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Open Debridement and Soft Tissue Release as a Salvage Procedure for the Severely Arthrofibrotic Knee

Peter J. Millett, MD, MSc, Riley J. Williams, III, MD and Thomas L. Wickiewicz, MD

The Sports Medicine and Shoulder Service, The Hospital for Special Surgery, Cornell University Medical College, New York, New York

Presented at the 65th annual meeting of the American Academy of Orthopaedic Surgeons, March 1998, New Orleans, Louisiana.

Address correspondence and reprint requests to Peter J. Millett, MD, MSc, The Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021

Postoperative loss of knee motion is a well-recognized phenomenon. This paper reports our results with open debridement and soft tissue release as a salvage procedure in the treatment of patients with severe arthrofibrosis on whom arthroscopic surgical techniques had failed. Eight knees (eight patients) were identified retrospectively. There were four men and four women; mean age was 29 years. All had severely restricted motion with extensive intraarticular and periarticular fibrosis. Range of motion averaged 62.5° preoperatively (flexion 81°, loss of extension 18.8°). Patients underwent open debridement and soft tissue release to restore motion. There were no complications. Motion improved to an average of 124° after surgery. Average flexion improved from 81° to 125°. Loss of extension improved from 18.8° to 1.25°. Functional outcome was good, with Lysholm II scores averaging 79. Patient satisfaction was high. There was a high incidence of patellofemoral arthritis at follow-up. Furthermore, the patellar tendon shortened approximately 6 mm over time. While we do not advocate open debridement and soft tissue release as a first-line treatment for arthrofibrosis, we do conclude that it can be effective as a salvage procedure to restore motion in the profoundly arthrofibrotic knee.

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