title: Arthrofibrosis of the knee following a fracture of the tibial plateau.
abstract: The aim of this study was to report the incidence of arthrofibrosis of the knee and identify risk factors for its development following a fracture of the tibial plateau. We carried out a retrospective review of 186 patients (114 male, 72 female) with a fracture of the tibial plateau who underwent open reduction and internal fixation. Their mean age was 46.4 years (19 to 83) and the mean follow-up was16.0 months (6 to 80). A total of 27 patients (14.5%) developed arthrofibrosis requiring a further intervention. Using multivariate regression analysis, the use of a provisional external fixator (odds ratio (OR) 4.63, 95% confidence interval (CI) 1.26 to 17.7, p = 0.021) was significantly associated with the development of arthrofibrosis. Similarly, the use of a continuous passive movement (CPM) machine was associated with significantly less development of arthrofibrosis (OR = 0.32, 95% CI 0.11 to 0.83, p = 0.024). The effect of time in an external fixator was found to be significant, with each extra day of external fixation increasing the odds of requiring manipulation under anaesthesia (MUA) or quadricepsplasty by 10% (OR = 1.10, p = 0.030). High-energy fracture, surgical approach, infection and use of tobacco were not associated with the development of arthrofibrosis. Patients with a successful MUA had significantly less time to MUA (mean 2.9 months; sd 1.25) than those with an unsuccessful MUA (mean 4.86 months; sd 2.61, p = 0.014). For those with limited movement, therefore, performing an MUA within three months of the injury may result in a better range of movement. Based our results, CPM following operative fixation for a fracture of the tibial plateau may reduce the risk of the development of arthrofibrosis, particularly in patients who also undergo prolonged provisional external fixation.
authors.affiliation: Department of Orthopaedics, University of Utah School of Medicine, 590 Wakara Way, Salt Lake City, Utah 84108, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Haller
authors.affiliation: Department of Orthopaedics, University of Utah School of Medicine, 590 Wakara Way, Salt Lake City, Utah 84108, USA.
authors.forename: D C
authors.initials: DC
authors.lastname: Holt
authors.affiliation: Department of Internal Medicine, Division of Epidemiology, 295 Chipeta Way, University of Utah, Salt Lake City, Utah, USA.
authors.forename: M L
authors.initials: ML
authors.lastname: McFadden
authors.affiliation: Department of Orthopaedics, University of Utah School of Medicine, 590 Wakara Way, Salt Lake City, Utah 84108, USA.
authors.forename: T F
authors.initials: TF
authors.lastname: Higgins
authors.affiliation: Department of Orthopaedics, University of Utah School of Medicine, 590 Wakara Way, Salt Lake City, Utah 84108, USA.
authors.forename: E N
authors.initials: EN
authors.lastname: Kubiak
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005355:Fibrosis / Q000209:etiology / Q000503:physiopathology; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D057072:Intra-Articular Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D007719:Knee Joint / Q000473:pathology* / Q000601:surgery; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011859:Radiography; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Continuous passive movement; External fixator; Manipulation under anaesthesia; Stiffness