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Loss of knee motion following anterior cruciate ligament reconstruction
154
ABSTRACTS
cellent pain relief in both groups. However, this was achieved an average of 3.4 months sooner in the arthroscopic group. In the open group, two patients complained of areas of skin numbness from transected cutaneous nerves and one of a keloid. The average hospital stay of the open group was 3 days, while the arthroscopic resections were done as outpatient procedures. Arthroscopic distal clavicle resection via a superior approach was found to achieve technical success in bone removal, comparable to traditional open techniques, with reduced morbidity. This approach is preferable when combined with an acromioplasty because time is not limited by additional swelling from a bursal approach to the distal clavicle. Loss of Knee Motion Following Anterior Cruciate Ligament Reconstruction. Freddie H. Fu, Jonathan J. Paul, James J. Irrgang, Rajiv Sawhney, and Christopher D. Harner. Pittsburgh, Pennsylvania,
U.S.A. This is a retrospective study to investigate the characteristics of patients who have failed to progress in physical therapy (PT) following arthroscopic anterior cruciate ligament (ACL) reconstruction. The frost 200 consecutive intra-articular ACL reconstructions performed by the same surgeon utilizing the same technique with a minimum of 1 year follow-up observation were reviewed. An aggressive rehabilitation program with early motion and patellar mobilization was advocated for each patient. Five patients were discarded from the study due to lack of adequate follow-up observation. Failure to progress in PT was defined as loss of extension (> IO”) or flexion (< 125”). Failure to achieve extension is a much more disabling problem and is the focus of this study. Significant loss of knee extension (LKE) is a flexion contracture >lo”. Loss of motion was seen in 16 patients for an overall incidence of 8.2%. Ten of these patients had loss of both extension and flexion, while the remaining six had loss of extension but normal flexion. Student’s t-test and chi-squared test for proportions without Yates correction were performed on the data. Meniscal surgery and the type of ACL donor graft (allograft versus autograft) showed no correlation with postoperative loss of motion. Older age (27 + 6.1 versus 23 + 7.1) and sex (male more than female) were associated with a significant (p < 0.01) in-
Arthroscopy, Vol. 6, No. 2. 1990
crease in loss of knee motion postoperatively. Patients who had reconstructions less than 6 months from their knee injury showed a higher incidence (p < 0.02) of decreased motion following ACL reconstruction. All 16 patients with LKE were initially treated with aggressive PT to attempt to correct their loss of motion. Ten patients with LKE have undergone an initial arthroscopic or open adhesiolysis procedure, and two patients have required a second adhesiolysis procedure. The average extension prior to adhesiolysis was 14.9” + 6.1” and after adhesiolysis was 2.3” + 2.1”. The average flexion prior to adhesiolysis was 109.1” + 30.9” and after adhesiolysis was 125” + 11.8”. The average time period between the ACL reconstruction and the initial adhesiolysis procedure was 6.1 months (range, 3-10 months). We believe that the etiology of LKE is multifactorial, ranging from intercondylar notch scarring to patellar entrapment. We conclude that loss of knee extension (or “stiff knee”) following arthroscopic ACL reconstruction is a common and serious clinical problem occurring postoperatively in 5-10% of intra-articular arthroscopic ACL reconstructions. In our patient population, risk factors for developing LKE include having an ACL reconstruction <6 months postinjury, being a male, and being 26 years of age or older. We also conclude that aggressive PT is vital for prevention of this problem, and successful treatment requires adhesiolysis. Meniscal Transplantation in the Human Knet+a Preliminary Report. John C. Garrett. Atlanta, Georgia. Robert N. Steensen. Hilliard, Ohio, U.S.A. Meniscectomy can result in degenerative disease, with younger patients having problems in middle age. In addition, loss of a major portion of a meniscus may increase instability in an anterior cruciate deficient knee. For these two reasons it is theoretically desirable to transplant menisci in selected patients. In this paper, nine patients who underwent allograft transplantation of a meniscus are presented to demonstrate the success of the operative procedure. Six underwent free meniscal transplantation (four medial and two lateral), and three had transplantation of the meniscus with the attached tibial plateau (two lateral and one medial). Follow-up extends from 8 to 34 months. All patients are free of episodes of locking. Four have
