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

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 30; no. 4; pp. 1443 - 1452
• Main Authors: Ebisz, Michał, Mostowy, Marcin, Góralczyk, Adrian, Hirschmann, Michael T., Skowronek, Paweł, LaPrade, Robert F., Malinowski, Konrad
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-04-2022; Springer Nature B.V
• Subjects: Adolescent; Adult; Arthroscopy - methods; Bias; Clinical trials; Cohort Studies; Complications; Database searching; Humans; Joint Capsule Release; Joint replacement surgery; Joint surgery; Knee; Knee Joint - surgery; Ligaments; Medicine; Medicine & Public Health; Middle Aged; Neurological disorders; Orthopedics; Patients; Poliomyelitis; Range of motion; Range of Motion, Articular; Recovery; Recovery (Medical); Recovery of function; Restoration; Risk assessment; Sports Medicine; Systematic review; Trauma; Treatment Outcome; Young Adult; Knee; Extension deficit; Capsule release; Capsulotomy; Arthroscopy; Flexion contracture
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-021-06634-4

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.