Nwachukwu Benedict U, McFeely Eric D, Nasreddine Adam, Udall John H, Finlayson Craig, Shearer David W, Micheli Lyle J, Kocher Mininder S
Harvard Medical School, Boston, MA, USA.
J Pediatr Orthop. 2011 Dec;31(8):811-7. doi: 10.1097/BPO.0b013e31822e0291.
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.
The study design was a retrospective case series. Medical records for 1016 consecutive ACL reconstructions in patients aged 7 to 18 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.
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.
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 4.
关节纤维化是前交叉韧带（ACL）重建术后已知的并发症。ACL重建术在儿科人群中的实施频率日益增加。本研究的目的是确定儿童和青少年关节纤维化的患病率，并识别关节纤维化的危险因素。
本研究设计为回顾性病例系列研究。回顾了1995年至2008年期间在一家大型三级儿童专科医院对1016例年龄在7至18岁的患者进行的连续ACL重建手术的病历，以确定术后关节纤维化病例。关节纤维化定义为与对侧膝关节相比伸直丧失5度或更多且需要后续手术治疗，或与对侧膝关节相比屈曲丧失15度或更多且需要后续手术治疗。记录患者数据并使用双变量模型进行分析，以识别关节纤维化的预测因素。此外，我们回顾了接受关节纤维化治疗的患者的临床过程，以评估该并发症的功能结局。
902例患者的933个膝关节符合本研究的纳入标准，其中60%为女性。手术时的平均年龄为15岁（范围7至18岁），自初次ACL重建后的平均随访时间为6.3年（范围1.6至14.2年）。我们队列中关节纤维化的总体患病率为8.3%，933个膝关节中有77个在ACL重建后至少接受了1次治疗关节纤维化的手术。关节纤维化的危险因素为女性（女性患病率11.1%，P = 0.0001）、年龄16至18岁的患者[11.6%；优势比（OR）3.51；P = 0.007]、髌腱自体移植（OR，1.7；P = 0.026）以及半月板修复同时进行（OR，2.08；P = 0.007）。既往膝关节手术以及伤后1个月内进行ACL重建与ACL重建术后关节纤维化无显著相关性。53例患者在接受关节纤维化手术后至少有6个月的临床随访。其中，46例患者（86.8%）在随访时活动范围正常。32例患者（60.4%）在最终随访时无症状。11例患者（20.8%）抱怨有一些持续性疼痛。
儿童和青少年ACL重建术后关节纤维化的发生率为8.3%。关节纤维化的危险因素为女性、年龄较大的青少年、同时进行半月板修复以及髌腱自体移植重建。儿科患者ACL重建术后关节纤维化的手术治疗能够使重建膝关节的活动度令人满意地恢复；然而，功能结局可能会受到影响。
4级。
