Arthrofibrosis Following Anterior Cruciate Ligament Reconstruction

Abstract

Introduction: Anterior cruciate ligament (ACL) tear is a frequent injury and its reconstruction is among the most commonly performed orthopaedic surgical procedures. ACL reconstruction generally yields good results. However, its recovery can be hampered by the development of postoperative complications. The aim of this study was to review complications following arthroscopic ACL reconstruction done in Hospital Raja Permaisuri Bainun, Ipoh and Hospital Teluk Intan, Perak with the emphasis on arthrofibrosis. Arthrofibrosis is defined as a loss of 15 degrees extension or more, with or without flexion loss compared to the contralateral knee.Materials and Methods: The study is based on a series of retrospective cases, on which medical records of 200 patients who underwent ACL reconstruction surgeries between March 2007 and December 2014 were reviewed. Follow-up treatment records were available for 166 patients (83%). The data was analysed to identify the risk factors for developing complications with an emphasis on arthrofibrosis.Results: Eight patients (5%) developed arthrofibrosis in the post-operative period. Early surgical intervention, preoperative limited range of motion and female gender are the risk factors correlate with arthrofibrosis. However, the type of graft used and meniscal procedure do not have a significant correlation with the development of arthrofibrosis. Other complications encountered are local infections, hypertrophic scar and chronic regional pain syndromes.Conclusion: The 5% incidence of arthrofibrosis following an ACL reconstruction in our centres can be reduced with proper preventive measures which include thorough preoperative evaluation, proper patient selection, restoration of ROM prior to surgery and proper timing of surgery.

Risk factors for reoperation for arthrofibrosis following primary anterior cruciate ligament reconstruction

“…In contrast, a history of previous knee surgery and female sex may be more important risk factors for developing arthrofibrosis following ACL reconstruction. Both factors were associated with a 1.8 times higher risk of a reoperation for arthrofibrosis, and this finding is consistent with previous literature [4–6, 17, 26, 27]. A transtibial drilling technique was also associated with a higher risk of arthrofibrosis; however, the reason for this association is unclear.…”

“…Loss of motion is a significant cause of morbidity following ACL reconstruction and may impair the ability for patients to return to activity [16]. However, the diagnosis of arthrofibrosis is complex with no consensus on how it should be defined, making it difficult to analyse [2,17]. Recent studies have focussed on analyzing the rate of reoperation for arthrofibrosis.…”

Acute and subacute anterior cruciate ligament reconstructions are associated with a higher risk of revision and reoperation

“…Early reconstruction has been defined as soon as 48 h and as long as up to 2 years after injury [13, 20]. One of the long‐standing arguments against performing ACLR early after injury is the risk of arthrofibrosis [2, 34]. However, a recent randomised controlled trial evaluated patients undergoing ACLR within 8 days after injury and found no increase in stiffness relative to those undergoing surgery 6–10 weeks after injury [43].…”

The role of leukotriene inhibition using a 5‐lipoxygenase (5‐LO) inhibitor in a joint contracture model

“…Incidence of arthrofibrosis after TKA varies, but can range between 1-13% [3,7]. Arthrofibrosis is the most common complication of ACL reconstruction with reported rates between 4 and 38% [8][9][10].…”