Archives of Orthopaedic and Trauma Surgery

, Volume 124, Issue 8, pp 518–522 | Cite as

Arthrofibrosis following ACL reconstruction—reasons and outcome

  • Hermann O. MayrEmail author
  • Thomas G. Weig
  • Wolfgang Plitz
Original Article



Arthrofibrosis is a complication that severely influences the clinical outcome after anterior cruciate ligament (ACL) reconstruction. This retrospective clinical study analyses risk factors and outcome after arthrolysis in a large population.

Material and methods

Two hundred twenty-three patients who had undergone arthrolysis after ACL reconstruction were examined. Range of motion (ROM) was reduced due to arthrofibrosis of the joint in 70% (n=156). Other reasons, such as cyclops syndrome or osteoarthritis were found in 30% (n=67). The mean time interval between arthrolysis and follow-up was 4.29 years. We recorded timing of surgery, additional injuries, state of the knee before reconstruction, range of motion, pain during rehabilitation, beginning, duration and type of rehabilitation, severity and etiology of joint stiffness and the time between ACL reconstruction and revision. The present state of the knee was documented using the IKDC form.


A significant correlation of arthrofibrosis and preoperative irritation (p<0.001), preoperative limited ROM (p=0.001), perioperative pain (p=0.046) and early beginning of muscle training (p=0.064) was found. Combination of a remaining loss of extension and development of degenerative joint disease was also significant (p=0.001). The decrease of sports activity compared with the level before ACL injury was highly significant (p<0,001). The criteria to minimize the risk of arthrofibrosis and the optimal timing of arthrolysis are pointed out.


