Arthrofibrosis After Total Knee Arthroplasty: A Critical Analysis Review.

IF 1.7 Q2 SURGERY JBJS Reviews Pub Date : 2023-12-11 eCollection Date: 2023-12-01 DOI:10.2106/JBJS.RVW.23.00140
Michael S Ramos, Ignacio Pasqualini, Peter A Surace, Robert M Molloy, Matthew E Deren, Nicolas S Piuzzi
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Abstract

» Arthrofibrosis after total knee arthroplasty (TKA) is the new formation of excessive scar tissue that results in limited ROM, pain, and functional deficits.» The diagnosis of arthrofibrosis is based on the patient's history, clinical examination, absence of alternative diagnoses from diagnostic testing, and operative findings. Imaging is helpful in ruling out specific causes of stiffness after TKA. A biopsy is not indicated, and no biomarkers of arthrofibrosis exist.» Arthrofibrosis pathophysiology is multifactorial and related to aberrant activation and proliferation of myofibroblasts that primarily deposit type I collagen in response to a proinflammatory environment. Transforming growth factor-beta signaling is the best established pathway involved in arthrofibrosis after TKA.» Management includes both nonoperative and operative modalities. Physical therapy is most used while revision arthroplasty is typically reserved as a last resort. Additional investigation into specific pathophysiologic mechanisms can better inform targeted therapeutics.

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全膝关节置换术后关节纤维化:批判性分析综述。
"全膝关节置换术(TKA)后关节纤维化是指新形成的过度瘢痕组织导致活动度受限、疼痛和功能障碍"。关节纤维化的诊断基于患者的病史、临床检查、诊断测试中无其他诊断结果以及手术结果。影像学检查有助于排除导致 TKA 术后关节僵硬的特定原因。活组织检查不适用,也不存在关节纤维化的生物标记物"。关节纤维化的病理生理学是多因素的,与肌成纤维细胞的异常激活和增殖有关,肌成纤维细胞主要沉积 I 型胶原蛋白以应对促炎环境。转化生长因子-β信号传导是TKA术后关节纤维化的最佳途径"。治疗包括非手术和手术两种方式。最常用的是物理疗法,而翻修关节置换术通常是最后的选择。对特定病理生理机制的进一步研究可以更好地为靶向治疗提供依据。
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来源期刊
JBJS Reviews
JBJS Reviews SURGERY-
CiteScore
4.40
自引率
4.30%
发文量
132
期刊介绍: JBJS Reviews is an innovative review journal from the publishers of The Journal of Bone & Joint Surgery. This continuously published online journal provides comprehensive, objective, and authoritative review articles written by recognized experts in the field. Edited by Thomas A. Einhorn, MD, and a distinguished Editorial Board, each issue of JBJS Reviews, updates the orthopaedic community on important topics in a concise, time-saving manner, providing expert insights into orthopaedic research and clinical experience. Comprehensive reviews, special features, and integrated CME provide orthopaedic surgeons with valuable perspectives on surgical practice and the latest advances in the field within twelve subspecialty areas: Basic Science, Education & Training, Elbow, Ethics, Foot & Ankle, Hand & Wrist, Hip, Infection, Knee, Oncology, Pediatrics, Pain Management, Rehabilitation, Shoulder, Spine, Sports Medicine, Trauma.
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