Dr Ben Graff, University of Wisconsin, wrote a paper - a decade or so ago - where he showed that if he didn’t use the epidural after surgical release approximately 30-40% of the patients reverted.
That’s what we’ve been saying for many many years. When you do surgery for arthrofibrosis the knee is now inflamed, it’s painful. You need to have a very gentle re-establishment of the range of motion using an epidural.
Now the epidural is only used in the most resistant cases. Many times after releasing the scar tissue I would probably say 75% were able to get by and not use an epidural. You know you have to use an epidural at the first week post operative where the motion limitation is returning, it’s painful for the patient, you have not achieved the goals of motion that you achieved when your patient was asleep, and very simply the muscles are going into spasm and they are limiting your motion and if you do not partially paralyse those muscles and move the knee through the next inflammatory stage you will lose all your motion gains and the scar tissue will reform.
I might also mention that in these highly resistant cases we have to use an anti-inflammatory medication, and in the most resistant cases we have to use a prednisone derivative.