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Malinowski K, Mostowy M, Kanak M, Pękala PA, Kim DW, Kennedy NI, LaPrade RF. Patellar Base Support Technique During Manipulation Under Anesthesia for Knee Arthrofibrosis Limits the Risk of Iatrogenic Complications. Arthrosc Tech 2023; 12:e2321-e2327. [PMID: 38196877 PMCID: PMC10773232 DOI: 10.1016/j.eats.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/01/2023] [Indexed: 01/11/2024] Open
Abstract
Knee extension contracture is a common postinjury and postsurgical complication, which decreases knee joint flexion. Many techniques have been described in the literature to restore knee flexion, with the most common one being an arthroscopic lysis of adhesions. However, in severe cases, additional intra- and extra-articular procedures are needed to restore full knee flexion. Manipulation under anesthesia (MUA) is one of them. Unfortunately, it may lead to devastating complications, such as iatrogenic rupture of the patellar tendon or fractures of the patella or tibial tuberosity. Therefore, the purpose of this report is to present a safer modification of MUA for knee extension contracture in cases in which excessive force is demanded to achieve flexion. The key aim of the "patellar base support" technique (PBS technique) is to stretch the contracted quadriceps muscle with controlled and decreased tension on the patella, patellar tendon, and tibial tuberosity.
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Affiliation(s)
- Konrad Malinowski
- Department of Anatomy, Jagiellonian University Medical College, International Evidence-Based Anatomy Working Group, Kraków, Poland
- Artromedical Orthopedic Clinic, Bełchatów, Poland
| | - Marcin Mostowy
- Artromedical Orthopedic Clinic, Bełchatów, Poland
- Orthopedic and Trauma Department, Veterans Memorial Teaching Hospital in Lodz, Medical University of Lodz, Lodz, Poland
| | - Michał Kanak
- Orthopedic and Trauma Department, Veterans Memorial Teaching Hospital in Lodz, Medical University of Lodz, Lodz, Poland
| | - Przemysław A. Pękala
- Department of Anatomy, Jagiellonian University Medical College, International Evidence-Based Anatomy Working Group, Kraków, Poland
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
- Lesser Poland Orthopedic and Rehabilitation Hospital, Kraków, Poland
| | - Dong Woon Kim
- Department of Anatomy, Jagiellonian University Medical College, International Evidence-Based Anatomy Working Group, Kraków, Poland
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Li J, You M, Yao L, Fu W, Li Q, Chen G, Tang X, Li J, Xiong Y. Topical administration of tranexamic acid reduces postoperative blood loss and inflammatory response in knee arthroscopic arthrolysis: a retrospective comparative study. BMC Musculoskelet Disord 2023; 24:269. [PMID: 37020204 PMCID: PMC10074680 DOI: 10.1186/s12891-023-06349-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 03/20/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Knee arthroscopic arthrolysis serves as an effective treatment for knee arthrofibrosis. However, hemarthrosis is the most common complication in arthroscopic surgery, which has potential adverse effects on postoperative rehabilitation. The purpose of this study was to evaluate the effects of topical tranexamic acid (TXA) in knee arthroscopic arthrolysis. METHODS A total of 87 patients with knee arthrofibrosis who underwent arthroscopic arthrolysis from September 2019 to June 2021 were eligible for this retrospective review. Patients in the TXA group (n = 47) received topical administration of TXA (50 mL, 10 mg/mL) at the end of the surgery, and patients in the control group (n = 40) received no TXA. The postoperative drainage volumes, hematologic levels, inflammatory marker levels, knee range of motion (ROM), visual analog scale (VAS) pain scores, Lysholm knee scores and complications were compared between the two groups. The curative effect of each group was calculated according to Judet's criteria. RESULTS The mean drainage volumes on postoperative day (POD) 1 and POD 2, and total drainage volume were significantly lower in the TXA group than in the control group (P < 0.001 for all). The TXA group had significantly lower postoperative CRP and IL-6 levels on POD 1 and POD 2, and at postoperative week (POW) 1 and POW 2 than the control group. The VAS pain scores in the TXA group were significantly lower on POD 1 and POD 2, and at POW 1 and POW 2 than those in the control group (P < 0.001 for all). Patients in the TXA group showed better postoperative ROM and Lysholm knee scores at POW 1 and POW 2. No patient had any complications such as deep venous thrombosis (DVT) or infection. The excellent and good rates of knee arthroscopic arthrolysis were comparable between the two groups at the sixth postoperative month (P = 0.536). CONCLUSIONS Topical administration of TXA in knee arthroscopic arthrolysis can reduce postoperative blood loss and inflammatory response, alleviate early postoperative pain, increase early postoperative knee ROM, and improve early postoperative knee function without increased risks.
