Arthrofibrosis Following ACL Reconstruction: Case Report
Authors: Andhika Pramana IGN Bagus , Aryana IGN Wien 
Published: March 2022

Introduction: Arthrofibrosis is a debilitating complication of loss of motion after ACL reconstruction following ACL injury with a reported incidence of 2% to 35%. Delayed ACL reconstruction has been the chosen management based on the suggestion from some studies of the risk reduction in developing arthrofibrosis and decreased range of motion (ROM) postoperatively.
Case Presentation: A 51-year-old female presented with complaints of pain, stiffness, and decreased range of motion following a knee ligament reconstructive arthroscopy of her right knee. After unsuccessful rehabilitative management, the patient underwent additional surgical repairs. Following the surgery, a fibrous thick scar tissue located at the suprapatellar pouch and mainly over the medial and lateral gutter was observed, in which an adhesiolysis was performed during the arthroscopic procedure. Passive range of motion of the affected knee was checked intra-operatively, showing the knee to be able to fully extend and flexed passively comparable to non affected knee. An intensive physiotherapy and continuous passive motion was begun immediately post-operatively. A 33-year-old male sustained an isolated complete tear of the left knee anterior cruciate ligament. An arthroscopy ACL single bundle reconstruction surgery with patellar tendon bone graft was done four weeks after the injury. Intraoperative was uneventful. Each end of graft was stitched together with a high strength of non-absorbable suture. Graft fixations used bio absorbable screws and loaded with extracortical buttons. After post operation, patient was observed to be able to perform full active knee extension. The patient was very compliant to rehabilitation program and also performed the exercises at home. However, on clinic follow-up, the patient started to gradually loss his active full extension and on subsequent visit further affected his passive full extension (10 degrees extension lag) at 4 months post operation. Regional examination showed diffused firm swelling over the anteromedial aspect of the knee just above the medial joint line that was very tender. An intensive physiotherapy and continuous passive motion were begun immediately post operatively.
Result: In the first patient, the functional outcome score showed improvement at the time of final follow-up, as well as the average pain scores. This case report emphasized on the importance of early recognition as well as assessment by the orthopaedic practitioners of arthrofibrosis as a complication of ACL reconstructive surgery is the key point in reducing the long-term morbidity caused by the condition in patients unable to regain flexibility at the expected rate after injury or surgical treatment. Rehabilitation protocols should mainly stress on early motion, rapid return of quadriceps function and excursion, and patella mobilization. The second patient, functional outcome was measured with KSS to assess pain and function after arthroscopy. The functional outcome score showed improvement from 68 points pre-operatively to 86 at the time of final follow-up. The average pain scores improved as well from 30 points pre-operatively to 41 at the time of final follow-up.
Conclusion: Arthrofibrosis following ACL reconstruction represents a broad continuum of abnormalities, and hence a thorough understanding of the condition and a comprehensive approach to its management is of importance to achieve a functional result.

Key words: Arthrofibrosis, Loss of motion, ACL Reconstruction, Arthroscopy.