The Journal of Bone and Joint Surgery (American). 2007;89:93-102.
doi:10.2106/JBJS.F.00963
© 2007 The Journal of Bone and Joint Surgery, Inc.
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A New Treatment Strategy for Severe Arthrofibrosis of the Knee

Surgical Technique

Jian-Hua Wang, MD1, Jin-Zhong Zhao, MD1 and Yao-Hua He, MD1

1 Department of Orthopaedic Surgery, Shanghai Jiao Tong University Sixth People's Hospital, 600 YiShan Road, Shanghai 200233, People's Republic of China. E-mail address for J.-H. Wang: shwangjianhua{at}hotmail.com

Investigation performed at the Department of Orthopaedic Surgery, Shanghai Jiao Tong University Sixth People's Hospital, Shanghai, People's Republic of China

The original scientific article in which the surgical technique was presented was published in JBJS Vol. 88-A, pp. 1245-1250, June 2006

DISCLOSURE: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

The line drawings in this article are the work of Joanne Haderer Müller of Haderer & Müller (biomedart{at}haderermuller.com).

BACKGROUND:

To reduce the morbidity of traditional quadricepsplasty for the treatment of severe arthrofibrosis of the knee, we instituted a treatment regimen consisting of an initial extra-articular mini-invasive quadricepsplasty and subsequent intra-articular arthroscopic lysis of adhesions during the same anesthesia session. The purpose of the present study was to determine the results of this technique.

METHODS:

From 1998 to 2001, twenty-two patients with severely arthrofibrotic knees were managed with this operative technique. The mean age of the patients at the time of the operation was thirty-seven years. After a mean duration of follow-up of forty-four months (minimum, twenty-four months), all patients were evaluated according to the criteria of Judet and The Hospital for Special Surgery knee-rating system.

RESULTS:

The average maximum degree of flexion increased from 27° preoperatively to 115° at the time of the most recent follow-up (p < 0.001). According to the criteria of Judet, the result was excellent for sixteen knees, good for five, and fair for one. The average Hospital for Special Surgery knee score improved from 74 points preoperatively to 94 points at the time of the most recent follow-up (p < 0.001). A superficial wound infection occurred in one patient. Only one patient had a persistent 15° extension lag.

CONCLUSIONS:

This mini-invasive operation for the severely arthrofibrotic knee can be used to increase the range of motion and enhance functional outcome.


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Related articles in JBJS:

A New Treatment Strategy for Severe Arthrofibrosis of the Knee. A Review of Twenty-Two Cases
Jian-Hua Wang, Jin-Zhong Zhao, and Yao-Hua He
JBJS 2006 88: 1245-1250. [Abstract] [Full Text]