Dataset Information

Arthroscopic Complete Posterior Capsulotomy for Knee Flexion Contracture.

ABSTRACT: Knee flexion contracture is a clinically important complication that can be observed after trauma, after knee surgery, or as a result of osteoarthritis. When it is left untreated, knee shearing forces increase not only in the affected joint but also in the contralateral knee, leading to mechanical overload in both limbs. Conservative management is a first-line treatment option for extension deficits, but when it fails, surgical treatment is necessary. Open as well as arthroscopic techniques focus mainly on an anterior arthrolysis and a posterior capsular release. Until now, posterior capsulotomy involved either a medial posterior capsular release or medial and lateral posterior capsular releases. Our aim is to present the technique of arthroscopic complete posterior capsulotomy for knee flexion contractures.

SUBMITTER: Malinowski K

PROVIDER: S-EPMC6262078 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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Arthroscopic Complete Posterior Capsulotomy for Knee Flexion Contracture.

Malinowski Konrad K Góralczyk Adrian A Hermanowicz Krzysztof K LaPrade Robert F RF Więcek Rafał R Domżalski Marcin E ME

Arthroscopy techniques 20181015 11

Knee flexion contracture is a clinically important complication that can be observed after trauma, after knee surgery, or as a result of osteoarthritis. When it is left untreated, knee shearing forces increase not only in the affected joint but also in the contralateral knee, leading to mechanical overload in both limbs. Conservative management is a first-line treatment option for extension deficits, but when it fails, surgical treatment is necessary. Open as well as arthroscopic techniques focu ...[more]

PMID: 30533360

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Project description:PurposeTo evaluate the biomechanics of simulated posterior cruciate ligament injuries (SimPCL) with and without internal brace suture tape augmentation (IBSTA) in cadaver knees.MethodsA total of 20 cadaveric knees were used, all male, with an average age of 65 ± 18 years. Femoral tunnel isometry was evaluated at the 1/11 o'clock and 2/10 o'clock femoral positions. SimPCL were created in 6 knees. IBSTA was performed, and load data were collected through knee range of motion. An additional 6 specimens were evaluated at the 1/11 femoral tunnel position, and load cell recordings were obtained at 10 different knee flexion angles. Cyclic displacement in 8 cadaver knees was assessed using an Instron machine. Load and displacement data were recorded. Testing was performed under 3 conditions for each specimen: intact PCL, SimPCL, and SimPCL/IBSTA using the 1/11 femoral tunnel position.ResultsThere was no difference in isometry when comparing the 1/11 o'clock (7.1 ± 4.0 ft∗lb) femoral position and the 2/10 o'clock (7.6 ± 4.2 ft∗lb) position (P = .467). SimPCL/IBSTA suture tape tension gradually increased with progressive flexion to a peak at approximately 120° of knee flexion. For cycle 100 tibial displacement, there was no difference between intact (4.41 mm) and SimPCL/IBSTA (5.59 mm, P = .391). There was a difference between intact (4.41 mm) and SimPCL (7.19 mm, P = .006) , but there was no significant difference between SimPCL/IBSTA (5.59 mm) and SimPCL (7.19 mm, P = .140). There was a difference in cycle 1 stiffness between intact (62.3 N/mm) and Sim2PCL (37 N/mm, P = .005). There was no difference between other groups.ConclusionsIn this cadaver study, there was a 1.18-mm average difference in posterior tibial displacement when comparing intact and SimPCL/IBSTA. The internal brace construct should be tensioned and fixed at approximately 100° of knee flexion to prevent loss of full flexion.Clinical relevanceThe presented biomechanical data for internal bracing of PCL injuries may lead to improved surgical techniques.

Dataset Information

Arthroscopic Complete Posterior Capsulotomy for Knee Flexion Contracture.

Publications

Arthroscopic Complete Posterior Capsulotomy for Knee Flexion Contracture.

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