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      Efficacy of non-operative treatment of patients with knee arthrofibrosis using high-intensity home mechanical therapy: a retrospective review of 11,000+ patients

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          Abstract

          Background

          Recovery from knee surgery or injury can be hindered by knee arthrofibrosis, which can lead to motion limitations, pain and delayed recovery. Surgery or prolonged physical therapy are often treatment options for arthrofibrosis, but they can result in increased costs and decreased quality of life. A treatment option that can regain lost motion without surgery would help minimize risks and costs for the patient. The purpose of this study was to determine treatment efficacy of high-intensity home mechanical stretch therapy in patients with knee arthrofibrosis.

          Methods

          Records were reviewed for 11,000+ patients who were prescribed a high-intensity stretch device to regain knee flexion. Initial and last recorded knee flexion and days between measurements were available for 9842 patients (Dataset 1). Dataset 2 was a subset of 966 patients from Dataset 1. These 966 patients had separate more rigorous measurements available from physical therapy notes (Dataset 3) in addition to data from the internal database (Dataset 2). Within and between dataset statistics were calculated using t tests for comparison of means and Cohen’s d for determination of effect size.

          Results

          All dataset showed significant gains in flexion ( p < 0.01). Mean initial flexion, last recorded flexion and flexion gain were 79.5°, 108.4°, and 29.9°, respectively in Dataset 1. Differences between Datasets 2 and 3 had small effect sizes (Cohen’s d < 0.17). The were no significant differences when comparing workers’ compensation and non-workers’ compensation patients. The average last recorded flexion for all datasets was above the level required to perform activities of daily living. Motion gains were recorded in under 60 days from device delivery.

          Conclusions

          High-intensity home mechanical stretch therapy was effective in restoring knee flexion, generally in 2 months or less, and in avoiding additional surgery in severe motion loss patients regardless of sex, age, or workers’ compensation status. We believe high-intensity stretching should be considered in any patient who is at risk for a secondary motion loss surgery, because in over 90% of these patients, the complications and costs associated with surgery can be avoided.

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          Most cited references40

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          Rates of Total Joint Replacement in the United States: Future Projections to 2020–2040 Using the National Inpatient Sample

          To project future total hip and knee joint arthroplasty (THA, TKA) use in the United States to 2040. We used the 2000–2014 US National Inpatient Sample (NIS) combined with Census Bureau data to develop projections for primary THA and TKA from 2020 to 2040 using polynomial regression to account for the nonlinearity and interactions between the variables, assuming the underlying distribution of the number of THA/TKA to be Poisson distributed. We performed sensitivity analyses using a negative binomial regression to account for overdispersion. Predicted total annual counts (95% prediction intervals) for THA in the United States by 2020, 2025, 2030, and 2040 are (in thousands): 498 (475, 523), 652 (610, 696), 850 (781, 925), and 1429 (1265, 1615), respectively. For primary TKA, predicted total annual counts for 2020, 2025, 2030, and 2040 are (in thousands): 1065 (937, 1211), 1272 (1200, 1710), 1921 (1530, 2410), and 3416 (2459, 4745), respectively. Compared to the available 2014 NIS numbers, the percent increases in projected total annual US use for primary THA and TKA in 2020, 2025, 2030, and 2040 are as follows: primary THA, by 34%, 75%, 129%, and 284%; and primary TKA, 56%, 110%, 182%, and 401%, respectively. Primary THA and TKA use is projected to increase for both females and males, in all age groups. Significant increases in use of THA and TKA are expected in the United States in the future, if the current trend continues. The increased use is evident across age groups in both females and males. A policy change may be needed to meet increased demand.
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            Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006.

            This study was proposed to investigate the changes in the utilization of knee arthroscopy in an ambulatory setting over the past decade in the United States as well as its implications. The National Survey of Ambulatory Surgery, last carried out in 1996, was conducted again in 2006 by the Centers for Disease Control and Prevention. We analyzed the cases with procedure coding indicative of knee arthroscopy or anterior cruciate ligament reconstruction. To produce estimates for all arthroscopic procedures on the knee in an ambulatory setting in the United States for each year, we performed a design-based statistical analysis. The number of arthroscopic procedures on the knee increased 49% between 1996 and 2006. While the number of arthroscopic procedures for knee injury had dramatically increased, arthroscopic procedures for knee osteoarthritis had decreased. In 1996, knee arthroscopies performed in freestanding ambulatory surgery centers comprised only 15% of all orthopaedic procedures, but the proportion increased to 51% in 2006. There was a large increase in knee arthroscopy among middle-aged patients regardless of sex. In 2006, >99% of arthroscopic procedures on the knee were in an outpatient setting. Approximately 984,607 arthroscopic procedures on the knee (95% confidence interval, 895,999 to 1,073,215) were performed in an outpatient setting in 2006. Among those, 127,446 procedures (95% confidence interval, 95,124 to 159,768) were for anterior cruciate ligament reconstruction. Nearly 500,000 arthroscopic procedures were performed for medial or lateral meniscal tears. This study revealed that the knee arthroscopy rate in the United States was more than twofold higher than in England or Ontario, Canada, in 2006. Our study found that nearly half of the knee arthroscopic procedures were performed for meniscal tears. Meniscal damage, detected by magnetic resonance imaging, is commonly assumed to be the source of pain and symptoms. Further study is imperative to better define the symptoms, physical findings, and radiographic findings that are predictive of successful arthroscopic treatment.
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              Knee joint kinematics in gait and other functional activities measured using flexible electrogoniometry: how much knee motion is sufficient for normal daily life?

              The knee joint kinematics of a group (n=20) of elderly normal subjects (mean age=67 years) were investigated using flexible electrogoniometry. The flexion-extension angle of the knee was recorded during a range of functional activities performed as part of a circuit in and around the hospital. The functions analysed including gait, walking on slopes, stair negotiation, the use of standard and low chairs and a bath. The data were used to produce the pattern of joint angulation against the percentage of the cycle for each individual conducting each activity. Further the maximum and minimum knee joint angles and the excursion of the joint during the cycle were identified. The results indicate gait and slopes require less than 90 degrees of knee flexion, stairs and chairs 90-120 degrees of flexion and a bath approximately 135 degrees of flexion. The data suggests that 110 degrees of flexion would seem a suitable goal for the rehabilitation of motion in the knee. It is concluded that flexible electrogoniometry is a suitable and practical method for evaluating knee motion during a range of functional activities.
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                Author and article information

                Contributors
                stinton@gmail.com
                Journal
                J Orthop Surg Res
                J Orthop Surg Res
                Journal of Orthopaedic Surgery and Research
                BioMed Central (London )
                1749-799X
                6 July 2022
                6 July 2022
                2022
                : 17
                : 337
                Affiliations
                [1 ]ArthroResearch LLC, 441 Armour Place NE, Atlanta, GA USA
                [2 ]Ermi LLC, 2872 Woodcock Blvd. Suite 100, Atlanta, GA USA
                Article
                3227
                10.1186/s13018-022-03227-w
                9258139
                13133a63-d7be-4951-af9d-089433ba0fd6
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 6 May 2022
                : 21 June 2022
                Categories
                Research
                Custom metadata
                © The Author(s) 2022

                Surgery
                arthrofibrosis,knee stiffness,mechanical therapy,non-operative treatment,high-intensity
                Surgery
                arthrofibrosis, knee stiffness, mechanical therapy, non-operative treatment, high-intensity

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