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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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
