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All-arthroscopic release for treating severe knee extension contractures could improve the knee range of motion and the mid-term functional outcomes

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Abstract

Purpose

To evaluate the safety, feasibility, and effectiveness of an all-arthroscopic technique for the intra- and extraarticular release of severe knee extension contractures.

Methods

From 2012 to 2016, 25 patients with severe knee extension contractures (less than 45° range of flexion) were treated with an all-arthroscopic release technique. The patients underwent intra- and extraarticular arthroscopic release and arthroscopic-assisted mini-incision quadriceps plasty. The post-operative rehabilitation was initiated the first day after the procedures. Comprehensive clinical follow-up evaluations including the range-of-motion (ROM) assessment, the Lysholm score, and the International Knee Documentation Committee (IKDC) score were performed on all patients.

Results

The median follow-up time was 28 months (range 12–65 months). The ROM improved from 23.9° ± 7.5° pre-operatively to 105.9° ± 6.5° at the final follow-up (P < 0.001). In addition, the Lysholm score increased from 59.9 ± 5.2 pre-operatively to 89.7 ± 3.3 (P < 0.001). The IKDC score increased from 47.6 ± 3.4 pre-operatively to 91.7 ± 2.4 (P < 0.001). All patients were satisfied with their final ROM and functional outcomes.

Conclusion

The all-arthroscopic release technique was a safe, feasible and effective method for treating severe knee extension contractures. The severe knee extension contractures may be successfully addressed by the all-arthroscopic release technique during our clinical practice.

Level of evidence

IV.

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Author information

Correspondence to Wei Huang or Yi Liu.

Ethics declarations

Conflict of interest

The author(s) declare that they have no competing interests.

Ethical approval

Ethical approval was obtained from the Institutional Review Board (20180317016).

Electronic supplementary material

Below is the link to the electronic supplementary material.

Video 1: The range of motion of the injured knee was assessed again after anesthesia (MP4 5060 KB)

Video 1: The range of motion of the injured knee was assessed again after anesthesia (MP4 5060 KB)

Video 2: Adhesions of the suprapatellar bursa and fibrous tissue were carefully cut using a shaver (MP4 66928 KB)

Video 2: Adhesions of the suprapatellar bursa and fibrous tissue were carefully cut using a shaver (MP4 66928 KB)

Video 3: The lateral half of the rectus femoris was partially transected (MP4 21345 KB)

Video 3: The lateral half of the rectus femoris was partially transected (MP4 21345 KB)

Video 4: When flexion of the knee exceeded 110°, the operative procedure was terminated (MP4 5439 KB)

Video 4: When flexion of the knee exceeded 110°, the operative procedure was terminated (MP4 5439 KB)

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Liu, Z., Li, Y., Sun, P. et al. All-arthroscopic release for treating severe knee extension contractures could improve the knee range of motion and the mid-term functional outcomes. Knee Surg Sports Traumatol Arthrosc 27, 724–730 (2019) doi:10.1007/s00167-018-5022-3

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Keywords

  • Knee extension contractures
  • All-arthroscopic release
  • Extraarticular adhesion
  • Stiffness