Download PDF
J Knee Surg 2023; 36(13): 1365-1373
DOI: 10.1055/a-1934-0776
Original Article

Risk Factors of Loss of Knee Range of Motion after Primary Anterior Cruciate Ligament Reconstruction following Preoperative Recovery of Knee Range of Motion

Takuji Yokoe 
1   Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
,
Takuya Tajima
1   Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
,
Nami Yamaguchi
1   Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
,
Yudai Morita
1   Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
,
Etsuo Chosa
1   Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

The loss of knee range of motion (ROM) is not an uncommon complication after anterior cruciate ligament reconstruction (ACLR). However, the risk factors of loss of knee ROM remain debatable. The purpose of this study was to evaluate the incidence and risk factors of loss of knee ROM at 12 months after primary ACLR performed after regaining full knee ROM preoperatively. Consecutive patients who underwent primary ACLR after regaining full ROM between January 2014 and January 2020 were retrospectively reviewed. Patients who received a surgical arthrolysis within 12 months after ACLR or those who had a loss of knee ROM at 12 months postoperatively were defined as the loss of ROM group. Possible risk factors of loss of knee ROM, including patient demographic, preoperative, surgical, and postoperative factors, were assessed. The notch wide index and radiographic parameters of the tibial spines; medial tibial spine height/tibial length (TL), lateral tibial spine height (LTSH)/TL, and tibial spine width (TSW)/TL, were also assessed. A total of 141 patients (141 knees) were included (mean age, 25.8 ± 11.4 years; male/female, 56/85). Of the 141 patients, three received surgical arthrolysis within 12 months, and 23 had a loss of knee ROM at 12 months after ACLR. On comparing patients with and without loss of knee ROM, significant differences were found in the age (p = 0.04), LTSH/TL (p = 0.02), and TSW/TL (p = 0.02). A multivariate regression analysis showed that the age (odds ratio [OR]; 1.05, 95% confidence interval [CI]: 1.01–1.09, p = 0.02), LTSH/TL (OR: 1.44, 95% CI: 1.01–2.1, p = 0.04), and TSW/TL (OR: 0.79, 95% CI: 0.65–0.97, p = 0.02) were identified as significant independent risk predictors of loss of knee ROM. This study showed that the incidence of loss of knee ROM at 12 months after primary ACLR was 18.4% (26/141). An older age, a higher LTSH/TL, and a smaller TSW/TL may be associated with loss of knee ROM at 12 months after ACLR.

Keywords

anterior cruciate ligament reconstruction - range of motion - body mass index - white blood cell - risk factors - osteoarthritis - medial tibial spine height


