Arthroscopic posteromedial capsular release for knee flexion contractures.

Extension deficits of the knee can cause functional limitations in patients after knee surgery or injury. Most frequently, they are treated with manipulations, arthroscopic anterior compartment debridements, or open posterior capsular releases once nonoperative treatment fails. However, an arthroscopic posteromedial capsular release to manage flexion deficits has yet to be studied comprehensively. Arthroscopic posteromedial capsular releases of the knee can result in improved knee motion postoperatively. An arthroscopic posteromedial capsular release involves sectioning the posteromedial capsule at its meniscofemoral portion, midway between its femoral attachment and its posterior horn medial meniscus junction. A review of 15 patients who underwent this operation was performed. Passive knee extension and flexion was measured in patients in the supine position using a goniometer at preoperative evaluations, under anesthesia prior to and immediately after the posteromedial capsular release, and at postoperative follow-up evaluations. The average time from the arthroscopic posteromedial capsular release to the final postoperative follow-up was 24.1 months. Preoperative knee extension averaged 14.7 degrees in 15 patients. The average immediate postoperative knee extension averaged -0.9 degrees. At the final postoperative follow-up, knee extension averaged 0.7 degrees. Overall knee motion improved from an average are of motion of 101.6 degrees-129.4 degrees. Arthroscopic posteromedial capsular releases and the concurrent postoperative rehabilitation program were effective in the treatment of knee extension deficits. The encouraging results of this study compare well to data presented in open posterior capsular release studies. We believe that arthroscopic posteromedial capsular releases are an effective means to address symptomatic knee extension deficits.

Expansion rates and outcomes for the 3.0-cm to the 3.9-cm infrarenal abdominal aortic aneurysm.

OBJECTIVE: This study was performed for the determination of the expansion rates and outcomes and for recommendations for the surveillance of the 3.0-cm to 3.9-cm abdominal aortic aneurysm (AAA). DESIGN: The study was observational with data from patients screened with ultrasound scanning for AAA at five Veterans Affairs Medical Centers for enrollment in the Aneurysm Detection and Management Trial. The eligibility requirements included: AAA from 3.0 cm to 3.9 cm in diameter and at least one repeat ultrasound scan more than 90 days after the initial screening. Patients also completed a questionnaire for demographic data and the determination of the presence of risk factors associated with AAA. The study endpoints included: 1, both mean and median expansion rates; 2, moderate expansion (>4 mm/year); 3, no expansion; 4, all causes of death; 5, AAA rupture; 6, expansion to 4 cm or more; 7, expansion to 5.0 cm or more; and 8, operative repair. RESULTS: Ultrasound scan screening results identified 1445 patients with 3.0-cm to 3.9-cm AAAs. Seven hundred ninety men met the ultrasound scan criterion of having at least two ultrasound scan studies during the study period, and these 790 men were used for this study. Mean AAA size was 3.3 cm, with an average follow-up period of 3.89 +/- 1.93 years. The median expansion rate was 0.11 cm/year. Expansion rates were significantly different (P <.001) between 3.0-cm and 3.4-cm cm AAA and 3.5-cm and 3.9-cm AAA. There were no reported AAA ruptures during the study period, although cause of death data were available in only 43% of the patients. Few 3.0-cm to 3.9-cm AAAs expanded to 5.0 cm or more during the study period. The patients with 3.0-cm to 3.9-cm AAAs who underwent operative repair during the study period were younger, had larger initial AAA diameters, and had more rapid expansion rates. CONCLUSION: AAAs of 3.0 cm to 3.9 cm expanded slowly, did not rupture, and rarely had operative repair or expanded to more than 5.0 cm in our study of male patients. Expansion rates and the incidence rate of operative repair are more common in the 3.5-cm to 3.9-cm AAA when compared with the 3.0-cm to 3.4-cm AAA.