Clinical reasoning of ultrasound imaging-guided manual passive manipulation for adhesion prevention in a patient with total knee arthroplasty: a case report

Kosuke Oku*, Mayumi Yabuki, Tomoya Kishimoto, Atsushi Shinonaga, Daisuke Kimura, Tomotaka Ito, Tatsuya Sugioka, Yusuke Kobayashi, Hayato Satake, Hideaki Nagamoto, Yasuyuki Kawaguchi, Tsukasa Kumai

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Patients with total knee arthroplasty occasionally develop postoperative abnormalities such as posttraumatic knee stiffness and arthrofibrosis, which may affect activities of daily living. However, there are no clear assessment methods or interventions for knee stiffness. Musculoskeletal ultrasound imaging enables real-time evaluation of mobility and flexibility of tissues. The purpose of this case report was to describe the use of musculoskeletal ultrasound imaging for evaluating the optimal location and methods of passive manipulation. Case description: The patient was an 82-year-old woman who had undergone total knee arthroplasty. She was unable to climb stairs due to limited knee flexion. Based on the results of musculoskeletal ultrasound imaging assessment, we hypothesized that the knee flexion limitation was caused by decreased sliding movement of the suprapatellar pouch. Hence, we performed passive manipulation on the tissue with decreased sliding under musculoskeletal ultrasound guidance. Outcomes: The patient’s knee flexion angle increased from 90° to 110° within 1 week of intervention, and her gait speed improved from 16.48 to 13.2 s per 10 m. Furthermore, after the intervention, she was able to climb 10 steps using a handrail. Discussion: Ultrasound imaging is important because it allows the examination of tissues with mobility changes such as in arthrofibrosis. Our work highlights the use of musculoskeletal ultrasound imaging for identifying the target region for therapy and for providing guidance during passive manipulation.

Original languageEnglish
Pages (from-to)1064-1071
Number of pages8
JournalPhysiotherapy Theory and Practice
Volume40
Issue number5
DOIs
Publication statusPublished - 2024

Keywords

  • Ultrasound imaging
  • passive manipulation
  • physiotherapy
  • total knee arthroplasty

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation

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