Application of modern rehabilitation techniques combined with external application of Traditional Chinese Medicine in the treatment of knee stiffness / 国际中医中药杂志

Objective:To explore the clinical efficacy of modern rehabilitation techniques combined with Traditional Chinese Medicine (TCM) external application in the treatment of knee stiffness.Methods:Prospective cohort study. A total of 80 patients with knee stiffness meeting the entry criteria admitted to the People's Hospital of Bozhou from January 2019 to December 2021 were selected and divided into the observation group ( n=40) and the control group ( n=40) according to the random ball touching method. Both groups were given routine physiotherapy. The control group was treated with TCM external application on the basis of the physiotherapy, and the observation was treated with modern rehabilitation techniques on the basis of the treatment of the control group. The goniometer was used to measure the knee flexion and extension before and after treatment, and the VAS scale was used to assess the knee pain. Fug l-Meyer motor function score was used to evaluate lower extremity motor function. Results:After treatment, the knee flexion [(96.43 ± 4.63) ° vs. (89.58 ± 4.67) °, t=6.59] in the observation group was higher than that of the control group ( P<0.01), and the extension [(8.32 ± 2.03) ° vs. (11.69 ± 2.37) °, t=6.83] in the control group was lower than that of the control group ( P<0.01); VAS score (2.06 ± 0.49 vs. 3.65 ± 0.76, t=11.12) was lower than that of the control group ( P<0.01), and Fugl Meyer motor function score (28.97 ± 3.76 vs. 20.43 ± 3.04, t=11.17) was higher than that of the control group ( P<0.01). Conclusion:The application of modern rehabilitation techniques combined with TCM external application in the treatment of knee stiffness can improve the range of motion of the knee joint, reduce the VAS score of pain, and improve the motor function.

Open arthrolysis for stiff knee after primary total knee arthroplasty / 中国修复重建外科杂志

Objective: To evaluate the effectiveness of open arthrolysis in treatment of the patient with stiff knee in late stage after primary total knee arthroplasty (TKA). Methods: Between January 2014 and October 2017, 7 female patients (7 knees) with stiff knee in late stage after primary TKA were admitted. The patients were 57-71 years old (mean, 63 years). There were 2 left knees and 5 right knees. All patients underwent TKA because of knee osteoarthritis. The interval between TKA and open arthrolysis was 8-30 months (mean, 13.6 months). There were 4 patients with 10-20° of extension deficit before arthrolysis. The range of motion of knee was (54.3±12.1)°. The clinical score, functional score, and total score of Knee Society Score (KSS) before arthrolysis were 76.3±7.6, 67.9±11.1, and 144.1±16.1, respectively. During the arthrolysis, periarticular soft tissue scar was removed, the range of motion of knee was restored, the gap balance and well patellar tracking were maintained. Intensive rehabilitation after operation was supplemented. Results: All wounds healed by first intention, without early stage complications. All patients were followed up 12-32 months with an average of 20.1 months. No abnormality of prosthesis was found by post-operative X-ray films. The knee movement improved significantly when compared with that before arthrolysis. The range of motion was less than 90° in 1 patient and 10° of extension deficit remained in 1 patient after operation. The range of motion was (92.9±4.9)° at last follow-up. The clinical score, functional score, and total score of KSS were 81.9±5.1, 74.3±9.8, and 156.1±13.7, respectively at last follow-up. The above indexes were superior to those before operation ( P<0.05). Conclusion: Open arthrolysis combined with intensive rehabilitation is a significant way to improve knee function for the patient with stiff knee in late stage after primary TKA.

Prognostic Factors of Modified Thompson Quadricepsplasty for the Stiff Knee / 대한정형외과학회잡지

PURPOSE: This study evaluated the prognostic factors of modified Thompson quadricepsplasty for a stiff knee. MATERIALS AND METHODS: From February 1987 to February 2007, 38 knees of 38 patients were managed with modified Thompson quadricepsplasty for a stiff knee. Thirty three males and 5 females were enrolled with a mean age of 36 years. The average follow-up duration was 92 months (range, 18 to 133 months). The most common cause of the stiff knee was a fracture around the knee in 33 cases. Multivariate logistic regression analysis was performed to evaluate the prognostic factors. RESULTS: Multivariate analysis showed that the gain of ROM after surgery was negatively correlated with the ROM before surgery (p<0.0001), and flexion contracture at the last follow up was positively correlated with the initial flexion contracture (p<0.0001). CONCLUSION: In a stiff knee, modified Thompson quadricepsplasty should be considered as soon as possible if the patient cannot gain an acceptable ROM through conservative management. More improvement in the ROM can be obtained in those with a more severe limitation of motion.

Simulated Stiff-knee Gait in Healthy Adults

OBJECTIVE: To investigate the effect of simulated stiff knee on the gait parameters. METHOD: Twenty healthy male adults were recruited. The temporospatial, kinematic & kinetic parameters and energy consumption were analyzed under three different conditions which were free gait, fixed knee flexion in neutral position and limited knee flexion to 30 degrees using knee orthosis. RESULTS: When knee flexion was fixed in neutral position, the cadence and walking speed significantly decreased, and the step time, step width, O2 cost significantly increased compared to free gait. When knee flexion was limited or fixed in neutral position, the kinematic and kinetic parameters in pelvis, hip, knee and ankle joints significantly changed compared with free gait. CONCLUSION: Simulated stiff-knee may affect not only knee joint but also pelvis, hip and ankle joints with increased energy consumption. These findings help us to understand the compensatory mechanism and energy conservation of stiff-knee gait.

