Analysis and Treatment of Complications after Unicompartmental Knee Arthroplasty.

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Abstract

Conflict of interest statement: Conflict of Interest: No potential conflict of interest relevant to this article was reported. 20. Knee Surg Sports Traumatol Arthrosc. 2017 Dec;25(12):3929-3937. doi: 10.1007/s00167-017-4482-1. Epub 2017 Mar 4. Arthrofibrosis after ACL reconstruction is best treated in a step-wise approach with early recognition and intervention: a systematic review. Ekhtiari S(1), Horner NS(2), de Sa D(2), Simunovic N(3), Hirschmann MT(4), Ogilvie R(2), Berardelli RL(5), Whelan DB(5), Ayeni OR(6). Author information: (1)Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada. (2)Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada. (3)Department of Clinical Epidemiology and Biostatistics, Centre for Evidence Based Orthopaedics, McMaster University, Hamilton, ON, Canada. (4)Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Basel, Switzerland. (5)St. Michael's Hospital, University of Toronto Orthopaedic Sports Medicine, Toronto, ON, Canada. (6)Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada. femiayeni@gmail.com. PURPOSE: Arthrofibrosis is the most common post-operative complication of anterior cruciate ligament (ACL) reconstruction. Risk factors and management strategies for arthrofibrosis remain unclear. The purpose of this review was to: (a) describe existing definitions of arthrofibrosis, and (b) characterize the management strategies and outcomes of arthrofibrosis treatment. METHODS: MEDLINE, EMBASE, and PubMed were searched from database inception to search date (March 21, 2016) and screened in duplicate for relevant studies. Data regarding patient demographics, indications, index surgery, management strategy, and outcomes were collected. RESULTS: Twenty-five studies of primarily level IV evidence (88%) were included. A total of 647 patients (648 knees) with a mean age of 28.2 ± 1.8 years (range 14-62 years) were treated for arthrofibrosis following ACL reconstruction and followed for a mean 30.1 ± 16.9 months (range 2 months-9.6 years). Definitions of arthrofibrosis varied widely and included subjective definitions and the Shelbourne classification system. Patients were treated by one or more of: arthroscopic arthrolysis (570 patients), manipulation under anaesthesia (MUA) (153 patients), oral corticosteroids (31 patients), physiotherapy (81 patients), drop-casting (17 patients), epidural therapy combined with inpatient physiotherapy (six patients), and intra-articular interleukin-1 antagonist injection (four patients). All studies reported improvement in range of motion post-operatively, with statistically significant improvement reported for 306 patients (six studies, p range