Operative Mobilization of Stiff Knees After Surgical Treatment of Knee Injuries and Posttraumatic Conditions

Abstract

Seven patients, aged 29–52, with disabling restriction of knee flexion after surgical treatment of knee injuries and posttraumatic conditions were treated with extensive capsulotomy. Five of the patients had been treated for ligament injuries. The average preoperative range of flexion was 70 degrees (30–90 degrees), and the average mobility at follow-up was 134 degrees (115–145 degrees). The average flexion obtained was only 10 degrees less than the mobility of the non-injured knee. Although a slight instability was found in some of the knees after capsulotomy, no patients had complaints due to instability. All patients were very satisfied with the results, their function having been markedly improved. The capsulotomies comprised a posteromedial capsular release, in addition to anterior capsulotomy and partial synovectomy. Even the collateral ligaments and the posterolateral part of the capsule had to be cut in some knees to obtain optimal flexion. The posteromedial capsulotomy was found to be an essential part of the procedure, since stiffness and adhesions of the posteromedial part of the capsule prevented normal internal rotation of the tibia during attempts at maximal flexion. An extensive capsulotomy may be indicated in relatively young patients even in cases with flexion up to 90 degrees.