A new treatment strategy for severe arthrofibrosis of the knee. Surgical technique.
BACKGROUND
To reduce the morbidity of traditional quadricepsplasty for the treatment of severe arthrofibrosis of the knee, we instituted a treatment regimen consisting of an initial extra-articular mini-invasive quadricepsplasty and subsequent intra-articular arthroscopic lysis of adhesions during the same anesthesia session. The purpose of the present study was to determine the results of this technique.


METHODS
From 1998 to 2001, twenty-two patients with severely arthrofibrotic knees were managed with this operative technique. The mean age of the patients at the time of the operation was thirty-seven years. After a mean duration of follow-up of forty-four months (minimum, twenty-four months), all patients were evaluated according to the criteria of Judet and The Hospital for Special Surgery knee-rating system.


RESULTS
The average maximum degree of flexion increased from 27 degrees preoperatively to 115 degrees at the time of the most recent follow-up (p < 0.001). According to the criteria of Judet, the result was excellent for sixteen knees, good for five, and fair for one. The average Hospital for Special Surgery knee score improved from 74 points preoperatively to 94 points at the time of the most recent follow-up (p < 0.001). A superficial wound infection occurred in one patient. Only one patient had a persistent 15 degrees extension lag.


CONCLUSIONS
This mini-invasive operation for the severely arthrofibrotic knee can be used to increase the range of motion and enhance functional outcome.
Wang
Jian-Hua
JH
Department of Orthopaedic Surgery, Shanghai Jiao Tong University Sixth People's Hospital, 600 YiShan Road, Shanghai 200233, People's Republic of China. shwangjianhua@hotmail.com
Zhao
Jin-Zhong
JZ
He
Yao-Hua
YH
D000328:Adult; D005355:Fibrosis; D005500:Follow-Up Studies; D006801:Humans; D007592:Joint Diseases / Q000601:surgery; D007719:Knee Joint / Q000503:physiopathology; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D016059:Range of Motion, Articular; D000267:Tissue Adhesions / Q000601:surgery