Purpose
To identify the postoperative characteristics associated with the need for subsequent
surgical intervention in pediatric anterior cruciate ligament reconstruction (ACLR).
Methods
Patients ≤18 years old who received operative treatment for arthrofibrosis following
ACLR versus age- and sex-matched controls with a satisfactory postoperative course
were retrospectively reviewed. The range of knee motion preoperatively and at each
postoperative visit was recorded. Based on the typical post-operative protocols, visits
were categorized into 3 groups: first (first 4 weeks), second (weeks 5-8), and third
(weeks 9-16) visits. The deficit in the total arc of range of motion (ROM) in the
operative knee relative to the nonoperative knee and the change in ROM between visits
were compared. Receiver operating characteristic analysis was performed to determine
the time point in which a diagnosis of arthrofibrosis could be predicted with the
greatest accuracy.
Results
In total, 18 patients with arthrofibrosis (mean age 14.2 ± 2.7 years, 9 male) and
36 control patients were included in the final analysis. Arthrofibrosis patients had
significantly larger ROM deficits at all visits, 93° vs 69° for the first, 69° vs
24° for the second, and 56° vs 2º for the third, compared with controls (P < .001 for all). Pairwise comparisons showed that in arthrofibrosis cases, the total
ROM did not change significantly between the second and third visits (P = .77), contrary to the controls. Receiver operating characteristic analysis revealed
that the total ROM deficit of 50.7° at the second postoperative visit is 89% sensitive
and 92.5% specific for development of arthrofibrosis.
Conclusions
We found that patients who go on to need manipulation of the knee under anesthesia/arthroscopic
lysis of adhesions do not experience a significant improvement in ROM after the first
5-8 weeks, and that a ROM deficit of >50° at the 5- to 8-week mark postoperatively,
is associated with ultimately needing operative intervention for arthrofibrosis. Based
on these findings, it may be appropriate to intervene earlier if a patient still has
a ROM deficit exceeding 50° by the second postoperative month.
Level of Evidence
Level III, retrospective comparative prognostic trial.
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References
- Arthrofibrosis following ACL reconstruction—reasons and outcome.Arch Orthop Trauma Surg. 2004; 124: 518-522
- Arthrofibrosis of the knee.J Am Acad Orthop Surg. 2007; 15: 682-694
- International consensus on the definition and classification of fibrosis of the knee joint.Bone Joint J. 2016; 98: 1479-1488
- Association of the graft size and arthrofibrosis in young patients after primary anterior cruciate ligament reconstruction.J Am Acad Orthop Surg. 2018; 26: e483-e489
- Arthrofibrosis after anterior cruciate ligament reconstruction in children and adolescents.J Pediatr Orthop. 2011; 31: 811-817
- Incidence and risk factors of joint stiffness after anterior cruciate ligament reconstruction.J Orthop Surg Res. 2020; 15: 1-10
- Classification and management of arthrofibrosis of the knee after anterior cruciate ligament reconstruction.Am J Sports Med. 1996; 24: 857-862
- Procedural intervention for arthrofibrosis after ACL reconstruction: Trends over two decades.Knee Surg Sports Traumatol Arthrosc. 2017; 25: 532-537
- Loss of extension following anterior cruciate ligament reconstruction: analysis of incidence and etiology using IKDC criteria.Arthroscopy. 2008; 24: 146-153
- Arthrofibrosis of the knee following anterior cruciate ligament reconstruction.J Orthop Sports Phys Ther. 2011; 41 (32-32)
- Risk factors for manipulation under anesthesia and/or lysis of adhesions after anterior cruciate ligament reconstruction.Orthop J Sports Med. 2018; 6 (2325967118794490)
- Incidence and predictors of subsequent surgery after anterior cruciate ligament reconstruction: A 6-year follow-up study.Am J Sports Med. 2020; 48: 2418-2428
- All-epiphyseal ACL reconstruction in children: Review of safety and early complications.J Pediatr Orthop. 2017; 37: 204-209
- Challenges in the management of anterior cruciate ligament ruptures in skeletally immature patients.J Am Acad Orthop Surg. 2018; 26: e50-e61
- Anterior cruciate ligament reconstruction in skeletally immature patients.Curr Rev Musculoskelet Med. 2016; 9: 445-453
- Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: Summary report.Pediatrics. 2007; 120: S164-S192
- Physeal sparing reconstruction of the anterior cruciate ligament in skeletally immature prepubescent children and adolescents: Surgical technique.J Bone Joint Surg Am. 2006; 88: 283-293
- General considerations and complications for pediatric anterior cruciate ligament reconstruction.in: Thompson S. Schmitz M. Complications in orthopaedics: Sports medicine. Elsevier, Philadelphia2019: 98-110
- Arthrofibrosis after total knee arthroplasty: Pathophysiology, diagnosis, and management.Orthop Clin North Am. 2019; 50: 269-279
- Pathological mechanisms and therapeutic outlooks for arthrofibrosis.Bone Res. 2019; 7: 1-24
- Clinical, objective, and functional outcomes of manipulation under anesthesia to treat knee stiffness following total knee arthroplasty.J Arthroplasty. 2014; 29: 548-552
- Stiffness after total knee arthroplasty: Prevalence, management and outcomes.Knee. 2006; 13: 111-117
- Arthrofibrosis after ACL reconstruction is best treated in a step-wise approach with early recognition and intervention: A systematic review.Knee Surg Sports Traumatol Arthrosc. 2017; 25: 3929-3937
- Arthrofibrosis associated with total knee arthroplasty.J Arthroplasty. 2017; 32: 2604-2611
- Range of motion improvement following surgical management of knee arthrofibrosis in children and adolescents.J Pediatr Orthop. 2018; 38: e495-e500
Article info
Publication history
Published online: February 11, 2022
Accepted:
January 30,
2022
Received:
April 21,
2021
Footnotes
The authors report the following potential conflicts of interest or sources of funding: T.J.G. reports personal fees from Vericel, Arthrex, and AlloSource, outside the submitted work. L.W. reports personal fees from Zimmer Biomet, Allergan, and Synthes, outside the submitted work. J.T.R.L. reports other from Sawbones, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2022 by the Arthroscopy Association of North America
