Incidence of arthrofibrosis in primary reconstruction of the anterior cruciate ligament (ACL) using quadriceps tendon graft
DOI:
https://doi.org/10.1016/j.rccot.2017.09.002Keywords:
arthrofibrosis, ACL, quadriceps tendonAbstract
Background: Knee arthrofibrosis is a significant complication that can occur in primary reconstruction surgery of the anterior cruciate ligament (ACL), and adversely affects the results due to loss of flexion-extension of the knee. The aim of this study is to establish the presence of arthrofibrosis in primary ACL reconstruction in patients in whom a quadriceps tendon autograft reconstruction technique was performed.
Materials and methods: A retrospective case series study was conducted over a four-year observation period on all patients with ACL lesion who were subjected to surgery, in which autograft of the tendon quadriceps without patellar bone block was used.
Results: A total of 127 patients underwent primary ACL surgery with quadriceps tendon autograft without patellar bone block during the observation period. The five (3.9%) patients that presented with arthrofibrosis were classified according to the Shelbourne classification as one type I patient, three type II patients, and one type III patient. All patients underwent total arthroscopic arthroscopy and aggressive rehabilitation. They all regained mobility ranges and returned to their sporting activity.
Discussion: Improvements in surgical technique, surgical instruments, accelerated rehabilitation protocols, and minimisation of associated risk factors have significantly reduced the incidence of arthrofibrosis.
Evidence level: Level IV.
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References
Sachs RA, Daniel DM, Stone MI, Garfein RF. Patellofemoral problems after anterior cruciate ligament reconstruction. Am J Sport Med. 1989;17:760-5. https://doi.org/10.1177/036354658901700606
Cosgarea AJ, DeHaven KE, Lovelock KE. The surgical treatment of arthrofibrosis of the knee. Am J Sport Med. 1994;22: 184-91. https://doi.org/10.1177/036354659402200206
Kim DH, Gill TJ, Millet PJ. Arthroscopic treatment of the arthrofibrotic knee. Arthroscopy 2004, 20 (suppl2):187-94. https://doi.org/10.1016/j.arthro.2004.04.036
Noyes FR, Berrios-Torres S, Barber-Westin SD, Heckmann TP. Prevention of permanent arthrofibrosis after anterior cruciate ligament reconstruction alone o combined with associated procedures: a prospective study in 443 knees. Knee Surg Sport Traumatol Arthrosc. 2000;8:196-206. https://doi.org/10.1007/s001670000126
Noyes FR, Barber-Westin SD. Prevention and treatment of knee arthrofibrosis. En: Noyes FR, Barber-Westin SD, editores. Noyes'knee disorders: surgery, rehabilitation, clinical outcomes. Philadelphia: Saunders; 2009. p. 1053-95. https://doi.org/10.1016/B978-1-4160-5474-0.00041-
Steadman JR, Dragoo JL, Hines SL, Briggs KK. Arthroscopic release for symptomatic scarring of the anterior interval of the knee. Am J Sport Med. 2008;36:1763-9. https://doi.org/10.1177/0363546508320480
Parisien JS. The role of arthroscopy in the treatment of postoperative fibroarthrosis of the knee joint. Clin Orthop Relat Res. 1988;229:185-92. https://doi.org/10.1097/00003086-198804000-00025
Chen MR, Dragoo JI. Arthroscopic release for arthrofibrosis of th knee. J Am Acad Orthop Surg. 2011;19:600-11. https://doi.org/10.5435/00124635-201111000-00007
Tonino P, Risinger RJ, García M, Bach BR Jr. Arthrofibrosis following ACL reconstruction, in Complications in Orthopaedics. Am Acad Orthop Surg. 2000;5:40-8.
Harner CD, Irrgang JJ, Paul J, Dearwater S, Fu FH. Loss of motion after anterior cruciate ligament reconstruction. Am J Sport Med. 1992;20:499-506. https://doi.org/10.1177/036354659202000503
Millett PJ, Johnson B, Carlson J, Krishnan S, Steadman JR. Rehabilitation of the arthrofibrotic knee. Am J Orthop. 2003;32:531-8.
Hasan SS, Saleem A, Bach BR Jr, Bush-Joseph CA, Bojchuk J. Results of arthroscopic treatment of symptomatic loss of extension following anterior cruciate ligament reconstruction. Am J Knee Surg. 2000;13:201-92.
Kwok CS, Harrison T, Servan T. The optimal timing for anterior cruciate ligament reconstruction with respect to the risk of postoperative stiffness. Arthroscopy. 2013;29:556-65. https://doi.org/10.1016/j.arthro.2012.09.005
Mayr HD, Stohr A. Arthroscopic treatment of the arthrofibrosis after ACL reconstruction. Local and generalized arthrofibrosis. Oper Orthop Traumatol. 2014;26:7-18.
Sunita D, Darshana S, Dinshaw P. Case series: Cyclops lesionextension loss after ACL reconstruction. Indian J Radiol Imaging. 2010;20:208-10. https://doi.org/10.4103/0971-3026.69361
Chambat P, Vargas R, Desnoyer J. Arthrofibrosis after anterior cruciate ligament reconstruction. The knee joint. Paris: Springer; 2012. p. 263-8. https://doi.org/10.1007/978-2-287-99353-4_23
Shelbourne KD, Patel DV, Martini DJ. Classification and management of arthrofibrosis of the knee after anterior cruciate ligament reconstruction. Am J Sport Med. 1996;24:857-62. https://doi.org/10.1177/036354659602400625
Shelbourne KD, Wilckens JH, Mollabashy A, DeCarlo M. Artrhrofibrosis in the acute anterior cruciate ligament reconstruction The effect of timing of reconstruction and rehabilitation. Am J Sport Med. 1991;19:332-6. https://doi.org/10.1177/036354659101900402
Outerbridge R. The etiology of chondromalacia patellae. J Bone Joint Surg Br. 1961;43:752-7. https://doi.org/10.1302/0301-620X.43B4.752
Aglietti P, Buzzi R, De Felice R, Paolini G, Zaccherotti G. Results of surgical treatment after ACL reconstruction. Knee Surg Sport Traumatol Arthrosc. 1995;3:83-8. https://doi.org/10.1007/BF01552380
Beron EG. Artrofibrosis de rodilla post-reconstrucción del LCA Asociación Argentina de Artroscopia. Artroscopia. 1999;6:82-7.
González D, Salazar R, Vargas O, Axotla V:. Artrofibrosis de la rodilla: epidemiología y tratamiento quirúrgico artroscópico. Rev Mex Ortop Traum. 2000;14:185-90.
