Prevention of permanent arthrofibrosis after anterior cruciate ligament reconstruction alone or combined with associated procedures: a prospective study in 443 knees

Abstract

We prospectively determined the effectiveness of an immediate knee motion and early intervention program to prevent permanent motion limitations in a consecutive series of patients who had anterior cruciate ligament autogenous patellar tendon reconstruction for isolated rupture (219 knees) or combined with other procedures (224 knees). The subjects were placed into either a progressive or delayed rehabilitation program and were followed for at least 12 months postoperatively. At follow-up a normal range of motion (0 degrees to at least 135 degrees) was found in 436 knees (98%), and mild losses of extension (-5 degrees) were found in 7 knees. Twenty-three knees (5%) required interventions; 9 had extension casts, 9 had gentle manipulations under anesthesia, 3 had arthroscopic debridements, and 2 had continuous epidural anesthetic and inpatient therapy. All of these 23 knees regained full motion. The 7 patients with mild losses of extension had refused treatment intervention. The 0% incidence rate of permanent arthrofibrosis, and 0.7% reoperation rate for knee motion limitations, demonstrated the effectiveness of our program.

Suggestions From the Field for Return to Sports Participation Following Anterior Cruciate Ligament Reconstruction: American Football

“…In addition, favorable scores on self-reported measures of knee function and disability are used. 31,37 Likewise, clinical components have included measures of anterior laxity using arthrometry devices, 22,32,35 the absence of a pivot shift upon clinical examination, and a minimum level of proficiency when strength of quadriceps and hamstrings is tested and bilateral comparisons are made. 17,37 Various types of functional tests, including hop and agility tests, have also been recommended 8,17,18,21,34 as a way to assess dynamic knee stability.…”

Meniscal Repair and Transplantation: Indications, Techniques, Rehabilitation, and Clinical Outcome

“…Individuals who develop a limitation in either flexion or extension are placed into a specific treatment program early postoperatively, as previously described in detail. 34,65 An overpressure program is usually successful in achieving the last few degrees of extension, if initiated within the first few weeks postoperative. The patient is instructed to prop the foot and ankle on a towel to elevate the hamstrings and gastrocnemius, which allows the knee to drop into full extension.…”

“…In addition, we have demonstrated that a rehabilitation program that implements immediate knee motion the first postoperative day after meniscus repair (performed either alone or with anterior cruciate ligament [ACL] reconstruction) is not deleterious to the healing meniscus tissue and prevents knee arthrofibrosis. 12,65,80 While many meniscus tears can be successfully repaired, not all are salvageable, especially if considerable tissue damage has occurred. Transplantation of human menisci was first reported in the English literature in 1984 51 and, while results of clinical investigations are mixed, the procedure is hypothesized to restore some load-bearing meniscus function.…”

Rehabilitation of Complex Knee Injuries and Key Points

“…Patellar mobilization and early postoperative passive ROM have been reported to counteract the development of arthrofibrosis (Noyes and Barber-Westin 1997;Noyes et al 2000;Yenchak et al 2011). Patellar mobilization should be performed 3-4 times a day by the patient and be reinforced by the treating therapist.…”