Abstract
BackgroundKnee flexion contractures have been associated with increased pain and a reduced ability to perform activities of daily living. Contractures can be treated either surgically or conservatively, but these treatment options may not be as successful with worker's compensation patients. The purposes of retrospective review were to 1) determine the efficacy of using adjunctive high-intensity stretch (HIS) mechanical therapy to treat flexion contractures, and 2) compare the results between groups of worker's compensation and non-compensation patients.MethodsFifty-six patients (19 women, 37 men, age = 51.5 ± 17.0 years) with flexion contractures were treated with HIS mechanical therapy as an adjunct to outpatient physical therapy. Mechanical therapy was only prescribed for those patients whose motion had reached a plateau when treated with physical therapy alone. Patients were asked to perform six, 10-minute bouts of end-range stretching per day with the ERMI Knee Extensionater(r) (ERMI, Inc., Atlanta, GA). Passive knee extension was recorded during the postoperative visit that mechanical therapy was prescribed, 3 months after beginning mechanical therapy, and at the most recent follow-up. We used a mixed-model 2 × 3 ANOVA (group × time) to evaluate the change in passive knee extension between groups over time.ResultsRegardless of group, the use of adjunctive HIS mechanical therapy resulted in passive knee extension deficits that significantly improved from 10.5° ± 5.2° at the initial visit to 2.6° ± 3.5° at the 3 month visit (p < 0.001). The degree of extension was maintained at the most recent follow-up (2.0° ± 2.9°), which was significantly greater than the initial visit (p < 0.001), but did not differ from the 3 month visit (p = 0.23). The gains in knee extension did not differ between worker's compensation and non-compensation patients (p = 0.56).ConclusionsWe conclude that the adjunctive use of HIS mechanical therapy is an effective treatment option for patients with knee flexion contractures, regardless of whether the patient is being treated as part of a worker's compensation claim or not.
Highlights
Knee flexion contractures have been associated with increased pain and a reduced ability to perform activities of daily living
Regardless of group, the use of adjunctive high-intensity stretch (HIS) mechanical therapy resulted in passive knee extension deficits that significantly improved from 10.5° ± 5.2° at the initial visit to 2.6° ± 3.5° at the 3 month visit (p < 0.001)
Passive extension for the UKA and total knee arthroplasty (TKA) patients improved from 9.6° ± 4.2° at the baseline visit to 2.7° ± 2.8° at the 3 month visit and 2.2° ± 2.7° at the most recent follow-up
Summary
Knee flexion contractures have been associated with increased pain and a reduced ability to perform activities of daily living. Postoperative loss of knee extension, sometimes referred to as flexion contractures, has been reported in 8% to 25% of patients having undergone total knee arthroplasty (TKA) or ACLR [1,2,3,4]. 58% of patients with more severe motion restriction (≥10°) were reported to have residual loss of knee extension two years after TKA. Walking distance is often reduced for ACLR patients with postoperative loss of extension, as the disadvantaged position and increased demand during bent-knee gait may lead to either quadriceps weakness and/or an earlier onset of quadriceps fatigue [9]. An inability to achieve full extension at a mean follow-up of 14 years after ACLR has been reported to result in both significantly reduced subjective outcome scores and a significantly greater prevalence of osteoarthritis in the involved knee [10]. An inability to achieve full postoperative extension after TKA has been reported to lead to a more rapid degeneration of the contralateral knee [11]
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