Etiopathology and Management of Stiff Knees: A Current Concept Review
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REVIEW ARTICLE
Etiopathology and Management of Stiff Knees: A Current Concept Review Abhishek Vaish1 · Raju Vaishya1 · Vishwa Bandhu Bhasin2 Received: 27 August 2020 / Accepted: 5 October 2020 © Indian Orthopaedics Association 2020
Abstract Background Knee stiffness after trauma, fracture fixation, arthroscopic surgery, infection, and knee arthroplasty is a known complication, which is challenging to manage and causes significant disability to the patients. Methods We did a comprehensive search on the stiff knees, in the last week of May 2020, from the search engines of PubMed, SCOPUS, Google Scholar, and Research Gates using the appropriate keywords. Results We found two types of articles related to knees stiffness: (a) following trauma, internal and external fixation of fractures and arthroscopic surgery, and (b) following total knee arthroplasty. Arthroscopic surgery was found to be a favored mode of management of stiff knees in both of the above groups. The Manipulation under Anesthesia (MUA) was also found effective if done carefully and in the early course of the stiffness. Conclusion Knee stiffness due to any cause is a trouble proposition to both patients and treating surgeons. Various methods of management have been described to deal with knee stiffness. Amongst the operative treatment, MUA and arthroscopic surgery were found to be the most effective. Arthroscopic surgery offers a good option of release stiff knees in the majority of cases, and it is most valuable and effective if done earlier in the course of the stiffness (preferably between 3 and 6 months). Keywords Stiff knees · Ankylosis · Arthrolysis · Arthroscopy · Injuries · Arthroplasty
Introduction Knee stiffness or ankylosis is not an uncommonly seen condition in clinical practice. The reported incidence of intraarticular fibrosis of the knee varies from 4 to 35% [1]. It is common (14.5%) after traumatic knee injuries (of the knee) and external fixation of the fractures [2]. The problem of knee stiffness has been studied extensively after the knee surgery like anterior cruciate ligament (ACL) reconstruction and total knee arthroplasty (TKA). It may or may not
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s43465-020-00287-0) contains supplementary material, which is available to authorized users. * Abhishek Vaish [email protected] 1
Department of Orthopaedics, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi 110076, India
Department of Orthopaedics, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi 1100060, India
2
be associated with pain and is usually a significant cause of disability to the patient and challenging to treat. A full range of motion is required for a normal gait and function of the knee, and hence the knee stiffness due to any cause could lead to pain and functional disability [3]. The common underlying causes of knee stiffness are injuries, infection, and surgery, on and around the knee joint (Table 1). The site and pathology of lesions in these
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