University of Alabama at Birmingham, 1201 11th Avenue South, Suite 200, Birmingham, AL, 35205, USA.
Knee Surg Sports Traumatol Arthrosc. 2019 Jul;27(7):2120-2123. doi: 10.1007/s00167-019-05399-1. Epub 2019 Feb 14.
Posterior capsular contracture is a potential consequence of osteoarthritis, post-traumatic arthritis, and surgical procedures of the knee. Many patients who undergo TKA will be found to have some degree of flexion contracture intraoperatively, which necessitates posterior capsular release. There is no information in the literature about the safety of posterior capsular release done during TKA. The present cadaveric study investigates the safety of posterior capsular release during TKA.
This study involved ten fresh-frozen cadaver specimens, each of which underwent three successive releases of the posterior capsule medially, laterally, and in the midline. One senior joint surgeon performed this procedure with a 1.27 cm curved osteotome, hugging the bone posteriorly on the distal aspect of the femur until the osteotome moved freely behind the bone without resistance. The distance from the distal aspect of the femur to the tip of the osteotome was then measured. Finally, the popliteal fossa was dissected, and the course of the neurovascular bundle was followed to assess for any macroscopic injury.
The capsule was penetrated at a median depth of 13.6 cm (range 10.3-17.6). Even at this depth, no injuries to the popliteal artery, tibial nerve, or popliteal vein occurred in any of the 30 penetrating events.
This study suggests that posterior capsular release can be performed safely with this technique.
后囊挛缩是骨关节炎、创伤后关节炎和膝关节手术的潜在后果。许多接受 TKA 的患者在术中会发现存在一定程度的屈曲挛缩，这需要进行后囊松解。目前文献中尚无关于 TKA 期间进行后囊松解安全性的信息。本尸体研究旨在探讨 TKA 期间进行后囊松解的安全性。
本研究涉及 10 个新鲜冷冻的尸体标本，每个标本均在内侧、外侧和中线连续进行 3 次后囊释放。一名资深关节外科医生使用 1.27cm 弯骨刀进行此操作，在股骨远端紧贴骨骼，直到骨刀在没有阻力的情况下在骨骼后面自由移动。然后测量从股骨远端到骨刀尖端的距离。最后，解剖腘窝，追踪神经血管束的走行，以评估是否有肉眼可见的损伤。
囊被穿透的中位数深度为 13.6cm（范围 10.3-17.6cm）。即使在这个深度，在 30 次穿透事件中，没有发生任何对腘动脉、胫神经或腘静脉的损伤。
本研究表明，使用这种技术可以安全地进行后囊松解。
