Arthrofibrosis after knee arthroscopy is a challenging complication. Previous studies reporting incidences of manipulation under anesthesia (MUA) or lysis of adhesions (LOA) after knee arthroscopy are limited by confounders such as small sample size and regional sampling bias.
Purpose:
To investigate the incidence of MUA or LOA after common arthroscopic knee procedures.
Study Design:
Descriptive epidemiology study.
Methods:
A national insurance database was retrospectively queried for arthroscopic knee procedures from 2007 to 2011. The incidence of postoperative MUA and LOA within 3 and 6 months postoperatively was determined for each of 13 common arthroscopic knee surgeries, including ligamentous reconstructive procedures, cartilage restoration procedures, and meniscal procedures.
Results:
A total of 330,714 unique patients who underwent knee arthroscopy were included in the study. The overall incidence of MUA was 0.06% to 6.00% by 3 months and 0.11% to 8.00% by 6 months postoperatively. The incidence of LOA was somewhat less, ranging from 0.04% to 4.00% by 3 months and 0.06% to 6.00% by 6 months postoperatively. Isolated arthroscopic partial meniscectomy had the lowest incidence of postoperative MUA and LOA, while multiligament reconstructions and meniscal transplants had the highest incidences.
Conclusion:
The overall incidence of MUA and LOA after arthroscopic knee procedures is low but rises significantly as the number of concomitant procedures or complexity of the procedures increases. This information may be useful in counseling patients on the likelihood of MUA or LOA based on the type of arthroscopic knee procedure that is planned.
AbramsGDFrankRMGuptaAK. Trends in meniscus repair and meniscectomy in the United States, 2005-2011. Am J Sports Med. 2013;41(10):2333-2339.
2.
AustinJCPhornphutkulCWojtysEM. Loss of knee extension after anterior cruciate ligament reconstruction: effects of knee position and graft tensioning. J Bone Joint Surg Am. 2007;89(7):1565-1574.
3.
AustinKSShermanOH. Complications of arthroscopic meniscal repair. Am J Sports Med. 1993;21(6):864-868; discussion 868-869.
4.
ColosimoAJCarrollPFHeidtRSJr. Simultaneous ACL and PCL reconstruction. J Knee Surg. 2003;16(4):191-196.
5.
DaffnerSDHymansonHJWangJC. Cost and use of conservative management of lumbar disc herniation before surgical discectomy. Spine J. 2010;10(6):463-468.
6.
DoddsJAKeeneJSGrafBK. Results of knee manipulations after anterior cruciate ligament reconstructions. Am J Sports Med. 1991;19(3):283-287.
7.
FreedmanKBD’AmatoMJNedeffDD. Arthroscopic anterior cruciate ligament reconstruction: a metaanalysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med. 2003;31(1):2-11.
8.
GarrettWEJrSwiontkowskiMFWeinsteinJN. American Board of Orthopaedic Surgery practice of the orthopaedic surgeon, part II: certification examination case mix. J Bone Joint Surg Am. 2006;88(3):660-667.
GudasRGudaiteAMickeviciusT. Comparison of osteochondral autologous transplantation, microfracture, or debridement techniques in articular cartilage lesions associated with anterior cruciate ligament injury: a prospective study with a 3-year follow-up. Arthroscopy. 2013;29(1):89-97.
11.
GudasRKalesinskasRJKimtysV. A prospective randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint in young athletes. Arthroscopy. 2005;21(9):1066-1075.
12.
HameSLNguyenVEllermanJ. Complications of arthroscopic meniscectomy in the older population. Am J Sports Med. 2012;40(6):1402-1405.
13.
HantesMEZachosVCVaritimidisSE. Arthroscopic meniscal repair: a comparative study between three different surgical techniques. Knee Surg Sports Traumatol Arthrosc. 2006;14(12):1232-1237.
14.
HarnerCDIrrgangJJPaulJ. Loss of motion after anterior cruciate ligament reconstruction. Am J Sports Med. 1992;20(5):499-506.
15.
HasanSSSaleemABachBRJr. Results of arthroscopic treatment of symptomatic loss of extension following anterior cruciate ligament reconstruction. Am J Knee Surg. 2000;13(4):201-209; discussion 209-210.
16.
HermansSCortenKBellemansJ. Long-term results of isolated anterolateral bundle reconstructions of the posterior cruciate ligament: a 6- to 12-year follow-up study. Am J Sports Med. 2009;37(8):1499-1507.
17.
JacksonDWSchaeferRK. Cyclops syndrome: loss of extension following intra-articular anterior cruciate ligament reconstruction. Arthroscopy. 1990;6(3):171-178.
18.
KotsovolosESHantesMEMastrokalosDS. Results of all-inside meniscal repair with the FasT-Fix meniscal repair system. Arthroscopy. 2006;22(1):3-9.
