Arthroscopic lysis of adhesions improves knee range of motion after fixation of intra-articular fractures about the knee.

Abstract

Post-traumatic stiffness after open reduction and internal fixation of fractures about the knee can have dramatic effects on function. Traditionally, open quadricepsplasty has been the treatment of choice, but is associated with significant morbidity. The purpose of this study is to examine the immediate and sustainable range of motion (ROM) changes after surgical arthroscopic lysis of knee adhesions (SALKA) for post-traumatic knee stiffness after open reduction internal fixation (ORIF). We retrospectively reviewed a consecutive series of patients at a single institution who underwent SALKA for knee stiffness after intra-articular fractures about the knee treated with ORIF from 2009 to 2015. Pre-operative and immediate post-operative total ROM was assessed while patients were sedated during the SALKA procedure. Total ROM was assessed in the office pre-operatively and compared to the latest post-operative follow-up visit. Immediate post-operative ROM was also compared to the latest post-operative follow-up visit. Two-tailed paired Student's t test was calculated for analysis. Of the 14 patients included in the study, 10 (71%) had tibial plateau ORIF, 3 (21%) had patella ORIF, and 1 (8%) had intra-articular distal femur ORIF. The mean time between ORIF and SALKA was 244days. The mean follow-up time after SALKA was 135days. Under sedation during SALKA, the mean total ROM increased from 72° to 127° immediately post-operatively (p<0.01). The mean pre-operative in-office total ROM was 73° and increased to 104° at the latest follow-up visit (p<0.01). The mean immediate post-operative ROM was 127° and decreased to 104° at the latest follow-up visit (p=0.01). Lysis of adhesions utilizing SALKA after ORIF about the knee improves knee ROM immediately post-operatively and in the short-term follow-up. However, there is a decrease in the gains in the range of motion over time. Patients should be counseled as such. Lysis of adhesions utilizing arthroscopic techniques may provide a favorable alternative to open quadricepsplasty.