Abstract
Posttraumatic arthrofibrosis is a common problem encountered in the orthopaedic setting
for which there is no agreement on the optimal management strategy. The literature
does not optimally describe the efficacy of arthroscopic lysis of adhesions for arthrofibrosis
following tibial plateau fracture. The purpose of this study is to quantify the efficacy
of arthroscopic lysis of adhesions with manipulation for the treatment of arthrofibrosis
of the knee in patients who previously underwent surgical management of tibial plateau
fracture. All patients who underwent arthroscopic lysis of adhesions from a single
surgeon since 1999 were retrospectively reviewed. Clinical outcomes were evaluated
by flexion, extension, and range of motion (ROM) preoperatively, intraoperatively,
and postoperatively at intervals of 1, 4, 8, and 12 weeks, and any additional long-term
follow-up. A total of 28 patients who had developed arthrofibrosis following surgical
management of a tibial plateau fracture and failed nonsurgical management of knee
stiffness were included in this study. There were significant improvements in total
ROM following intervention at all time points compared with preoperative values (p < 0.001), with mean improvements of 59.3 degrees intraoperatively, 32.9 degrees (1
week), 37.1 degrees (4 weeks), 41.5 degrees (8 weeks), and 47.6 degrees (12 weeks).
There were significant improvements in degrees of knee flexion following intervention
at all time points compared with preoperative values (p < 0.001), with mean improvements of 50.8 degrees intraoperatively, 27.3 degrees (1
week), 36.0 degrees (4 weeks), 38.3 degrees (8 weeks), and 43.9 degrees (12 weeks).
There were significant increases in degrees of knee extension intraoperatively (8.5
degrees) and at 1 week postoperatively (5.9 degrees) compared with preoperative values
(p <0.01). At 12 weeks postoperatively, those who had previously undergone external
fixation had significantly greater increases in ROM (p = 0.048). Arthroscopic lysis of adhesions for knee arthrofibrosis following surgical
management of tibial plateau fracture significantly improves knee ROM.
Keywords
arthroscopy - tibial plateau - arthrofibrosis - lysis of adhesions - manipulation
