Long-term Results of Arthroscopic Arthrolysis for Arthrofibrosis After Anterior Cruciate Ligament Reconstruction

• Published in: Arthroscopy Vol. 33; no. 2; pp. 408 - 414
• Main Authors: Mayr, Hermann O., M.D., Ph.D, Brandt, Christian M., M.D, Weig, Thomas, M.D, Koehne, Manuel, M.D, Bernstein, Anke, Ph.D, Suedkamp, Norbert P., M.D., Ph.D, Hube, Robert, M.D, Stoehr, Amelie, M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2017
• Subjects: Adult; Aged; Aged, 80 and over; Anterior Cruciate Ligament Reconstruction - adverse effects; Arthroscopy - methods; Female; Fibrosis - etiology; Fibrosis - surgery; Follow-Up Studies; Humans; Joint Diseases - etiology; Joint Diseases - surgery; Knee Joint - pathology; Knee Joint - surgery; Male; Middle Aged; Orthopedics; Osteoarthritis, Knee - classification; Osteoarthritis, Knee - etiology
• ISSN: 0749-8063; 1526-3231
• DOI: 10.1016/j.arthro.2016.07.029

Purpose The current study was conducted to evaluate the long-term clinical and radiological outcomes after arthroscopic arthrolysis for arthrofibrosis after anterior cruciate ligament reconstruction (ACLR). Methods All patients treated with arthrolysis between 1990 and 1998 were included. Indication was arthrofibrosis in at least one knee compartment or a cyclops syndrome limiting range of motion (ROM) by > 5° of extension deficit and 15° of flexion deficit. International Knee Documentation Committee (IKDC) 2000 subjective and objective, Lysholm score, and x-ray evaluation were documented. Statistical analysis and power calculation were performed ( P < .05). Results One hundred forty-one patients (follow-up, 71%) were examined at a mean of 18.7 ± 2.6 years after arthroscopic arthrolysis. Mean IKDC 2000 score was 79.49 ± 14.32. IKDC objective was normal in 0%, nearly normal in 6%, abnormal in 56%, and severely abnormal in 38%. One hundred percent of patients showed more than grade II osteoarthritis. ROM improvement after arthrolysis did not change significantly compared with midterm results ( t  = 4.5 years). Patients with persisting motion deficits ( P  = .02) and after medial meniscus resection ( P < .001) at time of ACLR showed significantly greater progression of osteoarthritis in comparison with patients without these additional disorders. In case of arthrolysis later than 1 year after ACLR, a more severe osteoarthritis grade (4% vs 20% grade III; P  = .038) and a lower jump distance (IKDC: 61% A, 25% B vs 39% A, 41% B; P  = .028) were obvious compared with patients who underwent arthrolysis within the first year after ACLR. Conclusions Long-term motion improvement can be achieved by arthrolysis. Persistent loss of motion resulted in a higher degree of osteoarthritis in the study population. Early intervention seems advisable as patients with arthrolysis later than 1 year after index surgery reached worse IKDC objective grading. Level of Evidence Level IV, therapeutic case series.