Enric Castellet - Academia.edu (original) (raw)

Papers by Enric Castellet

Osteoarthritis and Cartilage, Apr 1, 2013

International orthopaedics, Jun 28, 2024

Revista Española de Cirugía Ortopédica y Traumatología, Mar 1, 2013

The purpose of this paper is to develop a professional consensus that proposes, in the light of t... more The purpose of this paper is to develop a professional consensus that proposes, in the light of the current scientific evidence and the clinical experience of an expert panel, some clinical recommendations directed at the Orthopaedic and Trauma Surgery (OTS) specialist and with the aim of reducing the variability in the prophylactic management of venous thromboembolic disease in knee and hip arthroplasty in clinical practice. The Delphi method was used, which consisted of two rounds of an e-mail questionnaire. Of the 55 items considered, a consensus was reached in 37 (67.2%) of them. In 31 cases there was consensus with the formulation of the item, and in 6 cases there was no agreed consensus. It was observed that there was a consensus in multiple clinical recommendations that could help OTS specialists in the making of decisions in their clinical practice.

European Journal of Orthopaedic Surgery and Traumatology, Jan 17, 2019

Purpose Tibial-side avulsion injuries of the posterior cruciate ligament are rare injuries. In di... more Purpose Tibial-side avulsion injuries of the posterior cruciate ligament are rare injuries. In displaced fracture, the reduction and fixation is the treatment of choice, although the optimal surgical management has not yet been determined. The aim of this study was to evaluate the clinical, functional, and radiological outcome after an open reduction and internal fixation with staples of a posterior cruciate ligament tibial avulsion. Methods A historical cohort of patients who underwent open reduction and internal fixation with staple due to a posterior cruciate ligament tibial avulsion were reviewed. Minimum follow-up was 2 years. Demographic, clinical, and radiological data, including stress X-ray, were analyzed. Also, International Knee Documentation Committee Score, Tegner Knee Score, Lysholm Knee Score, Short-Form Health Survey, and four-point Likert scale were evaluated. Results Four males (57%) and 3 females (43%) were included in the final analysis. The mean age was 39 years (range 27-54). All patients had a fracture union. No implant migration was observed. Postoperative posterior drawer, reverse pivot shift, and varus/valgus stress were negative. In stress TELOS X-ray, no statistically significant differences were observed between the postoperative and contralateral knee. All evaluated scores had good or excellent results. Conclusions Our study provides further evidence that the use of an open reduction and internal fixation with a staple could be a simple and reliable management for posterior cruciate ligament avulsion fractures of the tibia. In our study, the postoperative stress TELOS X-ray analyze showed a correct fixation and biomechanical function of the posterior cruciate ligament.

Osteoporosis International, 2015

Biomedical Journal of Scientific & Technical Research, 2021

Patellar bone tumors are rare entities. The differential diagnosis is extensive, including both b... more Patellar bone tumors are rare entities. The differential diagnosis is extensive, including both benign and malignant tumors. Intraosseous gout tophi should be considered. The clinical and imaging features of this entity are unspecific, although in some cases it may carry a high suspicion diagnostic. We present a case of patella gout tophi who's clinical and imaging tests raised diagnostic questions, so an excisional biopsy was performed for diagnosis and treatment.

Journal of Orthopaedic Surgery, 2014

Purpose. To report outcomes of revision anterior cruciate ligament (ACL) reconstruction using tib... more Purpose. To report outcomes of revision anterior cruciate ligament (ACL) reconstruction using tibial or hamstring tendon allografts and to compare with another study using non-irradiated fresh-frozen bone-patellar tendon-bone allografts. Methods. Records of 12 men and 7 women aged 18 to 53 (mean, 33) years who underwent revision ACL reconstructions using tibial tendon (n=17) or hamstring tendon (n=2) allografts were retrospectively reviewed. At the time of primary ACL reconstruction, hamstring autografts (n=8) and bonepatellar tendon-bone allografts (n=11) were used. The mean time interval between surgeries was 93 (range, 11-225) months. The causes of failure were traumatic injury (n=7) and technical or biological reasons (n=12). The physical activity level was high in 2 patients, medium in 10, and low in 7. For clinical assessment, the Lysholm test, International Knee Documentation Committee (IKDC) scale, and visual analogue scale (VAS) for pain were used. Patient satisfaction was also assessed.

