Loss of Motion
Knee
John Albright, MD
Orthopaedics UIHC
Conference
November 4, 2004
LOM Definition
• Harner (AJSM ’92)
– Extension <10 degrees
– Flexion < 125 degrees
• Shelbourne (ESSKA 99)
– Any symptomatic LOM
LOM Definition
• Shellbourne ESSKA ‘99
LOM Definition
• Arthrofibrosis
– LOM symptomatic
– Resistant to rehab measures
LOM Causes
• Poor Graft Placement
– Visually clear in extension
• Full Ext
– Graft loose
– Graft taught
LOM Causes
• Poor Graft Placement
• Poorly supervised rehab
LOM Causes
• Poor Graft Placement
• Poorly supervised rehab
– Low pain threshold
– Lack of Goal Understanding
– Prolonged immobilization
• Flexed knee splinting (30 degrees)
LOM Causes
• Poor Graft Placement
• Poorly supervised rehab
• Cyclops syndrome
LOM Causes
• Poor Graft Placement
• Poorly supervised rehab
• Cyclops syndrome
• Acute Surgery on Swollen knee
LOM Causes
• Poor Graft Placement
• Poorly supervised rehab
• Cyclops syndrome
• Acute Surgery on Swollen knee
• Reflex Sympathetic Dystrophy
– Silent Quad
– Hemarthrosis
LOM Causes
• Poor Graft Placement
• Poorly supervised rehab
• Cyclops syndrome
• Acute Surgery on Swollen knee
• Reflex Sympathetic Dystrophy
• Concomitant MCL repair
Arthrofibrosis Classification
Shellbourne ESSKA ‘99
Arthrofibrosis Classification
•
Type
•
1
•
Description
Ext < 10
Arthrofibrosis Classification
•
Type
•
1
2
•
Description
Ext < 10
Ext >10
Arthrofibrosis Classification
•
Type
•
1
2
3
•
Description
Ext < 10
Ext >10
Ext > 10
+ Flex 25 + Pat m-l
Arthrofibrosis Classification
•
Type
•
1
2
3
4
•
Description
Ext < 10
Ext >10
Ext > 10
+ Flex 25 + Pat M-L
Ext >10 + Flex 30 + Pat Infra
Treatment
• Prevention
– Extension
• Prone heel height <3cm (7-10 days)
– Flexion
• 90 in 7-10 days
– Pat mobility
• M-L
• Sup-Inf
Treatment
• Prevention
• Rehab
– Pain control
• Cryo Cuff
• NSAIDs
• E-Stim
Treatment
• Prevention
• Rehab
– Pain control
– Quad stimulation
– ROM
• Active
• Active assist
• Passive
Treatment
• Prevention
• Rehab
• Surgical intervention
– Closed manip
– Scope + manip
– Scope + M-L release + Manip
– Open Quadriceps plasty
– Posterior Capsule release
Quadricepsplasty
