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Abstract
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.
Keywords
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Copyright
© 1992 Arthroscopy Association of North America. Published by Elsevier Inc.
