Surgical Complications of the Patellofemoral Articulation

Presentation and management of arthrofibrosis of the knee: A case report

STUDY DESIGN

Case report.

BACKGROUND

Arthrofibrosis is a debilitating condition that results in pain, decreased range of motion, and decreased function. Although surgical management of arthrofibrosis has been well described in the literature, rehabilitation of the arthrofibrotic knee is less well described.

CASE DESCRIPTION

A 28-year-old female presented with swelling, pain, and decreased strength, range of motion, patellar mobility, and function following an exploratory arthroscopy of her left knee. After failed conservative management, the patient underwent two additional surgeries to remove scar tissue. Following each surgery, the emphasis was on decreasing inflammation and maintaining patellar mobility while increasing joint range of motion and strength. Therapy progression was determined by the presence or absence of inflammatory signs. The second scar tissue removal surgery resulted in a femoral neuropathy that further complicated the rehabilitation process.

OUTCOMES

At 3-year follow-up, the patient continued to present with decreased range of motion and strength compared to the uninvolved limb, but had returned to a modified running program and reported pain no longer limited her ability to participate in activities of daily living.

DISCUSSION

This case report highlights the importance of recognizing that arthrofibrosis may result following a minor knee surgery and with minimal range of motion loss. Additional complications also may result during arthrofibrosis treatment. Progressing rehabilitation based on the inflammatory response may decrease the likelihood of additional scar tissue formation and potentially improve the outcome for the patient.

Revision of anterior cruciate ligament reconstruction with patellar tendon allograft and autograft: 2- and 5-year results

INTRODUCTION

The most common failure reasons of an anterior cruciate ligament (ACL) graft are incorrect positioning of the drill channels and insufficient fixation. In many cases, one-stage revision with patellar tendon graft and the appropriate corrections are possible. For previous use of the ipsilateral patellar tendon third, an allograft seems favorable for reconstruction. So far, no study compared the results of revision surgery of autologous versus allogenous patellar tendon grafts for revision surgery of the ACL in a 5-year follow-up.

MATERIALS AND METHODS

A retrospective study was conducted to analyze the clinical outcome and stability results 2 years (19.2 ± 5.8 months) and 5 years (68.8 ± 6.8 months) after revision of ACL reconstruction using middle-third patellar tendon allografts and autografts. The allografts were cleansed by mechanical means only. There were 15 patients in the allograft group and 14 in the autograft group. Patients with isolated re-rupture of the ACL graft were included in the study. Clinical results were evaluated by International Knee Documentation Committee 2000 forms (IKDC), Lysholm score, Tegner activity score, and visual analog scale. Stability was evaluated by means of KT-1000 arthrometer, Lachman test, and pivot-shift test. Location of drill holes was evaluated radiologically. Gonarthritis was graded according to Kellgren and Lawrence on the basis of radiographs.

RESULTS

There were no significant differences between the two groups in anterior translation, manual examination for stability, IKDC 2000 findings, Tegner activity score, or Lysholm score. Extension deficits were more frequent in the autograft group at the first follow-up (P = 0.010). Lateral gonarthritis and femoral tunnel widening were more common in the allograft group at the second follow-up (P = 0.049 and P = 0.023, respectively). Pain on walking downhill was significantly more frequent in the allograft group at the second follow-up (P = 0.027).

CONCLUSIONS

The functional results with allografts that had not undergone irradiation or chemical sterilization were comparable to those with autografts in ACL revision surgery. Allografts represent a good alternative to autogenous patellar tendons in revision surgery.

Patellar tendon length change after anterior cruciate ligament reconstruction using the midthird patellar tendon

The purpose of this study was to determine if use of the midthird patellar tendon autograft contributes to or causes patellar tendon shortening or patella baja in anterior cruciate ligament reconstruction. Thirty-six patients undergoing arthroscopically assisted midthird patellar tendon autograft anterior cruciate ligament reconstruction were studied prospectively. Intraoperative patellar tendon length changes were measured. Half of the patients had the tendon defect closed and half had it left open (closing peritenon only). Radiographic tendon length changes and patella baja were assessed using Insall-Salvati and Blackburne-Peel ratios measured on 45 degrees lateral knee radiographs using an adjustable polypropylene jig. Bilateral films were obtained preoperatively and at 2 weeks, 3 months, and 6 months postoperatively. No patients demonstrated evidence of patellar tendon shortening greater than the 5.5% measurement error. Tendon defect closure resulted in negligible tendon shortening intraoperatively, averaging 2.28% (1.11 mm). Of the 18 patients whose defects were closed, 5 showed no shortening. The remaining 13 patients had measurable tendon shortening less than 4% (2 mm). No patients developed patella baja.