Extensive arthroscopic release of the stiff total knee to improve range of motion after arthrofibrosis

Abstract

A retrospective chart review was conducted on patients that had undergone a total knee arthroplasty (TKA) done by the same orthopedic surgeon and subsequently were referred to a different surgeon who performed a diagnostic arthroscopy for debridement of soft tissue problems following the replacement. Twelve patients met criteria for inclusion in the study; however 6 patients were subsequently excluded. All of the hardware used in the first surgery was of appropriate size and position and no revision of hardware was necessary. All of the patients considered for this study suffered from arthrofibrosis following the TKA, resulting in decreased range of motion (ROM) and stiffness. The debridement included lysis of adhesions, release of the lateral retinaculum, fat pad revision, and a synovectomy. Some patients also required manipulation under anesthesia during the arthroscopy. Following the debridement, all patients were referred to physical therapy (PT) to continue increasing ROM and to prevent the formation of additional scar tissue lesions. The mean ROM for pre-operative extension improved from 24 o to a postoperative ROM 3.66o. The average improvement of extension was 25.33 o. The mean improvement in ROM for flexion improved from 88.33 o to 106 o. The average improvement in flexion was 17.66 o. Overall all patients were satisfied with the results. All patients had improvements in range of motion and decreased pain ratings.