ABSTRACT Loss of motion of the knee is a challenging dilemma to both the patient and the treating physician. The causes of arthrofibrosis are many but can usually be traced to a traumatic event, intra-articular/ligament knee surgery, knee arthroplasty, and possibly sepsis. Prevention is the best form of treatment, but when this entity does present, early recognition and a supervised physical therapy program are often successful. If conservative treatment fails, operative intervention is warranted. The purpose of this article is to discuss how to appropriately evaluate a patient with loss of knee motion, understand the pathogenesis and classification of arthrofibrosis, review our operative technique and postoperative management of these difficult patients, review the results in the literature concerning arthrofibrosis, and make the reader aware of possible concerns and the future direction of treatment of patients with arthrofibrosis.
Arthroscopic partial meniscectomies showed better clinical results with respect to complete meniscus removal, but at long-term follow-up a substantial number of patients suffer the effect of a lost meniscus cartilage. It is extremely important to preserve the meniscus as much as possible to avoid degenerative knee joint progression. During the 1980s Stone, Steadman and Rodkey developed a new collagen I scaffold to replace meniscus in the case of irreparable major tears: the CMI (Collagen Meniscus Implant). After 13 years of good results in implanting ReGen, Medial CMI, in 2006 we started a postmarketing study to evaluate the efficacy and effectiveness of an equivalent meniscal scaffold specifically designed to repair the lateral meniscal defect (ReGen, Lateral CMI). In this study, we describe indications for the implantation of a CMI device, the evolution of the surgical technique (from in-out arthroscopic suturing technique to all-inside arthroscopic scaffold implantation) in these 13 years of experience, and a short report of our clinical results.
Total knee arthroplasty is a very successful procedure in the treatment of end-stage osteoarthritis of the knee. However, the various components of the arthroplasty are interdependent, and correct spatial orientation in all 6 degrees of freedom is crucial for optimal functioning and longevity of the implant. In particular, the rotation of the femoral component is important for balancing the knee in flexion and for proper functioning of the patellofemoral joint. From a historical perspective, one can appreciate the evolution of the various techniques used to achieve correct alignment. This paper will discuss these various techniques, and will also highlight the various strengths and weaknesses of each. It is also possible that computer-aided surgery is the future of accurate component placement. We will discuss both the advantages and some of the drawbacks of using computer-aided navigation.
Osteotomy is a classic operation for the treatment of unicompartimental osteoarthrosis of the knee. It has often been presented as a possible alternative to prosthetic joint replacement, but the indications depend on the stage and articular diffusion of the degenerative changes, on the associated pathology, and on the patient's profile. These are very different, in most cases, from the indications of uni or total knee replacement. A relatively new technique in performing the open-wedge distal femoral osteotomy for the correction of the genu valgus will be illustrated here, with particular attention given to a “step by step” description of the details of operation.