European Journal of Orthopaedic Surgery & Traumatology, 2022

To analyze the outcomes of elderly patients with periprosthetic fractures around the knee operate... more To analyze the outcomes of elderly patients with periprosthetic fractures around the knee operated on with a distal femur replacement (DFR). We performed a retrospective case series study of eleven elderly patients who underwent DFR due to a periprosthetic fracture. Mean follow-up was 30.1 months (SD 28.1). Demographic, clinical and radiological data were reviewed. A descriptive analysis and a study of survival were conducted. Then, a comparative analysis between the patients who needed reoperation and did not need reoperation, and the patients who died and the patients who were alive during the follow-up was performed. Mean age was 77.1 years (SD 13.9). Reoperation rate was 36%, being infection the most common complication (27%). The risk of reoperation increased with a longer time between fracture and surgery. The 36.4% of patients died during the follow-up. Older age, need of blood transfusion and need of early reoperation were related to a higher risk of mortality. DFR could be a valuable option for knee periprosthetic fractures in elderly patients. However, surgeons should be aware of the high reoperation and mortality rate.

European Journal of Orthopaedic Surgery & Traumatology, 2019

The aim of this study was to compare the outcomes between anteromedial (AM) and transtibial (TT) ... more The aim of this study was to compare the outcomes between anteromedial (AM) and transtibial (TT) femoral tunnel positioning techniques for the reconstruction of chronic anterior cruciate ligament (ACL) rupture. Materials and methods It is a randomized prospective study of 106 patients who underwent ACL reconstruction because of a chronic ACL rupture (55 AMT, 51 TT). Minimum follow-up was 2 years. Demographic, clinical and radiological data, including MRI grafts' anatomy and biomechanics intraoperative navigation system evaluation, were analyzed. Also, International Knee Documentation Committee score, Tegner Knee score, Lysholm Knee Score, Short-Form Health Survey and 4-point Likert Scale were evaluated. Results The AM technique achieves a more anatomic graft than TT technique in both sagittal and coronal plane (6° approximately). Immediate postoperative biomechanical evaluation of the graft showed both techniques significantly improved translational and rotational laxity (p = 0.000). AMT showed superiority only in controlling internal rotation (p = 0.016). Both techniques reported significant improvement in all evaluated score scales, without differences between techniques. Independently of the femoral tunnel positioning technique, patients with cartilage lesion had worse clinical outcomes. Conclusions Our findings suggest that AMT achieves a more anatomical and biomechanically accurate graft allowing better control over internal rotation laxity; however, this does not lead to better clinical outcomes if we compare with TT in the reconstruction of chronic ACL rupture. Patients with chronic ACL rupture and cartilage lesion had worse clinical outcomes, independently the femoral tunnel positioning technique.

