Prospective Evaluation of Range of Motion in Acute ACL Reconstruction Using Patellar Tendon Autograft

Abstract

Background: Optimal timing of anterior cruciate ligament (ACL) reconstruction has been a topic of controversy. Reconstruction has historically been delayed for at least 3 weeks, given previous studies reporting a high risk of postoperative arthrofibrosis and suboptimal clinical results. Purpose: To prospectively evaluate postoperative range of motion following acutely reconstructed ACLs with patellar tendon autograft. Study Design: Case series; Level of evidence, 4. Methods: Patients (age >18 years) who had ACL reconstruction as soon as possible after injury, regardless of the condition or preoperative range of motion of the injured knee, underwent reconstruction with patellar tendon autograft. An identical standard surgical technique and postoperative rehabilitation were employed for all patients. Postoperative assessment included active range of motion measurements with a goniometer. Subjective outcomes were assessed with the Knee injury and Osteoarthritis Outcome Score (KOOS). Results: A total of 25 consecutive patients who met the inclusion criteria were enrolled. The mean age was 27.9 years (range, 20-48 years), and 19 were men. The time from injury to surgery was a mean 4.5 days (range, 1-9 days). The mean objective follow-up was 10.9 months (range, 3 days–19.4 months), and range of motion was regained at a mean 4.4 months (range, 1-9 months). Three meniscal repairs and 3 microfractures were performed concomitantly. There was 1 graft failure at 3 years postoperatively, noted at 50 months of subjective follow-up. There was no loss of extension >3° as compared with the contralateral knee in any patient. There was no loss of flexion >5° as compared with the contralateral knee in any patient who completed objective follow-up. The mean KOOS at final subjective follow-up was 82.8 (range, 57.7-98.8) at a mean 56.6 months postoperative (n = 14/24; range, 48-58 months). Conclusion: Excellent clinical results can be achieved following ACL reconstruction performed ≤9 days after injury with patellar tendon autograft. The authors found that early ACL reconstructions do not result in loss of motion or suboptimal clinical results as long as a rehabilitation protocol emphasizing extension and early range of motion is employed.

Relationship Between Timing of Anterior Cruciate Ligament Reconstruction and Chondral Injuries: A Systematic Review and Meta-analysis

“…In addition, there is concern that early ACL reconstruction may be associated with higher rates of arthrofibrosis and other complications, but the evidence with regard to this is highly conflicting. 6,26,37,39,43,50,51,54 Although our data showed an increased risk of chondral damage as time elapsed from injury to ACL reconstruction, this meta-analysis considered only those patients who ultimately underwent ACL reconstruction, and we can make no inferences about the rates of chondral damage in patients who were treated without ACL reconstruction. Therefore, the clinical conundrum and challenge remain the identification of which patients will require ACL reconstruction at an early stage in their treatment pathway, as our findings suggest that for these patients, early reconstruction may protect articular cartilage.…”

The safety and effectiveness comparison of Delta Medical's PEEK interface screw and Endobutton and that of Smith & Nephew's in arthroscopic anterior cruciate ligament reconstruction: A multicenter prospective double-blind randomized controlled clinical trial

“…Harris reported in his study that there was no loss of extension >3 degrees as compared with the contralateral knee in any patient. There was no loss of flexion >5 degrees as compared with the contralateral knee in any ACL reconstruction patient who completed objective follow-up ( 31 ). The mean active flexion range of motion in this study improved from 117.4 degrees preoperatively to 137.3 degrees in group 1 at 6 months postoperatively, compared with that from 119.8 degrees preoperatively to 137.7 degrees in group 2.…”

An Arthroscopic Procedure for Restoration of Posterolateral Tibial Plateau Slope in Tibial Plateau Fracture Associated With Anterior Cruciate Ligament Injuries

“…However, recent evidence supports that patients achieve comparable range of motion without an increased risk of arthrofibrosis, as well as good clinical outcomes, after an acute ACL reconstruction versus a delayed surgery. 13,14 A study directly comparing this one-stage technique versus staged operations is needed to further characterize postoperative clinical and functional outcomes and patient satisfaction.…”