[Arthroscopic treatment of arthrofibrosis after ACL reconstruction. Local and generalized arthrofibrosis]

Abstract

Objective: Restoration of free knee motion taking into account knee extension, knee flexion, and patella mobility.

Indications: Prolonged knee motion restriction after anterior cruciate ligament (ACL) reconstruction, persistent decreased patella mobility, or extension deficit.

Contraindications: Existing significant joint irritation or active reflex dystrophy with persistent distinctive pain syndrome.

Surgical technique: Arthroscopic arthrolysis possible in most cases. Removal of adhesions in all compartments. Elimination of intraarticular cause of patella infera by removing infrapatellar scar tissue and fibrotic fat pad. In case of severe peripatellar fibrotic tissue, lateral release is useful with partial transection of lateral retinacula. In case of strong capsular contracture, additional medial release indicated to improve patella mobility. Important goal of arthrolysis: full range of knee extension. Arthrolysis for scar tissue removal in the posterior recessus through dorsomedial arthroscopic approach possible. In severe cases posteromedial arthrotomy for posterior capsule release required. Cyclops syndrome makes removal of all tissue adherent to the ACL necessary. An irregular ACL insertion or intercondylar notch stenosis may require notchplasty. Postoperative recurrence of fibrosis may require repeated arthroscopic surgery to improve mobility, such as notchplasty, osteophytes resection, scar removal, and releases.

Postoperative management: Immediate postoperative pain-free physical therapy taking into account full range of extension and patella mobility. Passive exercises under traction. Lymphatic drainage. No exercising in pain throughout the entire postoperative physical therapy. Continuous passive motion treatment for 4 weeks postoperatively useful. No muscle strength or equipment training for at least 3 months postoperatively.

Results: Based on the observations in our working group, approximately pproximately 78% of patients develop knee osteoarthritis within 5 years.