Clinical research

Procedural manipulation under anesthesia for joint adhesion after trauma of knee operation: report of 21 cases

  • Xin JIANG ,
  • Ying HE ,
  • Bin CAI ,
  • Shuai FAN ,
  • Xiao-yan LI ,
  • Zhi-bin KANG
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  • 1.Department of Rehabilitation Medicine, Fengcheng Hospital of Fengxian District, Shanghai 201411, China
    2.Department of Rehabilitation Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China

Received date: 2020-05-18

  Online published: 2021-05-14

Supported by

National Key R&D Program of China(2018YFF0300504);Construction Plan of Clinical Diagnosis and Treatment Center of Fengxian District in Shanghai(fxlczlzx-a-201706);Shanghai Fengxian District Social Science and Technology Development Fund(20181901)

Abstract

Objective

· To investigate the clinical efficacy and safety of procedural manipulation under anesthesia (MUA) for joint adhesion after trauma of knee operation.

Methods

· Twenty one patients with joint adhesion after trauma of knee operation (including 6 cases after reconstruction and/or repair of multiple ligament injury of knee joint, 9 cases after internal fixation of fracture around the knee joint, and 6 cases after operation of patellar dislocation) were treated with procedural MUA. The knee flexion angle was evaluated before, during and after procedural MUA (2, 12 and 24 weeks) with joint protractor. The pain degree was evaluated by visual analogue scale (VAS) within 2 weeks after procedural MUA. The possible complications were recorded during and after procedural MUA.

Results

·Before, during and after procedural MUA (2, 12 and 24 weeks), the average knee flexion angle was 73.8°, 119.3°, 101.7°, 122.5° and 127.4°. Compared with preoperative, the average knee flexion angle increased 53.6° after procedural MUA (24 weeks). VAS evaluation results showed that the VAS score of patients in active state was more than 4 points only 1?3 days after operation. No complications occurred during and after the operation.

Conclusion

· Procedural MUA is relatively safe and effective in the treatment of joint adhesion after trauma of knee operation.

Cite this article

Xin JIANG , Ying HE , Bin CAI , Shuai FAN , Xiao-yan LI , Zhi-bin KANG . Procedural manipulation under anesthesia for joint adhesion after trauma of knee operation: report of 21 cases[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2021 , 41(4) : 479 -482 . DOI: 10.3969/j.issn.1674-8115.2021.04.010

References

1 Magit D, Wolff A, Sutton K, et al. Arthrofibrosis of the knee[J]. J Am Acad Orthop Surg, 2007, 15(11): 682-694.
2 McAlister I, Sems SA. Arthrofibrosis after periarticular fracture fixation[J]. Orthop Clin N Am, 2016, 47(2): 345-355.
3 Dodds JA, Keene JS, Graf BK, et al. Results of knee manipulations after anterior cruciate ligament reconstructions[J]. Am J Sports Med, 1991, 19(3): 283-287.
4 Noyes FR, Berrios-Torres S, Barber-Westin SD, et al. Prevention of permanent arthrofibrosis after anterior cruciate ligament reconstruction alone or combined with associated procedures: a prospective study in 443 knees[J]. Knee Surg Sports Traumatol Arthrosc, 2000, 8(4): 196-206.
5 Sanders TL, Kremers HM, Bryan AJ, et al. Procedural intervention for arthrofibrosis after ACL reconstruction: trends over two decades[J]. Knee Surg Sports Traumatol Arthrosc, 2017, 25(2): 532-537.
6 刘丽琨, 蔡斌, 岳冰, 等. 前交叉韧带重建术后关节粘连患者的综合物理治疗30例报告[J]. 中国骨与关节杂志, 2016, 5(10): 743-746.
7 王予彬, 王惠芳. 关节镜手术与康复[M]. 北京: 人民军医出版社, 2007.
8 姜鑫, 蔡斌, 王留根, 等. 程序化麻醉下手法松解术治疗膝关节粘连20例临床报告[J]. 中国康复, 2018, 33(5): 482-484.
9 Sassoon AA, Adigweme OO, Langford J, et al. Manipulation under anesthesia: a safe and effective treatment for posttraumatic arthrofibrosis of the knee[J]. J Orthop Trauma, 2015, 29(12): E464-E468.
10 Ipach I, Mittag F, Lahrmann J, et al. Arthrofibrosis after TKA: influence factors on the absolute flexion and gain in flexion after manipulation under anaesthesia[J]. BMC Musculoskelet Disord, 2011, 12(1): 1-6.
11 Kukreja M, Kang J, Curry EJ, et al. Arthroscopic Lysis of adhesions and anterior interval release with manipulation under anesthesia for severe post-traumatic knee stiffness: a simple and reproducible step-by-step guide[J]. Arthrosc Tech, 2019, 8(5): E429-E435.
12 Stiefel EC, McIntyre L. Arthroscopic Lysis of adhesions for treatment of post-traumatic arthrofibrosis of the knee joint[J]. Arthrosc Tech, 2017, 6(4): E939-E944.
13 Thompson R, Novikov D, Cizmic Z, et al. Arthrofibrosis after total knee arthroplasty: pathophysiology, diagnosis, and management[J]. Orthop Clin N Am, 2019, 50(3): 269-279.
14 Saini P, Trikha V. Manipulation under anesthesia for post traumatic stiff knee-pearls, pitfalls and risk factors for failure[J]. Injury, 2016, 47(10): 2315-2319.
15 Dailey K, McMorris M, Gross MT. Tibiofemoral joint mobilizations following total knee arthroplasty and manipulation under anesthesia[J]. Physiother Theory Pract, 2020, 36(7): 863-870.
16 Ghani H, Maffulli N, Khanduja V. Management of stiffness following total knee arthroplasty: a systematic review[J]. Knee, 2012, 19(6): 751-759.
17 Haller JM, Holt DC, McFadden ML, et al. Arthrofibrosis of the knee following a fracture of the tibial plateau[J]. Bone Joint J, 2015, 97-B(1): 109-114.
18 Evans KN, Lewandowski L, Pickett A, et al. Outcomes of manipulation under anesthesia versus surgical management of combat-related arthrofibrosis of the knee[J]. J Surg Orthop Adv, 2013, 22(1): 36-41.
19 Mariani PP, Santori N, Rovere P, et al. Histological and structural study of the adhesive tissue in knee fibroarthrosis: a clinical-pathological correlation[J]. Arthroscopy, 1997, 13(3): 313-318.
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