title: A mini-invasive technique for severe arthrofibrosis of the knee: A technical note.
abstract: OBJECTIVE
  In this article, a mini-invasive technique is described, which consists of arthroscopic adhesiolysis and quadriceps pie-crusting lengthening basing on pre-operative sonographic examination. Sonographic diagnostic value of quadriceps tendon fibrosis is also evaluated.
  
  
  METHODS
  Pre-operative sonographic examination was performed to make an accurate location diagnosis of quadriceps fibrosis. After arthroscopic adhesiolysis, percutaneous pie-crusting release was performed basing on preoperative sonographic examination. An 18-gauge needle was used to puncture the stiff fibrous band of the distal and lateral quadriceps tendon under maximum knee flexion. The contractural quadriceps tendon is gradually released after 60-100 needle punctures.
  
  
  RESULTS
  This technique was performed in five post-traumatic stiff knees and three stiff knees after previous infection. The contractural rectus femoris tendon is average 22% thinner than contralateral parts according to sonographic measurement. Mean maximum flexion increased from 35° preoperatively to 80° after arthroscopic adhesiolysis and 120° after pie-crusting.
  
  
  CONCLUSIONS
  This technique is a simple, effective and mini-invasive method, allowing an immediate, aggressive rehabilitation postoperatively. Pre-operative sonographic location of quadriceps tendon fibrosis could potentially improve the efficacy and accuracy of percutaneous pie-crusting procedures.
authors.affiliation: Department of Rehabilitation, Second Affiliated Hospital of Wenzhou Medical University, 109, Xueyuanxi road, 325027 Wenzhou, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Shang
authors.affiliation: Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, 109, Xueyuanxi road, 325027 Wenzhou, China. Electronic address: 474827623@qq.com.
authors.forename: Hai-Xiao
authors.initials: HX
authors.lastname: Liu
authors.affiliation: Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, 109, Xueyuanxi road, 325027 Wenzhou, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, 109, Xueyuanxi road, 325027 Wenzhou, China.
authors.forename: En-Xing
authors.initials: EX
authors.lastname: Xue
authors.affiliation: Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, 109, Xueyuanxi road, 325027 Wenzhou, China. Electronic address: xiaoyunpan@126.com.
authors.forename: Xiao-Yun
authors.initials: XY
authors.lastname: Pan
mesh_terms: D003286:Contracture; D006801:Humans; D007592:Joint Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000473:pathology* / Q000534:rehabilitation / Q000601:surgery; D052097:Quadriceps Muscle / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures; D013710:Tendons / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome
keywords: Arthrofibrosis; Arthroscopic; Knee; Mini-invasive