Sanders Thomas L, Kremers Hilal Maradit, Bryan Andrew J, Kremers Walter K, Stuart Michael J, Krych Aaron J
Departments of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Knee Surg Sports Traumatol Arthrosc. 2017 Feb;25(2):532-537. doi: 10.1007/s00167-015-3799-x. Epub 2015 Sep 26.
Arthrofibrosis is a rare complication after anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to (1) report a population-based incidence of arthrofibrosis (as defined by manipulation under anaesthesia or surgical lysis of adhesions) following ACL injury and reconstruction, (2) identify risk factors associated with development of arthrofibrosis, and (3) report outcomes of intervention for arthrofibrosis.
This was a historical cohort study performed in Olmsted County, Minnesota. The Rochester Epidemiology Project (REP) was used to identify a population-based cohort of individuals with new-onset, isolated ACL tears between 1 January 1990 and 31 December 2010. The REP database provides access to all medical records for each resident of Olmsted County, regardless of the facility where the care was delivered. A total of 1841 individuals were identified with new-onset, isolated ACL tears and were confirmed with chart review. The intervention incidence for arthrofibrosis was then calculated, and various predictive factors including age, sex, calendar year, and meniscal injury were investigated.
During follow-up, 5 patients (1.0 %) in the non-operative cohort and 23 patients (1.7 %) in the ACL reconstruction cohort received intervention for arthrofibrosis, corresponding to an incidence of 0.7 per 1000 person-years in the non-operative cohort and 1.9 per 1000 person-years in the ACL reconstruction cohort. Female patients were 2.5 times more likely to have arthrofibrosis than males. The mean preoperative range of motion was -8° to 83° and improved to a mean of -2° to 127° post-operatively.
Arthrofibrosis remains a rare but potentially devastating complication after ACL reconstruction, and roughly 2 % of patients had post-operative stiffness that required intervention. Female patients are at higher risk of arthrofibrosis. However, when patients develop severe motion complications after ACL injury, interventions are generally effective in preventing permanent arthrofibrosis.
关节纤维化是前交叉韧带（ACL）重建术后一种罕见的并发症。本研究的目的是：（1）报告ACL损伤和重建术后基于人群的关节纤维化发生率（根据麻醉下手法操作或手术松解粘连定义）；（2）确定与关节纤维化发生相关的危险因素；（3）报告关节纤维化的干预结果。
这是一项在明尼苏达州奥尔姆斯特德县进行的历史性队列研究。利用罗切斯特流行病学项目（REP）确定了一个基于人群的队列，该队列中的个体在1990年1月1日至2010年12月31日期间新发孤立性ACL撕裂。REP数据库提供了奥尔姆斯特德县每位居民的所有医疗记录，无论其接受治疗的机构如何。共识别出1841例新发孤立性ACL撕裂的个体，并通过病历审查进行了确认。然后计算关节纤维化的干预发生率，并研究包括年龄、性别、日历年和半月板损伤在内的各种预测因素。
在随访期间，非手术队列中有5例患者（1.0%）、ACL重建队列中有23例患者（1.7%）接受了关节纤维化干预，非手术队列中每1000人年的发生率为0.7，ACL重建队列中每1000人年的发生率为1.9。女性患者发生关节纤维化的可能性是男性的2.5倍。术前平均活动范围为-8°至83°，术后平均改善至-2°至127°。
关节纤维化仍然是ACL重建术后一种罕见但可能具有破坏性的并发症，约2%的患者术后出现需要干预的僵硬。女性患者发生关节纤维化的风险更高。然而，当患者在ACL损伤后出现严重的活动并发症时，干预措施通常对预防永久性关节纤维化有效。
