Early Identification of Arthrofibrosis in Adolescents Following Anterior Cruciate Ligament Reconstruction Is Associated With the Need for Subsequent Surgery: A Matched Case-Control Study

Abstract

Purpose: To identify the postoperative characteristics associated with the need for subsequent surgical intervention in pediatric anterior cruciate ligament reconstruction (ACLR).

Methods: Patients ≤18 years old who received operative treatment for arthrofibrosis following ACLR versus age- and sex-matched controls with a satisfactory postoperative course were retrospectively reviewed. The range of knee motion preoperatively and at each postoperative visit was recorded. Based on the typical post-operative protocols, visits were categorized into 3 groups: first (first 4 weeks), second (weeks 5-8), and third (weeks 9-16) visits. The deficit in the total arc of range of motion (ROM) in the operative knee relative to the nonoperative knee and the change in ROM between visits were compared. Receiver operating characteristic analysis was performed to determine the time point in which a diagnosis of arthrofibrosis could be predicted with the greatest accuracy.

Results: In total, 18 patients with arthrofibrosis (mean age 14.2 ± 2.7 years, 9 male) and 36 control patients were included in the final analysis. Arthrofibrosis patients had significantly larger ROM deficits at all visits, 93° vs 69° for the first, 69° vs 24° for the second, and 56° vs 2º for the third, compared with controls (P < .001 for all). Pairwise comparisons showed that in arthrofibrosis cases, the total ROM did not change significantly between the second and third visits (P = .77), contrary to the controls. Receiver operating characteristic analysis revealed that the total ROM deficit of 50.7° at the second postoperative visit is 89% sensitive and 92.5% specific for development of arthrofibrosis.

Conclusions: We found that patients who go on to need manipulation of the knee under anesthesia/arthroscopic lysis of adhesions do not experience a significant improvement in ROM after the first 5-8 weeks, and that a ROM deficit of >50° at the 5- to 8-week mark postoperatively, is associated with ultimately needing operative intervention for arthrofibrosis. Based on these findings, it may be appropriate to intervene earlier if a patient still has a ROM deficit exceeding 50° by the second postoperative month.

Level of evidence: Level III, retrospective comparative prognostic trial.