TY - JOUR
T1 - Arthroscopic Posterior Capsular Release Effectively Reduces Pain and Restores Terminal Knee Extension in Cases of Recalcitrant Flexion Contracture
AU - Reinholz, Anna K.
AU - Song, Bryant M.
AU - Wilbur, Ryan R.
AU - Levy, Bruce A
AU - Okoroha, Kelechi R.
AU - Camp, Christopher L.
AU - Krych, Aaron J.
N1 - Funding Information:
The authors report the following potential conflicts of interest or sources of funding: The authors would like to acknowledge the support from the Foderaro-Quattrone Musculoskeletal-Orthopaedic Surgery Research Innovation Fund. This study was partially funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program (T32AR56950). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. B.A.L. reports board or committee membership of Journal of Knee Surgery, Knee Surgery, Sports Traumatology, Arthroscopy, and Orthopedics Today; consulting fees from Smith & Nephew and Arthrex; IP royalties from Arthrex; and stock or stock options from COVR Medical LLC, outside the submitted work. K.R.O. is a paid consultant for Arthrex and Smith & Nephew, outside the submitted work. C.L.C. reports non-consulting fees from Arthrex and hospitality from Arthrex, Zimmer Biomet Holdings, Inc., and Gemini Medical, LLC. A.J.K. reports research support from Aesculap /B. Braun, Arthrex, Ceterix, and Histogenics; IP royalties from Arthrex; consulting fees from Arthrex, Vericel, and JRF Ortho; board or committee membership of ICRS, ISAKOS, Musculoskeletal Transplantation Foundation; and editorial or governing board membership of the Journal of Sports Medicine. Full ICMJE author disclosure forms are available for this article online, as supplementary material .
Funding Information:
The authors report the following potential conflicts of interest or sources of funding: The authors would like to acknowledge the support from the Foderaro-Quattrone Musculoskeletal-Orthopaedic Surgery Research Innovation Fund. This study was partially funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program (T32AR56950). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. B.A.L. reports board or committee membership of Journal of Knee Surgery, Knee Surgery, Sports Traumatology, Arthroscopy, and Orthopedics Today; consulting fees from Smith & Nephew and Arthrex; IP royalties from Arthrex; and stock or stock options from COVR Medical LLC, outside the submitted work. K.R.O. is a paid consultant for Arthrex and Smith & Nephew, outside the submitted work. C.L.C. reports non-consulting fees from Arthrex and hospitality from Arthrex, Zimmer Biomet Holdings, Inc., and Gemini Medical, LLC. A.J.K. reports research support from Aesculap/B. Braun, Arthrex, Ceterix, and Histogenics; IP royalties from Arthrex; consulting fees from Arthrex, Vericel, and JRF Ortho; board or committee membership of ICRS, ISAKOS, Musculoskeletal Transplantation Foundation; and editorial or governing board membership of the Journal of Sports Medicine. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Publisher Copyright:
© 2022 The Authors
PY - 2022
Y1 - 2022
N2 - Purpose: To 1) evaluate the clinical efficacy of arthroscopic posterior capsular release for improving range of motion (ROM) in cases of recalcitrant flexion contracture and 2) determine patient-reported outcomes (PROs) postoperatively. Methods: Retrospective chart review was performed to identify patients who underwent arthroscopic posterior capsular release due to persistent extension deficit of the knee despite comprehensive nonoperative physical therapy between 2008 and 2021. Knee ROM and PROs (International Knee Documentation Committee [IKDC], Tegner, and visual analog scale [VAS]) were collected at final follow-up. Results: Overall, 22 patients were included with a median age of 37 years (interquartile range [IQR]: 20.5-44.3). Of these, 8 (36%) were male and 14 (64%) were female, and average follow-up was 3.7 ± 3.3 years. The most common etiology was knee flexion contracture after anterior cruciate ligament (ACL) reconstruction (59%). All patients failed a minimum of 3 months of nonoperative management. Prior to operative intervention, 100% of patients received physical therapy, 64% received extension knee bracing or casting, and 36% received corticosteroid injection. Median preoperative extension was 15° (IQR: 10-25) compared to 2° (IQR: 0-5) postoperatively (P < .001). At final follow-up, median extension was 0° (IQR: 0-3.5). Postoperative VAS pain scores at rest (2 vs 0; P = .001) and with use (5 vs 1.8; P = .017) improved at final contact, and most (94%) patients reported maintaining their extension ROM. Patients with ACL-related extension deficit reported better IKDC (81 vs 51.3; P = .008), Tegner (5.8 vs 3.6; P = .007), and VAS pain scores (rest: 0.2 vs 1.8; P = .008; use: 1.3 vs 5; P = .004) compared to other etiologies. Conclusion: Arthroscopic posterior capsular release for recalcitrant flexion contracture provides an effective means for reducing pain and restoring terminal extension. The improvement in extension postoperatively was maintained for most (94%) patients at final follow-up with a 14% reoperation rate.
AB - Purpose: To 1) evaluate the clinical efficacy of arthroscopic posterior capsular release for improving range of motion (ROM) in cases of recalcitrant flexion contracture and 2) determine patient-reported outcomes (PROs) postoperatively. Methods: Retrospective chart review was performed to identify patients who underwent arthroscopic posterior capsular release due to persistent extension deficit of the knee despite comprehensive nonoperative physical therapy between 2008 and 2021. Knee ROM and PROs (International Knee Documentation Committee [IKDC], Tegner, and visual analog scale [VAS]) were collected at final follow-up. Results: Overall, 22 patients were included with a median age of 37 years (interquartile range [IQR]: 20.5-44.3). Of these, 8 (36%) were male and 14 (64%) were female, and average follow-up was 3.7 ± 3.3 years. The most common etiology was knee flexion contracture after anterior cruciate ligament (ACL) reconstruction (59%). All patients failed a minimum of 3 months of nonoperative management. Prior to operative intervention, 100% of patients received physical therapy, 64% received extension knee bracing or casting, and 36% received corticosteroid injection. Median preoperative extension was 15° (IQR: 10-25) compared to 2° (IQR: 0-5) postoperatively (P < .001). At final follow-up, median extension was 0° (IQR: 0-3.5). Postoperative VAS pain scores at rest (2 vs 0; P = .001) and with use (5 vs 1.8; P = .017) improved at final contact, and most (94%) patients reported maintaining their extension ROM. Patients with ACL-related extension deficit reported better IKDC (81 vs 51.3; P = .008), Tegner (5.8 vs 3.6; P = .007), and VAS pain scores (rest: 0.2 vs 1.8; P = .008; use: 1.3 vs 5; P = .004) compared to other etiologies. Conclusion: Arthroscopic posterior capsular release for recalcitrant flexion contracture provides an effective means for reducing pain and restoring terminal extension. The improvement in extension postoperatively was maintained for most (94%) patients at final follow-up with a 14% reoperation rate.
UR - http://www.scopus.com/inward/record.url?scp=85132315157&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85132315157&partnerID=8YFLogxK
U2 - 10.1016/j.asmr.2022.04.030
DO - 10.1016/j.asmr.2022.04.030
M3 - Article
AN - SCOPUS:85132315157
JO - Arthroscopy, Sports Medicine, and Rehabilitation
JF - Arthroscopy, Sports Medicine, and Rehabilitation
SN - 2666-061X
ER -