Acute Anterior Cruciate Ligament Reconstruction

Strum, G M; FRIEDMAN, MARC J.; Fox, JAMES M.; Ferkel, Richard D.; DOREY, FRED H.; PIZZO, WILSON DEL; SNYDER, STEPHEN J.

doi:10.1097/00003086-199004000-00025

Cited by 98 publications

(46 citation statements)

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“…Although some authors believe that early reconstruction (less than 1 week) does not affect the ultimate range of motion (ROM) that the patient achieves, 9,12,13 it seems that the majority of surgeons favor a delay varying from 1 to 3 weeks to allow resolution of the acute inflammation and restoration of ROM. 7,22,24,27 It must be remembered, however, that there is significant variability among patients in the intensity of the observed inflammation after acute ACL tear, and in our opinion, this is at least partially related to the energy of injury. Rather than relying on timetables or strictly followed protocols, we feel that the decision on the surgical timing should be based on clinical observation of subsidence of the posttraumatic inflammation, restoration of ROM, and normalization of gait.…”

Section: Surgical Factorsmentioning

confidence: 96%

Stiffness After Anterior Cruciate Ligament Reconstruction With Quadruple Hamstrings Graft: Etiology, Prevention, and Treatment

Karistinos

Paulos

2005

Techniques in Orthopaedics

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Motion loss continues to be one of the most common complications after anterior cruciate ligament reconstruction. The etiology is multifactorial. Genetic predisposition of certain patients, intervention in the acute phase after injury, errors in tunnel placement, overtensioning of the graft, and lack of or inappropriate rehabilitation are recognized as the most common causes. Preoperative anticipation, meticulous surgical technique, and ultimately thorough evaluation and early intervention can minimize this complication.

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Section: Surgical Factorsmentioning

confidence: 96%

Stiffness After Anterior Cruciate Ligament Reconstruction With Quadruple Hamstrings Graft: Etiology, Prevention, and Treatment

Karistinos

Paulos

2005

Techniques in Orthopaedics

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“…2 In a recent publication, Paxton et al 3 reported on one of the largest series of ACL reconstructions to date. In their prospective series of 4025 primary ACL reconstructions, the authors reported an overall reoperation rate of 4.4%.…”

Section: Epidemiologymentioning

confidence: 99%

Knee Stiffness After ACL Reconstruction

Nauth¹,

Gilbart²

2012

Techniques in Knee Surgery

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Postoperative knee stiffness after anterior cruciate ligament reconstruction surgery is a significant clinical problem. Clinical deficits of knee flexion more than 10 degrees can limit function and athletic performance, and extension deficits of more than 5 degrees can cause gait changes and altered knee kinematics. The incidence reported in the literature varies significantly. Risk factors for the development of this condition include technical factors, graft selection issues, the timing of surgery relative to the traumatic injury, the presence of associated injuries, and postoperative rehabilitation. This chapter will review the incidence, risk factors, pathology, prevention, treatment options, and the clinical results of management of this condition.Key Words: anterior cruciate ligament reconstruction, single-bundle anatomic ACL reconstruction, knee stiffness, arthrofibrosis of the knee, physical therapy (Tech Knee Surg 2012;11: 26-33) K nee stiffness continues to represent one of the most common complications after anterior cruciate ligament (ACL) reconstruction surgery. This complication is of particular importance as stiffness after ACL reconstruction results in inferior functional outcomes and a higher incidence of radiographic evidence of arthritis. Knee stiffness presents as loss of motion and can include loss of extension, loss of flexion, or both. Normal knee range of motion (ROM) is from 5 degrees of hyperextension to 140 degrees of flexion. Deficits of > 10 degrees of flexion can limit athletic performance. Extension loss is poorly tolerated, with deficits of 5 degrees or greater producing gait changes, altering quadriceps function, and leading to patellofemoral arthritis. Prevention of knee stiffness after ACL surgery remains essential and requires a thorough understanding of the potential causes of loss of motion in ACL reconstruction. The treatment of loss of motion after ACL reconstruction requires an understanding of these causes and the pathoanatomy of the stiff knee. In addition, a systematic approach toward treatment of specific anatomic structures associated with the different types of motion loss is required for effective management. This article reviews the incidence, classification, risk factors, pathoanatomy, prevention, and treatment of knee stiffness after ACL reconstruction. EPIDEMIOLOGYThe true incidence of knee stiffness after ACL reconstruction is difficult to estimate as different studies have used different criteria for loss of motion and estimates have ranged from 2% 1 to 35%. 2 In a recent publication, Paxton et al 3 reported on one of the largest series of ACL reconstructions to date. In their prospective series of 4025 primary ACL reconstructions, the authors reported an overall reoperation rate of 4.4%. Knee stiffness was the second most common cause for reoperation (18.9% of reoperations) after meniscal/chondral injury (34.3% of reoperations), confirming that stiffness is one of the most common complications after ACL reconstruction.Stiffness of the knee after ACL recons...

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“…The incidence of motion loss is estimated in the literature to range from 0% to 35%, and appears to be decreasing with the advent of new surgical techniques and changes in rehabilitation protocols. [7][8][9][10][11] This data is difficult to compare across studies due to differences in the way that motion loss is defined. One study defined motion loss as more than 10°of extension loss and less than 125°of knee flexion.…”

Section: Loss Of Motionmentioning

confidence: 99%

Failed Anterior Cruciate Ligament Reconstruction and Loss of Motion

Anderson¹,

Cosgarea²

2005

Sports Medicine and Arthroscopy Review

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More than 60,000 people in the United States undergo primary anterior cruciate ligament (ACL) reconstruction each year. Although this procedure has a high clinical success rate, some patients experience poor outcomes due to recurrent instability, persistent pain, and loss of motion. In evaluating a patient with a failed ACL and loss of motion the surgeon first needs to identify the cause of failure. The most common causes include inaccurate tunnel placement and arthrofibrosis. Initial treatment is nonoperative, using physical therapy, splints, and pharmacotherapy. If these measures fail operative intervention is indicated. The surgeon should follow a stepwise treatment protocol that begins with a gentle closed manipulation and progresses to a percutaneous and arthroscopic lysis of adhesions, and in some cases open debridement. If the graft has failed, or needs to be released as part of the treatment, it is critical to regain knee motion prior to performing a revision ACL reconstruction. Postoperatively, an appropriately aggressive rehabilitation program will help to prevent a recurrence of motion loss.

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Acute Anterior Cruciate Ligament Reconstruction

Cited by 98 publications

References 0 publications

Stiffness After Anterior Cruciate Ligament Reconstruction With Quadruple Hamstrings Graft: Etiology, Prevention, and Treatment

Stiffness After Anterior Cruciate Ligament Reconstruction With Quadruple Hamstrings Graft: Etiology, Prevention, and Treatment

Knee Stiffness After ACL Reconstruction

Failed Anterior Cruciate Ligament Reconstruction and Loss of Motion

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