title: Dynamic Splinting in Children and Adolescents With Stiffness After Knee Surgery.
abstract: OBJECTIVE
  The purpose of this study was to investigate the indications and outcomes of dynamic splinting (DS) of the arthrofibrotic knee in the pediatric population.
  
  
  METHODS
  Seventy-four patients (41 males, 33 females) with postoperative arthrofibrosis treated with DS after an index knee surgery were reviewed. Median age was 13 years (range, 4 to 18 y), and median follow-up was 17 months (interquartile range, 10 to 28 mo). Demographics, index surgery procedure, preoperative and postoperative knee range of motion (ROM) measurements, treatment length and subsequent need for manipulation under anesthesia (MUA), and surgical lysis of adhesions (LOA) were evaluated. A ROM deficit was defined as lack of extension ≥10 degrees or lack of flexion <130 degrees. Successful improvement of ROM was defined as an increase of ≥10 degrees in flexion, extension, or both. There were 23 patients with flexion deficit only, 17 with extension deficit only, and 34 with combined flexion and extension deficits. Wilcoxon signed-rank test was used to assess median improvement in ROM. Patients were classified into 4 surgical groups: anterior cruciate ligament (ACL) reconstruction without meniscal repair (n=19), ACL reconstruction with meniscal repair (n=12), tibial spine fracture repair (n=21), and other (n=22). Multivariable logistic regression was used to identify independent predictors of failure of DS requiring MUA and LOA.
  
  
  RESULTS
  A total of 57 patients with flexion deficits showed median improvement of 30 degrees in flexion (95% confidence interval, 0-90 degrees; P<0.001), and 51 patients with extension deficits showed median improvement of 7 degrees in extension (95% confidence interval, 0-60 degrees; P<0.001). DS was associated with ROM improvement in 84% and avoided the need for surgery in 58% of all 74 patients included in the study. Multivariate analysis of the ACL with meniscus repair subgroup revealed that each 1-month delay in DS treatment was associated with a 5-fold increased risk of undergoing a LOA (P=0.007). Thirty-six (63%) patients with flexion deficit avoided need for surgery, whereas 26 (51%) patients with extension deficits avoided surgery.
  
  
  CONCLUSIONS
  Our data suggest that DS is an effective method to increase knee ROM and reduce the need for subsequent MUA/LOA in the pediatric and adolescent patient with arthrofibrosis after an index knee surgery.
  
  
  METHODS
  Level IV-retrospective case series.
authors.affiliation: Division of Orthopaedic Surgery, Children's Hospital Los Angeles, Los Angeles, CA.
authors.forename: James L
authors.initials: JL
authors.lastname: Pace
authors.affiliation: Department of Orthopaedic Surgery.
authors.forename: Adam Y
authors.initials: AY
authors.lastname: Nasreddine
authors.affiliation: Harvard Medical School, Boston, MA.
authors.forename: Michael
authors.initials: M
authors.lastname: Simoni
authors.affiliation: Department of Orthopaedic Surgery.|Surgery.
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.affiliation: Department of Orthopaedic Surgery.|Harvard Medical School, Boston, MA.|Division of Sports Medicine, Boston Children's Hospital.
authors.forename: Mininder S
authors.initials: MS
authors.lastname: Kocher
mesh_terms: D000293:Adolescent; D059549:Anterior Cruciate Ligament Reconstruction / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000209:etiology / Q000628:therapy*; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000628:therapy*; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013165:Splints; D013977:Tibia / Q000601:surgery*