No risk of arthrofibrosis after acute anterior cruciate ligament reconstruction

Abstract

PurposeTo compare acute ACL reconstruction (ACLR) within 8 days of injury with delayed reconstruction after normalized range of motion (ROM), 6–10 weeks after injury. It was hypothesized that acute ACL reconstruction with modern techniques is safe and can be beneficial in terms of patient-reported outcomes and range of motion.MethodsSample size calculation indicated 64 patients would be required to find a 5° difference in ROM at 3 months. Seventy patients with high recreational activity level, Tegner level 6 or more, were randomized to acute (within 8 days) or delayed (6–10 weeks) ACLR between 2006 and 2013. During the first 3 months following surgery patients were contacted weekly by SMS and asked ‘How is your knee functioning?’, with answers given on a Visual-Analog Scale (0–10). ROM was assessed after 3 months by the rehab physiotherapist. Patient-reported outcomes, objective IKDC and manual stability measurements were collected by an independent physiotherapist not involved in the rehab at the 6-month follow-up.ResultsAt 3-month follow-up, 91% of the patients were assessed with no significant differences in flexion, extension or total ROM demonstrated between groups. At the 6-month follow-up, the acute group had significantly less muscle atrophy of the thigh muscle compared to the contralateral leg. Furthermore, a significantly higher proportion of patients in the acute group passed or were close to passing the one leg hop test (47 versus 21%, p = 0.009). No difference was found between the groups in the other clinical assessments. Additionally, no significant difference between the groups was found in terms of associated injuries.ConclusionAcute ACLR within 8 days of injury does not appear to adversely affect ROM or result in increased stiffness in the knee joint when compared to delayed surgery.Level of evidenceII.

Acute ACL reconstruction shows superior clinical results and can be performed safely without an increased risk of developing arthrofibrosis

“…This study supports the findings of other recent studies which have demonstrated that the timing of ACLR does not influence postoperative ROM [ 1 , 7 , 10 , 17 , 24 ] and contradicts the findings of older studies including Shelbourne et al [ 25 , 28 , 37 ]. These differences may be due to the fact that these older studies were performed without the use of contemporary arthroscopic techniques, were retrospective, and perhaps most importantly had a more restrictive postoperative rehabilitation regime.…”

“…The current recommendation is to delay ACLR after an acute injury due to the risk of arthrofibrosis and suboptimal clinical results [ 28 , 37 ]. However, several studies have shown similar postoperative range of motion (ROM) regardless of whether surgery was performed within 48 h, 2 weeks, or if ACLR was delayed for a minimum of 6 weeks [ 1 , 10 , 17 , 22 , 30 ]. Early ACLR can facilitate early return to sport and work, and has been reported to be more cost effective, while increased time between injury and surgical intervention is associated with increased incidence of meniscus and cartilage injuries [ 9 , 20 , 23 , 34 ].…”

Physiotherapy treatment and rehabilitation following anterior cruciate ligament injury in New Zealand: Are we doing enough?

“…There is no accepted definition for early or delayed ACLR (Beynnon et al, 2005), with "early" defined as between two days and seven months of DOI, and "delayed" as between three weeks and 24 years (Anderson et al, 2016). There are equivocal differences in outcomes between patients undergoing early verses delayed ACLR (Anderson et al, 2016;Eriksson, von Essen, Jönhagen, & Barenius, 2018;Lee, Lee, Lee, & Hui, 2018;Smith, Postle, Penny, McNamara, & Mann, 2014;Wittenberg, Oxfort, & Plafki, 1998), although early surgical intervention may reduce the risk of subsequent meniscal or chondral injury, both of which are associated with worse outcomes following ACLR (Cinque et al, 2018;Cox et al, 2014).…”

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“…There is no accepted definition for early or delayed ACLR (Beynnon et al, 2005), with "early" defined as between two days and seven months of DOI, and "delayed" as between three weeks and 24 years (Anderson et al, 2016). There are equivocal differences in outcomes between patients undergoing early verses delayed ACLR (Anderson et al, 2016;Eriksson, von Essen, Jönhagen, & Barenius, 2018;Lee, Lee, Lee, & Hui, 2018;Smith, Postle, Penny, McNamara, & Mann, 2014;Wittenberg, Oxfort, & Plafki, 1998), although early surgical intervention may reduce the risk of subsequent meniscal or chondral injury, both of which are associated with worse outcomes following ACLR (Cinque et al, 2018;Cox et al, 2014).…”