Efficacy of non-operative treatment of patients with knee arthrofibrosis using high-intensity home mechanical therapy: a retrospective review of 11,000+ patients

Abstract

Background Recovery from knee surgery or injury can be hindered by knee arthrofibrosis, which can lead to motion limitations, pain and delayed recovery. Surgery or prolonged physical therapy are often treatment options for arthrofibrosis, but they can result in increased costs and decreased quality of life. A treatment option that can regain lost motion without surgery would help minimize risks and costs for the patient. The purpose of this study was to determine treatment efficacy of high-intensity home mechanical stretch therapy in patients with knee arthrofibrosis. Methods Records were reviewed for 11,000+ patients who were prescribed a high-intensity stretch device to regain knee flexion. Initial and last recorded knee flexion and days between measurements were available for 9842 patients (Dataset 1). Dataset 2 was a subset of 966 patients from Dataset 1. These 966 patients had separate more rigorous measurements available from physical therapy notes (Dataset 3) in addition to data from the internal database (Dataset 2). Within and between dataset statistics were calculated using t tests for comparison of means and Cohen’s d for determination of effect size. Results All dataset showed significant gains in flexion (p < 0.01). Mean initial flexion, last recorded flexion and flexion gain were 79.5°, 108.4°, and 29.9°, respectively in Dataset 1. Differences between Datasets 2 and 3 had small effect sizes (Cohen’s d < 0.17). The were no significant differences when comparing workers’ compensation and non-workers’ compensation patients. The average last recorded flexion for all datasets was above the level required to perform activities of daily living. Motion gains were recorded in under 60 days from device delivery. Conclusions High-intensity home mechanical stretch therapy was effective in restoring knee flexion, generally in 2 months or less, and in avoiding additional surgery in severe motion loss patients regardless of sex, age, or workers’ compensation status. We believe high-intensity stretching should be considered in any patient who is at risk for a secondary motion loss surgery, because in over 90% of these patients, the complications and costs associated with surgery can be avoided.

Artrofibrosis de rodilla en cirugía ortopédica pediátrica

“…A recent study revealed that high-intensity home mechanical stretch therapy effectively restored knee flexion within two months or less. 76 This approach was shown to prevent additional surgery and minimize emotional distress, irrespective of sex, age, or worker's compensation status. 76 The authors recommended a high-intensity stretching program for any patient at risk of secondary motion loss after surgery.…”

“…76 This approach was shown to prevent additional surgery and minimize emotional distress, irrespective of sex, age, or worker's compensation status. 76 The authors recommended a high-intensity stretching program for any patient at risk of secondary motion loss after surgery. The 6-10 week program provided an average of > 25 o of flexion gain.…”

Pathophysiology of Arthrofibrosis of the Knee after Ligamentous Injury and Repair: Synthesizing Past and Current Knowledge for Personalized Prevention

“…19 Pain, delayed recovery, and motion limitations are all symptoms of arthrofibrosis post-ligamentous surgery that can significantly affect the livelihoods of patients and not only prevent them from work, but also create financial stress. 3 Even a small loss of knee extension, such as 5°, can debilitate a patient from walking normally and loss of flexion can create issues with climbing stairs, sleeping, driving, and getting in and out of chairs. 5 The inability to do these simple everyday tasks can significantly affect patients' careers, resulting in job loss in severe cases.…”

“…2 There are an estimated 85,000 patients who develop postoperative knee arthrofibrosis in the United States per year. 3 The rate of reported incidence of arthrofibrosis following ACL reconstruction ranges from 4% to 38%. 4 The types of surgeries and the percentage of patients that have continued severe motion loss beyond 1 year after that surgery (in parentheses) include anterior cruciate ligament (ACL) reconstruction (2-35%), multiple ligament reconstruction (13-22.4%), total knee arthroplasty (1.3-12%), tibial plateau fracture repair (14.5%), and femur fracture repair (29.5%).…”

“…4 The types of surgeries and the percentage of patients that have continued severe motion loss beyond 1 year after that surgery (in parentheses) include anterior cruciate ligament (ACL) reconstruction (2-35%), multiple ligament reconstruction (13-22.4%), total knee arthroplasty (1.3-12%), tibial plateau fracture repair (14.5%), and femur fracture repair (29.5%). 3 Mild, moderate, and severe arthrofibrosis were classified as having a flexion range of 90°-100°, 70°-89°, and less than 70°, respectively, and/or a loss of extension of 5°-10°, 11°-20°and more than 20°, respectively. 5 Arthrofibrosis is also characterized by an excessive production of scar tissue.…”