Evidence‐Based Orthopedics

Journal of Thrombosis and Haemostasis, 2012

Background: Semuloparin is a novel ultralow-molecular-weight heparin under development for venous... more Background: Semuloparin is a novel ultralow-molecular-weight heparin under development for venous thromboembolism (VTE) prevention in patients at increased risk, such as surgical and cancer patients. Objectives: Three Phase III studies compared semuloparin and enoxaparin after major orthopedic surgery: elective knee replacement (SAVE-KNEE), elective hip replacement (SAVE-HIP1) and hip fracture surgery (SAVE-HIP2). Patients/Methods: All studies were multinational, randomized and double-blind. Semuloparin and enoxaparin were administered for 7-10 days after surgery. Mandatory bilateral venography was to be performed between days 7 and 11. The primary efficacy endpoint was a composite of any deep vein thrombosis, non-fatal pulmonary embolism or all-cause death. Safety outcomes included major bleeding, clinically relevant non-major (CRNM) bleeding, and any clinically relevant bleeding (major bleeding plus CRNM). Results: In total, 1150, 2326 and 1003 patients were randomized in SAVE-KNEE, SAVE-HIP1 and SAVE-HIP2, respectively. In all studies, the incidences of the primary efficacy endpoint were numerically lower in the semuloparin group vs. the enoxaparin group, but the difference was statistically significant only in SAVE-HIP1. In SAVE-HIP1, clinically relevant bleeding and major bleeding were significantly lower in the semuloparin vs. the enoxaparin group. In SAVE-KNEE and SAVE-HIP2, clinically relevant bleeding tended to be higher in the semuloparin group, but rates of major bleeding were similar in the two groups. Other safety parameters were generally similar between treatment groups. Conclusions: Semuloparin was superior to enoxaparin for VTE prevention after hip replacement surgery, but failed to demonstrate superiority after knee replacement surgery and hip fracture surgery. Semuloparin and enoxaparin exhibited generally similar safety profiles.

Background: Semuloparin is a novel ultralow-molecular-weight heparin under development for venous... more Background: Semuloparin is a novel ultralow-molecular-weight heparin under development for venous thromboembolism (VTE) prevention in patients at increased risk, such as surgical and cancer patients. Objectives: Three Phase III studies compared semuloparin and enoxaparin after major orthopedic surgery: elective knee replacement (SAVE-KNEE), elective hip replacement (SAVE-HIP1) and hip fracture surgery (SAVE-HIP2). Patients/Methods: All studies were multinational, randomized and double-blind. Semuloparin and enoxaparin were administered for 7-10 days after surgery. Mandatory bilateral venography was to be performed between days 7 and 11. The primary efficacy endpoint was a composite of any deep vein thrombosis, non-fatal pulmonary embolism or all-cause death. Safety outcomes included major bleeding, clinically relevant non-major (CRNM) bleeding, and any clinically relevant bleeding (major bleeding plus CRNM). Results: In total, 1150, 2326 and 1003 patients were randomized in SAVE-KNEE, SAVE-HIP1 and SAVE-HIP2, respectively. In all studies, the incidences of the primary efficacy endpoint were numerically lower in the semuloparin group vs. the enoxaparin group, but the difference was statistically significant only in SAVE-HIP1. In SAVE-HIP1, clinically relevant bleeding and major bleeding were significantly lower in the semuloparin vs. the enoxaparin group. In SAVE-KNEE and SAVE-HIP2, clinically relevant bleeding tended to be higher in the semuloparin group, but rates of major bleeding were similar in the two groups. Other safety parameters were generally similar between treatment groups. Conclusions: Semuloparin was superior to enoxaparin for VTE prevention after hip replacement surgery, but failed to demonstrate superiority after knee replacement surgery and hip fracture surgery. Semuloparin and enoxaparin exhibited generally similar safety profiles.

Knee Surgery, Sports Traumatology, Arthroscopy

Revista Española de Artroscopia y Cirugía Articular English ed.

Revista Española de Artroscopia y Cirugía Articular

Clinics in orthopedic surgery, 2018

Mucoid degeneration of the anterior cruciate ligament is a rare pathological entity. Several auth... more Mucoid degeneration of the anterior cruciate ligament is a rare pathological entity. Several authors have identified this condition, described their experiences, and suggested their own guidelines for management. The aim of this study was to detail the clinical, radiological, arthroscopic, and pathological findings of mucoid degeneration of the anterior cruciate ligament and report the clinical outcomes following arthroscopic treatment. A historical cohort of patients who underwent arthroscopic total or partial excision of the anterior cruciate ligament due to mucoid degeneration between 2011 and 2014 were reviewed. The minimum follow-up was 3 years. Demographic, radiological, and histological findings, type of surgery, and clinical pre- and postoperative data were analyzed. The visual analogue scale score, the International Knee Documentation Committee score, and the Tegner Lysholm Knee Score were collected preoperatively, postoperatively, and during the follow-up period. Seventeen...

