Yayac Michael F, Albana Mohamed F, Braithwaite Hilton C, Post Zachary D, Ponzio Danielle Y, Tjoumakaris Fotios P, Ong Alving C
Deptartment of Orthopaedic Surgery, Inspira Health Network, Vineland, New Jersey.
Rutgers New Jersey Medical School, Newark, New Jersey.
J Arthroplasty. 2025 Oct;40(10):2525-2530. doi: 10.1016/j.arth.2025.05.017. Epub 2025 May 9.
Arthrofibrosis affects up to 13% of patients after total knee arthroplasty (TKA), causing major pain, and functional deficits, reducing quality of life, and is responsible for 10% of revision surgeries within the first five years. Arthroscopic lysis of adhesions (LOAs) is a potential treatment option to improve patients' pain and function, but current literature is limited and inconclusive. The purpose of this study was to report outcomes of TKA patients undergoing LOA and identify risk factors for failure.
Charts were reviewed for 103 patients who underwent LOA for arthrofibrosis following TKA from 2012 to 2022 by three surgeons in a single private practice. Patient demographics, comorbidities, operative factors, and outcomes were reported and compared between LOA patients who did and did not undergo revision TKA.
An LOA significantly improved knee flexion by 51.2°, extension by 8.9°, and total range of motion (ROM) by 60°. At final follow-up (mean 1.7 years), patients had mean extension of 2.8° (SD 4.9), flexion of 103° (SD 20.1) and total ROM 100.0° (SD 22.1). There were 14 (13.6%) patients who underwent revision TKA, eight (7.8%) of whom were for arthrofibrosis. The patient who underwent revision had significantly lower pre-LOA knee flexion, 72.5 versus 80.9°. Male sex (odds ratio [OR] 0.10), body mass index (OR 0.80), and pre-LOA knee flexion (OR 0.94) were significant predictors of requiring revision TKA for arthrofibrosis.
Arthroscopic lysis of adhesions significantly improved ROM for TKA patients who had arthrofibrosis and subsequent revisions were lower than those reported in literature. An LOA is a viable option for the treatment of arthrofibrosis that may reduce the risk of requiring revision TKA in select patients.
关节纤维化影响高达13%的全膝关节置换术（TKA）患者，导致严重疼痛和功能缺陷，降低生活质量，并占前五年翻修手术的10%。关节镜下粘连松解术（LOA）是改善患者疼痛和功能的一种潜在治疗选择，但目前的文献有限且尚无定论。本研究的目的是报告接受LOA的TKA患者的结果，并确定失败的风险因素。
回顾了2012年至2022年在一家私人诊所由三位外科医生为关节纤维化接受LOA的103例患者的病历。报告了患者的人口统计学、合并症、手术因素和结果，并在接受和未接受翻修TKA的LOA患者之间进行了比较。
LOA显著改善了膝关节屈曲51.2°，伸展8.9°，总活动范围（ROM）60°。在最后随访时（平均1.7年），患者的平均伸展度为2.8°（标准差4.9），屈曲度为103°（标准差20.1），总ROM为100.0°（标准差22.1）。有14例（13.6%）患者接受了翻修TKA，其中8例（7.8%）是因为关节纤维化。接受翻修的患者在LOA前的膝关节屈曲度明显较低，分别为72.5°和80.9°。男性（比值比[OR]0.10）、体重指数（OR 0.80）和LOA前膝关节屈曲度（OR 0.94）是因关节纤维化需要翻修TKA的显著预测因素。
关节镜下粘连松解术显著改善了患有关节纤维化的TKA患者的ROM，随后的翻修率低于文献报道。LOA是治疗关节纤维化的一种可行选择，可能会降低部分患者需要翻修TKA的风险。
