ARTHROSCOPIC TREATMENT OF ARTHROFIBROSIS OF THE KNEE

Abstract

Arthrofibrosis following ACL reconstruction is a well-recognized and disturbing complication. It may result in a greater functional deficit than the original ACL deficiency. The purposes of this retrospective study were to present our results of arthroscopic arthrolysis and gentle manipulation in 16 consecutive cases in the past almost 3 years, to determine and define the etiology and risk factors, to make recommendations regarding prevention and to develop a time-related management concept. All the 16 patients had previously undergone open ACL reconstruction and had developed arthrofibrosis. The average time from the index surgery to arthrolysis was 7.4 months (range 2.5 - 18.5 months) and the average follow-up was 17.6 months (range 6-38 months). After pathology-oriented arthroscopic debridement, notchplasty, cyclops resection etc., and following manipulation of the knee, range of motion was found to be improved in all cases at the final follow-up. The average of extension deficit was decreased from 20.0-degrees to 7.0-degrees and the flexion deficit from 34.4-degrees to 9.9-degrees. Only three patients regained normal range of motion compared to the other side. The only complication was an avulsion fracture of the fibula head which did not cause any lateral instability. No patient gained motion at the expense of joint stability. Patella baja was present in two and patellofemoral pain in seven cases at the final follow-up. Three patients underwent further surgery after the final follow-up. Arthrofibrosis, while having many causes, appears to be a preventable complication. For this reason, we suggest delaying reconstructive surgery at least 3-4 weeks from the time of acute ACL injury and using this interval to regain the full range of motion and strength preoperatively. It is also important to avoid cyclops syndrome and notch impingement by means of careful operative technique. An accelerated rehabilitation program emphasizing full extension and early motion and quadriceps rehabilitation with weight bearing as tolerated is another key aspect. The authors suggest that arthrofibrosis requires an early, aggressive, and time-related management concept. Since following intraarticular, ACL reconstruction the source of pathology for arthrofibrosis is usually also intraarticular, arthroscopic arthrolysis offers a safe, effective, minimally invasive alternative with low morbidity.