Arthroscopic Posterior Capsular Release for Loss of Knee Extension.
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ABSTRACT:
SUBMITTER: Jones DL
PROVIDER: S-EPMC7587019 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:PurposeTo 1) evaluate the clinical efficacy of arthroscopic posterior capsular release for improving range of motion (ROM) in cases of recalcitrant flexion contracture and 2) determine patient-reported outcomes (PROs) postoperatively.MethodsRetrospective chart review was performed to identify patients who underwent arthroscopic posterior capsular release due to persistent extension deficit of the knee despite comprehensive nonoperative physical therapy between 2008 and 2021. Knee ROM and PROs (International Knee Documentation Committee [IKDC], Tegner, and visual analog scale [VAS]) were collected at final follow-up.ResultsOverall, 22 patients were included with a median age of 37 years (interquartile range [IQR]: 20.5-44.3). Of these, 8 (36%) were male and 14 (64%) were female, and average follow-up was 3.7 ± 3.3 years. The most common etiology was knee flexion contracture after anterior cruciate ligament (ACL) reconstruction (59%). All patients failed a minimum of 3 months of nonoperative management. Prior to operative intervention, 100% of patients received physical therapy, 64% received extension knee bracing or casting, and 36% received corticosteroid injection. Median preoperative extension was 15° (IQR: 10-25) compared to 2° (IQR: 0-5) postoperatively (P < .001). At final follow-up, median extension was 0° (IQR: 0-3.5). Postoperative VAS pain scores at rest (2 vs 0; P = .001) and with use (5 vs 1.8; P = .017) improved at final contact, and most (94%) patients reported maintaining their extension ROM. Patients with ACL-related extension deficit reported better IKDC (81 vs 51.3; P = .008), Tegner (5.8 vs 3.6; P = .007), and VAS pain scores (rest: 0.2 vs 1.8; P = .008; use: 1.3 vs 5; P = .004) compared to other etiologies.ConclusionArthroscopic posterior capsular release for recalcitrant flexion contracture provides an effective means for reducing pain and restoring terminal extension. The improvement in extension postoperatively was maintained for most (94%) patients at final follow-up with a 14% reoperation rate.
| S-EPMC9402456 | biostudies-literature
Project description:Post-traumatic or postsurgical flexion contractures of the knee can significantly limit function and lead to gait abnormalities. In this setting, interventions to regain full extension may include bracing, physical therapy, and open or arthroscopic surgery. Open surgical approaches to restore full motion often demand extensive recovery and promote further adhesions and loss of motion, which has led to the advent of arthroscopic techniques to address these pathologies. We present a safe, effective, and reproducible arthroscopic technique for posteromedial capsular release to address knee flexion contractures.
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Project description:Knee stiffness with severe flexion and extension impediment is a common clinical condition that challenges orthopaedic surgeons. Arthroscopic release techniques have been reported, mostly for slight extension or flexion deficits. However, for severe flexion- and extension-impeding knee stiffness, especially when there is no intra-articular space in which to place the arthroscope, effective arthroscopic release techniques are still being pursued. We introduce a systemic arthroscopic release technique to address this special condition, in which a trans-infrapatellar fat pad release technique is developed to obtain access to the joint and to perform intra-articular and periarticular release, as well as scar tissue removal. One critical point of this technique is to create the posteromedial and posterolateral portals to re-establish the posterior compartments, remove the fibrotic posterior septum, and release the posterior capsule. This technique combines almost all related arthroscopic techniques in the treatment of knee stiffness. We consider that the introduction of this technique will provide a useful guide when surgical release is selected for this special condition.
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Project description:Arthroscopic techniques for posterior shoulder subluxation with labral injuries in athletes have shown good results. The difficulty with the procedure is gaining appropriate access to the posteroinferior quadrant of the glenoid at a steep enough angle that allows for safe anchor placement. Various portals have been described that can be used as accessory portals for anchor placement. Although the use of additional portals to create appropriate access to the joint is always encouraged, preoperative planning can minimize the need for their use. The video shows a simple technique for posterior labral repair with capsular plications through a lateralized posterior portal in the lateral decubitus position. This technique allows the surgeon to address posterior labral tears and capsular laxity without the need for accessory portals.
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Project description:Idiopathic adhesive capsulitis, or primary frozen shoulder syndrome, is a fairly common orthopaedic problem characterized by shoulder pain and loss of motion. In most cases, conservative treatment (6-month physical therapy program and intra-articular steroid injections) improves symptoms and restores shoulder motion. In refractory cases, arthroscopic capsular release is indicated. This surgical procedure carries several advantages over other treatment modalities. First, it provides precise and controlled release of the capsule and ligaments, reducing the risk of traumatic complications observed after forceful shoulder manipulation. Second, release of the capsule and the involved structures with a radiofrequency device delays healing, which prevents adhesion formation. Third, the technique is straightforward, and an oral postoperative steroid program decreases pain and allows for a pleasant early rehabilitation program. Fourth, the procedure is performed with the patient fully awake under an interscalene block, which boosts the patient's confidence and adherence to the physical therapy protocol. In patients with refractory primary frozen shoulder syndrome, arthroscopic capsular release emerges as a suitable option that leads to a faster and long-lasting recovery.
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Project description:Adhesive capsulitis of the ankle is also known as frozen ankle and results in marked fibrosis and contracture of the ankle capsule. Arthroscopic capsular release is indicated for symptomatic frozen ankle that is resistant to conservative treatment. It is contraindicated for ankle stiffness due to degenerative joint disease, intra-articular malunion, or adhesion of the extensors of the ankle. The procedure consists of endoscopic posterior ankle capsulectomy and arthroscopic anterior ankle capsulotomy. It has the advantages of being minimally invasive surgery and allowing early postoperative vigorous mobilization of the ankle joint.
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Project description:Recurrent shoulder instability complicated by capsular insufficiency due to underlying soft-tissue disorders or multiple prior failed surgical procedures poses a challenging surgical problem. Traditional capsulolabral soft-tissue reconstruction techniques are less effective in this setting, and bony procedures sacrifice normal anatomic relations. The described arthroscopic technique aims to prevent instability while maintaining range of motion through creation of a soft-tissue allograft "sling" augmenting the posterior glenohumeral capsule.
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Project description:Patients with rotator cuff tears may present with or subsequently develop concomitant shoulder stiffness. The treatment of rotator cuff tears in the face of passive glenohumeral motion loss is controversial. Preoperative shoulder stiffness has been considered by some a contraindication to rotator cuff repair. Some surgeons recommend staging surgical procedures and delaying rotator cuff repair until shoulder stiffness has resolved. However, this can lead to prolonged recovery times and patient dissatisfaction. We describe a surgical technique that allows for the single-stage arthroscopic management of rotator cuff tears with associated adhesive capsulitis. Arthroscopic capsular release and shoulder manipulation are performed in the same operative setting as arthroscopic rotator cuff repair. We have found that this combined, single-stage arthroscopic approach can effectively treat patients with rotator cuff tears and concomitant shoulder stiffness.
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Project description:Posterior glenohumeral capsular rupture is a rare cause of posterior glenohumeral instability. With advances in imaging and arthroscopic techniques, diagnosis and treatment of posterior glenohumeral instability are becoming more common in practice. We present a technique for arthroscopic repair of a posterior glenohumeral capsular rupture with concomitant anterior and posterior labrum detachment. Arthroscopic fixation was facilitated by use of a 70° arthroscope through an anterior viewing portal to allow accurate placement of the posterior portal in preparation for knot tying. This arthroscopic technique resulted in a successful outcome.
| S-EPMC5040481 | biostudies-literature
Project description: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.
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