Article
Improved technique for arthrolysis in chronic flexion deficits of the knee
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Published: | June 13, 2005 |
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Outline
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Introduction
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).
Results
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.
Conclusions
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.