Mini-open lysis of adhesions is a surgical technique for the management of arthrofibrosis after total knee arthroplasty (TKA). In mini-open lysis of adhesions, an obturator is placed through standard arthroscopy portals and used to bluntly dissect adhesions in the suprapatellar pouch, medial and lateral gutters, and infrapatellar space. Closed manipulation of the knee is then performed. The procedure takes less than 15 minutes. Mini-open lysis of adhesions is an alternative to manipulation under anesthesia, being equally effective at restoring motion even if performed months to years after index TKA. Mini-open lysis of adhesions differs from arthroscopic lysis of adhesions because the knee is never insulated and the adhesions are not directly visualized for débridement.

This video presents a case series of 53 knees in 49 patients (42 females, 11 males) who underwent mini-open lysis of adhesions for the management of arthrofibrosis. The mean patient age at the time of TKA was 61 years (range, 30 to 82 years; standard deviation [SD], 9.8 years). Before index TKA, none of the patients had knee flexion less than 90°, mean extension was 9° (range, 0° to 22°; SD, 6.5°), and mean flexion was 125°(range, 90° to 155°; SD, 17.1°). Time from index TKA to mini-open lysis of adhesions was 258 days (range, 54 to 1,373 days; SD, 278 days). Mean intraoperative motion before mini-open lysis of adhesions was 11° of extension (range, 0° to 34°; SD, 7°) to 90° of flexion (range, 55° to 124°; SD, 16.2°). Postoperatively, the mean gain in extension was 9° (range, 0° to 32°; SD, 6.8°), and the mean gain in flexion was 34° (range, 10° to 72°; SD, 14.6°). At a mean final follow-up of 180 days (range, 0 to 4 years), the mean gain in flexion was 21° (range, -14° to 55°; SD, 14.4°).

Ten patients (19%) underwent additional surgical procedures to improve knee motion; mini-open lysis of adhesions was considered a failure in these patients (nine females, one male). The mean body mass index of the patients in whom mini-open lysis of adhesions was a success and a failure was identical. In this group of patients, mean preoperative flexion was 92°, and mean final intraoperative flexion was 115°. Preoperative flexion and final intraoperative flexion in this group of patients were significantly different from that of the rest of the cohort in whom a secondary procedure was not required (P < 0.05).

Mini-open lysis of adhesions is a technique that may increase flexion by more than 34°, even if performed 6 months or more after index TKA. Most of the increased arc of motion is maintained at follow-up. The increase in motion may substantially improve patient function and satisfaction. We recommend mini-open lysis of adhesions over manipulation under anesthesia.