Cosgarea A J, Sebastianelli W J, DeHaven K E
Division of Orthopaedic Surgery, Ohio State University, Columbus.
Am J Sports Med. 1995 Jan-Feb;23(1):87-92. doi: 10.1177/036354659502300115.
A retrospective analysis was performed to explain the decreasing incidence of postoperative arthrofibrosis of the knee in 191 consecutive patients who had anterior cruciate ligament reconstruction using the central third patellar tendon from 1987 through 1991. Follow-up data were available on 188 patients (98%). Age, sex, time interval from injury, preoperative motion, and concomitant meniscal repair or partial meniscectomy were evaluated for their significance as risk factors. Twenty-two of 188 patients (12%) developed arthrofibrosis; the incidence was lower when the acute anterior cruciate ligament reconstruction was delayed at least 3 weeks from the injury, and when preoperative extension was 10 degrees or better. Age, sex, preoperative flexion, and need for concomitant meniscal surgery were not risk factors. The postoperative motion protocol evolved during the study period. Group 1 patients were braced in 45 degrees of flexion for 1 week before passive extension was allowed. In Group 2, motion was started after 48 hours. Group 3 patients were braced in full extension, with motion starting with 24 hours. With these changes, the incidence dropped from 23% to 3%. Decreases in the incidence of arthrofibrosis with modifications in operative technique and postoperative analgesia were not statistically significant.
对1987年至1991年间连续191例采用髌腱中央三分之一进行前交叉韧带重建的患者进行回顾性分析，以解释膝关节术后关节纤维化发生率下降的原因。188例患者（98%）有随访数据。对年龄、性别、受伤后的时间间隔、术前活动度以及半月板修复或部分半月板切除术作为危险因素的意义进行了评估。188例患者中有22例（12%）发生关节纤维化；当急性前交叉韧带重建在受伤后至少延迟3周进行，以及术前伸直角度为10度或更好时，发生率较低。年龄、性别、术前屈曲度以及是否需要同时进行半月板手术均不是危险因素。术后活动方案在研究期间有所变化。第1组患者在屈曲45度位支具固定1周后才允许被动伸直。第2组在48小时后开始活动。第3组患者在完全伸直位支具固定，24小时后开始活动。随着这些改变，发生率从23%降至3%。手术技术和术后镇痛的改变使关节纤维化发生率的降低无统计学意义。
