The role of arthroscopy in the treatment of postoperative fibroarthrosis of the knee joint.

Twenty-one patients with significantly limited range of motion of the knee secondary to open surgical procedures were treated by arthroscopic resection of the adhesions and gentle manipulation. The surgical procedures consisted of realignment procedures for patellar dislocation, arthrotomy for meniscectomy and synovectomy, ligamentous reconstruction, open reduction of intraarticular fractures, and prosthetic replacement. The interval between the arthroscopic treatment and the open procedures was from four months to two years. All patients had the arthroscopic releases performed with general or spinal anesthesia, were kept in the hospital for a minimum of three days, and were placed on a continuous passive motion machine. After discharge, an intensive rehabilitation program was instituted under the supervision of a physical therapist. With a follow-up period ranging from six months to two years, marked improvement of range of motion was obtained in most patients. Preoperative flexion was between 40 degrees and 50 degrees in 13 patients, 30 degrees in two patients, 60 degrees in four patients, 80 degrees in one patient, and 10 degrees in only one patient. The final flexion was between 120 degrees and 140 degrees in 12 patients. The remaining patients had postoperative flexion between 85 degrees and 100 degrees. One patient with 10 degrees of range of motion did not improve. Six of the eight patients with an extension lag preoperatively regained full or almost full extension after arthroscopic debridement. Morbidity was low and no serious complications were encountered. This study suggests that arthroscopic intraarticular release of adhesions is efficacious in the management of arthrofibrosis of the knee subsequent to previous open operative procedures.