Hermann O Mayr1, Christian M Brandt2, Thomas Weig3, Manuel Koehne4, Anke Bernstein5, Norbert P Suedkamp5, Robert Hube4, Amelie Stoehr4. 1. Department of Orthopedic and Trauma Surgery, Albert Ludwig University of Freiburg, Germany. Electronic address: hermann.mayr@uniklinik-freiburg.de. 2. Albert Ludwig University of Freiburg, Germany. 3. Department of Anaesthesiology, Munich University Hospital, Germany. 4. OCM-Clinic Munich, Germany. 5. Department of Orthopedic and Trauma Surgery, Albert Ludwig University of Freiburg, Germany.
Abstract
PURPOSE: The current study was conducted to evaluate the long-term clinical and radiological outcomes after arthroscopic arthrolysis for arthrofibrosis after anterior cruciate ligament reconstruction (ACLR). METHODS: All patients treated with arthrolysis between 1990 and 1998 were included. Indication was arthrofibrosis in at least one knee compartment or a cyclops syndrome limiting range of motion (ROM) by > 5° of extension deficit and 15° of flexion deficit. International Knee Documentation Committee (IKDC) 2000 subjective and objective, Lysholm score, and x-ray evaluation were documented. Statistical analysis and power calculation were performed (P < .05). RESULTS: One hundred forty-one patients (follow-up, 71%) were examined at a mean of 18.7 ± 2.6 years after arthroscopic arthrolysis. Mean IKDC 2000 score was 79.49 ± 14.32. IKDC objective was normal in 0%, nearly normal in 6%, abnormal in 56%, and severely abnormal in 38%. One hundred percent of patients showed more than grade II osteoarthritis. ROM improvement after arthrolysis did not change significantly compared with midterm results (t = 4.5 years). Patients with persisting motion deficits (P = .02) and after medial meniscus resection (P < .001) at time of ACLR showed significantly greater progression of osteoarthritis in comparison with patients without these additional disorders. In case of arthrolysis later than 1 year after ACLR, a more severe osteoarthritis grade (4% vs 20% grade III; P = .038) and a lower jump distance (IKDC: 61% A, 25% B vs 39% A, 41% B; P = .028) were obvious compared with patients who underwent arthrolysis within the first year after ACLR. CONCLUSIONS: Long-term motion improvement can be achieved by arthrolysis. Persistent loss of motion resulted in a higher degree of osteoarthritis in the study population. Early intervention seems advisable as patients with arthrolysis later than 1 year after index surgery reached worse IKDC objective grading. LEVEL OF EVIDENCE: Level IV, therapeutic case series.
PURPOSE: The current study was conducted to evaluate the long-term clinical and radiological outcomes after arthroscopic arthrolysis for arthrofibrosis after anterior cruciate ligament reconstruction (ACLR). METHODS: All patients treated with arthrolysis between 1990 and 1998 were included. Indication was arthrofibrosis in at least one knee compartment or a cyclops syndrome limiting range of motion (ROM) by > 5° of extension deficit and 15° of flexion deficit. International Knee Documentation Committee (IKDC) 2000 subjective and objective, Lysholm score, and x-ray evaluation were documented. Statistical analysis and power calculation were performed (P < .05). RESULTS: One hundred forty-one patients (follow-up, 71%) were examined at a mean of 18.7 ± 2.6 years after arthroscopic arthrolysis. Mean IKDC 2000 score was 79.49 ± 14.32. IKDC objective was normal in 0%, nearly normal in 6%, abnormal in 56%, and severely abnormal in 38%. One hundred percent of patients showed more than grade II osteoarthritis. ROM improvement after arthrolysis did not change significantly compared with midterm results (t = 4.5 years). Patients with persisting motion deficits (P = .02) and after medial meniscus resection (P < .001) at time of ACLR showed significantly greater progression of osteoarthritis in comparison with patients without these additional disorders. In case of arthrolysis later than 1 year after ACLR, a more severe osteoarthritis grade (4% vs 20% grade III; P = .038) and a lower jump distance (IKDC: 61% A, 25% B vs 39% A, 41% B; P = .028) were obvious compared with patients who underwent arthrolysis within the first year after ACLR. CONCLUSIONS: Long-term motion improvement can be achieved by arthrolysis. Persistent loss of motion resulted in a higher degree of osteoarthritis in the study population. Early intervention seems advisable as patients with arthrolysis later than 1 year after index surgery reached worse IKDC objective grading. LEVEL OF EVIDENCE: Level IV, therapeutic case series.
Authors: Daniel Pérez-Prieto; María E Portillo; Raúl Torres-Claramunt; Xavier Pelfort; Pedro Hinarejos; Joan C Monllau Journal: Knee Surg Sports Traumatol Arthrosc Date: 2017-10-07 Impact factor: 4.342
Authors: Betina B Hinckel; Charles A Baumann; Leandro Ejnisman; Leonardo M Cavinatto; Alexander Martusiewicz; Miho J Tanaka; Marc Tompkins; Seth L Sherman; Jorge A Chahla; Rachel Frank; Guilherme L Yamamoto; James Bicos; Liza Arendt; Donald Fithian; Jack Farr Journal: J Am Acad Orthop Surg Glob Res Rev Date: 2020-10-01