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Affiliation(s)
- Junqiao Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Mingke You
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Lei Yao
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Weili Fu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Qi Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Gang Chen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xin Tang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jian Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yan Xiong
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Muacevic A, Adler JR, H Amer M, Abdelaziz MK. Arthroscopic Lysis of Adhesions for Treatment of Post-Traumatic Knee Arthrofibrosis: A Prospective Study. Cureus 2023; 15:e33275. [PMID: 36606104 PMCID: PMC9809041 DOI: 10.7759/cureus.33275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2023] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Post-traumatic knee arthrofibrosis can have a significant effect on patients' function and the management can be challenging with a variety of options ranging from manipulation under anaesthesia (MUA) to more invasive procedures such as quadricepsplasty. The aim of the study is to evaluate the improvement of both knee range of motion (ROM) and functional outcomes after arthroscopic lysis of adhesions (ALA) for post-traumatic knee arthrofibrosis. MATERIALS AND METHODS A prospective study of 30 patients with post-traumatic knee arthrofibrosis was managed by arthroscopic arthrolysis. Aggressive rehabilitation protocol was initiated on the first day postoperatively. Comprehensive clinical follow-up evaluations including the ROM assessment and the Lysholm score were done for all patients. RESULTS The mean age was 36.17 years (±9.51). The mean follow-up time was 6.7 months (six to nine months). The ROM improved from 75° (±10.91°) preoperatively to 119.83° (± 10.38°) at the final follow-up (P < 0.001). Additionally, the Lysholm score increased from 56.90(±2.64) preoperatively to 85.27(±3.46) (P < 0.001). The ultimate final ROM and functional outcomes for all patients were satisfactory. CONCLUSION ALA for knee arthrofibrosis significantly improves the knee ROM and functional outcomes and can be a successful alternative to open quadricepsplasty.
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Gálvez-Sirvent E, Ibarzábal-Gil A, Rodríguez-Merchán EC. Complications of the surgical treatment of fractures of the tibial plateau: prevalence, causes, and management. EFORT Open Rev 2022; 7:554-568. [PMID: 35924649 PMCID: PMC9458943 DOI: 10.1530/eor-22-0004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Open reduction and internal fixation is the gold standard treatment for tibial plateau fractures. However, the procedure is not free of complications such as knee stiffness, acute infection, chronic infection (osteomyelitis), malunion, non-union, and post-traumatic osteoarthritis. The treatment options for knee stiffness are mobilisation under anaesthesia (MUA) when the duration is less than 3 months, arthroscopic release when the duration is between 3 and 6 months, and open release for refractory cases or cases lasting more than 6 months. Early arthroscopic release can be associated with MUA. Regarding treatment of acute infection, if the fracture has healed, the hardware can be removed, and lavage and debridement can be performed along with antibiotic therapy. If the fracture has not healed, the hardware is retained, and lavage, debridement, and antibiotic therapy are performed (sometimes more than once until the fracture heals). Fracture stability is important not only for healing but also for resolving the infection. In cases of osteomyelitis, treatment should be performed in stages: aggressive debridement of devitalised tissue and bone, antibiotic spacing and temporary external fixation until the infection is resolved (first stage), followed by definitive surgery with grafting or soft tissue coverage depending on the bone defect (second stage). Intra-articular or extra-articular osteotomy is a good option to correct malunion in young, active patients without significant joint damage. When malunion is associated with extensive joint involvement or the initial cartilage damage has resulted in knee osteoarthritis, the surgical option is total knee arthroplasty.
