Procedural intervention for arthrofibrosis after ACL reconstruction: trends over two decades

Abstract

Purpose Arthrofibrosis is a rare complication after anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to (1) report a population‐based incidence of arthrofibrosis (as defined by manipulation under anaesthesia or surgical lysis of adhesions) following ACL injury and reconstruction, (2) identify risk factors associated with development of arthrofibrosis, and (3) report outcomes of intervention for arthrofibrosis. Methods This was a historical cohort study performed in Olmsted County, Minnesota. The Rochester Epidemiology Project (REP) was used to identify a population‐based cohort of individuals with new‐onset, isolated ACL tears between 1 January 1990 and 31 December 2010. The REP database provides access to all medical records for each resident of Olmsted County, regardless of the facility where the care was delivered. A total of 1841 individuals were identified with new‐onset, isolated ACL tears and were confirmed with chart review. The intervention incidence for arthrofibrosis was then calculated, and various predictive factors including age, sex, calendar year, and meniscal injury were investigated. Results During follow‐up, 5 patients (1.0 %) in the non‐operative cohort and 23 patients (1.7 %) in the ACL reconstruction cohort received intervention for arthrofibrosis, corresponding to an incidence of 0.7 per 1000 person‐years in the non‐operative cohort and 1.9 per 1000 person‐years in the ACL reconstruction cohort. Female patients were 2.5 times more likely to have arthrofibrosis than males. The mean preoperative range of motion was −8° to 83° and improved to a mean of −2° to 127° post‐operatively. Conclusions Arthrofibrosis remains a rare but potentially devastating complication after ACL reconstruction, and roughly 2 % of patients had post‐operative stiffness that required intervention. Female patients are at higher risk of arthrofibrosis. However, when patients develop severe motion complications after ACL injury, interventions are generally effective in preventing permanent arthrofibrosis.

Cyclops lesions detected by MRI are frequent findings after ACL surgical reconstruction but do not impact clinical outcome over 2 years

“…As of June 2016 (Pubmed search) we did not find a prospective study assessing the MRI prevalence of cyclops lesions in asymptomatic patients who underwent arthroscopic ACL reconstruction. Sanders et al [22] enrolled 1841 patients retrospectively and reviewed their medical records, in particular the knee range of motion. They found that in 2% of the patients a second surgery was needed in order to treat cyclops lesions, however, the prevalence of cyclops lesions in patients without severe loss of knee extension was not assessed.…”

“…Arthroscopic studies have estimated the prevalence of symptomatic cyclops lesions after ACL surgery ranging between 1% and 9.8% [16, 17]. Symptomatic cyclops lesions, also referred as cyclops syndrome [8, 18], are treated by arthroscopic removal with eventually an additional notchplasty, regaining the full extension of the knee [19–22]. …”

Sulfasalazine Resolves Joint Stiffness in a Rabbit Model of Arthrofibrosis

“…Fibrosis often develops after joint trauma or major surgical procedures such as total knee arthroplasty (TKA) and anterior cruciate ligament (ACL) reconstruction . Approximately, 3–10% of TKA patients are treated for arthrofibrosis, while 2–35% of ACL reconstruction patients and 14.5% of patients with knee intra‐articular fractures require intervention . The standard‐of‐care is limited to arthroscopic debridement, capsule‐release, and manipulating limbs under anesthesia.…”

Physical therapy to improve mobility following surgery for multiple ligament knee injuries: A case report

“…Failure to address knee mobility deficits can result in arthrofibrosis. Arthrofibrosis is a rare complication following ACL reconstruction that affects ~2% of patients, but does seem to respond to appropriate interventions [13]. Therefore, it is important Physical therapists limit the effects of immobilization and create a comprehensive plan of care to prevent these complications.…”