PDF(Pubmed)
Abstract：
Arthrofibrosis (AF) after anterior cruciate ligament reconstruction (ACLR) remains a challenge. There is a paucity of data on arthroscopic interventions for AF after ACLR.
To (1) describe the patient, injury, and surgical characteristics and patient-reported outcomes (PROs) of those requiring an arthroscopic intervention for loss of motion after ACLR and (2) compare outcomes between patients undergoing an early intervention (within 3 months) versus those undergoing a late intervention (after 3 months).
Case series; Level of evidence, 4.
Patients with a history of ACLR and a subsequent operative procedure for postoperative AF at a single institution between 2000 and 2018 were retrospectively identified. Arthroscopic interventions included lysis of adhesions, capsular release with or without manipulation under anesthesia, and excision of cyclops lesions. Patients were excluded if they had a knee dislocation or multiple-ligament injury, a periarticular fracture, or less than 2-year follow-up from the arthroscopic intervention. PROs including the Tegner activity score, visual analog scale pain score, and International Knee Documentation Committee score as well as knee range of motion (ROM) were recorded.
A total of 40 patients were included with a mean age of 27.2 years (range, 11.0-63.8 years) at surgery and a mean follow-up of 10.0 years (range, 2.9-20.7 years). The mean preoperative flexion and extension were 102° (range, 40°-150°) and 8° (range, 0°-25°), respectively. The mean postoperative flexion and extension were 131° (range, 110° to 150°) and 0° (range, -10° to 5°), respectively. After the arthroscopic intervention, the mean ROM improved from 94° (range, 40°-140°) preoperatively to 131° (range, 107°-152°) at final follow-up (P < .001), and the visual analog scale pain score improved from 3.0 preoperatively to 1.2 postoperatively (P = .001). Overall, 13 patients (32.5%) underwent an intervention within 3 months and 27 (67.5%) after 3 months. The early intervention group had a higher postoperative International Knee Documentation Committee score compared with the late intervention group (86.8 vs 71.7, respectively; P = .035).
An arthroscopic intervention for AF after ACLR successfully improved knee ROM and pain. Patients who underwent either early or late surgery obtained satisfactory motion and function, although improved PROs were observed when the intervention occurred within 3 months of the primary procedure.
To (1) describe the patient, injury, and surgical characteristics and patient-reported outcomes (PROs) of those requiring an arthroscopic intervention for loss of motion after ACLR and (2) compare outcomes between patients undergoing an early intervention (within 3 months) versus those undergoing a late intervention (after 3 months).
Case series; Level of evidence, 4.
Patients with a history of ACLR and a subsequent operative procedure for postoperative AF at a single institution between 2000 and 2018 were retrospectively identified. Arthroscopic interventions included lysis of adhesions, capsular release with or without manipulation under anesthesia, and excision of cyclops lesions. Patients were excluded if they had a knee dislocation or multiple-ligament injury, a periarticular fracture, or less than 2-year follow-up from the arthroscopic intervention. PROs including the Tegner activity score, visual analog scale pain score, and International Knee Documentation Committee score as well as knee range of motion (ROM) were recorded.
A total of 40 patients were included with a mean age of 27.2 years (range, 11.0-63.8 years) at surgery and a mean follow-up of 10.0 years (range, 2.9-20.7 years). The mean preoperative flexion and extension were 102° (range, 40°-150°) and 8° (range, 0°-25°), respectively. The mean postoperative flexion and extension were 131° (range, 110° to 150°) and 0° (range, -10° to 5°), respectively. After the arthroscopic intervention, the mean ROM improved from 94° (range, 40°-140°) preoperatively to 131° (range, 107°-152°) at final follow-up (P < .001), and the visual analog scale pain score improved from 3.0 preoperatively to 1.2 postoperatively (P = .001). Overall, 13 patients (32.5%) underwent an intervention within 3 months and 27 (67.5%) after 3 months. The early intervention group had a higher postoperative International Knee Documentation Committee score compared with the late intervention group (86.8 vs 71.7, respectively; P = .035).
