Subsequent Surgery for Loss of Motion After Anterior Cruciate Ligament Reconstruction Does Not Influence Function at 2 Years: A Matched Case-Control Analysis

Abstract

Background: Loss of motion (LOM) remains a common complication after anterior cruciate ligament (ACL) reconstruction and can be detrimental to patient outcomes after surgery. LOM is multifactorial, but nonsurgical and surgical solutions to this complex problem are available. A paucity of quality data exists evaluating clinical outcomes after the surgical treatment of patients with LOM after ACL reconstruction. Hypothesis: Patients undergoing surgical lysis of adhesions and manipulation under anesthesia for LOM after ACL reconstruction will exhibit decreased function, lower outcome scores, and delayed time of release to play when compared with matched controls without LOM. Study Design: Cohort study; Level of evidence, 3 Methods: A database of 1572 patients undergoing ACL reconstruction was sampled from 2013 to 2017 to identify a total of 58 patients (LOM group [n = 29] vs matched control group [n = 29]). Group comparisons were examined for patients requiring a second surgical procedure for LOM versus matched controls after ACL reconstruction for differences in surgical timing, self-reported International Knee Disability Committee scores, objective function at release to play, and subjective knee function at 2 years with the Single Assessment Numeric Evaluation. The risk of a type I error was set at α = .05 for all statistical analyses. Results: Patients who underwent lysis of adhesions and manipulation under anesthesia for LOM after ACL reconstruction exhibited no differences in Single Assessment Numeric Evaluation knee function at 2 years when compared with matched controls (85.8 ± 14.9 vs 88.0 ± 10.8, P = .606). All patients met release-to-play criteria. Only International Knee Disability Committee scores ( P = .046) and single-legged hop testing ( P = .050) reached statistically significant differences, with higher scores in the control group. There was no difference in the time to release to play ( P = .034) or level of participation ( P = .180) between the control and surgical groups. Subjective function scores at 2 years were not significantly different between groups. Tourniquet time during the index ACL reconstruction was shorter in the control group ( P = .034). Conclusion: The findings of this study suggest that patients who undergo surgical treatment for LOM after ACL reconstruction can release to play at similar times but display relative deficits in single-legged-hop symmetry and lower self-reported function when compared with matched controls. Longer surgical times may increase the risk for LOM after ACL reconstruction. Registration: NCT03704376 (ClinicalTrials.gov identifier)

Incidence and Predictors of Subsequent Surgery After Anterior Cruciate Ligament Reconstruction: A 6-Year Follow-up Study

“…Patients who undergo subsequent surgery for loss of motion have been shown to return to sports at similar times as case-matched controls but have displayed poorer single-leg hop test results and self-reported function. 22 Based on our data, avoiding reconstruction with an allograft could decrease the incidence of subsequent surgery related to loss of motion. In a study of adolescent patients who had undergone ACL reconstruction, Nwachukwu et al 14 reported that female sex, age (ie, older adolescents), concurrent meniscal repair, and reconstruction with a patellar tendon autograft were risk factors for arthrofibrosis.…”

Arthrogenic muscle inhibition and return to sport after arthrofibrosis complicating anterior cruciate ligament surgery

“…Clinically, knee range of motion decreases, which is easily observable, and enables the surgeon to propose a mobilization under general anesthesia or an early arthrolysis 1,15,22,31,40 .…”

Manipulation under anaesthesia versus lysis of adhesions for arthrofibrosis of the knee: a 6-month randomized, multicentre, non-inferiority comparative effectiveness protocol

“…Eligible patients are randomly assigned to receive either LOA or MUA at these hospitals. To be included in the study, the surgeon has to understand the study design, review patient inclusion criteria, and complete two training sessions that introduce standardized surgical procedures that have been reported previously (9,27). Postoperative physical therapy (PT) is performed at the PT clinic of three participating hospitals.…”

“…Despite the abundant literature on PT for arthrofibrosis of the knee after surgical release, there is currently no gold standard. Notably, quadriceps muscle activation and knee ROM exercises are initiated immediately after surgery and aggressively advanced within the limits of patient tolerance (27).…”

“…Once sufficient muscle activation and knee motion are obtained, the patient will resume the criterionbased postoperative rehabilitation protocol (see online Supplementary appendix 1) at the caution of the treating physical therapist (27). The protocol includes phased knee ROM, lower limb strengthening, neuromuscular control, and an agility program.…”