Limited range of motion is frequently observed following intra- or periarticular fractures of the knee. What do you consider special about this entity in comparison to other types of arthrofibrosis? What are your criteria to indicate revision surgery and how do you address arthrofibrosis? What time point following fracture treatment is best to perform revision surgery?
This is a very difficult question. The "simple" answer would be that arthrolysis is rarely indicated in the era of joint replacement surgery. But the context of the question is different. It is well known that exact and perfect reduction of intraarticular fractures of the knee is not always possible. Haemarthrosis, loose bone fragments, soft-tissue damage, malunion, etc. make the recovery of optimal ROM problematic. In any case early kinesitherapy should be initiated as soon as possible. Close follow of the development of joint mobility is advisable too. In my opinion revision surgery (incl. arthrolysis) should be decided individually from case to case.Of course, haemarthrosis should be treated early on emergency base.
In any case, fracture healing should be the primary goal. When the fracture heals and the ROM is unacceptable, then there is a vast range of options including arthrolysis, arthrodesis, and last but not least TKA.
Thanks for your comprehensive statement. I absolutely agree that consolidation of the fracture certainly represents the primary goal in periarticular fractures. Nevertheless, there are some studies that show inferior results of surgical mobilization incl. arthrolysis in cases in which this is performed delayed, so that recommendation of these authors is to perform this within 12 months after surgery ... I personally believe this makes sense ...
I would agree with an aproximate 12 - months - period for arthrolysis. Trying to fix a more exact timing I would recommend an eventual arthrolysis to be performed as soon as the healing process has advanced to reliable consolidation.
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