2017 ISAKOS Biennial Congress ePoster #1006

 

Revision of ACL Reconstruction for Patients with Failed ACL Surgery and Flexion Contracture

Chong Bum Chang, MD, PhD, Seongnam-Si, Gyeonggi-do KOREA, REPUBLIC OF
Seung-Baik Kang, MD, PhD, Prof., Seoul KOREA, REPUBLIC OF
Moon Jong Chang, Prof., Seoul KOREA, REPUBLIC OF
Min Kyu Song, MD, Seoul KOREA, REPUBLIC OF
Chan Yoon, MD, Seoul KOREA, REPUBLIC OF
Jae-Hoon Shin, MD, Seoul KOREA, REPUBLIC OF

Seoul National University Boramae Hospital, Seoul, KOREA, REPUBLIC OF

FDA Status Cleared

Summary

When a patient with failed ACL surgery had a flexion contracture (FC) but well-preserved further flexion, the FC was correctable during the revision surgery, and the outcome would be satisfactory.

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Abstract

Contracture

Introduction

Knee stiffness after ACL reconstruction with significant extension and flexion loss would be mostly related to generalized arthrofibrosis. However, a subset of patients with failed ACL reconstruction have extension loss, i.e. flexion contracture, but well-preserved further flexion and could report instability-related symptoms with objective instability caused by ACL deficiency. We expected that flexion contracture in such a case would not be a stiffness by general arthrofibrosis but blocked extension caused by pathologic structures, which might be solved during the operation. In patients undergoing revision ACL reconstruction, this study sought to compare the various preoperative, intraoperative and postoperative clinical variables between the patients with flexion contracture more than 5° and those without the flexion contracture.

Methods

After implementing exclusion criteria, 58 knees in 58 patients undergoing revision ACL reconstruction remained in this study. All the subjects had well preserved maximum flexion which is 5° or less difference with the contralateral knees. Two comparative groups were developed, namely FC group (16 knees) which included knees with flexion contracture > 5° preoperatively, and non-FC group (42 patients) which included knees with no or minimal flexion contracture (= 5°). Besides basic procedures, in patients with flexion contracture, the three potential pathologic structures related to flexion contracture including continuous but tight nonanatomical graft, anvil osteophyte, and scaring band around the posterior intercondylar notch were removed or released during the revision ACL reconstruction. Comparative variables between the two groups were as follows: 1) preoperative variables included demographic variables, range of motion, side to side difference on stress radiographs, and clinical scores including Lysholm, Tegner activity level , IKDC subjective scores, and SF-36 physical component summary scores, 2) intraoperative variables included previous graft condition, presence of anvil osteophyte and scaring band around the posterior intercondylar notch, meniscal condition, and 3) postoperative 2-year variables same with preoperative ones.

Results

Preoperatively, the FC group had greater mean knee flexion contracture (16º vs. 3º, P < 0.001), poorer IKDC and SF-36 PCS scores (54 points vs. 48 points, P = 0.014; 42 points vs. 39 points, P = 0.031, respectively) than the non-FC group. Intraoperatively, the FC group showed significantly greater proportions of knees with continuous graft [8 knees (50%) vs. 2 knees (5%), P < 0.001], anvil osteophyte [7 knees (44%) vs. 0, P < 0.001], and scaring band around the posterior intercondylar notch [16 knees (100%) vs. 0, P < 0.001]. Two years after operation, all knees had flexion contracture of 5º or less with no significant differences between the FC and non-FC groups (2º vs. 0º on average, P = 0.106). Additionally, even though there was a trend of slightly poorer outcomes in the FC groups, their differences between the two groups did not reach statistical signi?cance.

Discussion And Conclusion

This study indicates when a patient with failed ACL surgery had flexion contracture but well-preserved further flexion, the flexion contracture would be correctable using relevant release procedures during the revision ACL reconstruction. The postoperative outcomes of the patients with flexion contracture were found to be comparable with those of patients without flexion contracture.