Arthroscopic Posterior Capsular Release Improves Range of Motion and Outcomes for Flexion Contracture After Anterior Cruciate Ligament Reconstruction in Athletes

Overview

Journal Arthrosc Sports Med Rehabil

Date 2024 Jul 15

PMID 39006795

Authors

Joseph C Brinkman

Jose M Iturregui

M Lane Moore

Jack Haglin

Adam Thompson

Justin Makovicka

Kostas J Economopoulos

Affiliations

Soon will be listed here.

Abstract

Purpose: To assess outcomes of arthroscopic posterior capsular release among athletes for loss of terminal extension following anterior cruciate ligament (ACL) reconstruction.

Methods: A retrospective review of prospectively collected data was performed for patients undergoing arthroscopic posterior capsular release for knee extension loss following ACL reconstruction between January 2014 and December 2019. Procedure indications included extension loss greater than 10° at least 3 months after ACL reconstruction that was refractory to physical therapy. Patients were included if they were involved in either high school or college athletics, had complete outcomes of interest, and had at least 2 years of follow-up. Prospectively collected outcomes included preoperative and postoperative measurement of knee extension, International Knee Documentation Committee score, Lysholm score, return to sport data, and complications.

Results: Eighteen athletes with minimum 2 years of follow-up who underwent posterior capsular release following ACL reconstruction performed by a single surgeon were included in the analysis. Patients underwent surgery at an average of 16 weeks after ACL reconstruction. Knee extension improved an average of 13.8° at 2 years' follow-up (prerelease mean extension deficit 15.1°, postrelease mean extension deficit 1.3°, < .005). Improvements in the International Knee Documentation Committee score averaged 21.7 at 6 months and 35.0 at 24 months, both of which were statistically significant ( < .001). Similarly, differences in Lysholm included a significant improvement of 23.0 and 34.2 at 6 months and 2 years, respectively ( < .001). In total, 77.8% returned to sport at an average of 9.8 months from their primary ACL surgery and 6.5 months following posterior capsular release surgery. No infections or neurovascular complications were observed. One patient required secondary release to achieve adequate extension.

Conclusions: For athletes with persistent knee extension loss after ACL reconstruction, knee extension was significantly improved at 2 years following arthroscopic posterior capsular release. Substantial improvements in patient-reported outcomes also were seen. In addition, subjects demonstrated a high rate of return to sport and return to preinjury performance levels.

Level Of Evidence: Level IV, therapeutic case series.

References

Nwachukwu B, McCormick F, Provencher M, Roche M, Rubash H . A comprehensive analysis of Medicare trends in utilization and hospital economics for total knee and hip arthroplasty from 2005 to 2011. J Arthroplasty. 2014; 30(1):15-8. DOI: 10.1016/j.arth.2014.08.025. View

Busfield B, Kharrazi F, Starkey C, Lombardo S, Seegmiller J . Performance outcomes of anterior cruciate ligament reconstruction in the National Basketball Association. Arthroscopy. 2009; 25(8):825-30. DOI: 10.1016/j.arthro.2009.02.021. View

Waldron K, Brown M, Calderon A, Feldman M . Anterior Cruciate Ligament Rehabilitation and Return to Sport: How Fast Is Too Fast?. Arthrosc Sports Med Rehabil. 2022; 4(1):e175-e179. PMC: 8811519. DOI: 10.1016/j.asmr.2021.10.027. View

Namdari S, Scott K, Milby A, Baldwin K, Lee G . Athletic performance after ACL reconstruction in the Women's National Basketball Association. Phys Sportsmed. 2011; 39(1):36-41. DOI: 10.3810/psm.2011.02.1860. View

DeFazio M, Curry E, Gustin M, Sing D, Abdul-Rassoul H, Ma R . Return to Sport After ACL Reconstruction With a BTB Versus Hamstring Tendon Autograft: A Systematic Review and Meta-analysis. Orthop J Sports Med. 2021; 8(12):2325967120964919. PMC: 7745570. DOI: 10.1177/2325967120964919. View

Ardern C, Taylor N, Feller J, Webster K . Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med. 2014; 48(21):1543-52. DOI: 10.1136/bjsports-2013-093398. View

