To Manipulate or Not? Management of Pediatric Knee Arthrofibrosis Following Operative Fixation of Tibial Spine Fractures
Background: Knee arthrofibrosis is a common complication after surgical fixation of tibial spine fractures. However, there is no standardized treatment modality for resultant arthrofibrosis, with some surgeons electing for nonoperative management, while others prefer manipulation under anesthesia wi...
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Elsevier
2024-11-01
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| Series: | Journal of the Pediatric Orthopaedic Society of North America |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2768276524009489 |
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| author | Matthew J. Folkman, BS Neeraj M. Patel, MD, MPH, MBS Alexandra C. Stevens, BS Aristides I. Cruz, Jr, MD R. Jay Lee, MD Indranil Kushare, MD Theodore J. Ganley, MD Henry Ellis, MD Peter Fabricant, MD Daniel Green, MD, MS Benjamin Johnson, PA-C Scott Mckay, MD Gregory Schmale, MD Yi-Meng Yen, MD, PhD R. Justin Mistovich, MD, MBA |
| author_facet | Matthew J. Folkman, BS Neeraj M. Patel, MD, MPH, MBS Alexandra C. Stevens, BS Aristides I. Cruz, Jr, MD R. Jay Lee, MD Indranil Kushare, MD Theodore J. Ganley, MD Henry Ellis, MD Peter Fabricant, MD Daniel Green, MD, MS Benjamin Johnson, PA-C Scott Mckay, MD Gregory Schmale, MD Yi-Meng Yen, MD, PhD R. Justin Mistovich, MD, MBA |
| author_sort | Matthew J. Folkman, BS |
| collection | DOAJ |
| description | Background: Knee arthrofibrosis is a common complication after surgical fixation of tibial spine fractures. However, there is no standardized treatment modality for resultant arthrofibrosis, with some surgeons electing for nonoperative management, while others prefer manipulation under anesthesia with a possible arthroscopic lysis of adhesions, if indicated. To better understand indications and outcomes from these treatment modalities for arthrofibrosis, we examined patients treated by both approaches. Methods: We performed a multicenter retrospective case series of patients with arthrofibrosis after tibial spine fracture surgery. Arthrofibrosis was defined as loss of knee extension ≥10.0° and/or knee flexion ≥25.0° compared to the contralateral, uninjured knee at three months following index surgery. Patients were organized into 2 cohorts: nonoperative and operative treatment. Data were collected for demographics, fracture classification, concomitant injuries, treatment timeline, and knee range of motion. Results: There were 16 patients in the operative group and 10 patients in the nonoperative group. At the time of diagnosis, the operative group had a mean 10° larger flexion deficit compared to the nonoperative group. Both treatment modalities resulted in similar ranges of motion at terminal evaluation. Final flexion was recorded as 130° in the operative group and 127° in the nonoperative group. Final extension deficits were 3° in both cohorts. Conclusions: Operative and nonoperative treatment modalities can be effective in management of knee arthrofibrosis after fixation of tibial spine fractures. Nonoperative treatment may be more suitable for milder range of motion deficits, but further research is necessary to guide clinical practice. Key Concepts: (1) Cohorts were similar in demographics, fracture classification, and concomitant injuries. (2) Patients who received a second operation presented with a greater flexion deficit. (3) The mean time between initial surgery and reoperation was 85 days. (4) Operative and nonoperative treatment of arthrofibrosis resulted in similar outcomes. Level of Evidence: Level IV, Case Series |
| format | Article |
| id | doaj-art-898cf8d9036b455ca4a57749d0a0fd93 |
| institution | Kabale University |
| issn | 2768-2765 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the Pediatric Orthopaedic Society of North America |
| spelling | doaj-art-898cf8d9036b455ca4a57749d0a0fd932024-11-29T06:25:28ZengElsevierJournal of the Pediatric Orthopaedic Society of North America2768-27652024-11-019100122To Manipulate or Not? Management of Pediatric Knee Arthrofibrosis Following Operative Fixation of Tibial Spine FracturesMatthew J. Folkman, BS0Neeraj M. Patel, MD, MPH, MBS1Alexandra C. Stevens, BS2Aristides I. Cruz, Jr, MD3R. Jay Lee, MD4Indranil Kushare, MD5Theodore J. Ganley, MD6Henry Ellis, MD7Peter Fabricant, MD8Daniel Green, MD, MS9Benjamin Johnson, PA-C10Scott Mckay, MD11Gregory Schmale, MD12Yi-Meng Yen, MD, PhD13R. Justin Mistovich, MD, MBA14Division of Pediatric Orthopedic Surgery, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA; The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USADivision of Orthopedic Surgery and Sports Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USAChildren's Hospital of Philadelphia, Philadelphia, PA, USADepartment of Orthopedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USAJohns Hopkins, Baltimore, MD, USATexas Children's Hospital the Woodlands, TX, USAChildren's Hospital of Philadelphia, Philadelphia, PA, USAScottish Rite Children's Hospital, University of Texas Southwestern Medical Center, Dallas, TX, USAHospital for Special Surgery, New York, NY, USAHospital for Special Surgery, New York, NY, USAScottish Rite Children's Hospital, University of Texas Southwestern Medical Center, Dallas, TX, USATexas Children's Hospital & Baylor College of Medicine, Houston, TX, USAUW School of Medicine, Department of Orthopedics and Sports Medicine, Kirkland, WA, USABoston Children's Hospital, Boston, MA, USADivision of Pediatric Orthopedic Surgery, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA; Corresponding author: University Hospitals Case Medical Center, 11100 Euclid Ave., Cleveland, OH 44106, USA.Background: Knee arthrofibrosis is a common complication after surgical fixation of tibial spine fractures. However, there is no standardized treatment modality for resultant arthrofibrosis, with some surgeons electing for nonoperative management, while others prefer manipulation under anesthesia with a possible arthroscopic lysis of adhesions, if indicated. To better understand indications and outcomes from these treatment modalities for arthrofibrosis, we examined patients treated by both approaches. Methods: We performed a multicenter retrospective case series of patients with arthrofibrosis after tibial spine fracture surgery. Arthrofibrosis was defined as loss of knee extension ≥10.0° and/or knee flexion ≥25.0° compared to the contralateral, uninjured knee at three months following index surgery. Patients were organized into 2 cohorts: nonoperative and operative treatment. Data were collected for demographics, fracture classification, concomitant injuries, treatment timeline, and knee range of motion. Results: There were 16 patients in the operative group and 10 patients in the nonoperative group. At the time of diagnosis, the operative group had a mean 10° larger flexion deficit compared to the nonoperative group. Both treatment modalities resulted in similar ranges of motion at terminal evaluation. Final flexion was recorded as 130° in the operative group and 127° in the nonoperative group. Final extension deficits were 3° in both cohorts. Conclusions: Operative and nonoperative treatment modalities can be effective in management of knee arthrofibrosis after fixation of tibial spine fractures. Nonoperative treatment may be more suitable for milder range of motion deficits, but further research is necessary to guide clinical practice. Key Concepts: (1) Cohorts were similar in demographics, fracture classification, and concomitant injuries. (2) Patients who received a second operation presented with a greater flexion deficit. (3) The mean time between initial surgery and reoperation was 85 days. (4) Operative and nonoperative treatment of arthrofibrosis resulted in similar outcomes. Level of Evidence: Level IV, Case Serieshttp://www.sciencedirect.com/science/article/pii/S2768276524009489ArthrofibrosisTibial spine fractureManipulation under anesthesiaTrauma |
| spellingShingle | Matthew J. Folkman, BS Neeraj M. Patel, MD, MPH, MBS Alexandra C. Stevens, BS Aristides I. Cruz, Jr, MD R. Jay Lee, MD Indranil Kushare, MD Theodore J. Ganley, MD Henry Ellis, MD Peter Fabricant, MD Daniel Green, MD, MS Benjamin Johnson, PA-C Scott Mckay, MD Gregory Schmale, MD Yi-Meng Yen, MD, PhD R. Justin Mistovich, MD, MBA To Manipulate or Not? Management of Pediatric Knee Arthrofibrosis Following Operative Fixation of Tibial Spine Fractures Journal of the Pediatric Orthopaedic Society of North America Arthrofibrosis Tibial spine fracture Manipulation under anesthesia Trauma |
| title | To Manipulate or Not? Management of Pediatric Knee Arthrofibrosis Following Operative Fixation of Tibial Spine Fractures |
| title_full | To Manipulate or Not? Management of Pediatric Knee Arthrofibrosis Following Operative Fixation of Tibial Spine Fractures |
| title_fullStr | To Manipulate or Not? Management of Pediatric Knee Arthrofibrosis Following Operative Fixation of Tibial Spine Fractures |
| title_full_unstemmed | To Manipulate or Not? Management of Pediatric Knee Arthrofibrosis Following Operative Fixation of Tibial Spine Fractures |
| title_short | To Manipulate or Not? Management of Pediatric Knee Arthrofibrosis Following Operative Fixation of Tibial Spine Fractures |
| title_sort | to manipulate or not management of pediatric knee arthrofibrosis following operative fixation of tibial spine fractures |
| topic | Arthrofibrosis Tibial spine fracture Manipulation under anesthesia Trauma |
| url | http://www.sciencedirect.com/science/article/pii/S2768276524009489 |
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