Outpatient Surgical Management of Arthrofibrosis After Anterior Cruciate Ligament Surgery

Abstract

We present a consecutive series of nine patients who were referred to us because of arthrofibrosis (loss of > 15 degrees of extension) after intraarticular anterior cruciate ligament reconstruction using autogenous patellar tendon (eight patients) or semitendinosus (one patient) graft. Eight patients had surgery within 2 weeks of injury. All patients had been immobilized in flexion after the anterior cruciate ligament reconstruction and they had failed to improve despite vigorous physical therapy and other closed methods of treatment. The mean time from anterior cruciate ligament reconstruction to the subsequent surgery was 10.2 months (range, 3 to 14). The patients underwent an outpatient arthroscopic anterior scar resection, notchplasty, a closed knee manipulation for flexion, and extension casting. Serial daily extension cast changes allowed the patients to obtain full extension, which was maintained by a bivalved extension splint for bedtime use. Flexion was actively sought by aggressive outpatient physical therapy. All patients except one noted near-normal ultimate range of motion. One patient could only attain 10 degrees short of flat extension at the end of his rehabilitation and was considered a failed result. At final followup (mean, 31 months), no patient complained of symptoms of instability, all had a normal gait, and all but one were able to return to athletic activities.

Current Concepts for Rehabilitation and Return to Sport After Knee Articular Cartilage Repair in the Athlete

“…142,163 Patients with limited knee motion due to arthrofibrosis often complain of anterior knee pain, swelling after prolonged positions or activity, quadriceps weakness, and joint stiffness, which can result in decreased tolerance to stand, walk, or run, and difficulty returning to previous levels of activity. 112,140,159,161 Additionally, increases in patellofemoral contact pressure have been documented in knees with quadriceps or patellar tendon adhesions.…”

Allograft Anterior Cruciate Ligament Reconstruction: Indications, Techniques, and Outcomes

“…This complication was largely attributed to poor preoperative ROM and early surgical intervention during the infl ammatory phase of healing. 18,44,45 More recent studies have shown early surgical intervention to be safe, 3,9,20 with the best indicator of postoperative ROM loss being the patient's preoperative ROM. 30 Patients should be carefully evaluated for preoperative ROM defi cits and aggressively treated to prevent postoperative complications.…”

Case Series Utilizing Drop-out Casting for the Treatment of Knee Joint Extension Motion Loss Following Anterior Cruciate Ligament Reconstruction

“…doi:10.2519/jospt.2007.2466 Several factors are associated with an increased risk for the development of knee extension loss following arthroscopically assisted ACLR. These include concomitant ligamentous injuries, 16 timing of surgery, 12,30,33 preoperative motion loss, 6,32 and surgical techniques, such as improper graft placement and extra-articular procedures. 12,20 Other risk factors include joint swelling and inflammation, 17 complex regional pain syndrome, 25 knee joint infection, 20 and postoperative/rehabilitation factors.…”

“…13,27 Numerous studies have documented the importance of obtaining and maintaining full knee extension following ACLR. 26,30,32,33 Patients with limited knee extension may complain of anterior knee pain, swelling after prolonged positions or activity, crepitus at terminal knee extension, quadriceps weakness, and joint stiffness. 32 Shelbourne et al 32 have associated the inability to achieve full knee extension with poor outcomes.…”