Rates of Arthrofibrosis Following Pediatric Anterior Cruciate Ligament Reconstruction Using a Quadriceps Tendon Autograft.

BACKGROUND

Arthrofibrosis is a somewhat rare complication of anterior cruciate ligament reconstruction (ACLR). Several factors may increase arthrofibrosis likelihood after ACLR, including sex, age, meniscal surgery, graft size, range of motion, and/or graft type. The purpose of this study was to determine arthrofibrosis rates following ACLR using 2 autograft choices: all-soft tissue quadriceps tendon (STQ) and quadriceps tendon with a patellar bone block (QPA). Additionally, we explored which variables were associated with the development of arthrofibrosis over the year following ACLR.

METHODS

Using a retrospective design, we evaluated outcomes among patients 10-18 years of age who underwent a primary ACLR using a quadriceps tendon autograft. Arthrofibrosis was defined as cases requiring follow-up surgical intervention involving manipulation under anesthesia (MUA) and/or lysis of adhesions (LOA) to restore range of motion. This definition was intended to capture clinically meaningful cases necessitating a second anesthesia exposure, rather than to measure the broad biological incidence of scar tissue formation. Predictor variables examined were sex, insurance type, preoperative range of motion, and graft choice.

RESULTS

A total of 352 patients who underwent ACLR were included, including surgeries performed on 366 unique ACLs. Of these, 342 ACLRs used a QPA graft and 24 used an STQ graft. The overall arthrofibrosis rate following ACLR was 3.6% (n = 13). Among these 13 patients, 8 underwent LOA for loss of terminal knee extension (STQ: n = 1, QPA: n = 7), 3 underwent MUA for loss of terminal knee flexion (STQ: n = 0, QPA: n = 3), and 2 required both procedures. The mean time from ACLR to secondary intervention was 8 months for LOA, 2.4 months for MUA, and 9.1 months when both procedures were performed simultaneously. Overall, 5.5% of female patients developed arthrofibrosis compared to 0.7% of male patients (OR = 0.13, 95% CI [0.01, 1.15]).

CONCLUSIONS AND CLINICAL RELEVANCE: Our data indicate that 3.6% of patients experienced arthrofibrosis requiring intervention following ACLR. We found no statistically significant clinical predictors of arthrofibrosis following quadriceps autograft ACL reconstruction in the studied dataset. Future work should seek to determine patient-specific arthrofibrosis risk factors.

KEY CONCEPTS: (1)Arthrofibrosis occurred in 3.6% of patients after anterior cruciate ligament reconstruction using either quadriceps tendon-patellar bone autografts or all-soft tissue quadriceps tendon autografts.(2)Female patients had a higher rate of arthrofibrosis than males, although the difference was not statistically significant.(3)Preoperative range of motion did not predict arthrofibrosis risk.(4)No single factor predicted arthrofibrosis risk, thus risk appears to be multifactorial.

LEVEL OF EVIDENCE: Level III.