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ARTHROSCOPIC
ARTHROFIBROLYSIS
FOR STIFF KNEE
DR . V . B . BHASIN
DR . AMARJEET
DR. SHASHANK MISHRA
ARTHROSCOPY UNIT
SIR GANGA RAM HOSPITAL
EMAIL:[email protected]
PROBLEMS ASSOCIATED
WITH OPEN FIBROLYSIS
SKIN BREAKDOWN
OPERATIVE TRAUMATIZATION OF
HEALTHY QUADRICEPS
MECHANISM
REANKYLOSIS
EXTENSOR LAG
ARTHROSCOPIC
ADVANTAGE
SURGICAL CUTTING IS CONFINED
TO THE OFFENDING SCAR TISSUE
ONLY
MINIMIZES THE DISADVANTAGES
OF OPEN FIBROLYSIS
TECHNICAL DIFFICULTY OF
ARTHROSCOPIC FIBROLYSIS
FIBROSIS ---
RESTRICTED
SCOPE AND
INSTRUMENT
MOBILITY
TRIANGULATION
DIFFICULTY DUE
TO FIBROUS
LOCULLI
ARTHROSCOPIC
ARTHROFIBROLYSISTECHNIQUE TO CUT AND REMOVE
FIBROSED MOTION RESTRICTING TISSUE FROM JOINT
SCOPE CAN DIRECTLY REACH THE SCAR TISSUE IN JOINT WITHOUT CUTTING THROUGH HEALTHY TISSUE
NO LARGE SKIN INCISION
CRITERIA FOR SELECTION OF
CASES FOR ARTHROFIBROLYSIS
NO GAIN IN MOTION BY
COSERVATIVE METHODS
SCARRING PATHOLOGY IN OR
AROUND JOINT ( PATELLAR
MOBILITY RESTRICTED )
NO ACTIVE INFECTION
JOINT SURFACES MAINTAINED
ALL FRACTURES HEALED
INSTRUMENTATION
TECHNIQUE
CASES SUITABLE
POST SURGICAL SCARRING STIFFNESS
POST IMMOBILIZATION STIFFNESS
PATELLAR FRACTURE
INTRA ARTICULAR TIBIAL AND
FEMORAL FRACTURES
LOWER FEMORAL FRACTURES
STIFF T. K . R .
STIFF KNEE WITH SCARRED SKIN
SCARRED SKIN
15 YEARS OLD SEPTIC
DRAINED SCARRED STIFF P
R
E
<
>
P
O
S
T
<
>
SCARRED SKIN ( COMPOUND
FRACTURE PATELLA )
PRE OP FLEXION POST OP 15 DAY
POST OP 2 MONTH
SCAR WRINKLES ON EXTENSION
INTRA - ARTICULAR WITH
PERIARTICULAR FIBROSIS
TECHNIQUE
FORE ARM PERIOSTEAL ELEVATOR THROUGH THE PORTAL
LOWER FEMORAL
FRACTURE
EXTENSION FLEXION
PRE OP
POST OP DAY 1 NO C P M
GAIN IN FLEXION
PRE OP FLEXION POST OP 1 MONTH
GAIN IN EXTENSION
WHY ??REMOVAL OF INFRAPATELLAR FIBROSIS
REMOVAL OF WASTED QUADRICEPS PULL
PRE OP EXTENSION POST OP EXTENSION
C. P. M.
C. P. M.
POST OP SIX MONTHS
POGNOSIS GOOD
POST SURGICAL FIBROSIS
JOINT SUFACES WELL PRESERVED
INTRA ARTICULAR FIBROSIS
PROGNOSIS
MODERATE
INTRA & PERI ARTICULAR FIBROSIS
JOINT CONGRUITY REASONABLE
HEALED INFECTION IN KNEE
PROGNOSIS BAD
SCARRING OF
QUADRICEPS
EXTERNAL
FIXATION
FEMORAL HEALED
OTEOMYELITIS
NO MOVEMENT
AT KNEE
POST TRAUMATIC
STIFF KNEECLINICAL APPLIED ARTHROSCOPY
COURSE
DR . V . B . BHASIN
Dr . AMARJEETARTHROSCOPY UNIT
SIR GANGA RAM HOSPITAL
EMAIL:[email protected]
VARIOUS TREATMENT
MODALITIES
MOBILIZING EXERCISES
MANIPULATION UNDER G . A .
INTRA ARTICULAR STEROID
OPEN RELEASE
ARTHROSCOPIC FIBROLYSIS
MOBILIZING EXERCISES
FOR PREVENTION AND REHAB AFTER
SURGERY
KNEE BECOMES STIFF IF INFLAMED
SURFACES ARE KEPT IMMOBILISED
BRIDGING TISSUE FORMS
INORDER FOR BRIDGING TISSUE NOT TO
FORM MAINTAIN MOBILITY EVEN IF
MINIMAL (NON UNION OF FIBROUS
BRIDGE)
MOBILIZING EXERCISES
FIBROUS TISSUE FORMS FASTER THAN BONEY TISSUE
IF ONE WAITS FOR BONEY HEALING IN INTRA ARTICULAR FRACTURE BEFORE MOBILIZING THEN FIBROUS TISSUE WOULD HAVE ALREADY FORMED IN THE JOINT STIFF
MOBILISE EARLY EVEN IF FIXATION LESS THAN ADEQUATE -- NON UNION OF CANCELLOUS BONE UNLIKELY
HEALTHY FOR ARTICULAR CARTILAGE
MANIPULATION UNDER GA
.
FIBROUS TISSUE MIGHT AVULSE
ARTICULAR CARTILAGE RATHER THAN
BREAKING SWELLING STIFFNESS
CAN BE USED TO STRETCH PERI
ARTICULAR TISSUES AFTER THE INTRA
ARTICULAR ADHESIONS HAVE BEEN
RELEASED
EARLY CASES OF STIFF KNEE WHERE
FIBROUS TISSUE IS NOT TOUGH
INTRA ARTICULAR
STEROID
GROSSLY STIFF KNEE HAS FIBROUS SEPTAE WHICH BREAK IT INTO SMALL LOCULLI
STEROID MAY NOT SPREAD
HELPS IN MILD STIFFNESS
INTERFERCE WITH HEALING OF FRACTURE
FORE ARM PERIOSTEAL
ELEVATOR THROUGH THE
PORTAL
TECHNIQUE
