A new technique for arthroscopic management of painful stiff knee after anterior cruciate ligament reconstruction due to femoral malposition

Abstract.

It is well known that a loss of motion occurs after ACL reconstruction, particularly after anterior placement of the femoral insertion of the graft. The problem, however, is related to the nonanatomical placement of the graft and not a consequence of an abnormal healing process. This situation can usually be improved by total graft resection. In our consideration the proximal transplant shift is probably a better treatment for patients with a structurally intact graft. This study was undertaken to illustrate our clinical findings. We examined 4 women and 7 men with a mean age of 28 years; the average follow-up period was 18 months. Preoperatively all patients complained of pain related to activity. The range of motion was 123°-9.5°–0° flexion-extension. Eight patients were unable to participate in sports, and three were unable to work. The IKDC scores were: one B, four C, and six D. The Lachman test was negative or slide positive (1+). Postoperatively all patients improved and reported no or slight pain with a free range of motion (140°–0°–0°). All patients returned to work, and eight patients were able to practice sports again. The IKDC scores were two A, seven B, and two C. The average Lysholm score was 86 points. The clinical Lachman test was slide positive (1+). The radiological Lachman test and the KT-1000 test had a side-to-side difference of 2 mm. Based on these results, the proximal transplant shift seems to be a good alternative treatment for us at the present time.