Etiopathology and Management of Stiff Knees: A Current Concept Review

Vaish, Abhishek; Vaishya, Raju; Bhasin, V. B.

doi:10.1007/s43465-020-00287-0

“…Arthroscopic release may be considered as an option when the stiffness lasts longer than 12 weeks or even earlier if there is a clear halt in the progression of joint range gain (34). A number of authors have suggested routine MUA associated with arthroscopic release, arguing that arthroscopic release of adhesions can reduce the complications associated with MUA (35).…”

Section: Arthroscopic Releasementioning

confidence: 99%

Complications of the surgical treatment of fractures of the tibial plateau: prevalence, causes, and management

Gálvez-Sirvent

¹

,

Ibarzábal-Gil

²

,

Rodríguez-Merchán

³

2022

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Open reduction and internal fixation is the gold standard treatment for tibial plateau fractures. However, the procedure is not free of complications such as knee stiffness, acute infection, chronic infection (osteomyelitis), malunion, non-union, and post-traumatic osteoarthritis. The treatment options for knee stiffness are mobilisation under anaesthesia (MUA) when the duration is less than 3 months, arthroscopic release when the duration is between 3 and 6 months, and open release for refractory cases or cases lasting more than 6 months. Early arthroscopic release can be associated with MUA. Regarding treatment of acute infection, if the fracture has healed, the hardware can be removed, and lavage and debridement can be performed along with antibiotic therapy. If the fracture has not healed, the hardware is retained, and lavage, debridement, and antibiotic therapy are performed (sometimes more than once until the fracture heals). Fracture stability is important not only for healing but also for resolving the infection. In cases of osteomyelitis, treatment should be performed in stages: aggressive debridement of devitalised tissue and bone, antibiotic spacing and temporary external fixation until the infection is resolved (first stage), followed by definitive surgery with grafting or soft tissue coverage depending on the bone defect (second stage). Intra-articular or extra-articular osteotomy is a good option to correct malunion in young, active patients without significant joint damage. When malunion is associated with extensive joint involvement or the initial cartilage damage has resulted in knee osteoarthritis, the surgical option is total knee arthroplasty.

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“…Due to external fixation of the knee joint after the operation, the synovial fluid in the joint failed to circulate effectively, and the fibrin formed adhesions in the folds of the joint capsule, the synovial reflex, and the muscles. After 5 to 7 days of joint immobilization, the muscle abdomen will shorten, and after 3 weeks, the loose connective tissue around the joint will become dense connective tissue, the motor neuron recruitment will decrease, and the joint will be rigid [ 11 ]. In addition, braking causes articular cartilage dystrophy, atrophy, necrosis, fibrosis, synovial sac drying, disappearance of adhesions, and joint stenosis causing adhesions [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of Remote Control Augmented Reality Multimedia Technology for Postoperative Rehabilitation of Knee Joint Injury

Li

¹

2022

Computational and Mathematical Methods in Medicine

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This study was aimed at exploring the application value of augmented reality (AR) in postoperative rehabilitation training for patients with knee joint injury. 40 patients who underwent knee joint injury surgery were selected as the research objects, and the patients were randomly divided into two groups: an experimental group (20 cases) and a control group (20 cases). Patients in the experimental group were treated with AR-based rehabilitation methods, while those in the control group were treated with traditional rehabilitation methods. Afterwards, the two groups of patients were compared with various indicators such as pain value, swelling, structural and functional recovery, time to complete weight bearing, time to return to work, and X-ray examination results. The main evaluation tools used were Hospital for Special Surgery (HSS) score and Visual Analogue Scale (VAS) score. The results showed that after six weeks, the HSS score of the control group was 82.88 ± 3.07 , and the HSS score of the experimental group was 85.46 ± 3.21 . The difference between the two groups was statistically significant ( P < 0.05 ). After three months, the HSS score of the control group was 89.96 ± 3.76 , and that of the experimental group was 93.21 ± 4.33 . The difference between the two groups was statistically significant ( P < 0.05 ). There was a significant difference in pain scores between the two groups at 7 days ( 3.81 ± 0.48 vs. 5.06 ± 0.66 ) and 14 days ( 2.03 ± 0.45 vs. 3.61 ± 0.63 ) after surgery, with statistical significances ( P < 0.05 ). There were statistically significant differences between the two groups in terms of time to complete weight bearing ( 7 ± 0.87 weeks vs. 8.82 ± 0.88 weeks) and time to return to work ( 8.69 ± 0.94 vs. 9.93 ± 0.88 weeks) ( P < 0.05 ). One month after surgery, the X-ray examination results of both groups showed recovery. The AR-based rehabilitation training system showed a good application effect and prospect in the postoperative structural and functional recovery of patients with knee joint injury.

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“…Patients would be made to bear 50% weight on the operated limb by the sixth week postoperatively, with aid, and unassisted 100% weight bearing by the 9th-10th week postoperatively. Postoperative knee stiffness was defined by a decrease in range of motion, which would decrease walking capacity to the extent that the patient would require aid to do so [21,22]. Fracture union was defined clinically when the patient was able to weight bear without walking aids, and radiologically union when there is progressive callous formation across two cortices in both views.…”

Section: Figure 2: Intraoperative Image Of Approach To Distal Femur U...mentioning

confidence: 99%

Study of Clinical Results and Functional Outcome of Patients With Distal Femur Fracture Treated With Dual Plating

Manjeswar¹,

Kale²,

Raithatha³

et al. 2023

Cureus

0

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IntroductionDistal femur fracture has been routinely fixed with a single lateral locking plate. This method of fixation in intra-articular distal femur fractures has proved to give a higher outcome of varus collapse as well as higher rates of mal-union due to inadequate fixation of the medial aspect of the distal femur. To address this drawback of single lateral plating, the use of medial assisted plating (MAP) has been introduced recently, which was proposed to give better stability to the medial fragments. This Is a prospective case series of 50 patients with distal femur fractures treated with dual plating. Materials and methodsFifty cases of patients with distal femur fractures were treated with dual plating between August 2020 and September 2022. Patients were followed up postoperatively till the third month, when patients were assessed clinically and radiologically. Range of motion of the knee, postoperative fracture displacement, limb shortening, and signs of union and infection were checked. Neer's scoring and Kolmet's scoring were used to grade the outcome for the patients. ResultsThe mean age of the patients was 39. Only 12% of the cases were open fractures. Eighty-four percent of the cases did not have fixed flexion deformity (FFD) and only 4% had FFD of 15 degrees; 72% of the cases achieved flexion of the knee beyond 120 degrees. Eighty-four percent of patients had normal walking ability by the 12th week postoperatively; 16% of the cases had a postoperative displacement of more than 1.6 cm, with the maximum being 2.5 cm. ConclusionFrom the study, we have concluded that outcomes were better for fractures of distal femur when treated with dual fixation, probably due to superior fixation and earlier postoperative mobilization.

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Etiopathology and Management of Stiff Knees: A Current Concept Review

Cited by 11 publications

References 26 publications

Complications of the surgical treatment of fractures of the tibial plateau: prevalence, causes, and management

Complications of the surgical treatment of fractures of the tibial plateau: prevalence, causes, and management

Effect of Remote Control Augmented Reality Multimedia Technology for Postoperative Rehabilitation of Knee Joint Injury

Study of Clinical Results and Functional Outcome of Patients With Distal Femur Fracture Treated With Dual Plating

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