Management for Arthrofibrosis Following ACL Reconstruction

Abstract

Introduction: Arthrofibrosis following ACL reconstruction is a debilitating complication. The incidence range from 2% to as high 35%. This Loss of motion not only cause of anterior knee pain but also inability to return to sports, and persistent weakness. The emergence of intra-articular scar tissue adhesions, or post-traumatic arthrofibrosis, may restrict the patient’s knee motion in the early postoperative period even though many factors may contribute to the development of motion loss. It might be difficult to manage motion loss once it has been diagnosed as a condition. Better understanding of the time of surgery, surgical technique improvement, and rehabilitation protocols showed less incidence of motion loss after ACL reconstruction. Case Presentation: A 46-year-old female complains of pain, stiffness, and decreased range of motion following arthroscopy ACL reconstruction of her left knee. Local examination showed diffused firm swelling over the anteromedial aspect of the knee and limitation of motion to mobilize the patella in all directions. Her bad rehabilitation program after surgery caused the main loss of her knee motion and the development of pain. Arthroscopic lysis of adhesions with manipulation under anesthesia was conducted. Following the surgery, graft observation was normal. A cyclops located between the infrapatellar pouch and medial gutter was observed and excised. Passive range of motion was also checked intra-operatively. Immediately after surgery, intensive physiotherapy was begun. The patient was very compliant with the rehabilitation program and the clinic follow-up schedule. Gradually, the patient started to regain her active full extension and flexion. Result: The functional outcome score showed improvement at the time of final follow-up, as did the average pain scores. Conclusion: Arthrofibrosis is multifactorial etiology. Knee joint ROM is better maximized by arthroscopic debridement and lysis of adhesions following arthrofibrosis after ACLR in conjunction with an intensive post-operative physical therapy plan.