Arthroscopic release of the posterior compartments in the treatment of extension deficit of knee

Fibroarthrosis following knee injury or synovial disease is characterized by the presence of dense adhesions filling the entire joint cavity and the fibrotic involvement of periarticular structures. In this particular subset of knee stiffness, both the open and the arthroscopic treatment may fail not addressing all pathology. The aim of the present study was to evaluate the efficacy of an all-arthroscopic treatment for the flexion contractures addressing both the intra-articular posterior adhesions and the fibrotic periarticular structures. From 2003 through 2007, 18 patients of the knee underwent on arthroscopic posterior arthrolysis with release of both gastrocnemius tendons using the trans-septal technique. The median interval between the index procedure and the arthrolysis was 15 (4-22) months. Eight patients had a previous arthroscopic arthrolysis, performed in other hospitals, and two patients had two arthroscopic procedures after the index procedure which failed to regain the extension deficit. The passive extension deficit averaged 34A degrees preoperatively (16A degrees-44A degrees). Six patients underwent a two-staged procedure: the first surgery addressed the presence of adhesions in the suprapatellar pouch and the medial and/or lateral gutters, to regain the flexion of the knee. At final follow-up, the passive extension deficit averaged 3A degrees (0A degrees-5A degrees). In all patients, total knee arc of motion increased from 60A degrees (30A degrees-85A degrees) to 95A degrees (5A degrees-110A degrees). The trans-septal portal allows a safe approach of the posterior compartments and allows addressing pathology of both compartments and the release of gastrocnemius tendons.