title: Manipulation Under Anesthesia: A Safe and Effective Treatment for Posttraumatic Arthrofibrosis of the Knee.
abstract: OBJECTIVE
  This study investigates the results of closed manipulations performed under anesthesia (MUA) to evaluate whether it is an effective means to treat posttraumatic knee arthrofibrosis.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Level I trauma center.
  
  
  METHODS
  Twenty-two patients with a mean age of 40 underwent closed MUA for posttraumatic knee arthrofibrosis. Injuries included fractures of the femur, tibia, and patella as well as ligamentous injuries and traumatic arthrotomies. The mean time from treatment to manipulation was 90 days. Mean follow-up after manipulation was 7 months.
  
  
  METHODS
  Closed knee MUA.
  
  
  METHODS
  Improvement of knee range of motion (ROM) arc was the primary outcome. Patient demographics were correlated with manipulation success using a 2-sample t test. A delay in manipulation of 90 days or greater was also evaluated in this fashion with regard to its role in predicting the benefit of MUA.
  
  
  RESULTS
  The mean premanipulation ROM arc was 59 ± 25 degrees. The mean intraoperative arc of motion, achieved at the time of the manipulation was 123 ± 14 degrees. No complications occurred during the MUA procedure. At the most recent follow-up, the mean ROM arc was 110 ± 19 degrees. Tobacco use, associated injuries, elevated body mass index, open fracture, and advanced age did not impact manipulation efficacy. Additionally, manipulations performed 90 days or more after surgical treatment provided a benefit equaling those performed more acutely (P = 0.12).
  
  
  CONCLUSIONS
  MUA is a safe and effective method to increase knee ROM in the setting of posttraumatic arthrofibrosis. Improvement in ROM was noted in all patients. A 90-day window between fracture fixation and manipulation did not impact ROM at final follow-up and may prevent fracture displacement during the MUA.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors: *Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA; and †Department of Orthopaedic Surgery, Orlando Regional Medical Center, Orlando, FL.
authors: Adam A
authors: AA
authors: Sassoon
authors: Obinna O
authors: OO
authors: Adigweme
authors: Joshua
authors: J
authors: Langford
authors: Kenneth J
authors: KJ
authors: Koval
authors: George J
authors: GJ
authors: Haidukewych
mesh_terms: D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D006801:Humans; D007592:Joint Diseases / Q000175:diagnosis / Q000209:etiology* / Q000534:rehabilitation*; D007718:Knee Injuries / Q000150:complications* / Q000175:diagnosis / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations / Q000379:methods*; D016059:Range of Motion, Articular; D016896:Treatment Outcome; D055815:Young Adult