Publication History

Received: 06 May 2022

Accepted: 26 August 2022

Accepted Manuscript online:
31 August 2022

Article published online:
30 December 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Kay J, Memon M, Marx RG, Peterson D, Simunovic N, Ayeni OR. Over 90 % of children and adolescents return to sport after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2018; 26 (04) 1019-1036
    CrossrefPubMedSearch in Google Scholar
  • 2 Lai CCH, Ardern CL, Feller JA, Webster KE. Eighty-three per cent of elite athletes return to preinjury sport after anterior cruciate ligament reconstruction: a systematic review with meta-analysis of return to sport rates, graft rupture rates and performance outcomes. Br J Sports Med 2018; 52 (02) 128-138
    CrossrefPubMedSearch in Google Scholar
  • 3 Robertson GA, Coleman SG, Keating JF. Knee stiffness following anterior cruciate ligament reconstruction: the incidence and associated factors of knee stiffness following anterior cruciate ligament reconstruction. Knee 2009; 16 (04) 245-247
    CrossrefPubMedSearch in Google Scholar
  • 4 Shelbourne KD, Wilckens JH, Mollabashy A, DeCarlo M. Arthrofibrosis in acute anterior cruciate ligament reconstruction. The effect of timing of reconstruction and rehabilitation. Am J Sports Med 1991; 19 (04) 332-336
    CrossrefPubMedSearch in Google Scholar
  • 5 Baba R, Kondo E, Iwasaki K. et al. Impact of surgical timing on clinical outcomes in anatomic double-bundle anterior cruciate ligament reconstruction using Hamstring tendon autografts. Orthop J Sports Med 2019; 7 (11) 2325967119880553
    CrossrefPubMedSearch in Google Scholar
  • 6 Kay J, Memon M, Shah A. et al. Earlier anterior cruciate ligament reconstruction is associated with a decreased risk of medial meniscal and articular cartilage damage in children and adolescents: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2018; 26 (12) 3738-3753
    CrossrefPubMedSearch in Google Scholar
  • 7 Lee YS, Lee OS, Lee SH, Hui TS. Effect of the timing of anterior cruciate ligament reconstruction on clinical and stability outcomes: a systematic review and meta-analysis. Arthroscopy 2018; 34 (02) 592-602
    CrossrefPubMedSearch in Google Scholar
  • 8 Meighan AA, Keating JF, Will E. Outcome after reconstruction of the anterior cruciate ligament in athletic patients. A comparison of early versus delayed surgery. J Bone Joint Surg Br 2003; 85 (04) 521-524
    CrossrefPubMedSearch in Google Scholar
  • 9 Wang B, Zhong JL, Xu XH, Shang J, Lin N, Lu HD. Incidence and risk factors of joint stiffness after anterior cruciate ligament reconstruction. J Orthop Surg Res 2020; 15 (01) 175
    CrossrefPubMedSearch in Google Scholar
  • 10 Huleatt J, Gottschalk M, Fraser K. et al. Risk factors for manipulation under anesthesia and/or lysis of adhesions after anterior cruciate ligament reconstruction. Orthop J Sports Med 2018; 6 (09) 2325967118794490
    CrossrefPubMedSearch in Google Scholar
  • 11 Rousseau R, Labruyere C, Kajetanek C, Deschamps O, Makridis KG, Djian P. Complications after anterior cruciate ligament reconstruction and their relation to the type of graft: a prospective study of 958 cases. Am J Sports Med 2019; 47 (11) 2543-2549
    CrossrefPubMedSearch in Google Scholar
  • 12 Mayr HO, Brandt CM, Weig T. et al. Long-term results of arthroscopic arthrolysis for arthrofibrosis after anterior cruciate ligament reconstruction. Arthroscopy 2017; 33 (02) 408-414
    CrossrefPubMedSearch in Google Scholar
  • 13 Briggs KK, Lysholm J, Tegner Y, Rodkey WG, Kocher MS, Steadman JR. The reliability, validity, and responsiveness of the Lysholm score and Tegner activity scale for anterior cruciate ligament injuries of the knee: 25 years later. Am J Sports Med 2009; 37 (05) 890-897
    CrossrefPubMedSearch in Google Scholar
  • 14 Fujii M, Furumatsu T, Miyazawa S. et al. Intercondylar notch size influences cyclops formation after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2015; 23 (04) 1092-1099
    CrossrefPubMedSearch in Google Scholar
  • 15 Noailles T, Chalopin A, Boissard M, Lopes R, Bouguennec N, Hardy A. Incidence and risk factors for cyclops syndrome after anterior cruciate ligament reconstruction: a systematic literature review. Orthop Traumatol Surg Res 2019; 105 (07) 1401-1405
    CrossrefPubMedSearch in Google Scholar
  • 16 Iriuchishima T, Goto B, Fu FH. The occurrence of ACL injury influenced by the variance in width between the tibial spine and the femoral intercondylar notch. Knee Surg Sports Traumatol Arthrosc 2020; 28 (11) 3625-3630
    CrossrefPubMedSearch in Google Scholar
  • 17 Harris MC, Venrick C, Hines AC. et al. Prospective evaluation of range of motion in acute ACL reconstruction using patellar tendon autograft. Orthop J Sports Med 2019; 7 (10) 2325967119875415
    CrossrefPubMedSearch in Google Scholar
  • 18 Sturnick DR, Argentieri EC, Vacek PM. et al. A decreased volume of the medial tibial spine is associated with an increased risk of suffering an anterior cruciate ligament injury for males but not females. J Orthop Res 2014; 32 (11) 1451-1457
    CrossrefPubMedSearch in Google Scholar
  • 19 Tajima T, Chosa E, Kawahara K, Yamaguchi N. Prospective comparisons of femoral tunnel enlargement with 3 different postoperative immobilization periods after double-bundle anterior cruciate ligament reconstruction with hamstring grafts. Arthroscopy 2015; 31 (04) 651-658
