OUTPATIENT SURGICAL-MANAGEMENT OF ARTHROFIBROSIS AFTER ANTERIOR CRUCIATE LIGAMENT SURGERY

We present a consecutive series of nine patients who were referred to us because of arthrofibrosis (loss of >15-degrees of extension) after intraarticular anterior cruciate ligament reconstruction using autogen ous patellar tendon (eight patients) or semitendinosus (one patient) g raft. Eight patients had surgery within 2 weeks of injury. All patient s had been immobilized in flexion after the anterior cruciate ligament reconstruction and they had failed to improve despite vigorous physic al therapy and other closed methods of treatment. The mean time from a nterior cruciate ligament reconstruction to the subsequent surgery was 10.2 months (range, 3 to 14). The patients underwent an outpatient ar throscopic anterior scar resection, notchplasty, a closed knee manipul ation for flexion, and extension casting. Serial daily extension cast changes allowed the patients to obtain full extension, which was maint ained by a bivalved extension splint for bedtime use. Flexion was acti vely sought by aggressive outpatient physical therapy. All patients ex cept one noted near-normal ultimate range of motion. One patient could only attain 10-degrees short of flat extension at the end of his reha bilitation and was considered a failed result. At final followup (mean , 31 months), no patient complained of symptoms of instability, all ha d a normal gait, and all but one were able to return to athletic activ ities.