Name of the Procedure:

Posterior Capsular Release of the Knee Common name(s): Capsulotomy, Posterior Capsular Release

Summary

A posterior capsular release of the knee, or capsulotomy, is a surgical procedure to release tight or contracted knee joint tissues known as the posterior capsule. This helps improve knee motion and alleviate pain.

Purpose

This procedure addresses conditions where the posterior capsule of the knee is tight, limiting joint movement and causing pain. The primary goals are to increase knee range of motion, alleviate pain, and improve overall knee function.

Indications

• Limited knee range of motion due to scarring or stiffness (arthrofibrosis).
• Persistent knee pain not relieved by conservative treatments.
• Recovery from knee replacement surgery or injury where the posterior capsule has become overly tight.
• Diagnosed conditions like adhesive capsulitis affecting the knee.

Preparation

• Patients might need to fast for 6-8 hours before the procedure.
• Adjustments to medication may be required; for example, stopping blood thinners.
• Preoperative imaging tests, such as X-rays or MRI, may be conducted for surgical planning.
• Preoperative physical therapy to evaluate the extent of joint movement limitation.

Procedure Description

1. The patient is usually put under general or regional anesthesia.
2. The surgical site is cleaned and prepped in a sterile manner.
3. Small incisions are made around the knee.
4. Surgical instruments are inserted through the incisions to access the posterior capsule.
5. The posterior capsule is carefully incised or cut to release the tightness.
6. Once the desired range of motion is achieved, the incisions are closed with sutures.
7. A sterile dressing is applied to the surgical site.

Duration

The procedure typically lasts about 1-2 hours.

Setting

Usually performed in a hospital or an outpatient surgical center.

Personnel

• Orthopedic Surgeon
• Anesthesiologist or nurse anesthetist
• Surgical Nurses
• Physical Therapist (for postoperative care)

Risks and Complications

• Infection at the surgical site.
• Bleeding or hematoma.
• Damage to surrounding tissues or nerves.
• Persistent stiffness or recurrence of the condition.
• Complications from anesthesia.

Benefits

• Improved knee range of motion.
• Reduction in pain and discomfort.
• Enhanced ability to perform daily activities and physical therapy.
• Benefits can often be noticed within weeks following the surgery.

Recovery

• Immediate postoperative care includes pain management and physical therapy.
• Patients may need crutches or a knee immobilizer initially.
• Follow-up appointments to monitor recovery.
• Complete recovery might take several weeks to months, depending on individual progress and adherence to physical therapy.

Alternatives

• Physical therapy alone for conservative management.
• Intra-articular steroid injections.
• Arthroscopic release of the anterior or lateral capsule if indicated.
• Each alternative has its own benefits and risks, and the best option varies based on the specific case.

Patient Experience

During the procedure, the patient is under anesthesia and will not feel pain. Postoperatively, there might be some discomfort or pain, managed with prescribed pain medications. Physical therapy will play a crucial role in recovery, and keeping up with the recommended exercises will enhance healing and outcome.