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INTRODUCTION
Arthrofibrosis after anterior cruciate ligament
reconstruction (ACLR) is a challenging
complication. Arecent epidemiological study by
Werner
et al.
[1] reported an incidence of 0.49%
of surgical lysis of adhesions after isolated
ACLR by 6 months post-operatively and 0.91%
when associated with a meniscal repair.
Flexion deficit is usually better tolerated than
an extension deficit, even 5 degrees, which
causes difficulties with walking and anterior
knee pain [2].
Most post-operative extension deficits result
from localized mechanical causes and can be
treated by isolated anterior arthroscopic release
[3]. In rare cases, a chronic flexion contracture
with generalized arthrofibrosis requires an
additional posterior release.
Even though open posterior release is the gold
standard procedure for treating chronic
extension deficit, only a few studies have
reported the results of this procedure.
Moreover, the four studies investigating
posterior open release outcomes used a single
posterior approach [4-8]. To our knowledge, no
study analysing the results of both
posteromedial and posterolateral approaches
has been performed so far.
The purpose of this study was [1] to analyse the
midterm outcome and complications of a
combined procedure – anterior arthroscopic
debridement and posterior open capsulotomy
– for the treatment of chronic extension deficits
after ACLR, and [2] to describe the surgical
technique of posterior open release with both
posteromedial and posterolateral approaches.
MATERIALAND METHODS
Subjects
Between 2005 and 2012, 14 patients were
secondarily referred to our institution for knee
range of motion (ROM) deficit following
ACLR. All patients had knee arthrolysis
performed by two senior orthopaedic surgeons
from our institution.
Inclusion criteria included the following:
1)
flexion contracture of 10° or more following
ACLR;
2)
chronic flexion contracture
persisting for 6 months or longer;
3)
failure of
conservative treatment or isolated anterior
arthroscopic release. A minimum 6 months’
follow-up after arthrolysis was requested.
Patients had no history of knee trauma or
surgery of the contralateral knee. Patients who
had undergone prosthetic knee surgery were
excluded from the study.
EXTENSION DEFICIT AFTER ACL
RECONSTRUCTION: Is Open Posterior
Release a Safe and Efficient Procedure?
N. TARDY, M. THAUNAT, B. SONNERY-COTTET,
C.G. MURPHY, P. CHAMBAT, J.M. FAYARD