Complete Arthroscopic Posterior Knee Capsulotomy in Patients With Knee Extension Deficit: Preliminary Results of a Clinical Trial

Overview

Journal Orthop J Sports Med

Specialty Orthopedics

Date 2023 Dec 4

PMID 38045767

Authors

Konrad Malinowski

Marcin Mostowy

Magdalena Kozlak

Przemyslaw A Pekala

Nicholas I Kennedy

Robert F LaPrade

Affiliations

Soon will be listed here.

Abstract

Background: Guided physiotherapy and surgical arthrolysis are effective in most patients with knee extension deficit. However, in refractory cases, posterior knee capsulotomy may be needed.

Purpose: To assess extension restoration, pain reduction, and functional improvement after arthroscopic complete posterior knee capsulotomy in patients with extension deficit refractory to guided physiotherapy and surgical arthrolysis.

Study Design: Case series; Level of evidence, 4.

Methods: Included were patients with symptomatic asymmetric extension deficit >3° refractory to at least 6 months of guided physiotherapy and initial arthrolysis (15 patients with 12-month follow-up and 8 patients with 24-month follow-up). The mean duration of extension deficit was 24.6 months. An arthroscopic complete posterior knee capsulotomy was performed with transection of the posteromedial, posterolateral and central capsule, and the posterior septum. The primary outcome measure was knee extension, with hyperextension denoted as negative knee extension values. Secondary outcome measures included visual analog scale (VAS) for pain during maximum effort and exercise, International Knee Documentation Committee (IKDC) score, and Knee injury and Osteoarthritis Outcome Score (KOOS).

Results: The mean patient age was 40.0 years (range, 26-70 years); 6 out of 15 patients had developed knee contracture after isolated anterior cruciate ligament reconstruction. The mean knee extension deficit decreased from 16.9° (range, 7° to 45°) preoperatively to -0.2° (range, -5° to 5°) at 12-month follow-up ( = .003) and to -0.3° (range, -5° to 5°) at 24-month follow-up ( = .035). The mean VAS pain score decreased from 3.5 (range, 1-6) preoperatively to 1.1 (range, 0-2) at 12-month follow-up ( = .004) and to 1.5 (range, 0-4) at 24-month follow-up ( = .005). The mean IKDC increased from 37.9 (range, 21-62) preoperatively to 63.9 (range, 46-87) at 12-month follow-up ( < .001) and to 60.9 (range, 39-80) at 24-month follow-up ( = .003). The mean KOOS increased from 45.0 (range, 30-62) preoperatively to 75.3 (range, 49-94) at 12-month follow-up ( < .001) and to 72.3 (range, 49-92) at 24-month follow-up ( = .003). There were no significant differences between 12- and 24-month follow-up in extension deficit or functional outcomes. One patient had a midcalf subcutaneous hematoma 5 weeks postoperatively, requiring evacuation.

Conclusion: Arthroscopic complete posterior knee capsulotomy was able to restore knee extension, reduce pain, and improve function, with 12-month follow-up results sustained at 24-month follow-up.

Registration: NCT05385393 (ClinicalTrials.gov identifier).

References

Campbell T, Trudel G . Knee Flexion Contracture Associated With a Contracture and Worse Function of the Contralateral Knee: Data From the Osteoarthritis Initiative. Arch Phys Med Rehabil. 2020; 101(4):624-632. DOI: 10.1016/j.apmr.2019.11.018. View

Lobenhoffer H, Bosch U, Gerich T . Role of posterior capsulotomy for the treatment of extension deficits of the knee. Knee Surg Sports Traumatol Arthrosc. 1996; 4(4):237-41. DOI: 10.1007/BF01567970. View

Scholes C, Ektas N, Harrison-Brown M, Jegatheesan M, Rajesh A, Kirwan G . Persistent knee extension deficits are common after anterior cruciate ligament reconstruction: a systematic review and meta-analysis of randomised controlled trials. Knee Surg Sports Traumatol Arthrosc. 2023; 31(8):3172-3185. DOI: 10.1007/s00167-022-07299-3. View

