1
|
Malinowski K, Mostowy M, Koźlak M, Pękala PA, Kennedy NI, LaPrade RF. Complete Arthroscopic Posterior Knee Capsulotomy in Patients With Knee Extension Deficit: Preliminary Results of a Clinical Trial. Orthop J Sports Med 2023; 11:23259671231203606. [PMID: 38045767 PMCID: PMC10693213 DOI: 10.1177/23259671231203606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/21/2023] [Indexed: 12/05/2023] Open
Abstract
Background Guided physiotherapy and surgical arthrolysis are effective in most patients with knee extension deficit. However, in refractory cases, posterior knee capsulotomy may be needed. Purpose To 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 Design Case series; Level of evidence, 4. Methods Included 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). Results The 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. Conclusion Arthroscopic 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. Registration NCT05385393 (ClinicalTrials.gov identifier).
Collapse
Affiliation(s)
- Konrad Malinowski
- Department of Anatomy, Jagiellonian University Medical College, International Evidence-Based Anatomy Working Group, Kraków, Poland
- Artromedical Orthopaedic Clinic, Belchatow, Poland
| | - Marcin Mostowy
- Artromedical Orthopaedic Clinic, Belchatow, Poland
- Orthopedic and Trauma Department, Veteran’s Memorial Teaching Hospital in Lodz, Medical University of Lodz, Lodz, Poland
| | | | - Przemyslaw 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
| | | | | |
Collapse
|
2
|
Campbell TM, Westby M, Ghogomu ET, Fournier J, Ghaedi BB, Welch V. Stretching, Bracing, and Devices for the Treatment of Osteoarthritis-Associated Joint Contractures in Nonoperated Joints: A Systematic Review and Meta-Analysis. Sports Health 2023; 15:867-877. [PMID: 36691685 PMCID: PMC10606959 DOI: 10.1177/19417381221147281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
CONTEXT Many patients with osteoarthritis (OA) develop range of motion (ROM) restrictions in their affected joints (contractures), associated with worse outcomes and rising healthcare costs. Effective treatment guidance for lost ROM in OA-affected joints is lacking. OBJECTIVE A systematic review and meta-analysis evaluating the effectiveness of stretching and/or bracing protocols on native (nonoperated) joint ROM in the setting of radiographically diagnosed OA. DATA SOURCES Seven databases, English-language. STUDY SELECTION Studies including participants with radiographically diagnosed OA in any native joint evaluating the effect of stretching or bracing on ROM. STUDY DESIGN Systematic review and meta-analysis. LEVEL OF EVIDENCE Level 2. DATA EXTRACTION Two reviewers independently screened articles for inclusion and assessed risk of bias in included trials. Primary outcomes were ROM, pain, and adverse events (AEs). RESULTS We identified 6284 articles. A total of 9 randomized controlled trials, all evaluating the knee, met eligibility criteria. For stretching, 3 pooled studies reported total ROM, which improved by mean difference (MD) of 9.3° (95% CI 5.0°,13.5°) versus controls. Two pooled studies showed improved knee flexion ROM (MD 10.8° [7.3°,14.2°]) versus controls. Five studies were pooled for knee extension with mean improvement 9.1° [3.4°,14.8°] versus controls. Seven pooled studies showed reduced pain (standardized MD 1.9 [1.2,2.6]). One study reported improved knee extension of 3.7° [2.9°,4.5°] with use of a device. No studies used orthoses. One study reported on AEs, with none noted. Performance bias was present in all included studies, and only 3 studies clearly reported blinding of outcome assessors. Strength of evidence for primary outcomes was considered moderate. CONCLUSION There was moderate-quality evidence that stretching is an effective strategy for improving knee total, flexion and extension ROM, and pain. Our findings suggest that stretching to regain joint ROM in OA is not futile and that stretching appears to be an appropriate conservative intervention to improve patient outcomes as part of a comprehensive knee OA treatment plan before arthroplasty.
