Prognostic Factors of Arthroscopic Adhesiolysis for Arthrofibrosis of the Knee

PURPOSE: To assess the results of arthroscopic adhesiolysis for arthrofibrosis of the knee and to investigate possible prognostic factors. MATERIALS AND METHODS: Among the patients who developed arthrofibrosis after knee joint surgery, 68 patients who underwent arthroscopic adhesiolysis and were available for at least one-year follow-up were evaluated with regard to the Lysholm knee score, International Knee Documentation Committee (IKDC) subjective knee score, patient satisfaction, and range of motion (ROM) of the knee. The influence of possible prognostic factors including the cause of arthrofibrosis, duration of disease, and age of the patient on the postoperative ROM was analyzed. RESULTS: Sixty-one patients (89.7%) obtained an average increase of 48.6degrees in ROM; however, the remaining seven patients (10.3%) did not show any increase at the final follow-up. The Lysholm knee score and IKDC subjective knee score increased significantly at the final follow-up. Patient satisfaction was high or very high in 89.7% of the patients at the final follow-up. There was no association between the cause of arthrofibrosis and the increase in postoperative ROM. The duration of disease was significantly related to the postoperative recovery of ROM. Age had no significant influence on the postoperative recovery of ROM. CONCLUSIONS: We believe that arthroscopic adhesiolysis is effective for the treatment of intraarticular arthrofibrosis. In particular, the duration of the disease had significant influence on the postoperative outcome.

Treatment of Stiff Knee

PURPOSE: In this study, the effect arthroscopic adhesiolysis and the need for additional quadricepsplasty were evaluated by reviewing the patients 'data. MATERIALS AND METHODS: From July 1996 to January 2002, 18 patients received operation for the stiff knee. The patients were classified into 2 groups according to treatment method - Group 1: arthroscopic adhesiolysis and Group 2: arthroscopic adhesiolysis plus Judet quadricepsplasty. The Judet quadricepsplasty was performed when maximal knee flexion was not achieved over 90 degree even after arthroscopic adhesiolysis. We reviewed primary causes and the duration of contracture of stiff knee. Preoperative, postoperative, and final range of motion was evaluated. RESULTS: Preoperative, postoperative, and final range of motion was evaluated. In group 1, the average range of motion was 34 degree preoperatively, 107 degree intraoperatively, and 103 degree at the last follow-up. In group 2, the average range of motion, 26 degree preoperatively, 67 degree (after arthroscopic adhesiolysis)-115 degree(after quadricepsplasty) intraoperatively, and 112 degree at the last follow-up. CONCLUSION: Arthroscopic adhesiolysis has an effect in releasing intrarticular adhesion. Additional quadricepsplasty should be considered when the duration of contracture is over 12 months and primary causes of stiff knee is distal femur fracture which causes damages in the quadriceps muscle.

Arthroscopic Adhesiolysis of Partial Knee Ankylosis / 대한정형외과학회잡지

Partial knee ankylosis is a recognized complication of following open operative procedure, trauma and disease processes about the knee. Intraarticular trauma or surgical procedures such as TKR, synovectomy or patellar fracture were main source of intraarticular or extraarticular soft tissue adhesion and contracture were resulted from distal femoral and proximal tibial fractures. The purpose of this study is to report the value of arthroscopic adhesiolysis of partial knee ankylosis and to evaluate the clinical results of its application in various conditions. From October 1982 to December 1992, 56 cases in 54 patients who had severe limitation of motion in the knee joint following open operative procedure or trauma about the knee were treated by fibroarthrolysis under the arthroscopic control. For release of thick fibrous tissue, we used our designed blunt metal bar. The following results were obtained. There were 30 males and 24 females and the age at the time of release ranged from 20 to 69 years old(average 38.7 years old). The interval between last open operative procedure or trauma and arthroscopic adhesiolysis ranged from 3 months to 6 years(average 16 months). The interval between arthroscopic adhesionlyssis and the last follow up evaluation ranged from 1 year to 9 years(average 49 months), The average preoperative range of knee motion was 42.2 and the postoperative range of motion under the anesthesia was 115.5 and the average final knee range of motion at follow up was 101.3. So the average loss of motion between postoperative and final motion was 14.2. Complications were one case of patellar and tibial condylar fracture respectively. In the author's experience, arthroscopic adhesiolysis seems to be applied to the various condition of the partial knee ankylosis and the results are better than the other surgical procedures when it was performed early enough16).

Methods of Treatment for Improving Joint Motion After Synovectomy in Tb. Knee / 대한정형외과학회잡지

In the treatment of Tb.knee, the preservation of mobility is an important issue, there are many difficulties due to pain and swelling in the trial of early ROM exercise, and various problems such as the recurrence of Tb. lesions, delayed wound healing and draining sinus formation. We analysed 30 cases of Tb. knee treated with synovectomy during 10 years since March, 1979. In Group I (25 cases), early ROM exercise were started about 4 weeks after synovectomy. And in Group II (5 csses), arthroscopic adhesiolysis was performed after minimum 6 month immobilization and chemotherapy following synovectomy. We compared the two Groups and the results were as followings: 1. Male was 15 patients and female was 15 patients, the average age was 28.1 years. 2. The average follow-up period was 18.3 months. 3. In Group I, the ROM exercise was performed before 4 weeks in 9 cases and after 4 weeks in 16 cases postoperatively. The average final ROM was 68.9° 4. Draining sinus formation was in 4 cases in Group I. 5. In Group II, arthroscopic adhesiolysis was performed in 5 cases after synovectomy and chemotherapy for average 8.8 months ranging from 6 to 14 months. 6. The average final ROM at follow-up was 111° in Group II. 7. In a case with the severe involvement of bone and cartilage in Tb. lesion at the synovectomy, ROM was reduced gradually to 50° after arthroscopic adhesiolysis. We could gain ROM of 120° by TKR. 8. Draining sinus formation was not found in Group II.