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接受手术治疗的急性膝关节脱位伴膝关节僵硬患者,在接受关节镜下关节松解术治疗时,其效果与膝关节未僵硬的患者相当。

Surgically treated acute knee dislocations with knee stiffness perform equally as well as non-stiff knees when treated with arthroscopic arthrolysis.

作者信息

Fahlbusch Hendrik, Neumann Markus, Frings Jannik, Frosch Karl-Heinz, Krause Matthias

机构信息

University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

出版信息

Knee. 2024 Dec;51:114-119. doi: 10.1016/j.knee.2024.08.017. Epub 2024 Sep 5.

DOI:10.1016/j.knee.2024.08.017
PMID:39241671
Abstract

PURPOSE

Postoperative knee stiffness is a common issue in multiligament knee injuries (MLKIs). This study aims to compare outcomes between MLKI patients who underwent postoperative arthroscopic lysis of arthrofibrosis (LOA) for limited range of motion (ROM) and those who did not.

METHODS

Thirty-one patients (10 IIIM, nine IIIL and 12 IV) were included in this retrospective clinical study with acute type III or IV knee dislocations, while two patients were lost to follow up. Thirteen patients underwent LOA at a mean of 18.7 ± 8.4 weeks (Group A), while 18 did not require this intervention (Group B). Patient-reported outcome measures (IKDC, Lysholm, VAS) and ROM were evaluated.

RESULTS

The average follow up period was 31.0 ± 10.2 months. The mean time to LOA was 19.4 ± 7.6 weeks and a significant increase in ROM was observed after LOA (flexion: before LOA: 83.8° ± 19.2, after LOA: 119.6° ± 9.9; P < 0.0001). There were no significant differences between groups regarding clinical scores (Lysholm: Group A 85.0 ± 13.4, Group B 84.6 ± 14.5; IKDC: Group A 74.3 ± 10.8, Group B 76.7 ± 14.7) and ROM (flexion: Group A 118.6° ± 9.8, Group B 124.3° ± 12.8). There were no complications regarding LOA.

CONCLUSIONS

Patients, whether undergoing LOA or not, performed equally well in terms of ROM and clinical scores at final follow up, while timing of LOA appears less critical. LOA is a simple, durable and safe method of treating ROM deficits in patients treated for acute knee dislocation, with very good results.

摘要

目的

膝关节术后僵硬是多韧带膝关节损伤(MLKIs)中的常见问题。本研究旨在比较因活动范围(ROM)受限而接受术后关节镜下粘连松解术(LOA)的MLKI患者与未接受该手术的患者的治疗结果。

方法

本回顾性临床研究纳入了31例急性III型或IV型膝关节脱位患者(10例IIIM型、9例IIIL型和12例IV型),2例患者失访。13例患者平均在18.7±8.4周时接受了LOA(A组),18例患者未接受该干预(B组)。评估了患者报告的结局指标(IKDC、Lysholm、VAS)和ROM。

结果

平均随访期为31.0±10.2个月。LOA的平均时间为19.4±7.6周,LOA后ROM显著增加(屈曲:LOA前:83.8°±19.2,LOA后:119.6°±9.9;P<0.0001)。两组在临床评分(Lysholm:A组85.0±13.4,B组84.6±14.5;IKDC:A组74.3±10.8,B组76.7±14.7)和ROM(屈曲:A组118.6°±9.8,B组124.3°±12.8)方面无显著差异。LOA无并发症。

结论

在最终随访时,接受或未接受LOA的患者在ROM和临床评分方面表现相当,而LOA的时机似乎不那么关键。LOA是治疗急性膝关节脱位患者ROM缺陷的一种简单、持久且安全的方法,效果非常好。

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引用本文的文献

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How do surgically treated multiligamentous knee injuries affect overall complication rate and especially stiffness? A systematic review.手术治疗的多韧带膝关节损伤如何影响总体并发症发生率,尤其是僵硬情况?一项系统评价。
Knee Surg Relat Res. 2025 May 1;37(1):18. doi: 10.1186/s43019-025-00270-9.