Collapse
Affiliation(s)
- T. Mark Campbell
- Department of Physical Medicine and Rehabilitation, Elisabeth Bruyère Hospital, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bone and Joint Laboratory, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- The Ottawa Hospital, Department of Medicine, Ottawa, Ontario, Canada
- University of Ottawa, Department of Cellular and Molecular Medicine, Ottawa, Ontario, Canada
| | - Marie Westby
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | | | - John Fournier
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | | | - Vivian Welch
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
3
|
Scarano KA, Montalbano A, Daugherty C, Sohn D. Knee Extension Lag Treated with Posterior Capsulotomy of the Knee: A Case Report and Review of the Literature. J Orthop Case Rep 2023; 13:152-156. [PMID: 38025359 PMCID: PMC10664223 DOI: 10.13107/jocr.2023.v13.i11.4042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/01/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The posterior capsule of the knee plays an important role in maintaining the integrity of the knee joint. Pathologies involving the posterior capsule have been implicated in developing flexion contractures. Posterior capsulotomy is a well-studied modality for this issue, performed through either an open or arthroscopic approach. Case Report A 74-year-old Caucasian male presented with a complex extensor lag of his right knee and an inability to gain full extension either actively or passively. Through the use of standard knee arthroscopy, the authors were able to not only correct his posterior capsular pathology but also address anterior knee lesions. Only the combination of both allowed a full extension of the joint. Conclusion Posterior capsulotomy of the knee may be carried out successfully and safely through either an open or arthroscopic approach. Arthroscopic capsulotomy is proposed as a safer, minimally invasive option that has been gaining recent favor compared to open approaches.
Collapse
Affiliation(s)
- Kyle Aaron Scarano
- Department of Orthopedic Surgery, University of Toledo, Toledo, OH 43614, United States
| | - Andrea Montalbano
- Department of Orthopedic Surgery, University of Toledo, Toledo, OH 43614, United States
| | - Clark Daugherty
- Department of Orthopedic Surgery, University of Toledo, Toledo, OH 43614, United States
| | - David Sohn
- Department of Orthopedic Surgery, University of Toledo, Toledo, OH 43614, United States
| |
Collapse
|
4
|
Arthroscopic Posterior Capsular Release Effectively Reduces Pain and Restores Terminal Knee Extension in Cases of Recalcitrant Flexion Contracture. Arthrosc Sports Med Rehabil 2022; 4:e1409-e1415. [PMID: 36033179 PMCID: PMC9402456 DOI: 10.1016/j.asmr.2022.04.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/27/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose To 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. Methods Retrospective 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. Results Overall, 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. Conclusion Arthroscopic 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.
Collapse
|
5
|
Jobe CM, Zuckerman LM. Ultrasound-Assisted Posterior Knee Arthroscopy: A Description of the Technique. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1949-1953. [PMID: 33155684 DOI: 10.1002/jum.15555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/06/2020] [Indexed: 06/11/2023]
Abstract
Entering the posterior knee with arthroscopy can be difficult. Scar tissue, a tumor, and the obese patient can make instrument placement difficult and risk iatrogenic injury. Ultrasound can be used to visualize the posterior knee and provide direct guidance of instrumentation. We describe the technique and indications for using ultrasound during arthroscopy. Accurate and atraumatic insertion of instruments can be performed with no damage to total knee components or the knee joint. Ultrasound guidance should be considered during difficult posterior knee arthroscopy.
Collapse
Affiliation(s)
- Christopher M Jobe
- Department of Orthopaedic Surgery, Oroville Hospital, Oroville, California, USA
| | - Lee M Zuckerman
- Division of Orthopaedic Surgery, City of Hope National Medical Center, Duarte, California, USA
| |
Collapse
|
6
|
Arthroscopic Posterior Capsulotomy for Knee Flexion Contracture Using a Spinal Needle. Arthrosc Tech 2021; 10:e1903-e1907. [PMID: 34401231 PMCID: PMC8355179 DOI: 10.1016/j.eats.2021.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/03/2021] [Indexed: 02/03/2023] Open
Abstract
Knee flexion contractures can arise from posterior capsule arthrofibrosis secondary to trauma, surgery, or chronic degenerative disease. This leads to limited knee extension and increased mechanical stress on the contralateral joint. Depending on the severity of the contracture, a treatment option may include surgical release of the posterior capsule. Arthroscopic posterior capsular release has been reported previously to have excellent resolution of extension deficits with minimal risk of postoperative complications. These techniques typically use an array of instruments, including shavers, biters, or scissors to perform arthrolysis of the posteromedial and posterolateral capsules. Our primary objective is to present a modified arthroscopic surgical technique for percutaneous treatment of knee flexion contracture using a spinal needle to perform a posterior capsule release.
Collapse
|
7
|
Arthroscopic Posterior Capsular Release for Loss of Knee Extension. Arthrosc Tech 2020; 9:e1439-e1446. [PMID: 33134044 PMCID: PMC7587019 DOI: 10.1016/j.eats.2020.06.001] [Citation(s) in RCA: 4] [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: 04/07/2020] [Accepted: 06/05/2020] [Indexed: 02/03/2023] Open
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.
