Outpatient Surgical Management of Arthrofibrosis After Anterior Cruciate Ligament Surgery

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Abstract
We present a consecutive series of nine patients who were referred to us because of arthrofibrosis (loss of >15° of extension) after intraarticular anterior cruciate ligament reconstruction using autogenous patellar ten don (eight patients) or semitendinosus (one patient) graft. Eight patients had surgery within 2 weeks of injury. All patients had been immobilized in flexion after the anterior cruciate ligament reconstruction and they had failed to improve despite vigorous physical therapy and other closed methods of treatment. The mean time from anterior cruciate ligament reconstruction to the subse quent surgery was 10.2 months (range, 3 to 14). The patients underwent an outpatient arthroscopic anterior scar resection, notchplasty, a closed knee manipulation for flexion, and extension casting. Serial daily extension cast changes allowed the patients to obtain full exten sion, which was maintained by a bivalved extension splint for bedtime use. Flexion was actively sought by aggressive outpatient physical therapy. All patients ex cept one noted near-normal ultimate range of motion. One patient could only attain 10° short of flat extension at the end of his rehabilitation and was considered a failed result. At final followup (mean, 31 months), no patient complained of symptoms of instability, all had a normal gait, and all but one were able to return to athletic activities.

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