Revista Española de Artroscopia y Cirugía Articular

La rigidez de rodilla tras una artroplastia es una alteración grave que provoca dolor y condicion... more La rigidez de rodilla tras una artroplastia es una alteración grave que provoca dolor y condiciona el futuro de la articulación. Las causas pueden ser primarias, cuando modifican la anatomía articular (genética, artrosis, deformidades, etc.), o secundarias, si están situadas fuera de la articulación. Dentro de estas, pueden ser atribuibles al paciente (por ejemplo, falta de movilidad previa) y/o a errores técnicos (asimetría de espacios, osteofitos posteriores, implante femoral en rotación interna, mal balance de ligamentos, sobredimensionamiento de los implantes, etc.) y complicaciones (por ejemplo, infección, fracturas pre-y periprotésicas, distrofias, etc.). Para un correcto tratamiento se debe identificar la etiología y solo en caso de no tener un diagnóstico de certeza, vamos a reconocer la artrofibrosis como causa de la rigidez, como un proceso de metaplasia del fibrocartílago con incremento de la fibrosis intersticial. En los casos de rigideces precoces, el tratamiento incluye una rehabilitación agresiva con una analgesia adecuada y suficiente. La técnica quirúrgica requiere un orden en el desbridamiento, que se inicia en el espacio intercondilar siguiendo por los recesos medial y lateral hasta llegar a la zona suprapatelar, donde reside la primera causa de limitación de la flexión. En caso de persistir la limitación de la extensión, se ABSTRACT Indications of arthroscopic lysis in stiffness after knee prosthesis

Osteoarthritis and Cartilage, Apr 1, 2013

International orthopaedics, Jun 28, 2024

Revista Española de Cirugía Ortopédica y Traumatología, Mar 1, 2013

The purpose of this paper is to develop a professional consensus that proposes, in the light of t... more The purpose of this paper is to develop a professional consensus that proposes, in the light of the current scientific evidence and the clinical experience of an expert panel, some clinical recommendations directed at the Orthopaedic and Trauma Surgery (OTS) specialist and with the aim of reducing the variability in the prophylactic management of venous thromboembolic disease in knee and hip arthroplasty in clinical practice. The Delphi method was used, which consisted of two rounds of an e-mail questionnaire. Of the 55 items considered, a consensus was reached in 37 (67.2%) of them. In 31 cases there was consensus with the formulation of the item, and in 6 cases there was no agreed consensus. It was observed that there was a consensus in multiple clinical recommendations that could help OTS specialists in the making of decisions in their clinical practice.

European Journal of Orthopaedic Surgery and Traumatology, Jan 17, 2019

Purpose Tibial-side avulsion injuries of the posterior cruciate ligament are rare injuries. In di... more Purpose Tibial-side avulsion injuries of the posterior cruciate ligament are rare injuries. In displaced fracture, the reduction and fixation is the treatment of choice, although the optimal surgical management has not yet been determined. The aim of this study was to evaluate the clinical, functional, and radiological outcome after an open reduction and internal fixation with staples of a posterior cruciate ligament tibial avulsion. Methods A historical cohort of patients who underwent open reduction and internal fixation with staple due to a posterior cruciate ligament tibial avulsion were reviewed. Minimum follow-up was 2 years. Demographic, clinical, and radiological data, including stress X-ray, were analyzed. Also, International Knee Documentation Committee Score, Tegner Knee Score, Lysholm Knee Score, Short-Form Health Survey, and four-point Likert scale were evaluated. Results Four males (57%) and 3 females (43%) were included in the final analysis. The mean age was 39 years (range 27-54). All patients had a fracture union. No implant migration was observed. Postoperative posterior drawer, reverse pivot shift, and varus/valgus stress were negative. In stress TELOS X-ray, no statistically significant differences were observed between the postoperative and contralateral knee. All evaluated scores had good or excellent results. Conclusions Our study provides further evidence that the use of an open reduction and internal fixation with a staple could be a simple and reliable management for posterior cruciate ligament avulsion fractures of the tibia. In our study, the postoperative stress TELOS X-ray analyze showed a correct fixation and biomechanical function of the posterior cruciate ligament.