Collapse
|
8
|
Ikuta F, Yoneta K, Miyaji T, Kidera K, Yonekura A, Osaki M, Gamada K. Association between stages of medial compartment osteoarthritis and three-dimensional knee alignment in the supine position: A cross-sectional study. J Clin Orthop Trauma 2020; 11:S130-S136. [PMID: 31992933 PMCID: PMC6978193 DOI: 10.1016/j.jcot.2019.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/24/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Osteoarthritis (OA) of the knee causes changes in knee alignment. A detailed knowledge of knee alignment is needed for correct assessment of the extent of disease progression, determination of treatment strategy, and confirmation of treatment effectiveness. However, deterioration of knee alignment during progression of OA has not been adequately characterized. The aims of this study were to clarify the changes in three-dimensional static knee alignment as knee OA stage progressed and to lay a foundation for an optimal treatment strategy to prevent knee malalignment. METHODS A total of 106 knees of 81 patients ((men/women) 45/36; mean age 48.4 ± 19.9 years; body mass index (BMI) 25.7 ± 4.4 kg/m2) were enrolled in this cross-sectional study, comprising 34 (33/1) in Kellgren-Lawrence (KL) grade 0, 17 (8/9) in KL grade 1, 26 (5/21) in KL grade 2, 19 (4/15) in KL grade 3, and 10 (1/9) in KL grade 4. In all cases, computed tomography images were obtained with the subject in a reclined and relaxed position with the knee straight. Three-dimensional bone models were created from the images and knee alignment was calculated with six degrees-of-freedom. Then, 40 knees were selected consisting of 10 sex- and BMI-matched knees from each KL grade group: KL grade 1 (mean age 54.6 ± 8.4 years; BMI 23.3 ± 3.5 kg/m2), grade 2 (64.7 ± 10.9 years; 27.3 ± 3.2 kg/m2), grade 3 (69.2 ± 11.4 years; 27.1 ± 4.3 kg/m2), and grade 4 (71.9 ± 9.2 years; 27.2 ± 3.6 kg/m2). The Mann-Whitney U test with Bonferroni correction for multiple comparisons was used to analyze static alignment (α < 0.05/6). RESULTS Alignment of the knee in flexion was -4.0 [95% confidence interval (CI): -6.4, -1.5] degrees, -3.4 [-8.0, 1.3] degrees, -0.1 [-3.7, 3.5] degrees, and 0.4 [-0.9, 1.6] degrees in the order of KL grade 1 to 4. There were significant differences between KL grade 1 and 4 (p = 0.0081). Anterior tibial translation was 6.6 [4.6, 8.6] mm, 5.8 [1.9, 9.7] mm, 1.0 [-2.5, 4.5] mm, and 1.3 [-2.4, 5.1] mm in the order of grade 1 to 4. There were significant differences between KL grade 1 and 4 (p = 0.0081). There were no significant differences in lateral tibial translation nor tibial rotation. CONCLUSIONS The severely osteoarthritic knee joint was flexed and the tibia was displaced posteriorly with respect to the femur. Preventing these changes in alignment would assist in the prevention and treatment of knee OA.
Collapse
Affiliation(s)
- Futoshi Ikuta
- Department of Medical Engineering and Technology, Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University, 555-36 Kurosegakuendai, Higashihiroshima City, Hiroshima, 739-2695, Japan,Inanami Spine and Joint Hospital, 3-17-5 Higashishinagawa Shinagawa-ku, Tokyo, 140-0002, Japan,Corresponding author. Department Medical Engineering and Technology, Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University, 555-36 Kurosegakuendai, Higashihiroshima City, Hiroshima, 739-2695, Japan.
| | - Kei Yoneta
- Department of Rehabilitation, Kobayashi Hospital, Kita 3 Jo Nishi 4, Kitami City, Hokkaido, 090-0043, Japan
| | - Takeshi Miyaji
- Department of Orthopaedic Surgery, Aino Memorial Hospital, 3838-1 Ainocho, Unzen City, Nagasaki, 854-0301, Japan
| | - Kenichi Kidera
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Akihiko Yonekura
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Makoto Osaki
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Kazuyoshi Gamada
- Department of Medical Engineering and Technology, Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University, 555-36 Kurosegakuendai, Higashihiroshima City, Hiroshima, 739-2695, Japan
| |
Collapse
|
9
|
Parmar L, Shandilya V, Shandilya A. Functional ambulation with bent knee prostheses for an adult with bilateral 90 degrees knee flexion contractures—A case report. J Family Med Prim Care 2020; 9:2492-2495. [PMID: 32754526 PMCID: PMC7380829 DOI: 10.4103/jfmpc.jfmpc_1043_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 12/05/2019] [Accepted: 12/20/2019] [Indexed: 11/04/2022] Open
|