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Procedural intervention for arthrofibrosis after ACL reconstruction: trends over two decades

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Arthrofibrosis is a rare complication after anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to (1) report a population-based incidence of arthrofibrosis (as defined by manipulation under anaesthesia or surgical lysis of adhesions) following ACL injury and reconstruction, (2) identify risk factors associated with development of arthrofibrosis, and (3) report outcomes of intervention for arthrofibrosis.

Methods

This was a historical cohort study performed in Olmsted County, Minnesota. The Rochester Epidemiology Project (REP) was used to identify a population-based cohort of individuals with new-onset, isolated ACL tears between 1 January 1990 and 31 December 2010. The REP database provides access to all medical records for each resident of Olmsted County, regardless of the facility where the care was delivered. A total of 1841 individuals were identified with new-onset, isolated ACL tears and were confirmed with chart review. The intervention incidence for arthrofibrosis was then calculated, and various predictive factors including age, sex, calendar year, and meniscal injury were investigated.

Results

During follow-up, 5 patients (1.0 %) in the non-operative cohort and 23 patients (1.7 %) in the ACL reconstruction cohort received intervention for arthrofibrosis, corresponding to an incidence of 0.7 per 1000 person-years in the non-operative cohort and 1.9 per 1000 person-years in the ACL reconstruction cohort. Female patients were 2.5 times more likely to have arthrofibrosis than males. The mean preoperative range of motion was −8° to 83° and improved to a mean of −2° to 127° post-operatively.

Conclusions

Arthrofibrosis remains a rare but potentially devastating complication after ACL reconstruction, and roughly 2 % of patients had post-operative stiffness that required intervention. Female patients are at higher risk of arthrofibrosis. However, when patients develop severe motion complications after ACL injury, interventions are generally effective in preventing permanent arthrofibrosis.

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Acknowledgments

This study was made possible by the Rochester Epidemiology Project which is supported by the National Institute on Aging of the National Institutes of Health under award number R01AG034676. The findings and conclusions of this report are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Departments of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Thomas L. Sanders, Hilal Maradit Kremers, Andrew J. Bryan, Michael J. Stuart & Aaron J. Krych

  2. Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Hilal Maradit Kremers & Walter K. Kremers

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  1. Thomas L. Sanders
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  2. Hilal Maradit Kremers
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Correspondence to Thomas L. Sanders.

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Sanders, T.L., Kremers, H.M., Bryan, A.J. et al. Procedural intervention for arthrofibrosis after ACL reconstruction: trends over two decades. Knee Surg Sports Traumatol Arthrosc 25, 532–537 (2017). https://doi.org/10.1007/s00167-015-3799-x

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  • DOI: https://doi.org/10.1007/s00167-015-3799-x

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