Predictors and Early Treatment of Knee Arthrofibrosis After Arthroscopic Knee Ligament Reconstruction Surgery in Adolescent Patients

Alejandro Marquez-Lara; William Padget; Eric J Wall; Shital N Parikh

doi:10.1177/23259671241299838

Predictors and Early Treatment of Knee Arthrofibrosis After Arthroscopic Knee Ligament Reconstruction Surgery in Adolescent Patients

Orthop J Sports Med. 2024 Dec 20;12(12):23259671241299838. doi: 10.1177/23259671241299838. eCollection 2024 Dec.

Authors

Alejandro Marquez-Lara¹, William Padget², Eric J Wall³, Shital N Parikh³

Affiliations

¹ Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA.
² Beaumont Hospital, Farmington Hills, Michigan, USA.
³ Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.

Abstract

Background: Postoperative knee arthrofibrosis after arthroscopic ligament reconstruction is a serious complication. Among adolescents, risk factors for postoperative arthrofibrosis are not well characterized and the effectiveness of early manipulation under anesthesia (MUA) is not well established.

Purposes: To identify risk factors for arthrofibrosis after arthroscopic knee ligament reconstruction in adolescent patients and to evaluate the safety and effectiveness of early MUA.

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

Methods: The charts of all adolescent patients (<19 years of age) who underwent early MUA (<3 months) for knee stiffness after anterior cruciate ligament (ACL) or medial patellofemoral ligament (MPFL) reconstructions between 2008 and 2021 were retrospectively reviewed. Patients were matched 2:1 with patients without MUA from the same study period. The primary outcome was the final range of motion (ROM) after MUA. Logistic regression analysis was performed to identify predictors of MUA.

Results: A total of 25 patients (10 with ACL reconstruction and 15 with MPFL reconstruction) with a mean age of 14.8 ± 2.6 years were included for analysis. Overall, 44% were skeletally immature. Patients underwent MUA at a mean of 63.3 ± 19.5 days after the index surgery. The mean ROM improved significantly from 96.3°± 20.5° to 135°± 9.7° after MUA after a median follow-up of 8.1 months (interquartile range, 5.4-15.0 months). There were no complications associated with MUA, but 2 patients (8.0%) had MUA treatment failure. There were no differences in body mass index, type and frequency of associated procedures, or patellar height on lateral radiographs between the cohorts. The MUA cohort had statistically significant increased operative time, decreased preoperative motion, decreased ROM at 6 weeks postoperatively, and increased pain at 6 weeks postoperatively when compared with the non-MUA cohort. Regression analysis demonstrated that ROM at 6 weeks (OR: 0.83, 95% CI, 0.69-0.98, p = .034) was significantly associated with the need for MUA.

Conclusion: The findings of this study suggest that early (<3 months) MUA is safe and effective in treating knee arthrofibrosis in adolescent patients. MUA is a treatment alternative for patients with restricted ROM at 6 weeks that may help them recover full ROM.

Keywords: anterior cruciate ligament reconstruction; knee arthrofibrosis; knee ligaments, ACL; manipulation under anesthesia; medial patellofemoral ligament reconstruction; pediatric sports medicine.