ARTHROSCOPIC TREATMENT OF ARTHROFIBROSIS OF THE KNEE

Arthrofibrosis following ACL reconstruction is a well-recognized and d isturbing complication. It may result in a greater functional deficit than the original ACL deficiency. The purposes of this retrospective s tudy were to present our results of arthroscopic arthrolysis and gentl e manipulation in 16 consecutive cases in the past almost 3 years, to determine and define the etiology and risk factors, to make recommenda tions regarding prevention and to develop a time-related management co ncept. All the 16 patients had previously undergone open ACL reconstru ction and had developed arthrofibrosis. The average time from the inde x surgery to arthrolysis was 7.4 months (range 2.5 - 18.5 months) and the average follow-up was 17.6 months (range 6-38 months). After patho logy-oriented arthroscopic debridement, notchplasty, cyclops resection etc., and following manipulation of the knee, range of motion was fou nd to be improved in all cases at the final follow-up. The average of extension deficit was decreased from 20.0-degrees to 7.0-degrees and t he flexion deficit from 34.4-degrees to 9.9-degrees. Only three patien ts regained normal range of motion compared to the other side. The onl y complication was an avulsion fracture of the fibula head which did n ot cause any lateral instability. No patient gained motion at the expe nse of joint stability. Patella baja was present in two and patellofem oral pain in seven cases at the final follow-up. Three patients underw ent further surgery after the final follow-up. Arthrofibrosis, while h aving many causes, appears to be a preventable complication. For this reason, we suggest delaying reconstructive surgery at least 3-4 weeks from the time of acute ACL injury and using this interval to regain th e full range of motion and strength preoperatively. It is also importa nt to avoid cyclops syndrome and notch impingement by means of careful operative technique. An accelerated rehabilitation program emphasizin g full extension and early motion and quadriceps rehabilitation with w eight bearing as tolerated is another key aspect. The authors suggest that arthrofibrosis requires an early, aggressive, and time-related ma nagement concept. Since following intraarticular, ACL reconstruction t he source of pathology for arthrofibrosis is usually also intraarticul ar, arthroscopic arthrolysis offers a safe, effective, minimally invas ive alternative with low morbidity.