Arthrofibrosis Stiff knee ACL reconstruction IKDC 


  1. 1.
    Almkinders LC, Moore T, Freedman D, Taft TN (1995) Post-operative problems following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 3(2):78–82PubMedGoogle Scholar
  2. 2.
    Anderson AF, Snyder RB, Federspiel CF, Lipscomb AB (1992) Instrumented evaluation of knee laxity: a comparison of five arthrometers. Am J Sports Med 20(2):135–140PubMedGoogle Scholar
  3. 3.
    Bosch U, Zeichen J, Lobenhoffer P, Albers I, van Griensven M (1999) Arthrofibrose—Ein chronisch inflammatorischer Prozeß? Arthroskopie 12(3):117–120CrossRefGoogle Scholar
  4. 4.
    Bosch U, Zeichen J, Skutek M, Haeder L, van Griensven M (2001) Arthrofibrosis is the result of a T Cell-mediated immune response. Knee Surg Sports Traumatol Arthrosc 9(5):282–289CrossRefPubMedGoogle Scholar
  5. 5.
    Dandy DJ, Edwards DJ (1994) Problems in regaining full extension of the knee after anterior cruciate ligament reconstruction: does arthrofibrosis exist? Knee Surg Sports Traumatol Arthrosc 2(2):76–79PubMedGoogle Scholar
  6. 6.
    Delince P, Krallis P, Descamps PY, Fabeck L, Hardy D (1998) Different aspects of the cyclops lesion following anterior cruciate ligament reconstruction: a multifactorial etiopathogenesis. Arthroscopy 14 (8):869–876PubMedGoogle Scholar
  7. 7.
    Ferretti A, Conteduca F, De Carli A, Fontana M, Mariani PP (1991) Osteoarthritis of the knee after ACL reconstruction. Int Orthop 15(4):367–371PubMedGoogle Scholar
  8. 8.
    Fink C, Hoser C, Benedetto KP (1994) Arthroseentwicklung nach Ruptur des vorderen Kreuzbands. Ein Vergleich von operativer und konservativer Therapie. Unfallchirurg 97(7):357–361PubMedGoogle Scholar
  9. 9.
    Földi M, Kubik S (1999) Lehrbuch der Lymphologie für Mediziner und Physiotherapheuten. Fischer, StuttgartGoogle Scholar
  10. 10.
    Hefti F, Müller W, Jako RP, Stäubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1:226–234PubMedGoogle Scholar
  11. 11.
    Jackson DW, Schaefer RK (1990) Cyclops syndrome: loss of extension following intra-articular anterior cruciate ligament reconstruction. Arthroscopy 6(3):171–178CrossRefPubMedGoogle Scholar
  12. 12.
    Kramer KL (1993) Scores, Bewertungsschemata und Klassifikationen in Orthopädie und Traumatologie. Thieme, StuttgartGoogle Scholar
  13. 13.
    Klein W, Shah N, Gassen A (1994) Arthroscopic management of postoperative arthrofibrosis of the knee joint: indication, technique, and results. Arthroscopy 10(6):591–597PubMedGoogle Scholar
  14. 14.
    Kleipool AE, Zijl JA, Willems WJ (1998) Arthroscopic anterior cruciate ligament reconstruction with bone-patellar tendon-bone allograft or autograft. A prospective study with an average follow up of 4 years. Knee Surg Sports Traumatol Arthrosc (6):224–230CrossRefGoogle Scholar
  15. 15.
    Küllmer K, Letsch R, Turowski B (1994) Which factors influence the progression of degenerative osteoarthritis after ACL surgery? Knee Surg Sports Traumatol Arthrosc (2):80–84Google Scholar
  16. 16.
    Lobenhoffer P (1998) [Golden standard: patellar tendon-plasty—technique and management of postoperative complications] Zentralbl Chir 123(9):981–993Google Scholar
  17. 17.
    Lobenhoffer P, Gerich T, Hernandez R (1996) Die Therapie von Streckdefiziten des Kniegelenkes durch arthroskopische Arthrolyse und dorsale Kapsulotomie. Unfallchirurg 99:487–491PubMedGoogle Scholar
  18. 18.
    Mok DW, Dowd GS (1993) Long-term results of anterior cruciate reconstruction with the patellar tendon. Injury 24(6):385–388CrossRefPubMedGoogle Scholar
  19. 19.
    Passler JM, Schippinger G, Schweighofer F, Fellinger M, Seibert FJ (1995) Complications in 283 cruciate ligament replacement operations with free patellar tendon transplantation. Modification by surgical technique and surgical timing? Unfallchirurgie 21(5):240–246PubMedGoogle Scholar
  20. 20.
    Seitz H, Chrysopoulos A, Egkher E, Mousavi M (1994) Long-term results of replacement of the anterior cruciate ligament in comparison with conservative therapy. Chirurg 65(11):992–998PubMedGoogle Scholar
  21. 21.
    Shelbourne KD, Gray T (1997) Anterior cruciate ligament reconstruction with autogenous patellar tendon graft followed by accelerated rehabilitation. Am J Sports Med 25(6):786–795PubMedGoogle Scholar
  22. 22.
    Shelbourne KD, Patel DV (1995) Timing of surgery in anterior cruciate ligament-injured knees. Knee Surg Sports Traumatol Arthrosc (3):148–156Google Scholar
  23. 23.
    Shelbourne KD, Wilckens JH, Mollabashi A, DeCarlo M (1991) Arthrofibrosis in acute anterior cruciate ligament reconstruction. The effect of timing of reconstruction and rehabilitation. Am J Sports Med 19(4):332–336PubMedGoogle Scholar
  24. 24.
    Shelbourne KD, Patel DV, Martini DJ (1996) Classification and management of arthrofibrosis of the knee after anterior cruciate ligament reconstruction. AM J Sports Med 24 (6):857–862PubMedGoogle Scholar
  25. 25.
    Sun Y, Sturmer T, Gunther KP, Brenner H (1997) Incidence and prevalence of cox- and gonarthrosis in the general population. Z Orthop Ihre Grenzgeb 135(3):184–192PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Hermann O. Mayr
    • 1
    Email author
  • Thomas G. Weig
    • 2
  • Wolfgang Plitz
    • 2
  1. 1.OCM-Clinic of Orthopaedic Surgery, MunichMunichGermany
  2. 2.Institute for Biomechanics and experimental OrthopedicsLudwig-Maximilians-University MunichMunichGermany

Personalised recommendations