Session Information
Session Title: AA 2022 Posters - Neurological Rehabilitation
Session Time: None. Available on demand.
Disclosures: Krupali Chokshi, MD: No financial relationships or conflicts of interest
Case Diagnosis: Post-operative Knee contracture and CRPS
Case Description or Program Description: A 49-year-old female presented with left knee stiffness and pain after a partial lateral meniscectomy. Initial physical therapy (PT) and continuous passive motion (CPM) did not help. Three months postoperatively, she underwent manipulation under anesthesia followed by PT, splinting and CPM however continued to have limited range of motion (ROM) and pain. 8 months postoperatively, exam revealed antalgic gait, tenderness to palpation of quadriceps, extension to 160 degrees, flexion to 90 degrees and 4/5 hamstring and quadriceps strength. She was prescribed diclofenac cream, stretching, and recumbent cycling. 4 months later, exam revealed full strength but persistent contracture with hyperalgesia around the knee. She was administered botulinum toxin injections for knee contracture and Chronic Regional Pain Syndrome (CPRS): 30 units into quadriceps, 15 units into medial gastrocnemius, and 15 units into lateral gastrocnemius.
Setting: Outpatient rehab facility
Assessment/Results: The patient had improvement in her pain and ambulation with botulinum toxin injections
Discussion (relevance): Surgery is a common cause of CRPS. Resulting hyperalgesia, weakness and contracture can severely impact quality of life (QOL). Patients with postoperative contracture may also experience rapid fatigue due to quadriceps overuse. When initial conservative treatments fail, botulinum toxin injections may help. Some literature suggests benefit due to down regulation of substance P and CGRP. The safety, efficacy and favorable side effect profile of Botulinum toxin make it a promising new choice to reduce spasticity, neurogenic inflammation and pain, increase ROM, and improve QOL.
Conclusions: Botulinum toxin injections for CRPS and postoperative contracture may be useful given highly variable outcomes with conservative treatments. Further research is needed to understand effective dosage, number of sites, and treatment timeline.
Level of Evidence: Level IV
To cite this abstract in AMA style:
Chokshi K, Fusco H, Desjardins EL. Treatment of Postoperative Knee Contracture with Botulinum Toxin [abstract]. PM R. 2022; 14(S1)(suppl 1). https://pmrjabstracts.org/abstract/treatment-of-postoperative-knee-contracture-with-botulinum-toxin/. Accessed May 4, 2025.« Back to AAPM&R Annual Assembly 2022
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/treatment-of-postoperative-knee-contracture-with-botulinum-toxin/