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Arthroscopic Posterior Capsular Release for Loss of Knee Extension.

ABSTRACT: Arthrofibrosis, as a result of osteoarthritis, after trauma, or after knee surgery, can have significant implications for patient function, satisfaction, and outcomes. When extensive conservative management fails to achieve satisfactory results, surgical intervention may be necessary. Arthroscopic techniques to release anterior adhesions are often viewed as easier and safer than posterior releases required for flexion contractures. We present our technique of a safe, effective, and reproducible arthroscopic complete posterior capsulotomy.

SUBMITTER: Jones DL

PROVIDER: S-EPMC7587019 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Arthroscopic Posterior Capsular Release for Loss of Knee Extension.

Jones Daniel L DL Neff Peter P Franklin Donald B DB Reid John B JB

Arthroscopy techniques 20200915 10

Arthrofibrosis, as a result of osteoarthritis, after trauma, or after knee surgery, can have significant implications for patient function, satisfaction, and outcomes. When extensive conservative management fails to achieve satisfactory results, surgical intervention may be necessary. Arthroscopic techniques to release anterior adhesions are often viewed as easier and safer than posterior releases required for flexion contractures. We present our technique of a safe, effective, and reproducible ...[more]

PMID: 33134044

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Project description:PurposeTo 1) evaluate the clinical efficacy of arthroscopic posterior capsular release for improving range of motion (ROM) in cases of recalcitrant flexion contracture and 2) determine patient-reported outcomes (PROs) postoperatively.MethodsRetrospective chart review was performed to identify patients who underwent arthroscopic posterior capsular release due to persistent extension deficit of the knee despite comprehensive nonoperative physical therapy between 2008 and 2021. Knee ROM and PROs (International Knee Documentation Committee [IKDC], Tegner, and visual analog scale [VAS]) were collected at final follow-up.ResultsOverall, 22 patients were included with a median age of 37 years (interquartile range [IQR]: 20.5-44.3). Of these, 8 (36%) were male and 14 (64%) were female, and average follow-up was 3.7 ± 3.3 years. The most common etiology was knee flexion contracture after anterior cruciate ligament (ACL) reconstruction (59%). All patients failed a minimum of 3 months of nonoperative management. Prior to operative intervention, 100% of patients received physical therapy, 64% received extension knee bracing or casting, and 36% received corticosteroid injection. Median preoperative extension was 15° (IQR: 10-25) compared to 2° (IQR: 0-5) postoperatively (P < .001). At final follow-up, median extension was 0° (IQR: 0-3.5). Postoperative VAS pain scores at rest (2 vs 0; P = .001) and with use (5 vs 1.8; P = .017) improved at final contact, and most (94%) patients reported maintaining their extension ROM. Patients with ACL-related extension deficit reported better IKDC (81 vs 51.3; P = .008), Tegner (5.8 vs 3.6; P = .007), and VAS pain scores (rest: 0.2 vs 1.8; P = .008; use: 1.3 vs 5; P = .004) compared to other etiologies.ConclusionArthroscopic posterior capsular release for recalcitrant flexion contracture provides an effective means for reducing pain and restoring terminal extension. The improvement in extension postoperatively was maintained for most (94%) patients at final follow-up with a 14% reoperation rate.

Project description:BackgroundGuided physiotherapy and surgical arthrolysis are effective in most patients with knee extension deficit. However, in refractory cases, posterior knee capsulotomy may be needed.PurposeTo assess extension restoration, pain reduction, and functional improvement after arthroscopic complete posterior knee capsulotomy in patients with extension deficit refractory to guided physiotherapy and surgical arthrolysis.Study designCase series; Level of evidence, 4.MethodsIncluded were patients with symptomatic asymmetric extension deficit >3° refractory to at least 6 months of guided physiotherapy and initial arthrolysis (15 patients with 12-month follow-up and 8 patients with 24-month follow-up). The mean duration of extension deficit was 24.6 months. An arthroscopic complete posterior knee capsulotomy was performed with transection of the posteromedial, posterolateral and central capsule, and the posterior septum. The primary outcome measure was knee extension, with hyperextension denoted as negative knee extension values. Secondary outcome measures included visual analog scale (VAS) for pain during maximum effort and exercise, International Knee Documentation Committee (IKDC) score, and Knee injury and Osteoarthritis Outcome Score (KOOS).ResultsThe mean patient age was 40.0 years (range, 26-70 years); 6 out of 15 patients had developed knee contracture after isolated anterior cruciate ligament reconstruction. The mean knee extension deficit decreased from 16.9° (range, 7° to 45°) preoperatively to -0.2° (range, -5° to 5°) at 12-month follow-up (P = .003) and to -0.3° (range, -5° to 5°) at 24-month follow-up (P = .035). The mean VAS pain score decreased from 3.5 (range, 1-6) preoperatively to 1.1 (range, 0-2) at 12-month follow-up (P = .004) and to 1.5 (range, 0-4) at 24-month follow-up (P = .005). The mean IKDC increased from 37.9 (range, 21-62) preoperatively to 63.9 (range, 46-87) at 12-month follow-up (P < .001) and to 60.9 (range, 39-80) at 24-month follow-up (P = .003). The mean KOOS increased from 45.0 (range, 30-62) preoperatively to 75.3 (range, 49-94) at 12-month follow-up (P < .001) and to 72.3 (range, 49-92) at 24-month follow-up (P = .003). There were no significant differences between 12- and 24-month follow-up in extension deficit or functional outcomes. One patient had a midcalf subcutaneous hematoma 5 weeks postoperatively, requiring evacuation.ConclusionArthroscopic complete posterior knee capsulotomy was able to restore knee extension, reduce pain, and improve function, with 12-month follow-up results sustained at 24-month follow-up.RegistrationNCT05385393 (ClinicalTrials.gov identifier).

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Arthroscopic Posterior Capsular Release for Loss of Knee Extension.

Publications

Arthroscopic Posterior Capsular Release for Loss of Knee Extension.

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