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CC BY-NC-ND 4.0 · Revista Chilena de Ortopedia y Traumatología 2018; 59(03): 095-099
DOI: 10.1055/s-0039-1677756
Review Article | Artículo de Revisión
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Rigidez en cirugía de reconstrucción del ligamento cruzado anterior

Knee Stiffness in Anterior Cruciate Ligament Reconstruction
David Figueroa
1   Departmento de Traumatología y Ortopedia, Clínica Alemana de Santiago SA, Vitacura, Región Metropolitana, Chile
,
Jaime Espinoza
2   Clínica Alemana Santiago, Universidad del Desarrollo, Vitacura, Región Metropolitana, Chile
,
Claudio Yañez
2   Clínica Alemana Santiago, Universidad del Desarrollo, Vitacura, Región Metropolitana, Chile
,
Nazira Bernal
2   Clínica Alemana Santiago, Universidad del Desarrollo, Vitacura, Región Metropolitana, Chile
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Weitere Informationen

Publikationsverlauf

28. Oktober 2018

04. Dezember 2018

Publikationsdatum:
21. Februar 2019 (online)

   Lizenzen und Reprints

Resumen

La rigidez de rodilla en cirugía de Reconstrucción del Ligamento Cruzado Anterior (R-LCA) es una complicación devastadora, alcanzando una incidencia variable entre el 4% y el 38%. La definición de artrofibrosis es aún poco clara, lo que ha llevado a distintos esquemas terapéuticos. Conocer la etiopatogenia es clave para entender los procesos y las posibles alternativas de tratamiento. Distintas clasificaciones han sido descritas, siendo la de Shelbourne la más usada, debido a su valor pronóstico asociado. El objetivo del tratamiento en una rodilla estable es mejorar la movilidad articular, la satisfacción del paciente, y disminuir el riesgo de artrosis a largo plazo. El tratamiento se puede dividir en quirúrgico y conservador. Ese último, se enfoca principalmente en buscar la causa y lograr una prevención e intervención temprana, siendo el manejo que con mayor frecuencia se realiza. El tratamiento quirúrgico es una opción cuando el tratamiento conservador falla. Se realizó una revisión de la literatura y de 150 pacientes sometidos a R-LCA, de los cuales 4 presentaron artrofibrosis a un seguimiento de 2 años. Además, presentamos nuestro algoritmo de manejo terapéutico.

Abstract

Knee stiffness in Anterior Cruciate Ligament Reconstruction (ACL-R) is a devastating complication, with a variable incidence of 4% to 38%. The definition of arthrofibrosis is still unclear, which has led to different therapeutic schemes. Knowing the etiopathogenesis is key to understanding the processes and possible treatment alternatives. Different classifications have been described, with Shelbourne being the most used, due to its associated prognostic value. The aim of treatment in a stable knee is to improve joint mobility, patient satisfaction, and decrease the risk of long-term osteoarthritis. The treatment can be divided into operative and non-operative. The latter focuses mainly on finding the cause and achieving prevention and early intervention, being the management that is most frequently performed. Surgical treatment is an option when conservative treatment fails. A review of the literature and of 150 patients undergoing R-LCA was performed, of which 4 presented arthrofibrosis at a 2-year follow-up. In addition, we present our therapeutic management algorithm.

