title: Arthroscopic lysis of adhesions for the stiff total knee: results after failed manipulation.
abstract: Arthrofibrosis after total knee arthroplasty (TKA) is a potentially devastating complication, resulting in loss of motion and function and residual pain. For patients in whom aggressive physical therapy and manipulation under anesthesia fail, lysis of adhesions may be the only option to rescue the stiff TKA. The purpose of this study is to report the results of arthroscopic lysis of adhesions after failed manipulation for a stiff, cruciate-substituting TKA. This retrospective study evaluated patients who had undergone arthroscopic lysis of adhesions for arthrofibrosis after TKA between 2007 and 2011. Minimum follow-up was 12 months (average, 31 months). Average total range of motion of patients in this series was 62.3°. Average preoperative flexion contracture was 16° and average flexion was 78.6°. Statistical analysis was performed using Student's t test. Pre- to postoperative increase in range of motion was significant (P<.001) (average, 62° preoperatively to 98° postoperatively). Average preoperative extension deficit was 16°, which was reduced to 4° at final follow-up. This value was also found to be statistically significant (P<.0001). With regard to ultimate flexion attained, average preoperative flexion was 79°, which was improved to 103° at final follow-up. This improvement in flexion was statistically significant (P<.0001). Patients can reliably expect an improvement after arthroscopic lysis of adhesions for a stiff TKA using a standardized arthroscopic approach; however, patients achieved approximately half of the improvement that was obtained at the time of surgery.
authors.forename: Fotios Paul
authors.initials: FP
authors.lastname: Tjoumakaris
authors.forename: Bradfords Chofield
authors.initials: BC
authors.lastname: Tucker
authors.forename: Zachary
authors.initials: Z
authors.lastname: Post
authors.forename: Matthew David
authors.initials: MD
authors.lastname: Pepe
authors.forename: Fabio
authors.initials: F
authors.lastname: Orozco
authors.forename: Alvin C
authors.initials: AC
authors.lastname: Ong
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001182:Arthroscopy; D005260:Female; D005355:Fibrosis; D006801:Humans; D007719:Knee Joint / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008349:Manipulation, Orthopedic; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery*; D026741:Physical Therapy Modalities; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D017211:Treatment Failure; D016896:Treatment Outcome