Millett P J, Williams R J, Wickiewicz T L
Sports Medicine and Shoulder Service, The Hospital for Special Surgery, Cornell University Medical College, New York, New York 10021, USA.
Am J Sports Med. 1999 Sep-Oct;27(5):552-61. doi: 10.1177/03635465990270050201.
Postoperative loss of knee motion is a well-recognized phenomenon. This paper reports our results with open debridement and soft tissue release as a salvage procedure in the treatment of patients with severe arthrofibrosis on whom arthroscopic surgical techniques had failed. Eight knees (eight patients) were identified retrospectively. There were four men and four women; mean age was 29 years. All had severely restricted motion with extensive intraarticular and periarticular fibrosis. Range of motion averaged 62.5 degrees preoperatively (flexion 81 degrees, loss of extension 18.8 degrees). Patients underwent open debridement and soft tissue release to restore motion. There were no complications. Motion improved to an average of 124 degrees after surgery. Average flexion improved from 81 degrees to 125 degrees . Loss of extension improved from 18.8 degrees to 1.25 degrees. Functional outcome was good, with Lysholm II scores averaging 79. Patient satisfaction was high. There was a high incidence of patellofemoral arthritis at follow-up. Furthermore, the patellar tendon shortened approximately 6 mm over time. While we do not advocate open debridement and soft tissue release as a first-line treatment for arthrofibrosis, we do conclude that it can be effective as a salvage procedure to restore motion in the profoundly arthrofibrotic knee.
膝关节术后活动度丧失是一种公认的现象。本文报告了我们采用切开清创和软组织松解作为挽救性手术治疗关节镜手术技术失败的严重关节纤维化患者的结果。回顾性确定了8例膝关节（8名患者）。其中男性4例，女性4例；平均年龄29岁。所有患者的活动度均严重受限，伴有广泛的关节内和关节周围纤维化。术前平均活动度为62.5度（屈曲81度，伸直丧失18.8度）。患者接受切开清创和软组织松解以恢复活动度。无并发症发生。术后活动度平均改善至124度。平均屈曲度从81度提高到125度。伸直丧失从18.8度改善到1.25度。功能结果良好，Lysholm II评分平均为79分。患者满意度较高。随访时髌股关节炎的发生率较高。此外，随着时间的推移，髌腱大约缩短了6毫米。虽然我们不主张将切开清创和软组织松解作为关节纤维化的一线治疗方法，但我们确实得出结论，它作为一种挽救性手术恢复严重关节纤维化膝关节的活动度是有效的。
