[Arthroscopic release for knee joint stiffness after total knee arthroplasty]

Overall, the results of total knee replacement surgery are quite excellent, both with regard to pain and range of motion. Pain relief is obtained in more than 95% of the cases and more than 90% of the patients are able to bend their knee over 90 degrees. Nevertheless, in a small number of cases, stiffness can be an impairment.

Between 1992 and 1998, six arthroscopic releases were performed on six patients who had undergone total knee replacement. The six patients suffered from unacceptable stiffness. The average age of the patients was 68.5 years, and the time elapsed from implantation to arthroscopy averaged 24 months (6 months to 6 years). Average follow-up was 19 months (6 to 96 months). The six stiff knees were treated with arthroscopic debridement of fibrous tissue around the patella and quadriceps tendon (to improve extension) and by arthroscopic division of the medial and lateral retinacula (to address flexion). A gentle manipulation was carried out following lysis of adhesions, using a slight pressure on the tubercle to avoid fractures and disruptions of the extensor mechanisms. Postoperatively, immediate physical therapy was performed including continuous passive motion and active muscular contraction. Early weight bearing was allowed.

The average flexion contracture decreased from 9 degrees prior to arthroscopy to 2.5 degrees at last follow-up. Average flexion increased from 70 to 100 degrees. Maximal improvement was obtained at three months.

Results were found to be quite good, with a final knee score of 93 and a function score of 92 (following International Knee Society scoring).

Arthroscopic release following total knee replacement complicated by joint stiffness provides a satisfactory increase in range of motion.