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Objective:To investigate the clinical efficacy and indications of arthrolysis plus Ilizarov technique in the treatment of traumatic fibrous stiffness of the knee.Methods:The clinical data were analyzed retrospectively of the 9 patients (10 knees) with traumatic fibrous stiffness who had been treated by arthrolysis plus Ilizarov technique from January 2012 to December 2020 at Department of Orthopaedics, Rehabilitation Hospital of National Research Center for Rehabilitation Technique Aids. There were 8 males and one female, aged from 15 to 42 years (average, 30.2 years). The left side was affected in 2 cases, the right side in 6 ones and bilateral sides in one. Their knee stiffness was all caused by injury around the knee. The time from injury to treatment ranged from 12 months to 38 years (average, 16.5 years). The admission examination revealed that the knee extension ranged from -40° to 0° and the knee flexion from -10° to 40°. Wearing time for the external fixator and incidence of complications were recorded; the ranges of knee motion were compared before and after treatment; the Qin Sihe criteria for postoperative limb deformity correction were used at the last follow-up to evaluate the curative efficacy.Results:The 9 patients were followed up for 20 to 78 months with an average of 35 months. The external fixators were worn for 14 to 200 days with an average of 78.4 days. During the traction period, pin tract reaction (3 holes) occurred in 2 patients with 3 knees, pin tract infection (2 holes) in 2 patients with 2 knees, the incision healed poorly in one patient, and no other complications occurred. The functional recovery of the knee was good at the last follow-up. The knee extension was 0°, insignificantly different from the preoperative value (-6.5°±12.9°) ( t=-1.591, P=0.146); the flexion angle was 70.0°±17.6°, significantly better than the preoperative value (15.0°±17.2°) ( t=-6.822, P< 0.001). According to the Qin Sihe postoperative criteria, the curative efficacy at the last follow-up was excellent in 7 knees and good in 3. Conclusion:In the treatment of traumatic fibrous stiffness of the knee, when the efficacy of simple arthrolysis is not good enough, a combination with Ilizarov technique can help improve the postoperative knee function and prevent severe complications.
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@#Introduction:Stiffness after Total Knee Arthroplasty (TKA) is a complication that decreases patient satisfaction. Patients in an Asian population have potentially different requirements of knee range of motion. The authors have encountered patients who complain of subjective stiffness post TKA who do not have a severely restricting range of motion (ROM). Some patients have persistent subjective stiffness and undergone Manipulation Under Anaesthesia (MUA). We look at their functional outcomes post MUA. Materials and Methods: This is a retrospective study, including 48 patients from a single institution who underwent MUA for stiffness, separated into objective and subjective knee stiffness. Patients with subjective knee stiffness who underwent MUA had failed conservative management. ROM, Oxford Knee Scores (OKS), Knee Society Scores (KSS) and Short Form 36 (SF36) scores were compared at two years post MUA. Results: The demographics of the two patient groups were similar. The time interval between index TKA and MUA was higher in the subjective knee stiffness group. Pre-MUA OKS, KS Function Score, KSS and SF36 scores were similar in both patient subgroups. There was no significant difference in the OKS, KSS or SF36 at two year follow-up. The proportion of patients in each group who achieved the Minimum Clinically Important Difference (MCID) improvement in the scores was also similar. Conclusions: Patients with subjective knee stiffness can achieve similar functional outcome improvements in Oxford and Knee Society Scores with MUA at two years follow-up.
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La rigidez de rodilla en cirugía de Reconstrucción del Ligamento Cruzado Anterior (R-LCA) es una complicación devastadora, alcanzando una incidencia variable entre el 4% y el 38%. La definición de artrofibrosis es aún poco clara, lo que ha llevado a distintos esquemas terapéuticos. Conocer la etiopatogenia es clave para entender los procesos y las posibles alternativas de tratamiento. Distintas clasificaciones han sido descritas, siendo la de Shelbourne la más usada, debido a su valor pronóstico asociado. El objetivo del tratamiento en una rodilla estable es mejorar la movilidad articular, la satisfacción del paciente, y disminuir el riesgo de artrosis a largo plazo. El tratamiento se puede dividir en quirúrgico y conservador. Ese último, se enfoca principalmente en buscar la causa y lograr una prevención e intervención temprana, siendo el manejo que con mayor frecuencia se realiza. El tratamiento quirúrgico es una opción cuando el tratamiento conservador falla. Se realizó una revisión de la literatura y de 150 pacientes sometidos a R-LCA, de los cuales 4 presentaron artrofibrosis a un seguimiento de 2 años. Además, presentamos nuestro algoritmo de manejo terapéutico.