Osteoporosis International, 2015

Biomedical Journal of Scientific & Technical Research, 2021

Patellar bone tumors are rare entities. The differential diagnosis is extensive, including both b... more Patellar bone tumors are rare entities. The differential diagnosis is extensive, including both benign and malignant tumors. Intraosseous gout tophi should be considered. The clinical and imaging features of this entity are unspecific, although in some cases it may carry a high suspicion diagnostic. We present a case of patella gout tophi who's clinical and imaging tests raised diagnostic questions, so an excisional biopsy was performed for diagnosis and treatment.

Journal of Orthopaedic Surgery, 2014

Purpose. To report outcomes of revision anterior cruciate ligament (ACL) reconstruction using tib... more Purpose. To report outcomes of revision anterior cruciate ligament (ACL) reconstruction using tibial or hamstring tendon allografts and to compare with another study using non-irradiated fresh-frozen bone-patellar tendon-bone allografts. Methods. Records of 12 men and 7 women aged 18 to 53 (mean, 33) years who underwent revision ACL reconstructions using tibial tendon (n=17) or hamstring tendon (n=2) allografts were retrospectively reviewed. At the time of primary ACL reconstruction, hamstring autografts (n=8) and bonepatellar tendon-bone allografts (n=11) were used. The mean time interval between surgeries was 93 (range, 11-225) months. The causes of failure were traumatic injury (n=7) and technical or biological reasons (n=12). The physical activity level was high in 2 patients, medium in 10, and low in 7. For clinical assessment, the Lysholm test, International Knee Documentation Committee (IKDC) scale, and visual analogue scale (VAS) for pain were used. Patient satisfaction was also assessed.

European Journal of Orthopaedic Surgery & Traumatology, 2022

To analyze the outcomes of elderly patients with periprosthetic fractures around the knee operate... more To analyze the outcomes of elderly patients with periprosthetic fractures around the knee operated on with a distal femur replacement (DFR). We performed a retrospective case series study of eleven elderly patients who underwent DFR due to a periprosthetic fracture. Mean follow-up was 30.1 months (SD 28.1). Demographic, clinical and radiological data were reviewed. A descriptive analysis and a study of survival were conducted. Then, a comparative analysis between the patients who needed reoperation and did not need reoperation, and the patients who died and the patients who were alive during the follow-up was performed. Mean age was 77.1 years (SD 13.9). Reoperation rate was 36%, being infection the most common complication (27%). The risk of reoperation increased with a longer time between fracture and surgery. The 36.4% of patients died during the follow-up. Older age, need of blood transfusion and need of early reoperation were related to a higher risk of mortality. DFR could be a valuable option for knee periprosthetic fractures in elderly patients. However, surgeons should be aware of the high reoperation and mortality rate.

