant increase in functional outcome scores. No neurovascular complications were reported within the studies. Due to the diverse methodology of studies, the direct comparison of arthroscopic versus open approaches was not possible. Concerning the risk of bias assessment, the greatest concerns raised the selection of participants among the included studies and the methods of outcome measurement. The certainty of evidence was very low according to the GRADE. Conclusions Both arthroscopic and open posterior capsulotomy of the knee results in restoration of normal or nearly normal knee extension and signiicant improvement in functional outcomes. Level of evidence IV.

Effect of posteromedial vertical capsulotomy with medial collateral ligament liberation on intraoperative medial component gap mismatch between extension and mid‐flexion during total knee arthroplasty

“…Medial soft tissue release demands strict control to achieve proper soft tissue mediolateral balance in flexion and extension in patients with medial stabilized implants for varus deformity. Soft tissue release techniques result in slightly different outcomes [3,11]. Previous clinical research revealed that the superficial MCL release effect was significantly greater in flexion than in extension during posteriorstabilized TKA [2].…”

Complete Arthroscopic Posterior Knee Capsulotomy in Patients With Knee Extension Deficit: Preliminary Results of a Clinical Trial

“…However, we are not aware of a different treatment modality other than posterior knee capsulotomy that is effective in the treatment of knee extension deficit refractory to guided physiotherapy and thorough joint arthrolysis. 3 , 10 It was therefore considered unethical to leave a control group with no treatment due to the highly debilitating nature of the disease. 1 , 2 , 5 Further, the study group was relatively heterogeneous, especially in comparison with previous works.…”

“…In such rare cases, the treatment consists of a posterior capsulotomy (posterior capsular release) of the affected joint. 3,7,10,16 Traditionally, this procedure has usually been performed through an open approach. 8,9,12,16 An arthroscopic approach is a less invasive procedure, 14,18 potentially resulting in limited postoperative pain, 14,18 faster recovery, 7,14,18 and increased postoperative function.…”

“…In such rare cases, the treatment consists of a posterior capsulotomy (posterior capsular release) of the affected joint. 3 , 7 , 10 , 16 Traditionally, this procedure has usually been performed through an open approach. 8 , 9 , 12 , 16 …”

Arthroscopic Trans-septal Portal of the Knee With Direct Visualization and No Need for Posterolateral Portal Creation

“…Among such procedures are removal of posterior pathologic findings (i.e., loose bodies, tumors, cysts), PCL reconstruction and repair, repair of the posterior meniscal horns, and posterior capsular release for extension contracture. 1 , 4 , 6 , 8 , 9 , 10 , 11 , 12 , 13 …”