Knee stiffness in Anterior Cruciate Ligament Reconstruction (ACL-R) is a devastating complication, with a variable incidence of 4% to 38%. The definition of arthrofibrosis is still unclear, which has led to different therapeutic schemes. Knowing the etiopathogenesis is key to understanding the processes and possible treatment alternatives. Different classifications have been described, with Shelbourne being the most used, due to its associated prognostic value. The aim of treatment in a stable knee is to improve joint mobility, patient satisfaction, and decrease the risk of long-term osteoarthritis. The treatment can be divided into operative and non-operative. The latter focuses mainly on finding the cause and achieving prevention and early intervention, being the management that is most frequently performed. Surgical treatment is an option when conservative treatment fails. A review of the literature and of 150 patients undergoing R-LCA was performed, of which 4 presented arthrofibrosis at a 2-year follow-up. In addition, we present our therapeutic management algorithm.
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Humans , Male , Female , Adolescent , Adult , Young Adult , Anterior Cruciate Ligament Reconstruction/adverse effects , Knee Injuries/etiology , Knee Injuries/physiopathology , Range of Motion, Articular/physiology , Knee Injuries/classification , Knee Injuries/therapyABSTRACT
AIM:To explore the effects of decorin on procollagen type I (PcI), mRNA expression,collagen type I synthesis and proliferation of synovial type B cells of stiff knee joint synovial membrane.METHODS:Type B cells of synovial membrane were isolated from the stiff knee joint synovial membrane and cultured in vitro.The cells were treated with decorin at concentrations of 0.1 mg/L, 5 mg/L and 10 mg/L.After cultured for 24 h, 48 h and 72 h, the cell proli-feration rates were measured by MTT colorimetric determination.Cell cycle distribution and apoptosis were analyzed by flow cytometry.The mRNA level of Pc I was detected by RT-PCR, while collagen type I was measured by Western blot.RE-SULTS:The proliferation of synovial type B cells was significantly inhibited, the percentage of synovial type B cells at G1 phase was significantly increased by 5 mg/L and 10 mg/L decorin (P<0.05), and PcⅠmRNA expression and collagen type I synthesis were significantly decreased.The cells with late apoptosis were not found in control group and experimental groups.CONCLUSION:Recombinant human decorin inhibits synovial type B cell proliferation and decreases PcⅠmRNA expression and collagen type I synthesis in synovial type B cells of stiff knee joint synovial membrane in vitro, suggesting that decorin potentially contributes to the therapy of human knee stiffness.
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Objective:To investigate and assess the systemic functional training in the prevention of lower limb trauma fracture surgery knee stiffness effect. Methods: Select General Hospital of PLA (301 Hospital) traumatic lower extremity Department of orthopedics from 2009 since April admissions of fractures in patients with 126 cases, according to the nursing methods of postoperative patients were divided into experimental group 63 cases and control group 63 cases, control group was given routine nursing after traumatic fracture of lower limb, the experimental group received training rehabilitation care plan and patient in the control group. Postoperative follow-up, the time of 5 months-2 years, two groups of patients were muscle strength, extension and flexion degree and the patients with complications were analyzed statistically, and the comprehensive evaluation of knee joint function recovery of patients. Results:The postoperative knee flexion strength and degree than the control group;experimental group, the complication rate was 15.9%in the control group of patients swelling after seven cases, the complication rate was 28.6%; comprehensive evaluation knee function two groups of patients in the experimental group was 82.5% excellent (52/63), good rate of the control group was 65.1% (41/63);said comparison items were statistically significant differences (x2=12.6, P<0.05). Conclusion: Lower limb trauma fracture surgery rehabilitation for patients with systemic functional training rehabilitation care, joint function recovery is remarkable, scientifically valid methods, should be further promoted.
