Arthroscopic release for stiff total knee arthroplasty / 中华骨科杂志

ABSTRACT

Objective To introduce and evaluate arthroscopic release technique for treatment of knee stiffness due to arthrofibrosis after total knee arthroplasty (TKA). Methods Five patients with mean age of 56 years (41－ 70 years) underwent knee arthroscopy for a history of arthrofibrosis following TKA. There was no painful stiff total knee or infected total knee in this series. All of 5 cases had good range of motion in the operation room after total knee replaced. The arthroscopy was performed at 6 months (3－ 12 months) after the TKA, and at this time the flexion was limited to 70 degrees (60－ 85 degrees).In 2 cases,the extension was limited to 10 degrees and 30 degrees. With 3 standard portals, we examined the knee joint and found the adhesions and fibrous band formed in the suprapatellar pouch and two gutters. By resection of those fibro- band and passive flexion of the knee, the satisfactory range of motion(ROM)could be achieved. For the 2 cases of extension limited, CR prothesis was replaced. We released the posterior cruciate ligaments through the anterior portals. Continuous passive motion was started immediately postoperatively at the first day. The patients were evaluated at an average time of 20 months (8－ 46 months) after the arthroscopy. Results The mean knee ROM was 116 degrees (100－ 130 degrees) at the end of arthroscopy and was 105 degrees (90－ 115 degrees)at the last review.The mean ROM was improved by 35 degrees (15－ 50 degrees). There were no complications in this series. Conclusion Arthroscopic release for the treatment of knee stiffness due to arthrofibrosis without pain and infection following TKA is a useful, reliable and safe technique, compared with closed or open procedure. The arthrolysis should be done at 3 to 6 months after the TKA in order to obtain better results.