Session VII - Knee & Tibia

Sat., 10/10/09 Knee/Tibia, Paper #83, 4:09 pm OTA-2009

Arthrofibrosis of the Knee following Lower Extremity Trauma Treated with Arthroscopic Lysis of Adhesions and Manipulation

Carole S. Vetter, MD (n); Jared Tyson, MD (n); David Hergan, MD (n);
Gregory Schmeling, MD (7-Zimmer);
Department of Orthopaedics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

Purpose: The objective of the study was to quantify the effect of arthroscopic lysis of adhesions and manipulation for the treatment of posttraumatic arthrofibrosis of the knee.

Methods: 67 patients were treated for posttraumatic arthrofibrosis of the knee with arthroscopic lysis of adhesions and manipulation from 1999 to 2008. The postoperative range of motion of the knee was compared to the preoperative, posttraumatic range of motion of the knee. The associated diagnoses included: tibial plateau fracture, 34; multiligamentous injury to the knee, 24; femur fracture, 21; knee extensor mechanism injury, 14; tibial shaft fracture, 3; and 1 traumatic arthrotomy with infection. Several patients had multiple diagnoses. All patients were followed for at least 4 months. In 23 patients, the mean follow-up was 41 months (range, 10-79). These 23 patients completed a patient satisfaction survey.

Results: For the 23 patients followed for 41 months, the average increase in the knee range of motion was 55° (P <0.0001). These 23 patients had a 6° increase in range of motion from 4 months to 41 months (95% CI: 2.1, 10.8; P = 0.0054). The majority of the observed increase in range of motion occurred in the first 4 months. The average increase in knee range of motion at 4 months for all of the patients was 48° (P <0.0001). All 23 patients who completed the survey were satisfied with the outcome and would have had the procedure again. Two patients (of 67) had a repeat procedure. There was 1 patella fracture, 1 patellar tendon rupture, and 1 distal femur fracture. All were successfully treated without recurrence of arthrofibrosis. There were no infections.

Conclusion: This is the first series reporting the treatment of posttraumatic knee arthrofibrosis with arthroscopic lysis and knee manipulation without an open quadricepsplasty. Arthroscopic lysis of adhesions with manipulation for traumatic knee arthrofibrosis compares favorably to an open or arthroscopic lysis of adhesions with quadricepsplasty but with less associated risk. Significant improvements in knee range of motion can be obtained and maintained with this technique.

Disclosure: (n=Respondent answered 'No' to all items indicating no conflicts; 1=Board member/owner/officer/committee appointments; 2=Medical/Orthopaedic Publications; 3=Royalties; 4=Speakers bureau/paid presentations; 5A=Paid consultant or employee; 5B=Unpaid consultant; 6=Research or institutional support from a publisher; 7=Research or institutional support from a company or supplier; 8=Stock or Stock Options; 9=Other financial/material support from a publisher; 10=Other financial/material support from a company or supplier).

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant