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Arthrofibrosis After Anterior Cruciate Ligament Reconstruction in Children and Adolescents

Nwachukwu, Benedict U. BA*,†; McFeely, Eric D. BA; Nasreddine, Adam MA; Udall, John H. MD†,‡; Finlayson, Craig MD; Shearer, David W. MD, MPH§; Micheli, Lyle J. MD*,‡; Kocher, Mininder S. MD, MPH*,‡

Journal of Pediatric Orthopaedics: December 2011 - Volume 31 - Issue 8 - p 811–817
doi: 10.1097/BPO.0b013e31822e0291

Introduction: Arthrofibrosis is a known complication after anterior cruciate ligament (ACL) reconstruction. ACL reconstruction is being performed with increased frequency in the pediatric population. The purpose of this study was to determine the prevalence of arthrofibrosis in children and adolescents and to identify risk factors for arthrofibrosis.

Methods: The study design was a retrospective case series. Medical records for 1016 consecutive ACL reconstructions in patients aged 7 to18 years old between 1995 to 2008 at a major tertiary care children’s hospital were reviewed to identify cases of postoperative arthrofibrosis. Arthrofibrosis was defined as a loss of 5 degrees or more extension compared with the contralateral knee that required a follow-up procedure or a loss of 15 degrees or more flexion compared with the contralateral knee that required a follow-up procedure. Patient data were recorded and analyzed using bivariate models to identify predictors for arthrofibrosis. Further, we reviewed the clinical course of patients with treated arthrofibrosis to assess functional outcomes of this complication.

Results: Nine hundred two patients with 933 knees met the inclusion criteria for this study, of which 60% were female. The mean age at the time of surgery was 15 years (range, 7 to 18 y), and the average follow-up from original ACL reconstruction was 6.3 years (range, 1.6 to 14.2 y). The overall prevalence of arthrofibrosis in our cohort was 8.3%, with 77 of the 933 knees had at least 1 procedure to treat arthrofibrosis after ACL reconstruction. Risk factors for arthrofibrosis were female sex (11.1% females, P=0.0001), patients aged 16 to 18 years [11.6%; odds ratio (OR) 3.51; P=0.007], patellar tendon autograft (OR, 1.7; P=0.026), and concomitant meniscal repair (OR, 2.08; P=0.007). Prior knee surgery and ACL reconstruction within 1 month of injury were not significantly associated with arthrofibrosis after ACL reconstruction. Fifty-three patients had a minimum of 6 months clinical follow-up after the procedure for arthrofibrosis. Of these, 46 patients (86.8%) had full range of motion at follow-up. Thirty-two patients (60.4%) were asymptomatic at final follow-up. Eleven patients (20.8%) complained of some persistent pain.

Conclusions: The rate of arthrofibrosis after ACL reconstruction in children and adolescents is 8.3%. Risk factors for arthrofibrosis are female sex, older adolescents, concurrent meniscal repair, and reconstruction with patellar tendon autograft. Surgical treatment for arthrofibrosis after ACL reconstruction in pediatric patients can satisfactorily regain motion in the reconstructed knee; however functional outcome may be compromised.

Level of Evidence: Level 4

*Harvard Medical School

§Harvard School of Public Health

Department of Orthopaedic Surgery, Children’s Hospital Boston

Division of Sports Medicine, Longwood Avenue, Boston

None of the authors received any external financial support pertaining to the completion of this study.

The authors declare no conflict of interest.

Reprint: Mininder S. Kocher, Department of Orthopaedic Surgery; 300 Longwood Avenue, Boston, MA, 02115. Email:

© 2011 Lippincott Williams & Wilkins, Inc.