Palabras-clave

artrofibrosis - rigidez de rodilla - artrofibrolisis - cirugia ligamentaria

Keywords

arthrofibrosis - knee stiffness - arthribrolysis - ligament surgery
 

  • Bibliografía

  • 1 Krenn V, Ruppert M, Knöß P. , et al. [Synovialitis of the arthrofibrotic type: criteria of a new synovialitis type for the diagnosis of arthrofibrosis]. Z Rheumatol 2013; 72 (03) 270-278 . Doi: 10.1007/s00393-012-1076-7
    CrossrefPubMedGoogle Scholar
  • 2 Kartus J, Magnusson L, Stener S, Brandsson S, Eriksson BI, Karlsson J. Complications following arthroscopic anterior cruciate ligament reconstruction. A 2-5-year follow-up of 604 patients with special emphasis on anterior knee pain. Knee Surg Sports Traumatol Arthrosc 1999; 7 (01) 2-8 . Doi: 10.1007/s001670050112
    CrossrefPubMedGoogle Scholar
  • 3 Langer F, Gross AE, Greaves MF. The auto-immunogenicity of articular cartilage. Clin Exp Immunol 1972; 12 (01) 31-37
    PubMedGoogle Scholar
  • 4 Noyes FR, Mangine RE, Barber SD. The early treatment of motion complications after reconstruction of the anterior cruciate ligament. Clin Orthop Relat Res 1992; (277) 217-228
    PubMedGoogle Scholar
  • 5 Sisto DJ, Warren RF. Complete knee dislocation. A follow-up study of operative treatment. Clin Orthop Relat Res 1985; (198) 94-101
    PubMedGoogle Scholar
  • 6 Shapiro MS, Freedman EL. Allograft reconstruction of the anterior and posterior cruciate ligaments after traumatic knee dislocation. Am J Sports Med 1995; 23 (05) 580-587
    CrossrefPubMedGoogle Scholar
  • 7 Magit D, Wolff A, Sutton K, Medvecky MJ. Arthrofibrosis of the knee. J Am Acad Orthop Surg 2007; 15 (11) 682-694
    CrossrefPubMedGoogle Scholar
  • 8 Border WA, Noble NA. Transforming growth factor beta in tissue fibrosis. N Engl J Med 1994; 331 (19) 1286-1292
    CrossrefPubMedGoogle Scholar
  • 9 Bonner JC. Regulation of PDGF and its receptors in fibrotic diseases. Cytokine Growth Factor Rev 2004; 15 (04) 255-273
    CrossrefPubMedGoogle Scholar
  • 10 Gharaee-Kermani M, Phan SH. Role of cytokines and cytokine therapy in wound healing and fibrotic diseases. Curr Pharm Des 2001; 7 (11) 1083-1103
    CrossrefPubMedGoogle Scholar
  • 11 Paulos LE, Rosenberg TD, Drawbert J, Manning J, Abbott P. Infrapatellar contracture syndrome. An unrecognized cause of knee stiffness with patella entrapment and patella infera. Am J Sports Med 1987; 15 (04) 331-341
    CrossrefPubMedGoogle Scholar
  • 12 Shelbourne KD, Wilckens JH, Mollabashy A, DeCarlo M. Arthrofibrosis in acute anterior cruciate ligament reconstruction. The effect of timing of reconstruction and rehabilitation. Am J Sports Med 1991; 19 (04) 332-336
    CrossrefPubMedGoogle Scholar
  • 13 Mayr HO, Weig TG, Plitz W. Arthrofibrosis following ACL reconstruction--reasons and outcome. Arch Orthop Trauma Surg 2004; 124 (08) 518-522
    CrossrefPubMedGoogle Scholar
  • 14 Magit D, Wolff A, Sutton K, Medvecky MJ. Arthrofibrosis of the knee. J Am Acad Orthop Surg 2007; 15 (11) 682-694
    CrossrefPubMedGoogle Scholar
  • 15 Sprague III NF, O'Connor RL, Fox JM. Arthroscopic treatment of postoperative knee fibroarthrosis. Clin Orthop Relat Res 1982; (166) 165-172
    PubMedGoogle Scholar
  • 16 Del Pizzo W, Fox JM, Friedman ML. , et al. Operative arthroscopy for the treatment of arthrofibrosis of the knee. Contemp Orthop 1985; 10: 67-72
    PubMedGoogle Scholar
  • 17 Blauth W, Jaeger T. [Arthrolysis of the knee joint]. [German] Orthopade 1990; 19 (06) 388-399
    PubMedGoogle Scholar
  • 18 Shelbourne KD, Patel DV, Martini DJ. Classification and management of arthrofibrosis of the knee after anterior cruciate ligament reconstruction. Am J Sports Med 1996; 24 (06) 857-862
    CrossrefPubMedGoogle Scholar
  • 19 Yaru NC, Daniel DM, Penner D. The effect of tibial attachment site on graft impingement in an anterior cruciate ligament reconstruction. Am J Sports Med 1992; 20 (02) 217-220
    CrossrefPubMedGoogle Scholar
