Skeletal immaturity may protect against arthrofibrosis after ACL reconstruction
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Key takeaways:
- Skeletally immature patients had significantly lower rates of arthrofibrosis vs. skeletally mature patients.
- Patients with higher weight and BMI were more likely to develop arthrofibrosis.
Results showed 3.9% of pediatric and adolescent patients who underwent ACL reconstruction developed arthrofibrosis; however, skeletally immature patients had significantly lower rates of arthrofibrosis vs. skeletally mature patients.
Researchers performed a retrospective chart review of 660 patients younger than 18 years (mean age, 15.44 years) who underwent ACL reconstruction between 2013 and 2023. Among the cohort, 461 patients had complete follow-up data at 6 months postoperatively.
Overall, 18 patients (3.9%) required reoperation for the development of arthrofibrosis after ACL reconstruction. Researchers found patients who were skeletally immature had significantly lower rates of arthrofibrosis vs. patients who were skeletally mature.
Among male patients, no patients who were skeletally immature and seven patients who were skeletally mature (4.8%) developed arthrofibrosis. Among female patients, one patient who was skeletally immature (4.2%) and 10 patients who were skeletally mature (5.6%) developed arthrofibrosis.
Researchers also found patients with higher weight (P = .0485) and BMI (P = .0410) were more likely to develop arthrofibrosis. They noted no associations between graft types or concomitant injuries and the development of arthrofibrosis among the cohort.
“Skeletal immaturity was found to be a protective factor against the development of arthrofibrosis in this cohort,” the researchers wrote in the study.
Perspective
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Arthrofibrosis is one of the most devastating complications associated with pediatric ACL reconstruction. The authors, from a single surgeon’s series, report an incidence of 3.9% pediatric patients requiring surgery for arthrofibrosis. More simply stated, one in 25 youth athletes may undergo a second surgery instead of their hopes of returning to their activity. Despite male patients and those with skeletal immaturity having a lower incidence of arthrofibrosis, there remain some considerations from this study that should not be overlooked. All but three cases of arthrofibrosis were from the quadricep autograft group, in which the primary surgeon transitioned to using in 2018. Both an increase in graft size in a pediatric ACL reconstruction and early use of the quadricep autograft have been implicated as risk factors for the development of arthrofibrosis in pediatric ACL reconstruction.
An interesting finding in this study was that 13 of 15 (87%) cases with arthrofibrosis using the quadricep autograft were utilizing an all-inside technique with suspensory fixation on both the femur and tibia. Although this was not statistically significant in this study, similar findings were recently presented from the SCORE registry (4,504 cases of pediatric ACL reconstruction). This should caution surgeons to avoid over-tensioning adjustable suspensory fixation with this technique.
In addition to minimizing risk factors, one of the best ways to prevent arthrofibrosis in pediatric ACL reconstruction is to ensure appropriate range of motion in a “quiet” knee prior to proceeding with operative management.
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