Arthroscopic arthrolysis of knee arthrofibrosis after anterior cruciate ligament reconstruction

Abstract EN

Hypothesis: Arthrofibrosis following anterior cruciate ligament (ACL) reconstruction may result in a greater functional deficit than the original ACL deficiency especially when both flexion and extension may be limited.

Arthroscopic arthrolysis for such cases is the treatment of choice because the pathology is intraarticular.

Methodology: This study represents the results of arthroscopic arthrolysis followed by immediate utilization of continuous passive motion (CPM) in 16 male patients who presented with knee stiffness after ACL reconstruction.

The mean age was 27 years (range 19-34), and the mean interval between ACL reconstruction and arthrolysis was 6.2 months (ranged 3-11).

In all cases arthrolysis included cutting of the intraarticular adhesions followed by handling of other associated pathology, like excision of cyclops fibrous nodule, notchplasty or partial release of tight misplaced graft.

The last step was forced manipulation of the knee into flexion.

CPM was used immediately after arthrolysis for 2 hours 4 times daily interrupted by isometric quadriceps and hamstring setting exercises, and leg lifts in the first postoperative 4 days, then active and active assistive exercises, were allowed.

Results: According to the criteria of Parisien we had 14 excellent and 2 good cases.

The average flexion range improved from 97° preoperatively to 133° postoperatively.

One complication occurred in this series in the form of avulsion of the inferior pole of the patella that occurred during the final manipulation of the knee into flexion after arthrolysis.

Internal fixation using tension band wiring was done and this patient went to a final quite satisfied range of motion (0°-125°) at 5 months follow up.

Conclusion: Arthroscopic arthrolysis for knee arthrofibrosis after ACL reconstruction is a safe effective procedure with low morbidity that sequentially facilitates an accelerated postoperative intensive physiotherapy of passive (CPM), active assistive and active exercises.