Summary

Retrospective that study shows promising results in arthroscopic lysis of adhesions at mid term follow up

Abstract

Background

Knee arthrofibrosis is a common complication after traumatic injuries. When the origin is intraarticular, arthroscopic lysis of adhesions (ALA) and manipulation under anesthesia (MUA) seems to be effective in increasing the range of movement (ROM). However, mid to long-term results of this procedure are lacking in post-traumatic arthrofibrosis of the knee.

Objectives:

The purpose of this study is to evaluate the immediate and sustainable ROM changes after ALA and MUA for post-traumatic knee stiffness.

Methods

We retrospectively analyzed a consecutive series of patients at a single trauma center who underwent ALA and MUA(in one single procedure) due to post-traumatic knee arthrofibrosis. We included patients with a decrease of 90º of flexion, 10º of extension, or both, treated from 2019 to 2020.
Total ROM was assessed under anesthesia pre-operatively and intraoperative, then at the office at 3 and 6 months of follow up. A two-tailed paired t-test was assessed.

Results

We included 51 patients, male/female ratio was 4:1, and median age 44 years (22-70). Tibial plateau fracture (33.3%), LCA rupture (1.9%), and distal femur fracture (23.5%) were the most common diagnosis, respectively. The mean time between injury and ALA+MUA was 5 months.

There were 45 patients included in the flexion deficit group. Pre-operative median flexion was 70º(10º-90º), and intraoperative median flexion was 110º(30º-140º), showing an improvement of 40º (57%, p < 0.0001). A significant loss of flexion was seen at three (100º; 10º-140º; p<0,0001)and six months follow up (100º; 20º-140º; p=0,0148), showing a significant decrease of 11.3º compared to intraoperative ROM. This represents a median flexion gain at final follow up of 30º (43%).

In the extension deficit group, seven patients were included. Pre-operative median extension was 10º(10º-15º), and intraoperative mean extension 0º(0-15º), showing an improvement of -10º (85%, p < 0.031). Mean extension at 3 and 6 months follow-up showed no significant difference compared to extension range achieved intraoperative (p 0.564 and p 0.858 at 3 and 6 months respectively).

Among complications, three patients had an intraoperative fracture, and three patients required a secondary ALA+MUA due to recalcitrant loss of ROM.

Conclusion

Arthroscopic lysis of adhesions and manipulation under anesthesia improves the range of motion in patients with knee flexion and extension deficit. There was a significant decrease in ROM at three months of follow-up, but there is no significant difference compared to ROM achieved intraoperatively at six months of follow-up. More studies are required to determine if this difference in ROM between 3 and 6 months represents a clinically relevant difference.