Patellofemoral Arthritis after Conservative Management for Post-operative Arthrofibrosis: A Case Report.

Gregory Benes, Rushyuan Jay Lee
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Abstract

Introduction: Arthrofibrosis of the knee is an adverse outcome after anterior cruciate ligament (ACL) reconstruction. Definitions and classifications vary widely based on extension and flexion losses, patellar mobility, and location. In general, it is understood as a restricted range of motion (ROM) due to scar tissue, and it is often defined as symptomatic limitation in knee ROM compared to the opposite knee. The frequency of ACL injuries, and consequently arthrofibrosis, is rising among children and adolescents, with an incidence rate ranging from 2 to 14% in the pediatric population. Treatment options for arthrofibrosis include oral corticosteroids, physical therapy, casting, manipulation under anesthesia, and arthroscopic lysis of adhesions, with early recognition being a crucial intervention. To our knowledge, this is the first report in the literature to describe the development of chondromalacia after the resolution of arthrofibrosis with conservative measures in a pediatric patient.

Case report: A 17-year-old male developed arthrofibrosis after combined ACL reconstruction and autologous osteochondral graft transfer. Knee flexion was restored with a high-frequency, intensive physical therapy and home exercise program but at a cost of developing anterior knee and patellofemoral chondromalacia.

Conclusion: Because complications can arise from the greater patellofemoral contact forces observed in arthrofibrosis, orthopaedic surgeons should consider early lysis of adhesions for the management of post-operative arthrofibrosis, particularly involving the parapatellar retinaculum, in adolescents who are non-responsive to conservative measures. In addition, restrictions on high levels of loading should be considered during the initial post-operative period in scenarios in which ROM has not been achieved.

术后关节纤维化保守治疗后髌骨关节炎1例报告。
膝关节关节纤维化是前交叉韧带(ACL)重建后的一个不良后果。根据伸展和屈曲损失、髌骨活动度和位置,定义和分类有很大差异。一般来说,它被理解为由于疤痕组织导致的活动范围受限(ROM),并且通常被定义为与对侧膝关节相比,膝关节ROM的症状性限制。在儿童和青少年中,前交叉韧带损伤和关节纤维化的发生率正在上升,在儿科人群中的发病率为2%至14%。关节纤维化的治疗选择包括口服皮质类固醇、物理治疗、铸造、麻醉下操作和关节镜下松解粘连,早期识别是至关重要的干预措施。据我们所知,这是文献中首次报道在儿童患者中采用保守措施解决关节纤维化后发生软骨软化症。病例报告:一名17岁男性在联合前交叉韧带重建和自体骨软骨移植后发生关节纤维化。膝关节屈曲可以通过高频率、高强度的物理治疗和家庭运动项目恢复,但代价是膝关节前侧和髌骨软骨软化。结论:由于关节纤维化中观察到的较大髌骨股接触力可能引起并发症,骨科医生应考虑早期松解粘连以处理术后关节纤维化,特别是涉及髌旁网膜,对保守措施无反应的青少年。此外,在未实现ROM的情况下,术后初期应考虑限制高水平的负荷。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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