Arthrofibrosis

from Wikipedia, the free encyclopedia
Classification according to ICD-10
M24.6 Arthrofibrosis
ICD-10 online (WHO version 2019)

A arthrofibrosis ( ancient Greek ἄρθρον Arthron , German , joint ' and Latin Fibra , fiber') is the name for a pathological proliferation of connective tissue ( fibrosis ), due to inflammatory processes within a joint (intra-articularly). It is a common complication after arthroscopic interventions in the knee joint , especially after reconstruction of the anterior cruciate ligament , but also after the implantation of knee joint endoprostheses.

A distinction is made between primary arthrofibrosis , which affects the entire joint, and local secondary arthrofibrosis .

etiology

While the causes that lead to primary arthrofibrosis are still largely unclear, the pathomechanisms that lead to secondary arthrofibrosis are well known.

The secondary form occurs locally in the knee joint and is usually the result of a mechanical problem, for example an incorrectly placed transplant or drill channel, or interference screws reaching into the joint space .

The restriction of movement caused by arthrofibrosis can lead to a greater handicap of the patient than the insufficiency in the knee joint that indicates the intervention (cruciate ligament reconstruction).

Incidence

The reported incidence of arthrofibrosis after anterior cruciate ligament reconstruction is in the range of 4 to 35 percent. The incidence of postoperative restriction of the extensibility of the knee joint after BTB reconstruction of the anterior cruciate ligament is over 10 percent.

Secondary arthrofibrosis

Arthroscopic image of a cyclops in a patient's knee.
A cyclops is secondary arthrofibrosis.

The secondary forms of arthrofibrosis include the cyclops syndrome , transplant hypertrophy in the case of impingement of the cruciate ligament cavity ( notch impingement ) and the formation of bridges inside and outside the joint body. In around 2 percent of all patients, after a cruciate ligament reconstruction, a cyclops is the cause of a loss of mobility when extending the knee joint. The volume of the transplant increases so much that a scar formation at the distal attachment causes a stretch deficit. In such cases, the cyclops is usually removed surgically.

therapy

Depending on the type of arthrofibrosis, specific treatment is given. The secondary form can be treated well by arthroscopy in most cases, while the primary form often involves several open operations ( debridement and capsulotomy ). The primary form of arthrofibrosis can usually not be successfully treated only arthroscopically - even with physiotherapeutic support.

Prevention

Some studies have shown that the risk of arthrofibrosis can be significantly reduced by delayed reconstruction - more than three weeks after the rupture of the cruciate ligament. Other studies, however, could not find any difference.

See also

Arthrofibrosis after knee arthroplasty

Individual evidence

  1. ↑ U. Bosch et al.: Arthrofibrosis - A chronic inflammatory process? In: Arthoskopie 12, 1999, pp. 117-120. doi : 10.1007 / s001420050084
  2. ^ T. Weig: Restriction of movement after anterior cruciate ligament reconstruction (analysis of causes, therapy results). Dissertation, LMU Munich, 2002
  3. ↑ SM Howell et al: A rationale for predicting anterior cruciate graft impingement by the intercondylar roof. In: Am J Sports Med 19, 1991, pp. 276-282. PMID
  4. ↑ KD Shelbourne et al.: Classification and management of arthrofibrosis of the knee after anterior cruciate ligament reconstruction. In: Am J Sports Med 24, 1996, pp. 857-862. PMID 8947412
  5. ↑ a b c K. E. DeHaven et al.: Arthrofibrosis of the knee following ligament surgery. In: Instr Course Lect 52, 2003, pp. 369-381. PMID 12690864 (Review)
  6. ↑ a b P. Rillmann et al.: Arthrofibrosis after early anterior cruciate ligament reconstruction . In: Arthoskopie 12, 1999, pp. 260-267. doi : 10.1007 / s001420050135
  7. ↑ J. Mauch: Results after anterior cruciate ligament surgery with the Semitendinosus Gracilis 4-bundle technique , dissertation, Albert-Ludwigs-Universität Freiburg im Breisgau, 2007
  8. ^ P. Lobenhoffer and H. Tscherne: The rupture of the anterior cruciate ligament. Today's treatment status. In: Unfallchirurg 96, 1993, pp. 150-154.
  9. ↑ a b P. Lobenhoffer et al.: Operative therapy of arthrofibrosis. In: Arthoskopie 12, 1999, pp. 252-259. doi : 10.1007 / s001420050134
  10. ^ J. Wang and Y. Ao: Analysis of different kinds of cyclops lesions with or without extension loss. In: Arthroscopy 25, 2009, pp. 626-631. PMID 19501293
  11. ↑ M. Immendörfer: 5-year results after hamstring VKB plastic with titanium interference screw fixation near the joint: does the technology meet the requirements of early functional rehabilitation? Dissertation, University of Hamburg, 2008
  12. ^ Arthrofibrosis from ACL Injuries. Wheeless' Textbook of Orthopedics
  13. ^ DW Jackson and RK Schaefer: Cyclops syndrome: loss of extension following intra-articular anterior cruciate ligament reconstruction. In: Arthroscopy 6, 1990, pp. 771-778. PMID 2206179
  14. ^ S. Kesting: Patellar tendon versus semitendinosus / gracilis tendon as a replacement for reconstructing the anterior cruciate ligament - 5-year results of a randomized group of patients - a clinical study. Dissertation, University Hospital Münster, 2008
  15. ↑ KD Shelbourne et al.: Arthrofibrosis in acute anterior cruciate ligament reconstruction. The effect of timing of reconstruction and rehabilitation. In: Am J Sports Med 19, 1991, pp. 332-336. PMID 1897645
  16. ↑ M. Schuhmacher: Changes in selected parameters of the knee joint mechanics before and after surgical replacement of the anterior cruciate ligament with different surgical techniques. (PDF) Dissertation, German Sport University Cologne, 2007
  17. ↑ AJ Cosgarea include: Prevention of arthrofibrosis after anterior cruciate ligament reconstruction using the central third patellar tendon autograft. In: Am J Sports Med 23, 1995, pp. 87-92. PMID 7726357
  18. ↑ M. Fenzl and C. Mucha: Results of a comparative study on the follow-up treatment method and the optimal time for surgery after an anterior cruciate ligament tear In: Phys Rehab Kur Med 8, 1998, pp. 123-127. doi : 10.1055 / s-2008-1061836
  19. ^ TO Smith et al.: Early versus delayed surgery for anterior cruciate ligament reconstruction: a systematic review and meta-analysis. In: Knee Surgery, Sports Traumatology, Arthroscopy 18, 2010, pp. 304-311. PMID 19838672 (Review)