Arthrofibrosis in acute anterior cruciate ligament reconstruction

Abstract

Arthrofibrosis is a potential complication of acute ACL reconstruction. Arthrofibrosis prevents the patient from regaining full range of motion, particularly the terminal 5 degrees of full extension, postoperatively. We did a retrospective study of 169 acute ACL reconstructions in a population of young athletes (average age, 22 years). We sought to determine the optimal time to perform acute ACL reconstruction with respect to arthrofibrosis and the effects of an accelerated versus conventional rehabilitation program. The short-term results were evaluated by range of motion measurements and 13 week Cybex scores. Patients whose ligaments were reconstructed within the 1st week after injury (Group I) had a statistically significant (P less than 0.05) increased incidence of arthrofibrosis (limited extension, scar tissue) over patients who had ACL reconstruction delayed 21 days or more (Group III). At 13 weeks after the reconstruction procedure, Group III patients scored an average of 70% (compared to 51% for Group I, P less than 0.05) on the Cybex evaluation. They also showed a trend toward more flexion of the knee as well as near full extension. Patients who had an ACL reconstruction between 8 and 21 days after injury (Group II) had a similar incidence of arthrofibrosis as Group I when they followed a conventional rehabilitation program postoperatively. However, only a small number of cases (approximately 4%) of Group II patients who followed an accelerated postoperative rehabilitation program had any arthrofibrosis--an observation we also made in the Group III patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Results of reconstruction of acute ruptures of the anterior cruciate ligament with an iliotibial band autograft

“…Deficits in flexion and extension ROM are related to tunnel placement, roof impingement and timing of surgery [9,11,21,24,31]. In the reported method, we fixed the graft in 30 deg of flexion, whereas most authors now recommend fixation of the graft with the joint in neutral position.…”

Prevention of Arthrofibrosis After Anterior Cruciate Ligament Reconstruction Using the Central Third Patellar Tendon Autograft

“…Patients need prolonged physical therapy and frequently require surgical intervention. 1,4,15,20 The surgical treatment of arthrofibrosis is demanding and requires familiarity with arthroscopic debridement techniques 2, 4,9,10,13,15,17,19,20 and, in some cases, anterior and posterior arthrotomy approaches. 1,7,14,22 Lysis of adhesions surgery has been shown to significantly improve knee motion ; however, final functional results are compromised, and there is a high incidence of degenerative changes seen radiographically.l,14 Concern has been expressed over loss of motion and subsequent abnormal knee kinematics leading to degenerative articular changes.~° 1~ Further study is needed to evaluate the progression of degenerative changes in these patients.…”

Failed Anterior Cruciate Ligament Reconstruction and Loss of Motion

“…12 The timing of surgery has been shown by numerous authors to correlate with postoperative motion. Several authors have found an association between early surgery and subsequent arthrofibrosis, 13,14 whereas others have found no relationship between loss of motion and acute ACL reconstruction. 15,16 Most investigators believe that too much emphasis has been placed on a specific period of time between injury and surgery.…”