Petsche T, Hutchinson M . Loss of extension after reconstruction of the anterior cruciate ligament. J Am Acad Orthop Surg. 1999; 7(2):119-27. DOI: 10.5435/00124635-199903000-00005. View

LaPrade R, Pedtke A, Roethle S . Arthroscopic posteromedial capsular release for knee flexion contractures. Knee Surg Sports Traumatol Arthrosc. 2008; 16(5):469-75. DOI: 10.1007/s00167-008-0496-z. View

Ardern C, Webster K, Taylor N, Feller J . Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med. 2011; 45(7):596-606. DOI: 10.1136/bjsm.2010.076364. View

10.

Nwachukwu B, Sullivan S, Rauck R, James E, Burger J, Altchek D . Patient-Reported Outcomes and Factors Associated with Achieving the Minimal Clinically Important Difference After ACL Reconstruction: Results at a Mean 7.7-Year Follow-up. JB JS Open Access. 2021; 6(4). PMC: 8613365. DOI: 10.2106/JBJS.OA.21.00056. View

11.

Chen M, Dragoo J . Arthroscopic releases for arthrofibrosis of the knee. J Am Acad Orthop Surg. 2011; 19(11):709-16. DOI: 10.5435/00124635-201111000-00007. View

12.

Zampogna B, Vasta S, Torre G, Gupta A, Hettrich C, Bollier M . Return to Sport After Anterior Cruciate Ligament Reconstruction in a Cohort of Division I NCAA Athletes From a Single Institution. Orthop J Sports Med. 2021; 9(2):2325967120982281. PMC: 7900794. DOI: 10.1177/2325967120982281. View

13.

Harris J, Erickson B, Bach Jr B, Abrams G, Cvetanovich G, Forsythe B . Return-to-Sport and Performance After Anterior Cruciate Ligament Reconstruction in National Basketball Association Players. Sports Health. 2014; 5(6):562-8. PMC: 3806178. DOI: 10.1177/1941738113495788. View

14.

Randsborg P, Cepeda N, Adamec D, Rodeo S, Ranawat A, Pearle A . Patient-Reported Outcome, Return to Sport, and Revision Rates 7-9 Years After Anterior Cruciate Ligament Reconstruction: Results From a Cohort of 2042 Patients. Am J Sports Med. 2022; 50(2):423-432. PMC: 8829731. DOI: 10.1177/03635465211060333. View

15.

Dean C, Chahla J, Mikula J, Mitchell J, LaPrade R . Arthroscopic Posteromedial Capsular Release. Arthrosc Tech. 2016; 5(3):e495-500. PMC: 5021185. DOI: 10.1016/j.eats.2016.01.034. View

16.

Suresh K, Ikwuezunma I, Margalit A, Lee R . Arthroscopic Posterior Capsulotomy for Knee Flexion Contracture Using a Spinal Needle. Arthrosc Tech. 2021; 10(8):e1903-e1907. PMC: 8355179. DOI: 10.1016/j.eats.2021.04.014. View

17.

Fabricant P, Tepolt F, Kocher M . Range of Motion Improvement Following Surgical Management of Knee Arthrofibrosis in Children and Adolescents. J Pediatr Orthop. 2018; 38(9):e495-e500. DOI: 10.1097/BPO.0000000000001227. View

18.

Rushdi I, Sharifudin S, Shukur A . Arthrofibrosis Following Anterior Cruciate Ligament Reconstruction. Malays Orthop J. 2020; 13(3):34-38. PMC: 6915315. DOI: 10.5704/MOJ.1911.006. View

19.

Ross B, Savage-Elliott I, Brown S, Mulcahey M . Return to Play and Performance After Primary ACL Reconstruction in American Football Players: A Systematic Review. Orthop J Sports Med. 2020; 8(10):2325967120959654. PMC: 7607798. DOI: 10.1177/2325967120959654. View

20.

Dandy D, Edwards D . Problems in regaining full extension of the knee after anterior cruciate ligament reconstruction: does arthrofibrosis exist?. Knee Surg Sports Traumatol Arthrosc. 1994; 2(2):76-9. DOI: 10.1007/BF01476476. View