An arthroscopic intervention for AF after ACLR successfully improved knee ROM and pain. Patients who underwent either early or late surgery obtained satisfactory motion and function, although improved PROs were observed when the intervention occurred within 3 months of the primary procedure.
摘要：
■前交叉韧带重建（ACLR）后的关节纤维化（AF）仍然是一个挑战。关于ACLR后房颤的关节镜干预的数据很少。
■为了(1)描述病人，损伤,ACLR后需要关节镜介入治疗的患者的手术特征和患者报告的结局(PRO);(2)比较接受早期介入治疗(3个月内)和接受晚期介入治疗(3个月后)的患者的结局.
■案例系列；证据级别，4.
■在2000年至2018年期间，在一家机构中对具有ACLR病史和随后的术后AF手术程序的患者进行了回顾性鉴定。关节镜干预包括粘连溶解，在麻醉下有或没有操作的囊膜释放，并切除独眼皮损.如果患者有膝关节脱位或多韧带损伤，则被排除在外。关节周围骨折,或少于2年的随访从关节镜干预。包括Tegner活动得分在内的专业人员，视觉模拟量表疼痛评分，并记录国际膝关节文献委员会评分以及膝关节活动范围(ROM).
■共纳入40例患者，平均年龄为27.2岁（范围，手术11.0-63.8年），平均随访10.0年（范围，2.9-20.7年）。术前平均屈伸为102°(范围，40°-150°)和8°(范围,0°-25°),分别。术后平均屈伸为131°（范围，110°至150°）和0°（范围，-10°至5°),分别。关节镜介入后，平均ROM从94°提高(范围，术前40°-140°)至131°(范围，107°-152°)在最终随访时(P<.001)，视觉模拟量表疼痛评分从术前3.0改善至术后1.2(P=0.001)。总的来说,13例（32.5%）在3个月内接受干预，27例（67.5%）在3个月后接受干预。与晚期干预组相比，早期干预组术后国际膝关节文献委员会评分较高（分别为86.8vs71.7；P=.035）。
■ACLR后对AF的关节镜干预成功改善了膝关节ROM和疼痛。接受早期或晚期手术的患者获得了令人满意的运动和功能，尽管在主要手术后3个月内进行干预时，观察到PRO改善。
■为了(1)描述病人，损伤,ACLR后需要关节镜介入治疗的患者的手术特征和患者报告的结局(PRO);(2)比较接受早期介入治疗(3个月内)和接受晚期介入治疗(3个月后)的患者的结局.
■案例系列；证据级别，4.
■在2000年至2018年期间，在一家机构中对具有ACLR病史和随后的术后AF手术程序的患者进行了回顾性鉴定。关节镜干预包括粘连溶解，在麻醉下有或没有操作的囊膜释放，并切除独眼皮损.如果患者有膝关节脱位或多韧带损伤，则被排除在外。关节周围骨折,或少于2年的随访从关节镜干预。包括Tegner活动得分在内的专业人员，视觉模拟量表疼痛评分，并记录国际膝关节文献委员会评分以及膝关节活动范围(ROM).
■共纳入40例患者，平均年龄为27.2岁（范围，手术11.0-63.8年），平均随访10.0年（范围，2.9-20.7年）。术前平均屈伸为102°(范围，40°-150°)和8°(范围,0°-25°),分别。术后平均屈伸为131°（范围，110°至150°）和0°（范围，-10°至5°),分别。关节镜介入后，平均ROM从94°提高(范围，术前40°-140°)至131°(范围，107°-152°)在最终随访时(P<.001)，视觉模拟量表疼痛评分从术前3.0改善至术后1.2(P=0.001)。总的来说,13例（32.5%）在3个月内接受干预，27例（67.5%）在3个月后接受干预。与晚期干预组相比，早期干预组术后国际膝关节文献委员会评分较高（分别为86.8vs71.7；P=.035）。
■ACLR后对AF的关节镜干预成功改善了膝关节ROM和疼痛。接受早期或晚期手术的患者获得了令人满意的运动和功能，尽管在主要手术后3个月内进行干预时，观察到PRO改善。
