CLASSIFICATION AND MANAGEMENT OF ARTHROFIBROSIS OF THE KNEE AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

We report 72 patients with disabling knee arthrofibrosis who were trea ted at our clinic. All patients had painful restriction of extension o r limitation of both extension and flexion that had persisted despite physical therapy. The level of arthrofibrosis was categorized into one of four types: Type 1 (25 patients), < 10 degrees extension loss and normal flexion; Type 2 (16 patients), > 10 degrees extension loss and normal flexion; Type 3 (15 patients), > 10 degrees extension loss and > 25 degrees flexion loss with a tight patella; and Type 4 (16 patient s), > 10 degrees extension loss, 30 degrees or more flexion loss, and patella infera with marked patellar tightness. All patients were treat ed with outpatient arthroscopic surgery. Anterior scar resection down to the proximal tibia was required for all patients with Types 2, 3, a nd 4 arthrofibrosis. Notchplasty was performed when necessary. Medial and lateral capsular releases and knee manipulation were required for patients with Type 3 or 4 arthrofibrosis. Postoperatively, all patient s with Types 2, 3, and 4 arthrofibrosis were treated with outpatient s erial extension casting. At the time of latest followup (28 to 115 mon ths), the mean improvement of range of motion was as follows: Type 1, 7 degrees of extension; Type 2, 14 degrees of extension; Type 3, 13 de grees of extension and 28 degrees of flexion; and Type 4, 18 degrees o f extension and 27 degrees of flexion. Improvement was also found for the mean stiffness, self-evaluation, functional activity, and Noyes kn ee scores in all groups.