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Arthrofibrosis risk after ACL reconstruction may not be linked to insurance status
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CHICAGO — Although several patient and surgical factors may be linked to arthrofibrosis after ACL reconstruction, insurance status was not a significant risk factor, according to results presented at the Arthroscopy Association of North America Annual Meeting.
Of 2,424 ACL reconstructions performed during a 10-year period, Joel Huleatt, MD, and colleagues found 8% of patients had government-sponsored insurance. In addition, results showed a 4.5% rate of requiring manipulation under anesthesia or lysis of adhesion performed at an average of 5.5 months after ACL reconstruction.
Investigators found patients who were adolescents, female gender, patients with contact injury, early surgery, primary reconstruction, concomitant procedures, quadriceps tendon autograft, infection and hematoma were risk factors for developing arthrofibrosis after ACL reconstruction.
Independently statistically significant risk factors for manipulation under anesthesia or lysis of adhesion included infection, adding the meniscal repair and using the quadriceps tendon autograft, according to results. Huleatt added revision ACL was associated with a lower risk of manipulation or lysis of adhesion.
“Government-sponsored insurance had an increased risk of requiring manipulation or lysis of adhesion by 44%,” Huleatt said in his presentation. “However, this was not found to be statistically significant.”
Results showed an overall graft failure rate of 7.3%, with a 2.8% risk of graft failure in patients who underwent manipulation under anesthesia or lysis of adhesion. Huleatt noted, despite being a 200% reduction in risk, it was not statistically significant.
“However, this brings up an interesting question: Is there an inverse correlation between the risk of arthrofibrosis and the risk of graft failure?” Huleatt said. “It seems that [bone-patellar tendon-bone] BTB grafts and quadriceps tendon autografts both have low failure rates, but may be at increased risk of arthrofibrosis or is this more related to a lower activity level gained by patients who undergo manipulation or lysis of adhesion? This will have to be looked at in further studies.” – by Casey Tingle
Reference:
Huleatt J, et al. Paper 9. Presented at: Arthroscopy Association of North America Annual Meeting; April 26-28, 2018; Chicago.
Disclosure: Huleatt reports no relevant financial disclosures.