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Affiliation(s)
- Elena Gálvez-Sirvent
- Department of Orthopaedic Surgery, "Infanta Elena" University Hospital, Valdemoro, Madrid, Spain.,Faculty of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | - Aitor Ibarzábal-Gil
- Department of Orthopaedic Surgery, "La Paz" University Hospital, Madrid, Spain
| | - E Carlos Rodríguez-Merchán
- Department of Orthopaedic Surgery, "La Paz" University Hospital, Madrid, Spain.,Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Autonomous University of Madrid), Madrid, Spain
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Zhao J. Arthroscopic Release of Severe Flexion- and Extension-Impeding Knee Stiffness With Inaccessible Joint. Arthrosc Tech 2021; 10:e2753-e2765. [PMID: 35004158 PMCID: PMC8719267 DOI: 10.1016/j.eats.2021.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 08/13/2021] [Indexed: 02/03/2023] Open
Abstract
Knee stiffness with severe flexion and extension impediment is a common clinical condition that challenges orthopaedic surgeons. Arthroscopic release techniques have been reported, mostly for slight extension or flexion deficits. However, for severe flexion- and extension-impeding knee stiffness, especially when there is no intra-articular space in which to place the arthroscope, effective arthroscopic release techniques are still being pursued. We introduce a systemic arthroscopic release technique to address this special condition, in which a trans-infrapatellar fat pad release technique is developed to obtain access to the joint and to perform intra-articular and periarticular release, as well as scar tissue removal. One critical point of this technique is to create the posteromedial and posterolateral portals to re-establish the posterior compartments, remove the fibrotic posterior septum, and release the posterior capsule. This technique combines almost all related arthroscopic techniques in the treatment of knee stiffness. We consider that the introduction of this technique will provide a useful guide when surgical release is selected for this special condition.
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Affiliation(s)
- Jinzhong Zhao
- Address correspondence to Jinzhong Zhao, M.D., Department of Sports Medicine, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai 200233, China.
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Comment on article by Eggeling et al.: Clinical results after very early, early, and late arthroscopic arthrolysis of the knee. INTERNATIONAL ORTHOPAEDICS 2021; 45:3285-3286. [PMID: 34657967 DOI: 10.1007/s00264-021-05241-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 10/06/2021] [Indexed: 10/20/2022]
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Quadriceps strength and knee joint function in patients with severe knee extension contracture following arthroscopic-assisted mini-incision quadricepsplasty. INTERNATIONAL ORTHOPAEDICS 2021; 45:2869-2876. [PMID: 33570669 DOI: 10.1007/s00264-021-04971-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate reserve quadriceps function and improve knee activity in patients with severe knee extension contracture following arthroscopic-assisted mini-incision quadricepsplasty as well as post-operative complications. METHODS From 2012 to 2019, 32 patients with severe knee extension contractures (less than 45° range of flexion) were treated with an all-arthroscopic release technique. The clinical results, including range of motion (ROM), quadriceps function (quadriceps index, QI), and knee function, were evaluated, and MRI of the healed tendon after partial quadricepsplasty was performed. The patellar track and length during knee flexion were measured on three normal knees under fluoroscopy. Three formalin-fixed lower limbs were used to mimic severely contracted quadriceps to evaluate the extension of the patellar track. RESULTS The median follow-up time was 2.1 years (1-5 years). The average QI was 92.0 ± 6.2, and the quadriceps muscle strength was increased from 3.28 to 4.72. At the final follow-up, 90% of the patients had no difficulty going upstairs, going downstairs, or rising from a chair. The ROM improved by 25.69 ± 3.6 preoperatively to 105.88 ± 6.6 at the final follow-up (P < 0.001). The open surgery showed that a 2-cm extension could be achieved by partly cutting the quadriceps tendon, and two cuts achieved a total extension of 5.2 ± 0.52 cm. The patellar tracking distance was 7.7 ± 0.43 cm, and the gap between the patella and femur was also reduced. CONCLUSION Partial quadricepsplasty of the rectus femoris extended the contracted quadriceps and maintained quadriceps strength, allowing for full knee flexion and satisfactory clinical outcomes of knee function with few complications.