    CrossrefPubMedSearch in Google Scholar
  • 20 Adachi N, Ochi M, Uchio Y, Sumen Y. Anterior cruciate ligament augmentation under arthroscopy. A minimum 2-year follow-up in 40 patients. Arch Orthop Trauma Surg 2000; 120 (3-4): 128-133
    CrossrefPubMedSearch in Google Scholar
  • 21 Ochi M, Adachi N, Uchio Y. et al. A minimum 2-year follow-up after selective anteromedial or posterolateral bundle anterior cruciate ligament reconstruction. Arthroscopy 2009; 25 (02) 117-122
    CrossrefPubMedSearch in Google Scholar
  • 22 Mae T, Shino K, Nakata K, Toritsuka Y, Otsubo H, Fujie H. Optimization of graft fixation at the time of anterior cruciate ligament reconstruction. Part II: effect of knee flexion angle. Am J Sports Med 2008; 36 (06) 1094-1100
    CrossrefPubMedSearch in Google Scholar
  • 23 Tajima T, Chosa E, Yamamoto K, Yamaguchi N. Arthroscopic anatomical double-bundle anterior cruciate ligament reconstruction for Asian patient using a bone-patellar tendon-bone and Gracilis tendon composite autograft: a technical note. Sports Med Arthrosc Rehabil Ther Technol 2012; 4 (01) 9
    CrossrefPubMedSearch in Google Scholar
  • 24 Tajima T, Yamaguchi N, Morita Y. et al. Clinical and radiographic outcomes of double-bundle anterior cruciate ligament reconstruction for Asian Patients with bone-patellar tendon-bone and Gracilis tendon grafts: a matched-control comparison. J Knee Surg 2021; 34 (14) 1545-1554
    Thieme ConnectPubMedSearch in Google Scholar
  • 25 Hara K, Kubo T, Suginoshita T, Shimizu C, Hirasawa Y. Reconstruction of the anterior cruciate ligament using a double bundle. Arthroscopy 2000; 16 (08) 860-864
    CrossrefPubMedSearch in Google Scholar
  • 26 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33 (01) 159-174
    Search in Google Scholar
  • 27 Ishii Y, Noguchi H, Sato J, Ishii H, Toyabe SI. Mediolateral coronal laxity does not correlate with knee range of motion after total knee arthroplasty. Arch Orthop Trauma Surg 2019; 139 (06) 851-858
    CrossrefPubMedSearch in Google Scholar
  • 28 von Essen C, Eriksson K, Barenius B. Acute ACL reconstruction shows superior clinical results and can be performed safely without an increased risk of developing arthrofibrosis. Knee Surg Sports Traumatol Arthrosc 2020; 28 (07) 2036-2043
    CrossrefPubMedSearch in Google Scholar
  • 29 Mohtadi NG, Chan DS, Dainty KN, Whelan DB. Patellar tendon versus hamstring tendon autograft for anterior cruciate ligament rupture in adults. Cochrane Database Syst Rev 2011; 9 (09) CD005960
    PubMedSearch in Google Scholar
  • 30 Mauro CS, Irrgang JJ, Williams BA, Harner CD. Loss of extension following anterior cruciate ligament reconstruction: analysis of incidence and etiology using IKDC criteria. Arthroscopy 2008; 24 (02) 146-153
    CrossrefPubMedSearch in Google Scholar
  • 31 Noll S, Garrison JC, Bothwell J, Conway JE. Knee extension range of motion at 4 weeks is related to knee extension loss at 12 weeks after anterior cruciate ligament reconstruction. Orthop J Sports Med 2015; 3 (05) 2325967115583632
    CrossrefPubMedSearch in Google Scholar
  • 32 Irrgang JJ, Anderson AF, Boland AL. et al. Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 2001; 29 (05) 600-613
    CrossrefPubMedSearch in Google Scholar
  • 33 Shelbourne KD, Gray T. Minimum 10-year results after anterior cruciate ligament reconstruction: how the loss of normal knee motion compounds other factors related to the development of osteoarthritis after surgery. Am J Sports Med 2009; 37 (03) 471-480
    CrossrefPubMedSearch in Google Scholar
  • 34 Ekhtiari S, Horner NS, de Sa D. et al. Arthrofibrosis after ACL reconstruction is best treated in a step-wise approach with early recognition and intervention: a systematic review. Knee Surg Sports Traumatol Arthrosc 2017; 25 (12) 3929-3937
    CrossrefPubMedSearch in Google Scholar
  • 35 Eriksson K, von Essen C, Jönhagen S, Barenius B. No risk of arthrofibrosis after acute anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26 (10) 2875-2882
    CrossrefPubMedSearch in Google Scholar
  • 36 Wang J, Ao YF. Anterior cruciate ligament remnants nodule: potential factor causing extension loss. Chin Med J (Engl) 2013; 126 (06) 1108-1111
    PubMedSearch in Google Scholar
  • 37 Scanzello CR, Umoh E, Pessler F. et al. Local cytokine profiles in knee osteoarthritis: elevated synovial fluid interleukin-15 differentiates early from end-stage disease. Osteoarthritis Cartilage 2009; 17 (08) 1040-1048
    CrossrefPubMedSearch in Google Scholar
  • 38 Snelling SJ, Bas S, Puskas GJ. et al. Presence of IL-17 in synovial fluid identifies a potential inflammatory osteoarthritic phenotype. PLoS One 2017; 12 (04) e0175109
    CrossrefPubMedSearch in Google Scholar
  • 39 Greene MA, Loeser RF. Aging-related inflammation in osteoarthritis. Osteoarthritis Cartilage 2015; 23 (11) 1966-1971
    CrossrefPubMedSearch in Google Scholar
  • 40 Shen J, Li S, Chen D. TGF-β signaling and the development of osteoarthritis. Bone Res 2014; 2: 14002
    CrossrefPubMedSearch in Google Scholar
  • 41 Ficek K, Rajca J, Cholewiński J. et al. Analysis of intercondylar notch size and shape in patients with cyclops syndrome after anterior cruciate ligament reconstruction. J Orthop Surg Res 2021; 16 (01) 554
    CrossrefPubMedSearch in Google Scholar