Functional Outcomes and the Restoration of Range of Motion After the Arthroscopic Complete Posterior Knee Capsulotomy in Patients With Extension Deficit of the Knee

NCT ID: NCT05385393

Last Updated: 2023-07-24

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: NA
• Total Enrollment: 10 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2020-06-01
• Study Completion Date: 2025-06-01

Brief Summary

The restriction of the range of motion is one of the most frequently encountered complications after the surgical procedures of the knee. While the flexion deficit is relatively well tolerated, even the small extension deficit significantly impairs the quality of life due to the increased stress on the patellofemoral joint, functional leg length discrepancy and the subsequent mechanical overload in the hip joint, lumbar spine and contralateral knee. In the majority of cases the guided physiotherapy protocol is sufficient to restore the full range of motion. In refractory cases, the treatment consists of the thorough arthrolysis of the affected knee, aiming to excise the adhesions, osteophytes and orthopaedic implants interfering with the knee range of motion. However, as the extension deficit persists, the contracture of the knee posterior capsule may develop and the sole debridement of the knee may be insufficient. In such rare cases the treatment consists of the posterior capsulotomy of the affected joint. Traditionally, this procedure was performed through the open approach. However, with the growing indications toward the arthroscopic procedures seen in recent decades, even such salvage procedures like posterior knee capsulotomy are increasingly performed through the arthroscopic approach. The aim of this study is to assess the outcomes of the arthroscopic complete posterior capsulotomy of the knee basing on the knee range of motion and functional outcomes. The primary outcome consists of the knee extension, whereas the secondary outcomes include knee flexion, knee total range of motion, The International Knee Documentation Committee Questionnaire and the Knee injury and Osteoarthritis Outcome Score.

Conditions

Knee Disease; Knee Deformity

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Arthroscopic posterior capsulotomy of the knee

Group Type: EXPERIMENTAL

Arthroscopic posterior capsulotomy of the knee

Intervention Type: PROCEDURE

The arthroscopic posterior capsulotomy of the knee is performed according to the predefined surgical technique, which was described in detail in the following publication:

Malinowski K, Góralczyk A, Hermanowicz K, LaPrade RF, Więcek R, Domżalski ME. Arthroscopic Complete Posterior Capsulotomy for Knee Flexion Contracture. Arthrosc Tech. 2018 Oct 15;7(11):e1135-e1139. doi: 10.1016/j.eats.2018.07.008. PMID: 30533360; PMCID: PMC6262078.

Interventions

Arthroscopic posterior capsulotomy of the knee

The arthroscopic posterior capsulotomy of the knee is performed according to the predefined surgical technique, which was described in detail in the following publication:

Malinowski K, Góralczyk A, Hermanowicz K, LaPrade RF, Więcek R, Domżalski ME. Arthroscopic Complete Posterior Capsulotomy for Knee Flexion Contracture. Arthrosc Tech. 2018 Oct 15;7(11):e1135-e1139. doi: 10.1016/j.eats.2018.07.008. PMID: 30533360; PMCID: PMC6262078.

Intervention Type: PROCEDURE

Eligibility Criteria

Inclusion Criteria

• Above 18 years old,
• Symptomatic asymmetric extension deficit >3 degrees,
• Impossibility to restore the full knee extension after 6 months of guided physiotherapy.

Exclusion Criteria

• Restoration of full knee extension after the initial knee arthrolysis,
• Active knee inflammation,
• Non-adherence of the patient to the treatment protocol.
• Contractures due to extra-articular reasons,
• Less than 6 months since the last surgical procedure affected knee.

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Artromedical Konrad Malinowski Clinic

OTHER

Sponsor Role: lead

Responsible Party

Konrad Malinowski MD

Head of the Clinic

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

Artromedical Orthopaedic Clinic

Bełchatów, , Poland

Site Status: RECRUITING

Countries

Poland

Central Contacts

Konrad Malinowski, MD PhD

Role: CONTACT

malwin8@wp.pl

+48 509 812 212

Facility Contacts

Konrad Malinowski, MD PhD

Role: primary

malwin8@wp.pl

+48 509 812 212

References

Campbell TM, Trudel G. Knee Flexion Contracture Associated With a Contracture and Worse Function of the Contralateral Knee: Data From the Osteoarthritis Initiative. Arch Phys Med Rehabil. 2020 Apr;101(4):624-632. doi: 10.1016/j.apmr.2019.11.018. Epub 2020 Jan 7.

Reference Type: BACKGROUND

PMID: 31917195 (View on PubMed)

Campbell TM, Trudel G, Laneuville O. Knee flexion contractures in patients with osteoarthritis: clinical features and histologic characterization of the posterior capsule. PM R. 2015 May;7(5):466-73. doi: 10.1016/j.pmrj.2014.12.001. Epub 2014 Dec 12.

Reference Type: BACKGROUND

PMID: 25511691 (View on PubMed)

Lobenhoffer HP, Bosch U, Gerich TG. Role of posterior capsulotomy for the treatment of extension deficits of the knee. Knee Surg Sports Traumatol Arthrosc. 1996;4(4):237-41. doi: 10.1007/BF01567970.

Reference Type: BACKGROUND

PMID: 9046510 (View on PubMed)

Malinowski K, Goralczyk A, Hermanowicz K, LaPrade RF, Wiecek R, Domzalski ME. Arthroscopic Complete Posterior Capsulotomy for Knee Flexion Contracture. Arthrosc Tech. 2018 Oct 15;7(11):e1135-e1139. doi: 10.1016/j.eats.2018.07.008. eCollection 2018 Nov.

Reference Type: BACKGROUND

PMID: 30533360 (View on PubMed)

Murata Y, Takahashi K, Yamagata M, Hanaoka E, Moriya H. The knee-spine syndrome. Association between lumbar lordosis and extension of the knee. J Bone Joint Surg Br. 2003 Jan;85(1):95-9. doi: 10.1302/0301-620x.85b1.13389.

Reference Type: BACKGROUND

PMID: 12585585 (View on PubMed)

Tardy N, Thaunat M, Sonnery-Cottet B, Murphy C, Chambat P, Fayard JM. Extension deficit after ACL reconstruction: Is open posterior release a safe and efficient procedure? Knee. 2016 Jun;23(3):465-71. doi: 10.1016/j.knee.2016.01.001. Epub 2016 Feb 11.

Reference Type: BACKGROUND

PMID: 26875053 (View on PubMed)

Malinowski K, Mostowy M, Kozlak M, Pekala PA, Kennedy NI, LaPrade RF. Complete Arthroscopic Posterior Knee Capsulotomy in Patients With Knee Extension Deficit: Preliminary Results of a Clinical Trial. Orthop J Sports Med. 2023 Dec 1;11(12):23259671231203606. doi: 10.1177/23259671231203606. eCollection 2023 Dec.

Reference Type: DERIVED

PMID: 38045767 (View on PubMed)

Other Identifiers

1-pro-ar-2021

Identifier Type: -

Identifier Source: org_study_id