Arthroscopy and joint stiffness

Definition

Joint stiffness is a limitation of extension or flexion amplitudes, whatever their origin. Physiologically, joint extension is complete, while flexion allows for the heel to come in contact with the buttocks. 

Etiology

Many pathologies may lead to a limitation of joint suppleness.
Advanced arthrosic knee injuries lead to a gradual loss of extension and flexing. This loss of mobility can be explained by a affection of the cartilage. Extreme injury involves the total disappearing of cartilaginous tissue from an area. Unfavourable mechanical results ensue, leading to certain bone structures' coming into contact with rough coating, thus limiting the mobility.

This arthrosic process will also create stiffness, caused by the foreign bodies it may release within the joint.

Thickening and fiber retraction of the synovial membrane may lead to a limitation of knee suppleness. These injuries may occur during the regression of traumatic bone and ligament injuries, an algodystrophy syndrome, or an insufficient post-operation re-education.

Clinical Symptoms

Apart from the symptoms linked to the original affection, stiffness may be defined as the impossibility of complete knee stretching (rectitude) or the limitation of flexing abilities as compared to a healthy limb. 

Evolution of ill-treated knee stiffness

How serious joint stiffness may be depends directly on etiology and the new mechanical conditions imposed upon the pathological joint (associated ligament injuries, cartilaginous destruction, fibrosis around the joint..).

Joint stiffness treatment is chiefly preventive (reducing scab inflammation processes, suitable re-education, preventing algodystrophy).

Whenever stiffness cannot be avoided through medical treatment, its prognosis is all the more serious as it gets older.

When the inflammation linked to the scab disappears, stiffness stabilises, creating a more or less important handicap, depending on the movement where suppleness is lost (stretching or flexing). If the patient finds this handicap unbearable, and once a suitable clinical and paraclinical checkup is done, a surgical solution may be suggested with the aim of regaining part of the lost joint mobility.

Surgical Treatment

Following certain specific indications, a knee arthrolysis through arthroscopy may be suggested to the patient. Arthrolysis consists in freeing and “peeling off” the sticking areas. This work is aimed at restituting, as much as possible, the knee’s sliding space.

Exploration also allows for verifying the totality of the intra-joint structures (evenness of cartilaginous surfaces, the state the ligaments are in, searching for foreign bodies).

Incapacity and rehabilitation

Temporary total incapacity depends on the origin of joint stiffness. It lasts longer for an arthroscopic menisectomy. The operation is always followed by re-education. 

Complications

Compared to arthroscopic menisectomy, arthroscopic arthrolysis naturally generates more important hydarthrosic and inflammatory reactions. Temporary total incapacity takes always longer than for an arthroscopy of meniscus injury or ablation of foreign bodies. 

Results

The expected amplitude increase depends on the length of time the stiffness has existed but also on its original pathology. A ten degree increase in stretching and an improvement of 20 to 30° in flexing can be considered as a good result for this type of surgery.

Arthroscopie et raideur articulaire