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

Study Overview
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Brief Summary
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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.

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

Conditions
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Knee Disease, Knee Deformity

Intervention / Treatment
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* Procedure: Arthroscopic posterior capsulotomy of the knee


Participation Criteria
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Eligibility Criteria
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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.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Arthroscopic posterior capsulotomy of the knee<br> | Procedure: Arthroscopic posterior capsulotomy of the knee<br>* 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.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The extension of the knee | The extension of the knee will be measured with the goniometer with the patient lying supine. The hyperextension of the knee will be denoted as the negative value of knee extension. | Immediately after the surgery. | 
| The extension of the knee | The extension of the knee will be measured with the goniometer with the patient lying supine. The hyperextension of the knee will be denoted as the negative value of knee extension. | At the 3 month of the follow-up. | 
| The extension of the knee | The extension of the knee will be measured with the goniometer with the patient lying supine. The hyperextension of the knee will be denoted as the negative value of knee extension. | At the 6 month of the follow-up. | 
| The extension of the knee | The extension of the knee will be measured with the goniometer with the patient lying supine. The hyperextension of the knee will be denoted as the negative value of knee extension. | At the 12 month of the follow-up. | 
| The extension of the knee | The extension of the knee will be measured with the goniometer with the patient lying supine. The hyperextension of the knee will be denoted as the negative value of knee extension. | At the 24 month of the follow-up. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The flexion of the knee | The flexion of the knee will be measured with the goniometer with the patient lying supine. | Immediately after the surgery | 
| The flexion of the knee | The flexion of the knee will be measured with the goniometer with the patient lying supine. | At the 3 month of the follow-up. | 
| The flexion of the knee | The flexion of the knee will be measured with the goniometer with the patient lying supine. | At the 6 month of the follow-up. | 
| The flexion of the knee | The flexion of the knee will be measured with the goniometer with the patient lying supine. | At the 12 month of the follow-up. | 
| The flexion of the knee | The flexion of the knee will be measured with the goniometer with the patient lying supine. | At the 24 month of the follow-up. | 
| The range of motion of the knee | The range of motion of the knee will be measured with the goniometer with the patient lying supine as a difference between knee flexion and knee extension. | Immediately after the surgery | 
| The range of motion of the knee | The range of motion of the knee will be measured with the goniometer with the patient lying supine as a difference between knee flexion and knee extension. | At the 3 month of the follow-up. | 
| The range of motion of the knee | The range of motion of the knee will be measured with the goniometer with the patient lying supine as a difference between knee flexion and knee extension. | At the 6 month of the follow-up. | 
| The range of motion of the knee | The range of motion of the knee will be measured with the goniometer with the patient lying supine as a difference between knee flexion and knee extension. | At the 12 month of the follow-up. | 
| The range of motion of the knee | The range of motion of the knee will be measured with the goniometer with the patient lying supine as a difference between knee flexion and knee extension. | At the 24 month of the follow-up. | 
| The functional assessment with the International Knee Documentation Committee Questionnaire | Min of 0 max of 87 points, higher scores mean a better outcome | Immediately after the surgery. | 
| The functional assessment with the International Knee Documentation Committee Questionnaire | Min of 0 max of 87 points, higher scores mean a better outcome | At the 3 month of the follow-up. | 
| The functional assessment with the International Knee Documentation Committee Questionnaire | Min of 0 max of 87 points, higher scores mean a better outcome | At the 6 month of the follow-up. | 
| The functional assessment with the International Knee Documentation Committee Questionnaire | Min of 0 max of 87 points, higher scores mean a better outcome | At the 12 month of the follow-up. | 
| The functional assessment with the International Knee Documentation Committee Questionnaire | Min of 0 max of 87 points, higher scores mean a better outcome | At the 24 month of the follow-up. | 
| The functional assessment with the Knee injury and Osteoarthritis Outcome Score | Min of 0 max of 100 points, higher scores mean a better outcome | Immediately after the surgery | 
| The functional assessment with the Knee injury and Osteoarthritis Outcome Score | Min of 0 max of 100 points, higher scores mean a better outcome | At the 3 month of the follow-up. | 
| The functional assessment with the Knee injury and Osteoarthritis Outcome Score | Min of 0 max of 100 points, higher scores mean a better outcome | At the 6 month of the follow-up. | 
| The functional assessment with the Knee injury and Osteoarthritis Outcome Score | Min of 0 max of 100 points, higher scores mean a better outcome | At the 12 month of the follow-up. | 
| The functional assessment with the Knee injury and Osteoarthritis Outcome Score | Min of 0 max of 100 points, higher scores mean a better outcome | At the 24 month of the follow-up. |