[Long-term peridural anesthesia and minimally invasive therapy of arthrofibrosis of the knee joint].
We report on our experiences with continuous epidural anesthesia after arthrolysis of the knee joint. The restoration of knee motion is the main goal of our treatment regimen which includes daily passive full mobilisation of the knee joint with a continuous epidural catheter after arthroscopic lysis and a functional after treatment with full weight bearing. From December 1992 to November 1996 32 arthroscopic lysis have been performed at the Surgical Department of Triemli Hospital in Zürich, Switzerland. The indications for prior knee surgery included 22 ACL reconstructions, 4 sustained fractures about the knee and 6 miscellaneous etiologies. Arthroscopic lysis was performed for any failure in improving knee motion despite intensive physical therapy. According to Gassen et al. [4] we found one (3.1%) very severe, 5 (15.6%) severe, 12 (37.5%) moderate and 14 (43.8%) minor cases of arthrofibrosis. After 8 months on average, a second lysis had to be performed in six cases. All had an ACL reconstruction as prior surgery, in four out of these six patients only physiotherapeutic after treatment was performed after the first lysis, 2 patients developed a symptomatic patella baja. At the end of the treatment after 10 months on average, 16 (50%) cases showed a very good, 7 (22%) a good, 5 (16%) a satisfactory and 4 (12%) a poor result concerning range of motion. We think that a daily passive full mobilisation under regional anesthesia with a continuous epidural catheter is the key to hold the intraoperatively reached range of motion especially for moderate to very severe cases of arthrofibrosis.
Chirurgische Klinik, Stadtspital Triemli, Zürich.
P
P
Rillmann
R
R
Berbig
D000328:Adult; D015360:Analgesia, Epidural; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D020679:Arthroscopes; D019723:Endoscopes; D005260:Female; D005355:Fibrosis; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D008297:Male; D015915:Motion Therapy, Continuous Passive; D011182:Postoperative Care; D011183:Postoperative Complications / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology; D012086:Reoperation
Langzeit-Periduralanästhesie und minimalinvasive Therapie der Arthrofibrose am Kniegelenk.