2023 ISAKOS Biennial Congress ePoster
Predictors and Early Management of Knee Arthrofibrosis After Arthroscopic Knee Ligament Reconstruction Surgery in Adolescent Patients
Alejandro Marquez-Lara, MD, PhD UNITED STATES
William Padget, DO, Rochester, MI UNITED STATES
Shital N. Parikh, MD, Cincinnati, OH UNITED STATES
Cincinnati Children's Medical Center, Cincinnati, Ohio, UNITED STATES
FDA Status Not Applicable
Summary
Prompt recognition of knee arthrofibrosis after knee arthroscopy can be safely and successfully managed with early (<3 months) MUA in adolescent patients.
ePosters will be available shortly before Congress
Abstract
Introduction
Management of postoperative knee arthrofibrosis can be challenging, and recent evidence suggests a stepwise approach that begins with diagnosis and treatment within the first 3 months after index surgery can be effective. However, few studies have reported on the safety and effectiveness of early (<3 months) manipulation under anesthesia (MUA) following knee arthroscopy in adolescent patients with arthrofibrosis. The purpose of this study is to evaluate the safety and effectiveness associated with early MUA following arthroscopic knee ligament reconstruction in adolescent patients.
Methods
A list of all ligamentous arthroscopic knee procedures between 2008-2021 was queried to identify patients who had undergone anterior cruciate ligament (ACL) reconstruction or medial patellofemoral
reconstruction (MPFL). From this patient cohort, adolescent patients (<19 years) who required MUA after index procedure were identified. Patients were matched 2:1 with a non MUA cohort to assess predictors of early MUA.
Results
A total of 25 patients (10 ACL and 15 MPFL) with an average age of 14.7±2.5 were included for analysis. Patients underwent MUA at a mean 63.7±18.9 days after index surgery. Median follow up was 8.4 months (IQR 4.7-16.1). ROM achieved during MUA was significantly greater compared to 6 weeks post index surgery and Pre MUA ROM. ROM subsequently increased significantly >6 weeks after MUA (p=0.002). Only two patients (8.0%) were considered to have failed MUA treatment based on the need for second MUA or subsequent lysis of adhesions and achieved full ROM after final treatment. Matched cohort analysis demonstrated a greater proportion of African American patients in the MUA cohort compared to non-MUA patients. Compared to non MUA patients, ROM was significantly restricted in MUA patients prior to index surgery, 7 days after index surgery, and 6 weeks after index surgery. Furthermore, 31.8% of MUA patients reported pain 6 weeks after index surgery compared to only 6.9% of non MUA patients (p=0.021).
Conclusion
The findings of this study suggest knee arthrofibrosis can be safely and successfully managed with early (<3 months) MUA in adolescent patients. Although further research is warranted to better characterize risk factors ROM <90 degrees and pain with ROM at 6 weeks postop may suggest future arthrofibrosis and management of knee stiffness/arthrofibrosis with MUA is a safe and effective treatment to help patients regain full ROM without invasive LOA.