Research Article| Volume 8, ISSUE 1, P10-18, March 1992

Download started.


Intraarticular fibrous nodule as a cause of loss of extension following anterior cruciate ligament reconstruction

      This paper is only available as a PDF. To read, Please Download here.


      Loss of motion is a well-known complication following anterior cruciate ligament (ACL) reconstruction. We have found that loss of extension is more disabling than loss of flexion, and is a more common problem following arthroscopic assisted ACL reconstruction. We are reporting on a group of 21 patients who have developed restricted knee extension following ACL reconstruction utilizing either the central one-third of the patellar ligament or the hamstring tendons as an autogenous graft. The patients presented at an average of 4 months postoperatively with a clinical syndrome of loss of extension associated with pain at terminal extension, crepitus, and grinding with attempted extension beyond their limit. The consistent finding at arthroscopy was a fibrous nodule occupying the intercondylar notch, varying in size from 1 × 1 to 2 × 3 cm, and presenting a mechanical block to full extension. It appears that anterior placement of the graft, particularly on the tibia, results in injury to the graft and subsequent nodule formation. Removal of the nodule resulted in improvement of an average preoperative loss of extension of 11°, to 3° at surgery, and 0° at 1 year follow-up. The average side-to-side difference in terminal extension at final examination, using the uninvolved limb for comparison, was 3°. Histology was available for review on 19 of the 21 patients operated on. The consistent microscopic finding within the nodule was the presence of disorganized dense fibroconnective tissue that, with time, underwent modulation to fibrocartilage. It is postulated that this occurs in response to compressive loading of the nodule.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Enneking WF
        • Horowitz M
        The intrarticular effects of immobilization of the human knee.
        J Bone Joint Surg. 1972; 54A: 973-985
        • Fullerton LR
        • Andrews JR
        Mechanical block to extension following augmentation of the anterior cruciate ligament.
        Am J Sports Med. 1984; 12: 166-168
        • Smillie IS
        Injuries of the knee joint.
        in: 4th ed. Williams and Wilkins, Baltimore1973: 365-386
        • Sprague NF
        Motion limiting arthrofibrosis of the knee: the role of arthroscopic management.
        Clin Sports Med. 1987; 6: 537-540
        • Sprague NF
        • O'Connor RL
        • Fox JM
        Arthroscopic treatment of postoperative knee fibroarthrosis.
        Clin Orthop. 1980; 166: 165-172
        • Thompson TC
        Quadricepsplasty to improve knee function.
        J Bone Joint Surg. 1944; 26: 366-379
        • Nicoll EA
        J Bone Joint Surg. 1963; 45B: 483-490
        • Peacock EE
        Some biochemical and biophysical aspects of joint stiffness: role of collagen synthesis as opposed to altered molecular bonding.
        Ann Surg. 1966; 164: 1-12
        • Graf B
        • Uhr F
        Complications of intra-articular anterior cruciate ligament reconstruction.
        Clin Sports Med. 1988; 7: 835-848
        • Hughston JC
        Complications of anterior cruciate ligament surgery.
        Orthop Clin. 1985; 16: 237-240
        • DeLee JC
        Complications of arthroscopy and arthroscopic surgery: results of a national survey.
        Arthroscopy. 1985; 1: 214-220
        • Del Pizzo W
        • Fox JM
        • Friedman MJ
        • et al.
        Operative arthroscopy for the treatment of arthrofibrosis of the knee.
        Contemp Orthop. 1985; 10: 67-72
        • Jackson DW
        • Schaefer RK
        Cyclops syndrome: loss of extension following intra-articular anterior cruciate ligament reconstruction.
        Arthroscopy. 1990; 6: 171-178
        • Okuda Y
        • Gorski JP
        • An KN
        • Amadio PC
        Biochemical, histological, and biomechanical analysis of canine tendon.
        J Orthop Res. 1987; 5: 60-68
        • Arnoczky SP
        • Warren RF
        • Spivak JM
        Meniscal repair using an exogenous fibrin clot.
        J Bone Joint Surg. 1988; 70A: 1209-1217
        • Arnoczky SP
        • Tarvin GB
        • Marshall JM
        Anterior cruciate ligament replacement using patella tendon.
        J Bone Joint Surg. 1982; 64A: 217-223