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

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.

Keywords: ACL Injury; ACL reconstruction; Arthrofibrosis; Lysis of adhesions; Manipulation; Procedural Intervention.

Figure 1. Probability of intervention for arthrofibrosis in a cohort of 1,841 patients with new-onset ACL injury

Kaplan-Meier curves of time to intervention for arthrofibrosis over 60 months of follow-up. The dashed line corresponds to analyses where follow-up is censored at the time of surgery, whereas the solid line illustrates all arthrofibrosis interventions in the entire cohort irrespective of ACL surgery status. Although most of the interventions for arthrofibrosis occurred soon after ACL injury or surgery (as indicated by the early drop off of the Kaplan-Meier curve), there were still patients who required intervention for arthrofibrosis several months after ACL reconstruction.