Clinical Outcomes After Arthroscopic Release of Patellofemoral Arthrofibrosis in Patients With Prior Anterior Cruciate Ligament Reconstruction

Abstract

Purpose: The purpose of this study was to review our results of arthroscopic release in patients diagnosed with refractory patellofemoral arthrofibrosis (PFA) after having undergone anterior cruciate ligament (ACL) reconstruction.

Methods: From 2006 to 2016, all patients who underwent arthroscopic release for refractory PFA after ACL reconstruction were reviewed retrospectively. All patients then completed surveys containing the International Knee Documentation Committee (IKDC) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and were asked 2 subjective questions. Patients included in the study exhibited at least one finding of PFA and failed conservative treatment for at least 3 months. Included patients also had a minimum of 12 months of postoperative follow-up after PFA release. Patients who underwent any other concomitant surgery in the same operative setting as arthroscopic release for PFA were excluded from the study.

Results: Thirty-two patients were included in the study. The mean age was 32.8 years (range, 19-58 years) with an average follow-up of 43.6 months (range, 16-98 months). There was a statistically significant increase preoperatively to postoperatively in the IKDC score from 49.6 to 69.4 (P < .00001), and 16 of 32 patients (50%) achieved a minimal clinically important difference (MCID). WOMAC scores also significantly increased from 74 to 85.3 (P < .00001), with 15 of 32 patients (47%) achieving MCID. Thirty-one patients (97%) reported that the procedure helped, and 25 patients (78%) said they would have the procedure again.

Conclusions: Arthroscopic release, consisting of an extended lateral release, debridement of the notch/fat pad, and manual manipulation of the patella, results in significant increases in validated outcome measures and is well tolerated by patients.

Level of evidence: Level IV, case series.