Prevention of permanent arthrofibrosis after anterior cruciate ligament reconstruction alone or combined with associated procedures: a prospective study in 443 knees

We prospectively determined the effectiveness of an immediate knee motion a nd early intervention program to prevent permanent motion limitations in a consecutive series of patients who had anterior cruciate ligament autogenou s patellar tendon reconstruction for isolated rupture (219 knees) or combin ed with other procedures (224 knees). The subjects were placed into either a progressive or delayed rehabilitation program and were followed for at le ast 12 months postoperatively. At follow-up a normal range of motion (0 deg rees to at least 135 degrees) was found in 436 knees (98%), and mild losses of extension (-5 degrees) were found in 7 knees. Twenty-three knees (5%) r equired interventions; 9 had extension casts, 9 had gentle manipulations un der anesthesia, 3 had arthroscopic debridements, and 2 had continuous epidu ral anesthetic and inpatient therapy. All of these 23 knees regained full m otion. The 7 patients with mild losses of extension had refused treatment i ntervention. The 0% incidence rate of permanent arthrofibrosis, and 0.7% re operation rate for knee motion limitations, demonstrated the effectiveness of our program.