Mayr Hermann O, Weig Thomas G, Plitz Wolfgang
OCM-Clinic of Orthopaedic Surgery, Munich, Steinerstrasse 6, 81369 Munich, Germany.
Arch Orthop Trauma Surg. 2004 Oct;124(8):518-22. doi: 10.1007/s00402-004-0718-x. Epub 2004 Aug 3.
Arthrofibrosis is a complication that severely influences the clinical outcome after anterior cruciate ligament (ACL) reconstruction. This retrospective clinical study analyses risk factors and outcome after arthrolysis in a large population.
Two hundred twenty-three patients who had undergone arthrolysis after ACL reconstruction were examined. Range of motion (ROM) was reduced due to arthrofibrosis of the joint in 70% (n=156). Other reasons, such as cyclops syndrome or osteoarthritis were found in 30% (n=67). The mean time interval between arthrolysis and follow-up was 4.29 years. We recorded timing of surgery, additional injuries, state of the knee before reconstruction, range of motion, pain during rehabilitation, beginning, duration and type of rehabilitation, severity and etiology of joint stiffness and the time between ACL reconstruction and revision. The present state of the knee was documented using the IKDC form.
A significant correlation of arthrofibrosis and preoperative irritation (p<0.001), preoperative limited ROM (p=0.001), perioperative pain (p=0.046) and early beginning of muscle training (p=0.064) was found. Combination of a remaining loss of extension and development of degenerative joint disease was also significant (p=0.001). The decrease of sports activity compared with the level before ACL injury was highly significant (p<0.001). The criteria to minimize the risk of arthrofibrosis and the optimal timing of arthrolysis are pointed out.
关节纤维化是一种严重影响前交叉韧带（ACL）重建术后临床疗效的并发症。这项回顾性临床研究分析了大量人群关节松解术后的危险因素及疗效。
对223例ACL重建术后接受关节松解术的患者进行了检查。70%（n = 156）的患者因关节纤维化导致活动范围（ROM）减小。30%（n = 67）的患者存在其他原因，如独眼巨人综合征或骨关节炎。关节松解术与随访之间的平均时间间隔为4.29年。我们记录了手术时间、其他损伤情况、重建术前膝关节状态、活动范围、康复期间的疼痛、康复开始时间、持续时间及类型、关节僵硬的严重程度和病因以及ACL重建与翻修之间的时间。使用IKDC表格记录膝关节的当前状态。
发现关节纤维化与术前刺激（p < 0.001）、术前ROM受限（p = 0.001）、围手术期疼痛（p = 0.046）和早期开始肌肉训练（p = 0.064）之间存在显著相关性。伸直受限残留与退行性关节病的发展之间的联合情况也具有显著性（p = 0.001）。与ACL损伤前的水平相比，体育活动的减少非常显著（p < 0.001）。指出了将关节纤维化风险降至最低的标准及关节松解术的最佳时机。