Gittings D, Hesketh P, Dattilo J, Zgonis M, Kelly J, Mehta S . Arthroscopic lysis of adhesions improves knee range of motion after fixation of intra-articular fractures about the knee. Arch Orthop Trauma Surg. 2016; 136(12):1631-1635. DOI: 10.1007/s00402-016-2561-2. View

Mariani P . Arthroscopic release of the posterior compartments in the treatment of extension deficit of knee. Knee Surg Sports Traumatol Arthrosc. 2009; 18(6):736-41. DOI: 10.1007/s00167-009-0920-z. View

Millett P, Williams 3rd R, Wickiewicz T . Open debridement and soft tissue release as a salvage procedure for the severely arthrofibrotic knee. Am J Sports Med. 1999; 27(5):552-61. DOI: 10.1177/03635465990270050201. View

Reinholz A, Song B, Wilbur R, Levy B, Okoroha K, Camp C . Arthroscopic Posterior Capsular Release Effectively Reduces Pain and Restores Terminal Knee Extension in Cases of Recalcitrant Flexion Contracture. Arthrosc Sports Med Rehabil. 2022; 4(4):e1409-e1415. PMC: 9402456. DOI: 10.1016/j.asmr.2022.04.030. View

Wierer G, Runer A, Gfoller P, Fink C, Hoser C . Extension deficit after anterior cruciate ligament reconstruction: Is arthroscopic posterior release a safe and effective procedure?. Knee. 2016; 24(1):49-54. DOI: 10.1016/j.knee.2016.09.018. View

Tardy N, Thaunat M, Sonnery-Cottet B, Murphy C, Chambat P, Fayard J . Extension deficit after ACL reconstruction: Is open posterior release a safe and efficient procedure?. Knee. 2016; 23(3):465-71. DOI: 10.1016/j.knee.2016.01.001. View

10.

Paradowski P, Keska R, Witonski D . Validation of the Polish version of the Knee injury and Osteoarthritis Outcome Score (KOOS) in patients with osteoarthritis undergoing total knee replacement. BMJ Open. 2015; 5(7):e006947. PMC: 4499743. DOI: 10.1136/bmjopen-2014-006947. View

11.

Harato K, Nagura T, Matsumoto H, Otani T, Toyama Y, Suda Y . Knee flexion contracture will lead to mechanical overload in both limbs: a simulation study using gait analysis. Knee. 2008; 15(6):467-72. DOI: 10.1016/j.knee.2008.07.003. View

12.

. Declaration of Helsinki. Ethical principles for medical research involving human subjects. J Indian Med Assoc. 2009; 107(6):403-5. View

13.

Attias M, Chevalley O, Bonnefoy-Mazure A, De Coulon G, Cheze L, Armand S . Effects of contracture on gait kinematics: A systematic review. Clin Biomech (Bristol). 2016; 33:103-110. DOI: 10.1016/j.clinbiomech.2016.02.017. View

14.

Irrgang J, Anderson A, Boland A, Harner C, Kurosaka M, Neyret P . Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med. 2001; 29(5):600-13. DOI: 10.1177/03635465010290051301. View

15.

Leie M, de Castro J, Gomes J . Posterior Knee Capsulotomy for the Relief of Patellofemoral Joint Pain: Long-Term Follow-up. J Knee Surg. 2019; 34(2):164-170. DOI: 10.1055/s-0039-1693730. View

16.

LaPrade R, Pedtke A, Roethle S . Arthroscopic posteromedial capsular release for knee flexion contractures. Knee Surg Sports Traumatol Arthrosc. 2008; 16(5):469-75. DOI: 10.1007/s00167-008-0496-z. View

17.

Ebisz M, Mostowy M, Goralczyk A, Hirschmann M, Skowronek P, LaPrade R . Both arthroscopic and open posterior knee capsulotomy are effective in terms of extension recovery and functional improvement-systematic review. Knee Surg Sports Traumatol Arthrosc. 2021; 30(4):1443-1452. DOI: 10.1007/s00167-021-06634-4. View

18.

Malinowski K, Goralczyk A, Hermanowicz K, LaPrade R, Wiecek R, Domzalski M . Arthroscopic Complete Posterior Capsulotomy for Knee Flexion Contracture. Arthrosc Tech. 2018; 7(11):e1135-e1139. PMC: 6262078. DOI: 10.1016/j.eats.2018.07.008. View