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Yamashita T, Ozawa K, Gamada K. Validity and reliability of velocity measurements on ultrasonography using custom software with an optical-flow algorithm. J Phys Ther Sci 2020; 32:130-139. [PMID: 32158076 PMCID: PMC7032980 DOI: 10.1589/jpts.32.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 11/20/2019] [Indexed: 11/25/2022] Open
Abstract
[Purpose] The purposes of this study were: 1) to validate a commercial software program
using an optical-flow algorithm to measure the velocity of muscle movement; and 2) to
determine optimal image quality and the size and location of regions of interest.
[Materials and Methods] First, a block of pork thigh muscle was pulled at 33 different
constant velocities. Subsequently, an accelerometer, a high-velocity camera, and
ultrasonography were used to obtain measurements, and an Echolizer software was used to
determine ultrasound-based velocities. Finally, the impact of the location and size of the
regions of interest and the brightness and contrast of the images was analyzed. [Results]
The regression equation was expressed as y=1.150 × −0.071 with a determination coefficient
of 0.996. The average absolute error of the software was 0.02 mm/s, and the average
relative error was 0.20% of the actual velocity between 2.5 and 16.5 mm/s after the
regression equation was applied to the measured data. The accuracy of measurement was
reduced owing to the increased size of the regions of interest, which included poor image
quality or a deeper zone. [Conclusion] Our method of measuring muscle velocity using a
custom program showed high validity and reliability. It is necessary to use the regression
equation in the program to improve accuracy. However, the validity of the method could be
reduced if the regions of interest involve deep tissues or areas with poor visualization
of the muscle bundles, or if the brightness and contrast of the image are set
inaccurately.
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Affiliation(s)
- Tomoko Yamashita
- Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University: 555-36 Kurose-Gakuendai, Higashihiroshima, Hiroshima 739-2695, Japan
| | | | - Kazuyoshi Gamada
- Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University: 555-36 Kurose-Gakuendai, Higashihiroshima, Hiroshima 739-2695, Japan
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Hou J, Li W, Chen Y, Yang L, Li L, Zhao L. Early preoperative versus postoperative administration of meloxicam in pain control, patient global status improvement, knee function recovery of arthroscopic knee surgery. Medicine (Baltimore) 2019; 98:e17133. [PMID: 31577705 PMCID: PMC6783223 DOI: 10.1097/md.0000000000017133] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This study aimed to investigate the efficacy and safety between early preoperative administration and postoperative administration of oral meloxicam in patients underwent arthroscopic knee surgery (AKS). METHODS Totally 296 patients with the intention to undergo AKS were recruited and randomly allocated as 1:1 ratio into early preoperative analgesia (EPA) group and postoperative analgesia (POA) group. Pain visual analog scale (VAS) score and severity (at rest and at flexion), patient global assessment (PGA) score, the consumption of rescue analgesia (pethidine), and adverse events were evaluated during the perioperation. And knee range of motion (ROM), International Knee Documentation Committee (IKDC) score, and Lysholm score were assessed at baseline and at 3 months after AKS. RESULTS Both pain VAS score and severity (at rest and at flexion) were decreased at 4, 8, and 12 hours, but similar at -24, -2, 24, 36, and 48 hours after AKS in EPA group compared with POA group. Besides, PGA score was lower at 4, 8, 12, and 24 hours, but similar at -24, -2, 36, and 48 hours after AKS in EPA group compared with POA group. As to the consumption of pethidine in perioperative period, it was decreased in EPA group compared with POA group. No difference was observed in knee ROM, IKDC score, Lysholm score, and adverse effects between EPA group and POA group. CONCLUSION Early preoperative administration of meloxicam was a superior approach in pain control compared with postoperative administration in treating patients underwent AKS.
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Affiliation(s)
| | - Wei Li
- Department of Anesthesiology
| | | | - Liping Yang
- Department of Obstetrics and Gynecology, Handan Central Hospital, Handan, China
| | | | - Lu Zhao
- Department of Anesthesiology
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