  • 20 Bach Jr BR, Jones GT, Sweet FA, Hager CA. Arthroscopy-assisted anterior cruciate ligament reconstruction using patellar tendon substitution. Two- to four-year follow-up results. Am J Sports Med 1994; 22 (06) 758-767
    CrossrefPubMedGoogle Scholar
  • 21 Markolf KL, Burchfield DM, Shapiro MM, Davis BR, Finerman GA, Slauterbeck JL. Biomechanical consequences of replacement of the anterior cruciate ligament with a patellar ligament allograft. Part I: insertion of the graft and anterior-posterior testing. J Bone Joint Surg Am 1996; 78 (11) 1720-1727
    CrossrefPubMedGoogle Scholar
  • 22 Pinczewski LA, Deehan DJ, Salmon LJ, Russell VJ, Clingeleffer A. A five-year comparison of patellar tendon versus four-strand hamstring tendon autograft for arthroscopic reconstruction of the anterior cruciate ligament. Am J Sports Med 2002; 30 (04) 523-536
    CrossrefPubMedGoogle Scholar
  • 23 Sajovic M, Vengust V, Komadina R, Tavcar R, Skaza K. A prospective, randomized comparison of semitendinosus and gracilis tendon versus patellar tendon autografts for anterior cruciate ligament reconstruction: five-year follow-up. Am J Sports Med 2006; 34 (12) 1933-1940
    CrossrefPubMedGoogle Scholar
  • 24 Harner CD, Irrgang JJ, Paul J, Dearwater S, Fu FH. Loss of motion after anterior cruciate ligament reconstruction. Am J Sports Med 1992; 20 (05) 499-506
    CrossrefPubMedGoogle Scholar
  • 25 Dodds JA, Keene JS, Graf BK, Lange RH. Results of knee manipulations after anterior cruciate ligament reconstructions. Am J Sports Med 1991; 19 (03) 283-287
    CrossrefPubMedGoogle Scholar
  • 26 Shelbourne KD, Wilckens JH, Mollabashy A, DeCarlo M. Arthrofibrosis in acute anterior cruciate ligament reconstruction. The effect of timing of reconstruction and rehabilitation. Am J Sports Med 1991; 19 (04) 332-336
    CrossrefPubMedGoogle Scholar
  • 27 Wasilewski SA, Covall DJ, Cohen S. Effect of surgical timing on recovery and associated injuries after anterior cruciate ligament reconstruction. Am J Sports Med 1993; 21 (03) 338-342
    CrossrefPubMedGoogle Scholar
  • 28 Hooper GJ, Walton DI. Reconstruction of the anterior cruciate ligament using the bone-block iliotibial-tract transfer. J Bone Joint Surg Am 1987; 69 (08) 1150-1154
    CrossrefPubMedGoogle Scholar
  • 29 Sanders TL, Kremers HM, Bryan AJ, Kremers WK, Stuart MJ, Krych AJ. Procedural intervention for arthrofibrosis after ACL reconstruction: trends over two decades. Knee Surg Sports Traumatol Arthrosc 2017; 25 (02) 532-537
    CrossrefPubMedGoogle Scholar
  • 30 Kwok CS, Harrison T, Servant C. The optimal timing for anterior cruciate ligament reconstruction with respect to the risk of postoperative stiffness. Arthroscopy 2013; 29 (03) 556-565
    CrossrefPubMedGoogle Scholar
  • 31 Magit D, Wolff A, Sutton K, Medvecky MJ. Arthrofibrosis of the Knee. J Am Acad Orthop Surg 2007; 15 (11) 682-694
    CrossrefPubMedGoogle Scholar
  • 32 Millett PJ, Wickiewicz TL, Warren RF. Motion loss after ligament injuries to the knee. Part II: prevention and treatment. Am J Sports Med 2001; 29 (06) 822-828
    CrossrefPubMedGoogle Scholar
  • 33 Chen MR, Dragoo JL. Arthroscopic releases for arthrofibrosis of the knee. J Am Acad Orthop Surg 2011; 19 (11) 709-716
    CrossrefPubMedGoogle Scholar
  • 34 Mayr HO, Brandt CM, Weig T. , et al. Long-term Results of Arthroscopic Arthrolysis for Arthrofibrosis After Anterior Cruciate Ligament Reconstruction. Arthroscopy 2017; 33 (02) 408-414
    CrossrefPubMedGoogle Scholar
  • 35 Noyes FR, Berrios-Torres S, Barber-Westin SD, Heckmann TP. Prevention of permanent arthrofibrosis after anterior cruciate ligament reconstruction alone or combined with associated procedures: a prospective study in 443 knees. Knee Surg Sports Traumatol Arthrosc 2000; 8 (04) 196-206
    CrossrefPubMedGoogle Scholar
  • 36 Ekhtiari S, Horner NS, de Sa D. , et al. Arthrofibrosis after ACL reconstruction is best treated in a step-wise approach with early recognition and intervention: a systematic review. Knee Surg Sports Traumatol Arthrosc 2017; 25 (12) 3929-3937
    CrossrefPubMedGoogle Scholar