The effect of manipulation under anesthesia on knee kinematics in individuals with arthrofibrosis after anterior cruciate ligament reconstruction
Abstract Background Manipulation under anesthesia (MUA) has been recommended for refractory arthrofibrosis after anterior cruciate ligament (ACL) reconstruction. However, the effectiveness of MUA to restore normal kinematics of the arthrofibrotic knee is still unclear. The objective of this study wa...
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BMC
2024-11-01
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| Series: | Journal of Orthopaedic Surgery and Research |
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| Online Access: | https://doi.org/10.1186/s13018-024-05159-z |
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| author | Ling Zhang Shuai Fan Xuan Zhao Ye Luo Bin Cai Shao-bai Wang |
| author_facet | Ling Zhang Shuai Fan Xuan Zhao Ye Luo Bin Cai Shao-bai Wang |
| author_sort | Ling Zhang |
| collection | DOAJ |
| description | Abstract Background Manipulation under anesthesia (MUA) has been recommended for refractory arthrofibrosis after anterior cruciate ligament (ACL) reconstruction. However, the effectiveness of MUA to restore normal kinematics of the arthrofibrotic knee is still unclear. The objective of this study was to evaluate tibiofemoral and patellofemoral kinematics in six degrees-of-freedom (6DOF) in patients with arthrofibrosis before and after MUA. Methods Computed tomography and dual fluoroscopic imaging system were used to assess in vivo knee kinematics. Ten patients (6 women and 4 men; 32.6 ± 6.5y, 168.4 ± 7.8 cm, 61.8 ± 13.2 kg) were included in this study. The tibiofemoral and patellofemoral kinematics in 6DOF were collected before and one year after MUA. A simple analysis of variance was used to evaluate kinematic data of preoperative arthrofibrotic knee, postoperative arthrofibrotic knee, and the contralateral knee. Results The patella in the postoperative arthrofibrotic knee shifted significantly more inferiorly compared to the preoperative knee at 45° (P = 0.010), 60° (P = 0.008), and 75° (P = 0.049) of flexion. The patellar flexion in the postoperative arthrofibrotic knee significantly increased at 45° (P = 0.048), 60° (P = 0.037), and 75° (P = 0.006) of flexion compared to the preoperative arthrofibrotic knee. The patellar tilt was significantly decreased at 60° (P = 0.006) and at 75° (P = 0.037) of knee flexion in the postoperative arthrofibrotic knee compared to the contralateral knee. MUA significantly increased tibial internal rotation angle in the arthrofibrotic knee at 45° (P = 0.047), at 60° (P = 0.033), and at 75° (P = 0.021) of knee flexion. Conclusions MUA could restore normal patellar inferior shift, flexion, and tibial rotation compared to the contralateral side. However, the MUA could not restore normal patellar tilt of the arthrofibrotic knee. This indicated that improvement of patellar tilt should be emphasized in postoperative rehabilitation. |
| format | Article |
| id | doaj-art-19df85b80d9b40228eb06935e3dc2033 |
| institution | OA Journals |
| issn | 1749-799X |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMC |
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| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj-art-19df85b80d9b40228eb06935e3dc20332025-08-20T02:13:32ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2024-11-011911910.1186/s13018-024-05159-zThe effect of manipulation under anesthesia on knee kinematics in individuals with arthrofibrosis after anterior cruciate ligament reconstructionLing Zhang0Shuai Fan1Xuan Zhao2Ye Luo3Bin Cai4Shao-bai Wang5School of Exercise and Health, Shanghai University of SportDepartment of Rehabilitation Medicine, Ninth People’s Hospital, Shanghai Jiao Tong University School of MedicineSchool of Exercise and Health, Shanghai University of SportSchool of Exercise and Health, Shanghai University of SportDepartment of Rehabilitation Medicine, Ninth People’s Hospital, Shanghai Jiao Tong University School of MedicineSchool of Exercise and Health, Shanghai University of SportAbstract Background Manipulation under anesthesia (MUA) has been recommended for refractory arthrofibrosis after anterior cruciate ligament (ACL) reconstruction. However, the effectiveness of MUA to restore normal kinematics of the arthrofibrotic knee is still unclear. The objective of this study was to evaluate tibiofemoral and patellofemoral kinematics in six degrees-of-freedom (6DOF) in patients with arthrofibrosis before and after MUA. Methods Computed tomography and dual fluoroscopic imaging system were used to assess in vivo knee kinematics. Ten patients (6 women and 4 men; 32.6 ± 6.5y, 168.4 ± 7.8 cm, 61.8 ± 13.2 kg) were included in this study. The tibiofemoral and patellofemoral kinematics in 6DOF were collected before and one year after MUA. A simple analysis of variance was used to evaluate kinematic data of preoperative arthrofibrotic knee, postoperative arthrofibrotic knee, and the contralateral knee. Results The patella in the postoperative arthrofibrotic knee shifted significantly more inferiorly compared to the preoperative knee at 45° (P = 0.010), 60° (P = 0.008), and 75° (P = 0.049) of flexion. The patellar flexion in the postoperative arthrofibrotic knee significantly increased at 45° (P = 0.048), 60° (P = 0.037), and 75° (P = 0.006) of flexion compared to the preoperative arthrofibrotic knee. The patellar tilt was significantly decreased at 60° (P = 0.006) and at 75° (P = 0.037) of knee flexion in the postoperative arthrofibrotic knee compared to the contralateral knee. MUA significantly increased tibial internal rotation angle in the arthrofibrotic knee at 45° (P = 0.047), at 60° (P = 0.033), and at 75° (P = 0.021) of knee flexion. Conclusions MUA could restore normal patellar inferior shift, flexion, and tibial rotation compared to the contralateral side. However, the MUA could not restore normal patellar tilt of the arthrofibrotic knee. This indicated that improvement of patellar tilt should be emphasized in postoperative rehabilitation.https://doi.org/10.1186/s13018-024-05159-zKneeLoss of motionReleaseDual fluoroscopic systemRehabilitation |
| spellingShingle | Ling Zhang Shuai Fan Xuan Zhao Ye Luo Bin Cai Shao-bai Wang The effect of manipulation under anesthesia on knee kinematics in individuals with arthrofibrosis after anterior cruciate ligament reconstruction Journal of Orthopaedic Surgery and Research Knee Loss of motion Release Dual fluoroscopic system Rehabilitation |
| title | The effect of manipulation under anesthesia on knee kinematics in individuals with arthrofibrosis after anterior cruciate ligament reconstruction |
| title_full | The effect of manipulation under anesthesia on knee kinematics in individuals with arthrofibrosis after anterior cruciate ligament reconstruction |
| title_fullStr | The effect of manipulation under anesthesia on knee kinematics in individuals with arthrofibrosis after anterior cruciate ligament reconstruction |
| title_full_unstemmed | The effect of manipulation under anesthesia on knee kinematics in individuals with arthrofibrosis after anterior cruciate ligament reconstruction |
| title_short | The effect of manipulation under anesthesia on knee kinematics in individuals with arthrofibrosis after anterior cruciate ligament reconstruction |
| title_sort | effect of manipulation under anesthesia on knee kinematics in individuals with arthrofibrosis after anterior cruciate ligament reconstruction |
| topic | Knee Loss of motion Release Dual fluoroscopic system Rehabilitation |
| url | https://doi.org/10.1186/s13018-024-05159-z |
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