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The surgical treatment of arthrofibrosis of the knee. Am J Sports Med 1994 Mar-Apr;22(2):184-91 Related. Cosgarea AJ, DeHaven KE, Lovelock JE. Department of Orthopaedic Surgery, University of Rochester Medical Center, New York.Sixty-one lysis of adhesion procedures were performed for arthrofibrosis of the knee between 1981 and 1990. In 43 cases (37 patients) the etiology was prior knee ligament surgery. Ten cases had sustained fractures about the knee and eight had miscellaneous etiologies. Six patients required a second lysis of adhesion procedure. A retrospective analysis of the 43 ligament patients was undertaken to evaluate the results of surgical treatment. All 43 cases were available for followup at an average of 3.6 years. Surgical indications included flexion or extension deficits of > or = 10 degrees or when motion failed to improve despite 2 months of intense therapy. Follow-up assessment included clinical and radiographic evaluation. Flexion improved from 83% to 97% of the contralateral side. Extension deficits improved from 14 degrees to 3 degrees. Only 23 of 37 patients (62%) achieved satisfactory functional results. Radiographic evidence of degenerative changes, soft tissue calcification, and patella infera was found in 89%, 51%, and 9% of the patients, respectively. Patients requiring surgical treatment for arthrofibrosis after knee ligament surgery achieved excellent motion gains, but functional outcome scores were compromised and radiographic findings were concerning. Patients with the localized anterior intraarticular variant or those undergoing lysis of adhesion surgery sooner than 6 months had outcomes comparable with controls.
Lysis of Pretibial Patellar Tendon Adhesions (Anterior Interval Release) to Treat Anterior Knee Pain After ACL Reconstruction Sports Med/Arthroscopy Sumant Krishnan, MD Dallas TX J Richard Steadman, MD Vail CO Kim Hydeman, BA Vail CO Matthew Close, BA Vail CO Anterior knee pain (AKP) after ACL reconstruction is a well documented complication. AKP may be attributed to infrapatellar contracture syndrome--anterior tibial adhesions that restrict patellar mobility. We report results with the anterior interval release for recalcitrant AKP associated with decreased patellar mobility after ACL reconstruction. METHODS: Nineteen consecutive patients with recalcitrant AKP and decreased patellar mobility after ACL reconstruction underwent arthroscopic anterior interval release. Initial ACL procedures were autograft BTB reconstructions; all patients participated in the same postoperative rehabilitation program. AKP was treated with patellar mobilization exercises and NSAID's. Failure of nonoperative treatment was defined as no improvement in functional outcome, assessed by Lysholm scores and patient questionnaires. Minimum follow-up was 2 years. RESULTS: After failure of nonoperative treatment, Lysholm score averaged 68 (range: 18 to 90). Postoperative Lysholm score averaged 85 (range: 68 to 100)(p < 0.0001). Range of motion did not change significantly; instability examinations were all graded zero. Preoperatively, 74% reported moderate to severe pain, 63% reported moderate to severe stiffness, and 58% reported abnormal knee function. Postoperatively, 21% reported moderate to severe pain, 5% reported moderate to severe stiffness, and 16% reported abnormal knee function. Average patient satisfaction at follow-up was 8.0 (1 = very dissatisfied; 10 = very satisfied). DISCUSSION: Pretibial patellar tendon adhesions after ACL reconstruction can be a debilitating source of AKP and poor functional results. We have altered our postoperative ACL rehabilitation program to include aggressive emphasis on patellar and patellar tendon mobilization exercises. Operative intervention (anterior interval release) has been shown in this series to result in significantly improved functional outcomes.
