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Randomized Controlled Trial
. 2018 Oct;26(10):2875-2882.
doi: 10.1007/s00167-017-4814-1. Epub 2017 Nov 29.

No risk of arthrofibrosis after acute anterior cruciate ligament reconstruction

Karl Eriksson  1 , Christoffer von Essen  2 , Sven Jönhagen  3 , Björn Barenius  1
Affiliations
Randomized Controlled Trial

No risk of arthrofibrosis after acute anterior cruciate ligament reconstruction

Karl Eriksson et al. Knee Surg Sports Traumatol Arthrosc. 2018 Oct.

Abstract

Purpose: To compare acute ACL reconstruction (ACLR) within 8 days of injury with delayed reconstruction after normalized range of motion (ROM), 6-10 weeks after injury. It was hypothesized that acute ACL reconstruction with modern techniques is safe and can be beneficial in terms of patient-reported outcomes and range of motion.

Methods: Sample size calculation indicated 64 patients would be required to find a 5° difference in ROM at 3 months. Seventy patients with high recreational activity level, Tegner level 6 or more, were randomized to acute (within 8 days) or delayed (6-10 weeks) ACLR between 2006 and 2013. During the first 3 months following surgery patients were contacted weekly by SMS and asked 'How is your knee functioning?', with answers given on a Visual-Analog Scale (0-10). ROM was assessed after 3 months by the rehab physiotherapist. Patient-reported outcomes, objective IKDC and manual stability measurements were collected by an independent physiotherapist not involved in the rehab at the 6-month follow-up.

Results: At 3-month follow-up, 91% of the patients were assessed with no significant differences in flexion, extension or total ROM demonstrated between groups. At the 6-month follow-up, the acute group had significantly less muscle atrophy of the thigh muscle compared to the contralateral leg. Furthermore, a significantly higher proportion of patients in the acute group passed or were close to passing the one leg hop test (47 versus 21%, p = 0.009). No difference was found between the groups in the other clinical assessments. Additionally, no significant difference between the groups was found in terms of associated injuries.

Conclusion: Acute ACLR within 8 days of injury does not appear to adversely affect ROM or result in increased stiffness in the knee joint when compared to delayed surgery.

Level of evidence: II.

Keywords: ACL; Acute; Outcome; Range of motion; Reconstruction.

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Conflict of interest statement

Conflict of interest

The authors have no conflicts of interest.

Ethical approval

The study was approved by the regional ethics committee at the Karolinska Institute, Stockholm Sweden (reference no. 2006/404-31/3/2008/1541-32).

Informed consent

Informed consent was obtained by each patient.

Figures

Fig. 1
Fig. 1
Enrollment and Randomization of Subjects
Fig. 2
Fig. 2
How is your knee working? Weekly SMS survey for the first 3 months after the reconstruction. The diagram above show the mean results from the SMS-survey, red lines for the acute group and blue for the delayed. The error bars indicate one standard deviation. Ten was defined as no knee function and 0 normal function. There was no significant difference between the groups at any time-point
Fig. 3
Fig. 3
Mean KOOS score. Mean KOOS scores with significant changes after injury to 6 months, but no significant difference between the groups at any time
See this image and copyright information in PMC

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