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superior pole of the patella. Arthrofibrosis Arthrofibrosis is defined as knee stiffness after TKA, which is a serious complication. The loss of movement, mainly in extension, is poorly tolerated, especially in younger and more active
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Casa di Cura Villa Betania, Rome, Italy
Marrelli Hospital, Crotone, Italy
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The posterior oblique ligament (POL) is the predominant ligamentous structure on the posterior medial corner of the knee joint. A thorough understanding of the anatomy, biomechanics, diagnosis, treatment and rehabilitation of POL injuries will aid orthopaedic surgeons in the management of these injuries.
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The resulting rotational instability, in addition to valgus laxity, may not be tolerated by athletes participating in pivoting sports. The most common mechanism of injury – accounting for 72% of cases – is related to sports activity, particularly football, basketball and skiing. Moreover, three different injury patterns have been reported: those associated with injury to the capsular arm of the semimembranosus (SM), those involving a complete peripheral meniscal detachment and those involving disruption of the SM and peripheral meniscal detachment.
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The hallmark of an injury related to POL lesions is the presence of anteromedial rotatory instability (AMRI), which is defined as ‘external rotation with anterior subluxation of the medial tibial plateau relative to the distal femur’.
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In acute settings, POL lesions can be easily identified using coronal and axial magnetic resonance imaging (MRI) where the medial collateral ligament (MCL) and POL appear as separate structures. However, MRI is not sensitive in chronic cases.
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Surgical treatment of the medial side leads to satisfactory clinical results in a multi-ligamentous reconstruction scenario, but it is known to be associated with secondary stiffness.
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In young patients with high functional demands, return to sports is allowed no earlier than 9–12 months after they have undergone a thorough rehabilitation programme.
Cite this article: EFORT Open Rev 2021;6:364-371. DOI: 10.1302/2058-5241.6.200127
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% developing later due to ACL deficiency. 31 , 34 Arthrofibrosis - joint stiffness that prevents restoration of full range of motion (particularly the loss of the 5°to full extension) - has been associated with early ACL reconstruction. In a large
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will complain of pain, stiffness of the MTP joint and swelling. They may describe weakness in push-off. Clinical assessment begins with inspection of the great toe for swelling, ecchymosis or malalignment, as well as palpation of the collateral
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stiffness. No limits should be set in flexion-extension during bracing and early restitution of full knee extension should be the goal, especially in cases with injuries near the femoral insertion. Gradual return to sports after active quadriceps and
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systematically review and meta-analyze the reported complications of TKA following ACL reconstruction including wound complications, stiffness, infection, deep venous thrombosis (DVT), patellar crepitus, patella baja, nerve injury, extensor mechanism damage and
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suture anchors. A) Bony avulsion of MCL: Femoral avulsion of the sMCL leaves the best tissue for repair using suture anchors, staples, or a screw and washer. However, repair in this location is associated with postoperative stiffness more than in other
Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research – IdiPAZ (La Paz University Hospital – Autonomous University of Madrid), Madrid, Spain
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remembered that allografts tolerate long periods of immobilization better than autografts. Johannesmeyer et al use an algorithm developed by Cosgarea et al to treat stiff knees. 10 , 14 Table 6. Prevention of arthrofibrosis after multiligamentous knee
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joint stiffness, neurovascular injuries and failure of the meniscus to heal ( Fig. 7 ). 73 The ‘inside-out’ techniques have been widely used for large repairs on the mid-body and posterior parts of the meniscus, but no differences have been
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damage is lower. However, acute surgery carries the risk of arthrofibrosis and knee stiffness. 3 , 21 , 24 If arthroscopic repair/reconstruction is undertaken acutely, a delay of 1–2 weeks to allow capsular healing is recommended to prevent fluid
