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Both arthroscopic and open posterior knee capsulotomy are effective in terms of extension recovery and functional improvement—systematic review

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To assess the recovery of extension and improvement in functional scores after an arthroscopic or open posterior knee capsulotomy in the setting of an extension deficit.

Methods

A systematic search of articles published between 1980 and 2020 was performed in the MEDLINE/PubMed database, EMBASE/Ovid database and Web of Science database. The inclusion criteria consisted of patients with primary extension deficits > 5° who underwent an arthroscopic or open posterior knee capsulotomy. The assessed outcomes were preoperative and postoperative range of motion and functional outcome scores. Randomized controlled trials, cohort studies and case series with a follow-up longer than 6 months were included. The risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool for case series. The certainty of evidence was assessed using the GRADE approach.

Results

Of 226 records identified through database searching, 7 studies were included in the final analysis. The outcomes of 107 patients with a mean age of 34.1 (range 15–63) years were available. In all the included studies, a posterior capsulotomy resulted in the restoration of knee extension to normal or nearly normal values (mean postoperative extension deficit: 0.4–4.2 degrees) with a significant increase in functional outcome scores. No neurovascular complications were reported within the studies. Due to the diverse methodology of studies, the direct comparison of arthroscopic versus open approaches was not possible. Concerning the risk of bias assessment, the greatest concerns raised the selection of participants among the included studies and the methods of outcome measurement. The certainty of evidence was very low according to the GRADE.

Conclusions

Both arthroscopic and open posterior capsulotomy of the knee results in restoration of normal or nearly normal knee extension and significant improvement in functional outcomes.

Level of evidence

IV.

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Abbreviations

ACL:

Anterior Cruciate Ligament

GRADE:

Grading of Recommendation, Assessment, Development and Evaluation

VAS:

Visual Analogue Pain Scale

dMCL:

Deep Medial Collateral Ligament

IKDC:

International Knee Documentation Committee Score

KOOS:

Knee Injury and Osteoarthritis Outcome Score

PCL:

Posterior Cruciate Ligament

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Funding

This research received no external funding.

Author information

Authors and Affiliations

  1. Artromedical Orthopaedic Clinic, Antracytowa 1, 97-400, Belchatow, Poland

    Michał Ebisz & Konrad Malinowski

  2. Orthopedic and Trauma Department, Veteran’s Memorial Teaching Hospital in Lodz, Medical University of Lodz, Zeromskiego 113, 90-549, Lodz, Poland

    Marcin Mostowy

  3. ORTIM Orthopaedic Clinic, Mlynowa 17, 15-568, Bialystok, Poland

    Adrian Góralczyk

  4. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101, Bruderholz, Switzerland

    Michael T. Hirschmann

  5. University of Basel, CH-4051, Basel, Switzerland

    Michael T. Hirschmann

  6. Department of Orthopaedic, Trauma Surgery S. Zeromski Hospital, Os. Na Skarpie 66, 31-913, Krakow, Poland

    Paweł Skowronek

  7. Twin Cities Orthopedics, 4010 W 65th St Edina, Minnesota, 55435, USA

    Robert F. LaPrade

Authors
  1. Michał Ebisz
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  2. Marcin Mostowy
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  3. Adrian Góralczyk
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  4. Michael T. Hirschmann
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  6. Robert F. LaPrade
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  7. Konrad Malinowski
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Contributions

Conceptualization: M. and KM; methodology: ME; investigation: ME and MM; writing—original draft preparation: ME, MM and AG; writing—review and editing: KM, PS, MH and RFL; supervision: KM, PS, MH and RFL.

Corresponding author

Correspondence to Konrad Malinowski.

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Conflict of interest

Michał Ebisz, Marcin Mostowy, Adrian Góralczyk, Michael T. Hirschmann and Paweł Skowronek declare that they have no competing interests. Robert F. LaPrade serves as a Consultant and receives royalties from Arthrex, Ossur and Smith and Nephew; Editorial Boards of AJSM, JEO and KSSTA. K. Malinowski serves as a Zimmer Biomet consultant; PTArtro Board.

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Not applicable (The article is a systematic review of the previously published literature and as far as we are concerned does not require the ethical approval statement).

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Ebisz, M., Mostowy, M., Góralczyk, A. et al. Both arthroscopic and open posterior knee capsulotomy are effective in terms of extension recovery and functional improvement—systematic review. Knee Surg Sports Traumatol Arthrosc 30, 1443–1452 (2022). https://doi.org/10.1007/s00167-021-06634-4

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  • DOI: https://doi.org/10.1007/s00167-021-06634-4

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