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By Robert E. Hunter

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Potential Locations of Entrapment The suprapatellar pouch, also referred to as the suprapatellar bursa, is the superior continuation of the knee joint. This area is posterior to the quadriceps tendon and anterior to the femur. It continues on either side of the patella as the medial and lateral gutters. This area is covered by a synovial membrane. The suprapatellar pouch should extend 3 to 4 cm above the patella. It is the most common area of arthrofibrosis. With extensive scarring of the suprapatellar pouch, knee flexion is typically lost (Fig.

30 AANA ADVANCED ARTHROSCOPY: THE KNEE can lead to inflammation and scar tissue formation, creating a negative effect on the knee instead of the positive one that was intended. Acute ligament reconstruction of the knee has been shown to have a higher incidence of arthrofibrosis than delayed reconstruction. 7 Others have found no difference in arthrofibrosis rates and surgical timing. 8 It is our opinion that the condition of the soft tissue dictates the timing of the surgery. If the patient has good active quadriceps control, near-normal preoperative range of motion, and no longer has a warm swollen knee, then surgical reconstruction may be undertaken safely, regardless of the time from injury.

Poor placement of Steinmann pins or screws may result in injury to the neurovascular structures; use fluoroscopy for all fixation pins and screws. Screw fixation may cause physeal arrest; be aware of open physes. POSTOPERATIVE MANAGEMENT Patients are placed in a hinged knee brace locked in 0 degrees of flexion for the first 4 weeks and allowed to perform passive or active-assisted range of motion exercises in the prone position through an arc of 0 to 90 degrees. Patients may bear weight as tolerated, with the brace locked at 0 degrees.

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