Medical stretching devices are effective in the treatment of knee arthrofibrosis: A systematic review

Abstract

Aims This systematic review examines the available evidence on the use of medical stretching devices to treat knee arthrofibrosis, it suggests a focus for future studies addressing limitations in current research and identifies gaps in the published literature to facilitate future works. Materials and methods Articles were identified using the Cochrane Library, MEDLINE, PubMed and SCOPUS databases. Articles from peer reviewed journals investigating the effectiveness of medical stretching devices to increase range of movement when treating arthrofibrosis of the knee were included. Results A total of 13 studies (558 participants) met the inclusion criteria with the devices falling into the following categories; CPM, load control or displacement control stretching devices. A statistically significant increase in range of movement was demonstrated in CPM, load-control and displacement-control studies (p ​< ​0.001). The results show that the stretch doses applied using the CPM, load-control devices were performed over a considerably longer treatment time and involved significantly more additional physiotherapy compared to the displacement-control and patient actuated serial stretching devices. Conclusion The systematic review indicates that load-control and displacement-control devices are effective in increasing range of movement in the treatment of knee arthrofibrosis. Displacement-control devices involving patient actuated serial stretching techniques, may be more effective in increasing knee flexion than those utilising static progressive stretch. The paucity of research in this field indicates that more randomised controlled trials are required to investigate the superiority of the different types of displacement-control stretching devices and which of these would be most effective for use in clinical practice and to compare these with standard physiotherapy treatment.

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

“…Nonoperative treatment options focus on physical therapy and stretching. 9 , 38 However, these options are often not successful, with physical therapy alone offering just 3° of mean improved motion in one study. 39 For the persistently stiff knee, operative management includes open arthrolysis, arthroscopic lysis of adhesions, and/or a manipulation under anaesthesia (MUA), all with similar levels of improvement.…”

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

“…23 Additionally, the application of continuous passive motion (CPM) has been discussed widely, and many studies have found it to be highly effective in increasing the range of motion of patients with arthrofibrosis. 27 According to one study, patients who used a CPM machine had a significant mean range of motion increase in flexion of 34.6°+ -17°. 27 CPM can be a highly effective option along with the use of physical therapy to help counter the debilitating effects of arthrofibrosis.…”

“…27 According to one study, patients who used a CPM machine had a significant mean range of motion increase in flexion of 34.6°+ -17°. 27 CPM can be a highly effective option along with the use of physical therapy to help counter the debilitating effects of arthrofibrosis.…”

Metformin improves fibroblast metabolism and ameliorates arthrofibrosis in rats

“…Surgical interventions may rapidly improve joint ROM but are associated with specific complications [ 3 ]. In addition, surgical trauma can trigger inflammatory reactions, giving rise to even more distinct fibrotic changes [ [4] , [5] , [6] ]. Thus, safe and effective alternative therapeutics are needed to treat this debilitating joint disorder.…”