ABSTRACTS
cellent pain relief in both groups. However, this was achieved an average of 3.4 months sooner in the arthroscopic group. In the open group, two patients complained of areas of skin numbness from transected cutaneous nerves and one of a keloid. The average hospital stay of the open group was 3 days, while the arthroscopic resections were done as outpatient procedures. Arthroscopic distal clavicle resection via a superior approach was found to achieve technical success in bone removal, comparable to traditional open techniques, with reduced morbidity. This approach is preferable when combined with an acromioplasty because time is not limited by additional swelling from a bursal approach to the distal clavicle. Loss of Knee Motion Following Anterior Cruciate Ligament Reconstruction. Freddie H. Fu, Jonathan J. Paul, James J. Irrgang, Rajiv Sawhney, and Christopher D. Harner. Pittsburgh, Pennsylvania,
U.S.A. This is a retrospective study to investigate the characteristics of patients who have failed to progress in physical therapy (PT) following arthroscopic anterior cruciate ligament (ACL) reconstruction. The frost 200 consecutive intra-articular ACL reconstructions performed by the same surgeon utilizing the same technique with a minimum of 1 year follow-up observation were reviewed. An aggressive rehabilitation program with early motion and patellar mobilization was advocated for each patient. Five patients were discarded from the study due to lack of adequate follow-up observation. Failure to progress in PT was defined as loss of extension (> IO”) or flexion (< 125”). Failure to achieve extension is a much more disabling problem and is the focus of this study. Significant loss of knee extension (LKE) is a flexion contracture >lo”. Loss of motion was seen in 16 patients for an overall incidence of 8.2%. Ten of these patients had loss of both extension and flexion, while the remaining six had loss of extension but normal flexion. Student’s t-test and chi-squared test for proportions without Yates correction were performed on the data. Meniscal surgery and the type of ACL donor graft (allograft versus autograft) showed no correlation with postoperative loss of motion. Older age (27 + 6.1 versus 23 + 7.1) and sex (male more than female) were associated with a significant (p < 0.01) in-
Arthroscopy, Vol. 6, No. 2. 1990
crease in loss of knee motion postoperatively. Patients who had reconstructions less than 6 months from their knee injury showed a higher incidence (p < 0.02) of decreased motion following ACL reconstruction. All 16 patients with LKE were initially treated with aggressive PT to attempt to correct their loss of motion. Ten patients with LKE have undergone an initial arthroscopic or open adhesiolysis procedure, and two patients have required a second adhesiolysis procedure. The average extension prior to adhesiolysis was 14.9” + 6.1” and after adhesiolysis was 2.3” + 2.1”. The average flexion prior to adhesiolysis was 109.1” + 30.9” and after adhesiolysis was 125” + 11.8”. The average time period between the ACL reconstruction and the initial adhesiolysis procedure was 6.1 months (range, 3-10 months). We believe that the etiology of LKE is multifactorial, ranging from intercondylar notch scarring to patellar entrapment. We conclude that loss of knee extension (or “stiff knee”) following arthroscopic ACL reconstruction is a common and serious clinical problem occurring postoperatively in 5-10% of intra-articular arthroscopic ACL reconstructions. In our patient population, risk factors for developing LKE include having an ACL reconstruction <6 months postinjury, being a male, and being 26 years of age or older. We also conclude that aggressive PT is vital for prevention of this problem, and successful treatment requires adhesiolysis. Meniscal Transplantation in the Human Knet+a Preliminary Report. John C. Garrett. Atlanta, Georgia. Robert N. Steensen. Hilliard, Ohio, U.S.A. Meniscectomy can result in degenerative disease, with younger patients having problems in middle age. In addition, loss of a major portion of a meniscus may increase instability in an anterior cruciate deficient knee. For these two reasons it is theoretically desirable to transplant menisci in selected patients. In this paper, nine patients who underwent allograft transplantation of a meniscus are presented to demonstrate the success of the operative procedure. Six underwent free meniscal transplantation (four medial and two lateral), and three had transplantation of the meniscus with the attached tibial plateau (two lateral and one medial). Follow-up extends from 8 to 34 months. All patients are free of episodes of locking. Four have