gms | German Medical Science

54. Jahrestagung der Norddeutschen Orthopädenvereinigung e. V.

Norddeutsche Orthopädenvereinigung

16.06. bis 18.06.2005, Hamburg

Improved technique for arthrolysis in chronic flexion deficits of the knee

Meeting Abstract

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  • corresponding author D. Freiling - Klinik für Unfall-und Wiederherstellungschirurgie, Henriettenstiftung Hannover, Unfallchirurgie, Hannover
  • D. Galla - Hannover
  • P. Lobenhoffer - Hannover

Norddeutsche Orthopädenvereinigung. 54. Jahrestagung der Norddeutschen Orthopädenvereinigung e.V.. Hamburg, 16.-18.06.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc05novK5.03

The electronic version of this article is the complete one and can be found online at:

Published: June 13, 2005

© 2005 Freiling et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.




Flexion deficits of the knee cause significant disability and reduction of life quality. Surgical arthrolysis is often not successful. We present an improved operative approach focused on the specific pathology of the patient.

Materials and methods

Three factors are analysed by clinical examination and MR scan preoperatively: patella tendon shortening, intraarticular fibrosis and vastus intermedius muscle fibrosis. During surgery, al pathological factors are addressed if necessary by a specific technique: cranialisation of the tibial tuberosity and/or patellar tendon lengthening, intraarticular arthrolysis and retinaculum plasty and resection of the vastus intermedius muscle (Thompson).


From 2002 to 2004 22 patients with knee flexion deficits were treated. These patients had a mean of 4 surgeries before without success. 19 patients (11 women/ 8 men, age 35,4 years) were followed. 17 of 19 patients increased the preoperative flexion by an average of 26° up to 112°. One patient had no improvement (<5°) and one patient reduced her knee flexion by 10°. A mean increase in the subjective outcome score of 60% was acheived.


Chronic flexion deficits of the knee are often multifactorial and difficult to treat. We established a treatment protocol addressing the main pathogenetic factors: patellar tendon shortening, intraarticlar fibrosis and vastus intermedius fibrosis. We found good results and a high success rate in our patient group despite multiple previous surgeries and long case histories. We advocate this protocol for arthrolysis for knee flexion.