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N. TARDY, M. THAUNAT, B. SONNERY-COTTET, C.G. MURPHY, P. CHAMBAT, J.M. FAYARD
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mobility exercises. Extension postures had to
be maintained for long periods of time (1 hour
every 4 hours). Complete weight-bearing was
authorized as tolerated. Patients walked with
crutches until extension and quadriceps
contraction during the stance phase were
achieved. All patients were systematically
addressed to a rehabilitation centre for 3 weeks.
Clinical Evaluation
At final follow-up, objective and subjective
International Knee Documentation Committee
(IKDC) forms, KOOS score and activity level
were recorded. The range of motion (ROM)
was measured preoperatively and at follow-up
with a goniometer and compared to the
contralateral healthy knee both for extension
and flexion.
All patients gave their informed consent before
they were included in the study, and the study
protocol was reviewed and approved by the
institutional review board.
Statistical Analysis
The Wilcoxon-Mann-Whitney test was
conducted using the GNU GSPP v.3 free
software. A
p
-value <0.05 was considered
significant.
RESULTS
At median follow-up of 38 months (range
6-90 months) after arthrolysis, a total of
12 patients were reviewed (5 women, 7 men).
Two patients were lost to follow-up. The
median age at final follow-up was 36 years
(range 20-56 years).
Knee stiffness was secondary to primary bone-
to-bone ACLR in all 12 patients and associated
with medial menisectomy in 4 cases (Table 1).
All primary surgeries to regain ROM had been
performed in other institutions and all patients
were referred secondarily to our service. Seven
patients had sustained surgery to treat knee
stiffness prior to presenting to our service
(Table 1).
The median time between the primary operation
and the secondary surgical release was
17 months (range 6-84). Surgical findings
during the arthrolysis are summarized in
Table 1. The mean operation time was 54min
(range 40-78min).
Preoperatively, all patients had more than 10°
of extension loss (Table 2). Ten patients
presented a global form of arthrofibrosis with a
combined extension and flexion deficit. Two
patients had more than 10° extension loss with
a flexion loss of less than 15° (“isolated”
extension loss; patients 7 and 8 - Table 2).
At follow-up, all patients except one (93%)
achieved complete extension (Table 2). Only
1 patient (patient 11) (7%) had a residual post-
operative flexion deformity of 5°. Extension
and flexion improvements were highly
significant after arthrolysis (
p
<0.001).
Analysis of mean ROM of the operated knee
before arthrolysis showed 96° ± 14.3°. The
ROM improved significantly after arthrolysis
to 143° ± 7° (
p
<0.001).
Intra-operative findings during arthrolysis are
summarized in Table 1.
No post-operative complications were
recorded. No patients required further open
debridement. No neurovascular deficits were
noted after the posterior release.
Pre- and post-operative objective IKDC scores
as well as post-operative subjective IKDC
scores are shown in Table 2.
The post-operative KOOS distribution was as
follows: pain 93.8 ± 5; symptoms 88 ± 8.6;
ADL 96.8 ± 3.7; sports activities 83.6 ± 12.3;
and quality of life 82.9 ± 8.8.
With regard to the activity level, at follow-up,
all patients (100%) had returned to sport, or
daily living activities for the 2 patients who did