Cohen Jordan S, Gu Alex, Kapani Nisha, Asadourian Paul A, Stake Seth, Quan Theodore, Malahias Michael A, Sculco Peter K
Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, Washington, District of Columbia.
Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
J Knee Surg. 2021 Oct;34(12):1349-1354. doi: 10.1055/s-0040-1709182. Epub 2020 Apr 30.
Stiffness after total knee arthroplasty (TKA) remains a clinical challenge for health care professionals. Historically, arthroscopic arthrolysis is a treatment modality that has been reserved for patients that have failed other conservative modalities, including manipulation under anesthesia. However, a systematic review of the literature evaluating the clinical efficacy and complications of arthroscopic arthrolysis for stiffness after TKA has not been performed. A systematic review of medical databases (PubMed, EMBASE, Cochrane Library) was undertaken for articles published from January 1980 to October 2018. A descriptive and critical analysis of the results was performed. From 1,326 studies, 7 studies met the inclusion criteria for this study. A total of 160 patients who underwent arthroscopic arthrolysis for arthrofibrosis following TKA were included for analysis. The quality of the evidence for the included studies ranged between moderate and high. Overall, patients had significant increased range of motion and flexion by 32.5 and 26.7 degrees, respectively following arthroscopic arthrolysis. Functional outcome scores also significantly improved for patients who underwent arthroscopic arthrolysis after TKA. Arthroscopic arthrolysis is an efficacious modality for treatment of stiffness following TKA. The greatest benefit is seen among patients that present with significant loss of flexion. Arthroscopic arthrolysis should be reserved for patients that have previously failed more conservative modalities.
全膝关节置换术（TKA）后的僵硬问题仍是医疗保健专业人员面临的临床挑战。从历史上看，关节镜下关节松解术一直是一种治疗方式，仅用于那些其他保守治疗方式（包括麻醉下手法松解）失败的患者。然而，尚未对评估TKA后关节镜下关节松解术治疗僵硬的临床疗效和并发症的文献进行系统评价。我们对医学数据库（PubMed、EMBASE、Cochrane图书馆）进行了系统检索，查找1980年1月至2018年10月发表的文章。对结果进行了描述性和批判性分析。从1326项研究中，有7项研究符合本研究的纳入标准。共有160例TKA后因关节纤维性强直接受关节镜下关节松解术的患者纳入分析。纳入研究的证据质量从中等到高不等。总体而言，关节镜下关节松解术后患者的活动范围和屈曲度分别显著增加了32.5度和26.7度。TKA后接受关节镜下关节松解术的患者功能结局评分也显著改善。关节镜下关节松解术是治疗TKA后僵硬的一种有效方式。在屈曲度显著丧失的患者中获益最大。关节镜下关节松解术应仅用于那些先前保守治疗方式失败的患者。
