Aglietti P, Buzzi R, De Felice R, Paolini G, Zaccherotti G
First Orthopaedic Clinic of the University of Florence, Firenze, Italy.
Knee Surg Sports Traumatol Arthrosc. 1995;3(2):83-8. doi: 10.1007/BF01552380.
We prospectively studied 31 knee arthrolyses performed for loss of motion after intra-articular anterior cruciate ligament (ACL) reconstruction. The arthrolysis was performed on average 10.6 months after the reconstruction (range 4-25). Seven knees were localized forms. They were treated with arthroscopic removal of a fibrous nodule and scar tissue anterior to the ACL, which was preserved. Twenty-four knees were global forms and treated arthroscopically (14) or in open procedure (10). Suprapatellar, medial, and lateral gutter adhesions were sectioned, and fibrous tissue was removed from the anterior compartment. A posteromedial and/or posterolateral capsulotomy was necessary in 7 knees. The ACL graft was nonfunctional and/or malpositioned in 19 knees. The results were evaluated with the IKDC form with an average follow-up of 3.5 years (range 1.5-7). Preoperatively the localized forms had an average extension loss of 11 degrees and an average flexion loss of 14 degrees compared to the opposite knee. At follow-up all the knees were satisfactory for symptoms. All except one achieved a satisfactory motion (within 5 degrees of extension loss and 15 degrees of flexion loss) and a satisfactory final result. Global forms had a greater preoperative flexion loss (average 34 degrees) and extension loss (average 17 degrees). At follow-up 58% were satisfactory for symptoms and 71% for arc of motion. However, the final result was satisfactory in only 37%. In conclusion, local forms have a good prognosis. In global forms motion may be improved by surgery, but the final result is downgraded by symptoms. Arthrolyses performed within 8 months from index operation had a better outcome.
我们对31例因关节内前交叉韧带（ACL）重建后活动度丧失而进行的膝关节松解术进行了前瞻性研究。膝关节松解术平均在重建后10.6个月进行（范围为4 - 25个月）。7例为局限性类型。对这些膝关节进行关节镜下切除ACL前方的纤维结节和瘢痕组织，保留ACL。24例为广泛性类型，采用关节镜治疗（14例）或开放手术治疗（10例）。切开髌上、内侧和外侧沟的粘连，从前侧间室清除纤维组织。7例膝关节需要进行后内侧和/或后外侧关节囊切开术。19例膝关节的ACL移植物无功能和/或位置不良。采用IKDC表格对结果进行评估，平均随访3.5年（范围为1.5 - 7年）。术前，与对侧膝关节相比，局限性类型平均伸直受限11度，平均屈曲受限14度。随访时，所有膝关节的症状均令人满意。除1例之外，所有膝关节均获得了满意的活动度（伸直受限在5度以内，屈曲受限在15度以内）和满意的最终结果。广泛性类型术前屈曲受限更严重（平均34度），伸直受限更严重（平均17度）。随访时，58%的患者症状令人满意，71%的患者活动弧度令人满意。然而，最终结果仅37%令人满意。总之，局限性类型预后良好。广泛性类型通过手术可改善活动度，但最终结果因症状而降低。初次手术8个月内进行的膝关节松解术效果更好。
