Mayr Hermann O, Brandt Christian M, Weig Thomas, Koehne Manuel, Bernstein Anke, Suedkamp Norbert P, Hube Robert, Stoehr Amelie
Department of Orthopedic and Trauma Surgery, Albert Ludwig University of Freiburg, Germany.
Albert Ludwig University of Freiburg, Germany.
Arthroscopy. 2017 Feb;33(2):408-414. doi: 10.1016/j.arthro.2016.07.029. Epub 2016 Oct 24.
The current study was conducted to evaluate the long-term clinical and radiological outcomes after arthroscopic arthrolysis for arthrofibrosis after anterior cruciate ligament reconstruction (ACLR).
All patients treated with arthrolysis between 1990 and 1998 were included. Indication was arthrofibrosis in at least one knee compartment or a cyclops syndrome limiting range of motion (ROM) by > 5° of extension deficit and 15° of flexion deficit. International Knee Documentation Committee (IKDC) 2000 subjective and objective, Lysholm score, and x-ray evaluation were documented. Statistical analysis and power calculation were performed (P < .05).
One hundred forty-one patients (follow-up, 71%) were examined at a mean of 18.7 ± 2.6 years after arthroscopic arthrolysis. Mean IKDC 2000 score was 79.49 ± 14.32. IKDC objective was normal in 0%, nearly normal in 6%, abnormal in 56%, and severely abnormal in 38%. One hundred percent of patients showed more than grade II osteoarthritis. ROM improvement after arthrolysis did not change significantly compared with midterm results (t = 4.5 years). Patients with persisting motion deficits (P = .02) and after medial meniscus resection (P < .001) at time of ACLR showed significantly greater progression of osteoarthritis in comparison with patients without these additional disorders. In case of arthrolysis later than 1 year after ACLR, a more severe osteoarthritis grade (4% vs 20% grade III; P = .038) and a lower jump distance (IKDC: 61% A, 25% B vs 39% A, 41% B; P = .028) were obvious compared with patients who underwent arthrolysis within the first year after ACLR.
Long-term motion improvement can be achieved by arthrolysis. Persistent loss of motion resulted in a higher degree of osteoarthritis in the study population. Early intervention seems advisable as patients with arthrolysis later than 1 year after index surgery reached worse IKDC objective grading.
Level IV, therapeutic case series.
本研究旨在评估前交叉韧带重建（ACLR）术后关节纤维化行关节镜下松解术后的长期临床和影像学结果。
纳入1990年至1998年间接受松解治疗的所有患者。指征为至少一个膝关节腔存在关节纤维化或“独眼巨人”综合征，导致活动范围（ROM）伸直受限超过5°且屈曲受限超过15°。记录国际膝关节文献委员会（IKDC）2000主观和客观评分、Lysholm评分以及X线评估结果。进行统计学分析和效能计算（P < 0.05）。
141例患者（随访率71%）在关节镜下松解术后平均18.7±2.6年接受检查。IKDC 2000平均评分为79.49±14.32。IKDC客观评分为正常的占0%，接近正常的占6%，异常的占56%，严重异常的占38%。100%的患者显示有超过II级的骨关节炎。与中期结果相比（时间间隔4.5年），松解术后ROM改善情况无显著变化。与无这些额外病症的患者相比，ACLR时存在持续活动受限（P = 0.02）以及内侧半月板切除术后（P < 0.001）的患者骨关节炎进展明显更严重。ACLR术后1年以后行松解术的患者，与ACLR术后1年内行松解术的患者相比，骨关节炎分级更严重（III级：4% 对20%；P = 0.038）且跳跃距离更低（IKDC：A级61%，B级25% 对A级39%，B级41%；P = 0.028）。
关节镜下松解术可实现长期活动改善。在研究人群中，持续的活动受限导致更高程度的骨关节炎。早期干预似乎是可取的，因为初次手术后1年以后行松解术的患者IKDC客观分级更差。
IV级，治疗性病例系列。