European Journal of Orthopaedic Surgery & Traumatology, 2019

The aim of this study was to compare the outcomes between anteromedial (AM) and transtibial (TT) ... more The aim of this study was to compare the outcomes between anteromedial (AM) and transtibial (TT) femoral tunnel positioning techniques for the reconstruction of chronic anterior cruciate ligament (ACL) rupture. Materials and methods It is a randomized prospective study of 106 patients who underwent ACL reconstruction because of a chronic ACL rupture (55 AMT, 51 TT). Minimum follow-up was 2 years. Demographic, clinical and radiological data, including MRI grafts' anatomy and biomechanics intraoperative navigation system evaluation, were analyzed. Also, International Knee Documentation Committee score, Tegner Knee score, Lysholm Knee Score, Short-Form Health Survey and 4-point Likert Scale were evaluated. Results The AM technique achieves a more anatomic graft than TT technique in both sagittal and coronal plane (6° approximately). Immediate postoperative biomechanical evaluation of the graft showed both techniques significantly improved translational and rotational laxity (p = 0.000). AMT showed superiority only in controlling internal rotation (p = 0.016). Both techniques reported significant improvement in all evaluated score scales, without differences between techniques. Independently of the femoral tunnel positioning technique, patients with cartilage lesion had worse clinical outcomes. Conclusions Our findings suggest that AMT achieves a more anatomical and biomechanically accurate graft allowing better control over internal rotation laxity; however, this does not lead to better clinical outcomes if we compare with TT in the reconstruction of chronic ACL rupture. Patients with chronic ACL rupture and cartilage lesion had worse clinical outcomes, independently the femoral tunnel positioning technique.

Evidence‐Based Orthopedics

Journal of Thrombosis and Haemostasis, 2012

Background: Semuloparin is a novel ultralow-molecular-weight heparin under development for venous... more Background: Semuloparin is a novel ultralow-molecular-weight heparin under development for venous thromboembolism (VTE) prevention in patients at increased risk, such as surgical and cancer patients. Objectives: Three Phase III studies compared semuloparin and enoxaparin after major orthopedic surgery: elective knee replacement (SAVE-KNEE), elective hip replacement (SAVE-HIP1) and hip fracture surgery (SAVE-HIP2). Patients/Methods: All studies were multinational, randomized and double-blind. Semuloparin and enoxaparin were administered for 7-10 days after surgery. Mandatory bilateral venography was to be performed between days 7 and 11. The primary efficacy endpoint was a composite of any deep vein thrombosis, non-fatal pulmonary embolism or all-cause death. Safety outcomes included major bleeding, clinically relevant non-major (CRNM) bleeding, and any clinically relevant bleeding (major bleeding plus CRNM). Results: In total, 1150, 2326 and 1003 patients were randomized in SAVE-KNEE, SAVE-HIP1 and SAVE-HIP2, respectively. In all studies, the incidences of the primary efficacy endpoint were numerically lower in the semuloparin group vs. the enoxaparin group, but the difference was statistically significant only in SAVE-HIP1. In SAVE-HIP1, clinically relevant bleeding and major bleeding were significantly lower in the semuloparin vs. the enoxaparin group. In SAVE-KNEE and SAVE-HIP2, clinically relevant bleeding tended to be higher in the semuloparin group, but rates of major bleeding were similar in the two groups. Other safety parameters were generally similar between treatment groups. Conclusions: Semuloparin was superior to enoxaparin for VTE prevention after hip replacement surgery, but failed to demonstrate superiority after knee replacement surgery and hip fracture surgery. Semuloparin and enoxaparin exhibited generally similar safety profiles.