19.
KreuzPCSteinwachsMRErggeletC. Results after microfracture of full-thickness chondral defects in different compartments in the knee. Osteoarthritis Cartilage. 2006;14(11):1119-1125.
20.
KrychAJCareyJLMarxRG. Does arthroscopic knee surgery work?Arthroscopy. 2014;30(5):544-545.
21.
MohtadiNGWebster-BogaertSFowlerPJ. Limitation of motion following anterior cruciate ligament reconstruction: a case-control study. Am J Sports Med. 1991;19(6):620-624; discussion 624-625.
22.
MontgomerySRNgoSSHobsonT. Trends and demographics in hip arthroscopy in the United States. Arthroscopy. 2013;29(4):661-665.
23.
MookWRMillerMDDiduchDR. Multiple-ligament knee injuries: a systematic review of the timing of operative intervention and postoperative rehabilitation. J Bone Joint Surg Am. 2009;91(12):2946-2957.
24.
NoyesFRBarber-WestinSD. The treatment of acute combined ruptures of the anterior cruciate and medial ligaments of the knee. Am J Sports Med. 1995;23(4):380-389.
25.
NoyesFRBerrios-TorresSBarber-WestinSD. Prevention of permanent arthrofibrosis after anterior cruciate ligament reconstruction alone or combined with associated procedures: a prospective study in 443 knees. Knee Surg Sports Traumatol Arthrosc. 2000;8(4):196-206.
26.
NoyesFRMangineREBarberSD. The early treatment of motion complications after reconstruction of the anterior cruciate ligament. Clin Orthop Relat Res. 1992;277:217-228.
27.
PetscheTSHutchinsonMR. Loss of extension after reconstruction of the anterior cruciate ligament. J Am Acad Orthop Surg. 1999;7(2):119-127.
28.
RosenbergTDScottSMCowardDB. Arthroscopic meniscal repair evaluated with repeat arthroscopy. Arthroscopy. 1986;2(1):14-20.
29.
RossoFBisicchiaSBonasiaDEAmendolaA. Meniscal allograft transplantation: a systematic review. Am J Sports Med. 2015;43(4):998-1007.
30.
RyuRKDunbarWHIV. Arthroscopic meniscal repair with two-year follow-up: a clinical review. Arthroscopy. 1988;4(3):168-173.
31.
ShapiroMSFreedmanEL. Allograft reconstruction of the anterior and posterior cruciate ligaments after traumatic knee dislocation. Am J Sports Med. 1995;23(5):580-587.
32.
ShelbourneKDGrayT. Minimum 10-year results after anterior cruciate ligament reconstruction: how the loss of normal knee motion compounds other factors related to the development of osteoarthritis after surgery. Am J Sports Med. 2009;37(3):471-480.
33.
ShelbourneKDNitzP. Accelerated rehabilitation after anterior cruciate ligament reconstruction. Am J Sports Med. 1990;18(3):292-299.
34.
ShelbourneKDWilckensJHMollabashyA. Arthrofibrosis in acute anterior cruciate ligament reconstruction: the effect of timing of reconstruction and rehabilitation. Am J Sports Med. 1991;19(4):332-336.
35.
SistoDJWarrenRF. Complete knee dislocation: a follow-up study of operative treatment. Clin Orthop Relat Res. 1985;198:94-101.
WestermannRWWrightRWSpindlerKP. Meniscal repair with concurrent anterior cruciate ligament reconstruction: operative success and patient outcomes at 6-year follow-up. Am J Sports Med. 2014;42(9):2184-2192.
38.
YeranosianMGArshiATerrellRD. Incidence of acute postoperative infections requiring reoperation after arthroscopic shoulder surgery. Am J Sports Med. 2014;42(2):437-441.
39.
YeranosianMGPetriglianoFATerrellRD. Incidence of postoperative infections requiring reoperation after arthroscopic knee surgery. Arthroscopy. 2013;29(8):1355-1361.
40.
YeranosianMGTerrellRDWangJC. The costs associated with the evaluation of rotator cuff tears before surgical repair. J Shoulder Elbow Surg. 2013;22(12):1662-1666.
41.
ZhangALKreulenCNgoSS. Demographic trends in arthroscopic SLAP repair in the United States. Am J Sports Med. 2012;40(5):1144-1147.
42.
ZhangALMontgomerySRNgoSS. Arthroscopic versus open shoulder stabilization: current practice patterns in the United States. Arthroscopy. 2014;30(4):436-443.
43.
ZhangHSunYHanX. Simultaneous reconstruction of the anterior cruciate ligament and medial collateral ligament in patients with chronic ACL-MCL lesions: a minimum 2-year follow-up study. Am J Sports Med. 2014;42(7):1675-1681.