Stiff Knee by Entrapment of Quadriceps Femoris Tendon at Fracture Site in Paediatric Distal Femur Shaft Fracture

The complications following paediatric femur fracture are leg length discrepancy, angulation deformity, rotational deformity, ischemic limb. But, stiff knee is rarely expressed after trauma like paediatric femur fracture. We report a case of stiff knee due to entrapment of quadriceps femoris tendon at displaced fracture site after conservative treatment by Russel traction and hip spica cast in paediatric femur fracture. We treated successfully by resection of distal end of proximal segment of femur and release of quadriceps femoris tendon for flexion contracture of the knee.

Stiff Knee by Entrapment of Quadriceps Femoris Tendon at Fracture Site in Paediatric Distal Femur Shaft Fracture

The complications following paediatric femur fracture are leg length discrepancy, angulation deformity, rotational deformity, ischemic limb. But, stiff knee is rarely expressed after trauma like paediatric femur fracture. We report a case of stiff knee due to entrapment of quadriceps femoris tendon at displaced fracture site after conservative treatment by Russel traction and hip spica cast in paediatric femur fracture. We treated successfully by resection of distal end of proximal segment of femur and release of quadriceps femoris tendon for flexion contracture of the knee.

The Relationship between Weight-Bearing and Stiff-Knee Gait in Hemiplegic Patients

OBJECTIVE: To determine whether insufficient weight-bearing on the hemiparetic side has a correlation with the degree of stiff-knee gait in hemiplegic patients. METHOD: Fifty hemiplegic patients were included. In all patients, 3-dimensonal gait analysis and static and dynamic foot pressure measurements were taken. The degree of stiff-knee gait was evaluated using the peak knee flexion angle and the knee flexion slope at toe-off in hemiplegic limb. The degree of weight-bearing was evaluated using the percentage of hemiplegic foot pressure and pressure-time integration on the non-hemiplegic side. RESULTS: The static and dynamic mean pressure ratios and pressure-time integration ratio were statistically correlated with peak knee flexion angle and knee flexion slope (p<0.01). CONCLUSION: As a result, insufficient weight-bearing had a correlation with the degree of stiff-knee gait in hemiplegic patients. Insufficient weight-bearing should be further investigated to determine whether it is one of the characteristic findings of stiff-knee gait, or another cause of stiff-knee gait.

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.

Quadricepsplasty for the Stiff Knee / 대한정형외과학회잡지

PURPOSE: To report the technique of modified Thompson quadricepsplasty with postoperative treatment using string tie and the results for stiff knees. MATERIALS AND METHODS: From June 1987 to June 1997, we evaluated the results of 20 knees of 19 patients who were managed with modified Thompson quadricepsplasty for the stiff knee and were followed up for an average of 29 months (range, 18 to 49 months). We performed modified Thompson quadricepsplasty, which included arthrolysis, anterolateral or lateral approach, transverse incision on tensor fascia lata, release of middle and distal third of quadriceps muslce. If the knee flexion was less than 130 degree, Z-plasty on distal tendinous portion of rectus femoris was performed. Postoperatively, the knees were flexed with string tie for 3 hours. And then the knees were extended for 3 hours. This periodic passive exercise was started by the 21st day after the surgery. RESULTS: The average gain in flexion from preoperative to postoperative was 74.7 degree+/-25.1 degree. At the latest follow-up, the average loss of range of motion from that obtained in the operating room was 5.3 degree+/-7.2 degree. According to Judet's assessment of results, there were 17 excellent and 3 good results. There was one wound infection but it resolved after wound care and intravenous antibiotics for 3 weeks. CONCLUSIONS: The modified Thompson quadricepsplasty and postoperative care with string tie provided good results for the stiff knee.

Quadricepsplasty and Arthrolysis in Stiff Knee / 대한정형외과학회잡지

Many people who sustain injuries to the femur or muscles of thigh are handicapped for life by varing degree of limitation of motion of the knee joint flexion such as squatting or kneeling. Many surgical procedures were reported by Thompson (1944), Judet (1959), van Nes (1962), Nicoll (1963), Hesketh (1963), Jahng (1965), Han (1979, 1986), and Daoud (1982). During the period from March 1987 to August 1989, 12 cases of stiff knee joint were treated surgically in our clinics. l. 12 cases of stiff knee treated by modified Judet technique of quadricepsplasty and arthrolysis. 2. The stiff knee was corrected successfully without release of rectus femoris muscle in our cases. 3. The string tie was very useful in postoperative care. String tie was applied with the knee in a full flexed position and when it was discarded, knee was extended and quadriceps setting exercise was begun. 4. In 10 cases, plate removal was added, in two eases, combined bone surgery and quadricepsplasty for malunion or nonunion of the femur, which showed good results. 5. The average flexion achieved by operation was 119.6, the average flexion gain 70.8, while the average extension gain 8.8. 6. By Judet criteria, the result of 11 cases were excellent and one case showed fair result.