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. 2019 Mar 8;7(3):2325967119829547.
doi: 10.1177/2325967119829547. eCollection 2019 Mar.

Factors Associated With a Delay in Achieving Full Knee Extension Before Anterior Cruciate Ligament Reconstruction

Andrew Gage  1 , Melissa A Kluczynski  1 , Leslie J Bisson  1 , John M Marzo  1
Affiliations

Factors Associated With a Delay in Achieving Full Knee Extension Before Anterior Cruciate Ligament Reconstruction

Andrew Gage et al. Orthop J Sports Med. .

Abstract

Background: Arthrofibrosis commonly occurs after an acute anterior cruciate ligament (ACL) injury and following ACL reconstruction and can lead to poor outcomes. Preoperative stiffness has been shown to be associated with postoperative stiffness; however, few studies have examined predictors of preoperative delay in obtaining full knee extension.

Purpose: To examine demographic and injury factors as predictors of time required to achieve full knee extension preoperatively in patients with an acute ACL injury.

Study design: Case-control study; Level of evidence, 3.

Methods: A total of 172 patients with an acute ACL tear at presentation (defined as ≤3 weeks from injury) who underwent magnetic resonance imaging (MRI) within 6 weeks of the injury were included in this analysis. Preoperative data included date of injury, age at injury, sex, body mass index, mechanism of injury (noncontact/contact), time from injury to surgery (days), time to achieve full extension prior to surgery (weeks), and bone bruising on MRI. Time to achieve full extension was categorized as <3 or ≥3 weeks. Unadjusted and adjusted logistic regression was used to examine predictors of delayed time to achieve full extension (≥3 vs <3 weeks). Odds ratios and 95% CIs were reported.

Results: Time to achieve full extension was early (<3 weeks) in 98 patients and delayed (≥3 weeks) in 74 patients. The average time to achieve full extension was 7 days in the early group and 32.5 days in the delayed group. Delayed time to achieve full extension was associated with increased lateral femoral condyle (LFC) bruising compared with early time to achieve extension (82.8% vs 66.7%, respectively; P = .03). No other statistically significant predictors were found after adjustment for age, sex, body mass index, and mechanism of injury.

Conclusion: Acute ACL injuries associated with LFC bone bruising seen on MRI are more likely to result in reduced extension prior to ACL reconstruction. These injuries should be identified and addressed by an appropriate preoperative rehabilitation program, and surgery should be delayed to avoid risking arthrofibrosis postoperatively by reconstructing a knee with less than full extension.

Keywords: anterior cruciate ligament; bone bruise; delayed extension; range of motion; reconstruction.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: This study was funded by the Ralph C. Wilson, Jr. Foundation. L.J.B. has received research support from Arthrex and educational support from Zimmer Biomet and Prodigy Surgical Distribution. J.M.M. has received research support from Carestream Health, educational support from Arthrex, and hospitality payments from Linvatec. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

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