Prevention of Arthrofibrosis After Anterior Cruciate Ligament Reconstruction Using the Central Third Patellar Tendon Autograft

A retrospective analysis was performed to explain the decreasing incidence of postoperative arthrofibrosis of the knee in 191 consecutive patients who had anterior cruciate ligament reconstruction using the central third patellar tendon from 1987 through 1991. Follow-up data were available on 188 patients (98%). Age, sex, time interval from injury, preoperative motion, and concomi tant meniscal repair or partial meniscectomy were evaluated for their significance as risk factors. Twenty- two of 188 patients (12%) developed arthrofibrosis; the incidence was lower when the acute anterior cruciate ligament reconstruction was delayed at least 3 weeks from the injury, and when preoperative extension was 10° or better. Age, sex, preoperative flexion, and need for concomitant meniscal surgery were not risk factors. The postoperative motion protocol evolved during the study period. Group 1 patients were braced in 45° of flexion for 1 week before passive extension was al lowed. In Group 2, motion was started after 48 hours. Group 3 patients were braced in full extension, with mo tion starting within 24 hours. With these changes, the incidence dropped from 23% to 3%. Decreases in the incidence of arthrofibrosis with modifications in opera tive technique and postoperative analgesia were not statistically significant.