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@#Objective To observe the dose-effect relationship and side effects caused by epidural ketamine for patients after surgical intervention for knee stiffness (SIKS). Methods 80 patients undergoing SIKS at one knee joint under combined spinal and epidural anesthesia were randomly divided into 4 groups. Patients in these groups would receive analgesia respectively provided by femoral nerve block (FNB)(group C, n=20), FNB combined with 0.15 mg/kg epidural ketamine (group K1, n=20), FNB combined with 0.2 mg/kg epidural ketamine(group K2, n=20), and FNB combined with 0.25 mg/kg epidural ketamine (group K3, n=20). When spinal anesthesia was finished, the corresponding dose of ketamine was injected in patients in groups K1, K2, and K3 and 0.9% sodium chloride was injected in group C via an epidural catheter. After the operation, a catheter was left in the femoral nerve sheath and the solution of 60 mg ropivacaine in 30 ml (0.2%) was injected. All patients were performed rehabilitation therapy at postoperative 8, 24, 32, and 48 h and the same ropivacaine solution was injected in the femoral nerve sheath before each rehabilitation therapy started. Visual analogue score (VAS), active range of motion (AROM) of the suffered knee joint, and side effects were observed. Results There were 73 patients enrolled in the final statistic analysis. At postoperative 8 h, the VAS scores were lower in groups K1, K2 and K3 than in group C (P<0.05). At postoperative 24 h, 32 h, and 48 h, the VAS scores were lower in groups K2 and K3 than in groups C and K1 (P<0.05). AROM was larger in groups K2 and K3 than in groups C and K1. patients appeared psychiatric symptoms in group K3. Conclusion Small dose of epidural ketamine is a feasible method for analgesia in early rehabilitation therapy and the dose of 0.2 mg/kg is effective and safe.
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@#ObjectiveTo compare the effect of rehabilitation training after surgical intervention of knee stiffness (SIKS) between femoral nerve block (FNB) and epidural nerve block (ENB).Methods60 patients undergoing SIKS at one knee joint were randomly assigned to two groups: 40 patients accepting a catheter for FNB in group A and 20 patients accepting a catheter for ENB in group B. All patients participated in passive rehabilitation therapy (PRT) and active rehabilitation therapy (ART) at 12 hours, 24 hours, 36 hours, and 48 hours after operation. 10 ml of lidocaine were applied via these catheters before rehabilitation therapy. The visual analogue score (VAS) for pain in PRT, the time needed from the end of PRT to the start of ART, and the incidence of side effects such as hypotension or nausea were recorded.ResultsThere was no significant difference in VAS between groups A and B. The time needed from the end of PRT to the start of ART in group A was significantly less than that of group B. The incidence of hypotension or nausea in group A was significantly less than those of group B.ConclusionFNB provides the same analgesic effect as ENB, has less time needed from the end of PRT to the start of ART, and lowers incidence of hypotension or nausea.
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@#ObjectiveTo investigate the characteristics of knee stiffness and the results of rehabilitation after the fractures of distal femur （DF）, tibial plateau （TP） or patella （PF）. Methods70 cases with knee stiffness after DF, TP or PF were analyzed retrospectively. ResultsNo significant difference was observed in passive range of motion (PROM) among three groups (F=1.671，P=0.196) before rehabilitation. The differences were significantly different (F=19.264, P=0.000) 8 weeks after rehabilitation. Further LSD analysis revealed that there was significant difference between DF and TP (P=0.000) as well as DF and PF (P=0.000), but no significant difference was observed between TP and PF (P=0.114). ConclusionThe outcome of rehabilitation is associated with the locations of fracture, and the distal femoral fractures is the worst.
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PURPOSE: The purpose of this study is evaluating the result of Judet's technique of quadricepsplasty for the treatmeot of the stiffness of the knee. MATERIALS AND METHODS: We analysed 30 patients performed Judets quadricepsplasty for extension contracture after trauma. The mean age was 36.6 years, mean follow-up period was 48 months. The cause of contracture was 26 fractures around knee, and non-articular fractures were 4 femoral shaft fractures with infection. The mean period from trauma to quadricepsplasty was 37 months. Clinical analysis was evaluated by Judet's criteria. According to joint involvement, we divided to group A and group B, and group I and group II by period of knee joint immobilization after trauma. RESULTS: According to Judet's criteria, excellent were 14 cases, good 11 cases, and fair 5 cases. The mean preoperative flexion contracture was 6 degree, and final was 1.5 degree. We gained 4.5 degree of flexion contracture. The mean preoperative further flexion was 45 degree, and final was 105.5 degree. So we gained 60.5 degree of further flexion. There was no statistically significant difference according to the joint involvement. There was difference according to immobilization period, but no statistically significant difference. CONCLUSION: Judet's quadricepsplasty and arthrolysis was effective technique for stiffness of the knee, We analysed the effect of joint involvement and immobilization period until quadricepsplasty, but there was no significant statistically different effect.
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Humans , Contracture , Follow-Up Studies , Immobilization , Joints , Knee Joint , KneeABSTRACT
110?),5 good(90?-109?)and 1 acceptable(60?～89?)and no poor results(