The authors of this paper followed 342 patients all having the same procedure (anterior cruciate ligament reconstruction using patellar tendon), and all procedures were performed by the same surgeon.
They found that five percent of these patients after at least four months of intensive physiotherapy had 'symptomatic extension deficits', that is they were unable to fully extend their knee and further efforts to achieve extension were painful. These patients went on to 'secondary' procedures - examination under anaesthesia (EUA), notchplasty where necessary (widening the bony notch in which the cruciates lie), surgical removal of adhesions, and controlled manipulation (MUA). After the intervention they were assigned to a closely supervised rehab protocol and the majority were followed up for several years to determine the eventual outcome.
Outcome of Surgery
The authors report that the eventual outcome was that these patients after their secondary surgery and rehabilitation improved from a 10° extension loss to only a 3° loss, giving no functional difference from the patients who had not had any problem. They did note, however, that these patients were still left with some deficit in flexion.
They emphasise that the best management of arthrofibrosis of the knee is preventative, and they advocate careful patient selection, appropriate timing of surgery, and close attention to graft positioning and the ensuring adequacy of the notch during surgery.
However, for those patients that still go on to have an extension deficit, surgery should be undertaken to rectify any problems. In the authors' opinion this is best undertaken in the 6-12 week period after the ligament reconstruction, but patients can still have significant improvement even 8-11 months after the reconstruction.