Background: Semuloparin is a novel ultralow-molecular-weight heparin under development for venous... more Background: Semuloparin is a novel ultralow-molecular-weight heparin under development for venous thromboembolism (VTE) prevention in patients at increased risk, such as surgical and cancer patients. Objectives: Three Phase III studies compared semuloparin and enoxaparin after major orthopedic surgery: elective knee replacement (SAVE-KNEE), elective hip replacement (SAVE-HIP1) and hip fracture surgery (SAVE-HIP2). Patients/Methods: All studies were multinational, randomized and double-blind. Semuloparin and enoxaparin were administered for 7-10 days after surgery. Mandatory bilateral venography was to be performed between days 7 and 11. The primary efficacy endpoint was a composite of any deep vein thrombosis, non-fatal pulmonary embolism or all-cause death. Safety outcomes included major bleeding, clinically relevant non-major (CRNM) bleeding, and any clinically relevant bleeding (major bleeding plus CRNM). Results: In total, 1150, 2326 and 1003 patients were randomized in SAVE-KNEE, SAVE-HIP1 and SAVE-HIP2, respectively. In all studies, the incidences of the primary efficacy endpoint were numerically lower in the semuloparin group vs. the enoxaparin group, but the difference was statistically significant only in SAVE-HIP1. In SAVE-HIP1, clinically relevant bleeding and major bleeding were significantly lower in the semuloparin vs. the enoxaparin group. In SAVE-KNEE and SAVE-HIP2, clinically relevant bleeding tended to be higher in the semuloparin group, but rates of major bleeding were similar in the two groups. Other safety parameters were generally similar between treatment groups. Conclusions: Semuloparin was superior to enoxaparin for VTE prevention after hip replacement surgery, but failed to demonstrate superiority after knee replacement surgery and hip fracture surgery. Semuloparin and enoxaparin exhibited generally similar safety profiles.

Knee Surgery, Sports Traumatology, Arthroscopy

Revista Española de Artroscopia y Cirugía Articular English ed.

Revista Española de Artroscopia y Cirugía Articular

Clinics in orthopedic surgery, 2018

Mucoid degeneration of the anterior cruciate ligament is a rare pathological entity. Several auth... more Mucoid degeneration of the anterior cruciate ligament is a rare pathological entity. Several authors have identified this condition, described their experiences, and suggested their own guidelines for management. The aim of this study was to detail the clinical, radiological, arthroscopic, and pathological findings of mucoid degeneration of the anterior cruciate ligament and report the clinical outcomes following arthroscopic treatment. A historical cohort of patients who underwent arthroscopic total or partial excision of the anterior cruciate ligament due to mucoid degeneration between 2011 and 2014 were reviewed. The minimum follow-up was 3 years. Demographic, radiological, and histological findings, type of surgery, and clinical pre- and postoperative data were analyzed. The visual analogue scale score, the International Knee Documentation Committee score, and the Tegner Lysholm Knee Score were collected preoperatively, postoperatively, and during the follow-up period. Seventeen...

Revista Española de Artroscopia y Cirugía Articular

La rigidez de rodilla tras una artroplastia es una alteración grave que provoca dolor y condicion... more La rigidez de rodilla tras una artroplastia es una alteración grave que provoca dolor y condiciona el futuro de la articulación. Las causas pueden ser primarias, cuando modifican la anatomía articular (genética, artrosis, deformidades, etc.), o secundarias, si están situadas fuera de la articulación. Dentro de estas, pueden ser atribuibles al paciente (por ejemplo, falta de movilidad previa) y/o a errores técnicos (asimetría de espacios, osteofitos posteriores, implante femoral en rotación interna, mal balance de ligamentos, sobredimensionamiento de los implantes, etc.) y complicaciones (por ejemplo, infección, fracturas pre-y periprotésicas, distrofias, etc.). Para un correcto tratamiento se debe identificar la etiología y solo en caso de no tener un diagnóstico de certeza, vamos a reconocer la artrofibrosis como causa de la rigidez, como un proceso de metaplasia del fibrocartílago con incremento de la fibrosis intersticial. En los casos de rigideces precoces, el tratamiento incluye una rehabilitación agresiva con una analgesia adecuada y suficiente. La técnica quirúrgica requiere un orden en el desbridamiento, que se inicia en el espacio intercondilar siguiendo por los recesos medial y lateral hasta llegar a la zona suprapatelar, donde reside la primera causa de limitación de la flexión. En caso de persistir la limitación de la extensión, se ABSTRACT Indications of arthroscopic lysis in stiffness after knee prosthesis