Arthrofibrosis is a common but poorly defined complication in multiligament knee injuries: a systematic review

Abstract

Purpose The purpose of this study is to systematically review multiligament knee injury (MLKI) outcome studies to determine definitions of arthrofibrosis (AF) and provide information about incidence, management as well as potential risk factors. Methods A systematic literature search was performed (PubMed and Cochrane library) following the PRISMA guidelines of operatively treated MLKI (Schenck II–IV) studies reporting the incidence of AF. Twenty-five studies met the inclusion criteria. Injury pattern, timing of surgery, surgical technique, treatment of AF, rehabilitation programs and PROMS were inquired. Risk of bias and quality of evidence were assessed using the Coleman methodological score. Results Twenty-five studies with a total of 709 patients with a mean age of 33.6 ± 4.8 years were included and followed 47.2 ± 32.0 months. The majority of studies (22/25) used imprecise and subjective definitions of AF. A total of 86 patients were treated for AF, resulting in an overall prevalence of 12.1% (range 2.8–57.1). Higher-grade injuries (Schenck III–IV), acute treatment and ROM (range of motion) limiting rehabilitation programs were potential risk factors for AF. The time from index surgery to manipulation anesthesia (MUA) and arthroscopic lysis of adhesions (LOA) averaged at 14.3 ± 8.8 and 27.7 ± 12.8 weeks. Prior to MUA and LOA, the ROM was 51.7° ± 23.5 and 80.2° ± 17.0, resulting in a total ROM gain after intervention of 65.0° ± 19.7 and 48.0° ± 10.6, respectively; with no reports of any complication within the follow-up. The overall methodological quality of the studies was poor as measured by the Coleman score with average 56.3 ± 12.5 (range 31–84) points. Conclusions AF is a common but poorly defined complication particularly in high-grade MLKI. Early postoperative and intensified physiotherapy is important to reduce the risk of AF. MUA and LOA are very effective treatment options and result in good clinical outcome. Prospective studies with bigger study population are needed to optimize treatment algorithms of further patients after MLKI. The protocol of this systematic review has been prospectively registered with PROSPERO (CRD42021229187, January 4th, 2021).

ACL reconstruction provides superior stability than ACL repair in patients with Schenck III and IV knee joint dislocations: first results of a 12 month follow-up study

“…Nevertheless, a considerable rate of stiffness and subsequent LOA in both groups has to be acknowledged. In comparison to a recently published systematic review [9], the rate of LOA was higher in our study as the indication for early LOA was made generous in this study. This decision was based on a recent study that revealed significantly improved range of motion and functional scores of early LOA (within 6 month) compared to late LOA (> 6 month) [7].…”

An examination from 1990 to 2019: investigating the burden of knee dislocation on a global scale

“…Heterotopic ossification may restrict knee joint movement, reduce its function, and in severe cases, require additional surgery. Arthrofibrosis, as another common but easily overlooked complication, occurred in 12.1% of knee dislocation patients ( 11 ). Knee dislocation often requires surgical treatment ( 12 ), and the optimal management is still controversial ( 13 , 14 ).…”