title: Arthrofibrosis after anterior cruciate ligament reconstruction in children and adolescents.
abstract: BACKGROUND
  Arthrofibrosis is a known complication after anterior cruciate ligament (ACL) reconstruction. ACL reconstruction is being performed with increased frequency in the pediatric population. The purpose of this study was to determine the prevalence of arthrofibrosis in children and adolescents and to identify risk factors for arthrofibrosis.
  
  
  METHODS
  The study design was a retrospective case series. Medical records for 1016 consecutive ACL reconstructions in patients aged 7 to 18 years old between 1995 to 2008 at a major tertiary care children's hospital were reviewed to identify cases of postoperative arthrofibrosis. Arthrofibrosis was defined as a loss of 5 degrees or more extension compared with the contralateral knee that required a follow-up procedure or a loss of 15 degrees or more flexion compared with the contralateral knee that required a follow-up procedure. Patient data were recorded and analyzed using bivariate models to identify predictors for arthrofibrosis. Further, we reviewed the clinical course of patients with treated arthrofibrosis to assess functional outcomes of this complication.
  
  
  RESULTS
  Nine hundred two patients with 933 knees met the inclusion criteria for this study, of which 60% were female. The mean age at the time of surgery was 15 years (range, 7 to 18 y), and the average follow-up from original ACL reconstruction was 6.3 years (range, 1.6 to 14.2 y). The overall prevalence of arthrofibrosis in our cohort was 8.3%, with 77 of the 933 knees had at least 1 procedure to treat arthrofibrosis after ACL reconstruction. Risk factors for arthrofibrosis were female sex (11.1% females, P = 0.0001), patients aged 16 to 18 years [11.6%; odds ratio (OR) 3.51; P = 0 .007], patellar tendon autograft (OR, 1.7; P = 0.026), and concomitant meniscal repair (OR, 2.08; P = 0.007). Prior knee surgery and ACL reconstruction within 1 month of injury were not significantly associated with arthrofibrosis after ACL reconstruction. Fifty-three patients had a minimum of 6 months clinical follow-up after the procedure for arthrofibrosis. Of these, 46 patients (86.8%) had full range of motion at follow-up. Thirty-two patients (60.4%) were asymptomatic at final follow-up. Eleven patients (20.8%) complained of some persistent pain.
  
  
  CONCLUSIONS
  The rate of arthrofibrosis after ACL reconstruction in children and adolescents is 8.3%. Risk factors for arthrofibrosis are female sex, older adolescents, concurrent meniscal repair, and reconstruction with patellar tendon autograft. Surgical treatment for arthrofibrosis after ACL reconstruction in pediatric patients can satisfactorily regain motion in the reconstructed knee; however functional outcome may be compromised.
  
  
  METHODS
  Level 4.
authors.affiliation: Harvard Medical School, Boston, MA, USA.
authors.forename: Benedict U
authors.initials: BU
authors.lastname: Nwachukwu
authors.forename: Eric D
authors.initials: ED
authors.lastname: McFeely
authors.forename: Adam
authors.initials: A
authors.lastname: Nasreddine
authors.forename: John H
authors.initials: JH
authors.lastname: Udall
authors.forename: Craig
authors.initials: C
authors.lastname: Finlayson
authors.forename: David W
authors.initials: DW
authors.lastname: Shearer
authors.forename: Lyle J
authors.initials: LJ
authors.lastname: Micheli
authors.forename: Mininder S
authors.initials: MS
authors.lastname: Kocher
mesh_terms: D000293:Adolescent; D016118:Anterior Cruciate Ligament / Q000473:pathology* / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000009:adverse effects*; D002648:Child; D005260:Female; D005355:Fibrosis / Q000453:epidemiology / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D007592:Joint Diseases / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D008297:Male; D008499:Medical Records; D015995:Prevalence; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012307:Risk Factors