title: Extension deficit after anterior cruciate ligament reconstruction: Is arthroscopic posterior release a safe and effective procedure?
abstract: BACKGROUND
  Postoperative extension deficits following anterior cruciate ligament (ACL) reconstruction can cause major limitation during daily life. The purpose of this study was to evaluate the efficiency of an all-arthroscopic approach and posterior capsule release for the treatment of persistent knee extension deficits following ACL reconstruction.
  
  
  METHODS
  Between 2009 and 2013 a total of 10 patients with knee flexion contractures after ACL reconstruction were assessed following an all-arthroscopic approach and posterior capsulotomy. The clinical outcomes were reviewed using the range of motion (ROM), Tegner Activity Level, Lysholm score and visual analogue pain scale (VAS).
  
  
  RESULTS
  Four women and six men with a median age of 34years (range: 17 to 49years) were included in the study. The median follow-up period was 25months (range: 14 to 69months). The median preoperative extension deficit was 15° (range: 10 to 20°) compared to the normal contralateral knee. Postoperatively at final follow-up the median extension deficit was one degree (range: 0 to five degrees) (P<0.01). The median preoperative Lysholm score improved from 52 (range: 32 to 67) to 92 (range: 84 to 100) postoperatively (P<0.01), while the median Tegner Activity Level improved from three (range: two to six) to six (range: three to seven) respectively (P<0.02). The median VAS status for pain decreased from five (range: one to 10) to one (range: 0 to three) (P<0.01). No complications were observed.
  
  
  CONCLUSIONS
  Arthroscopic posterior capsulotomy is a safe and effective additional procedure in the treatment of persistent knee extension deficits following ACL reconstruction with excellent results regarding ROM and subjective outcomes.
  
  
  METHODS
  Level IV.
authors.affiliation: Department of Traumatology and Sports Injuries, Paracelsus Medical University Salzburg, Muellner Hauptstrasse 48, 5020 Salzburg, Austria; Gelenkpunkt - Center for Sports and Joint Surgery, Olympiastraße 39, 6020 Innsbruck, Austria. Electronic address: wierer@gmail.com.
authors.forename: Guido
authors.initials: G
authors.lastname: Wierer
authors.affiliation: Gelenkpunkt - Center for Sports and Joint Surgery, Olympiastraße 39, 6020 Innsbruck, Austria; Medical University Innsbruck, 6020 Innsbruck, Austria. Electronic address: Armin.Runer@rolmail.net.
authors.forename: Armin
authors.initials: A
authors.lastname: Runer
authors.affiliation: Gelenkpunkt - Center for Sports and Joint Surgery, Olympiastraße 39, 6020 Innsbruck, Austria. Electronic address: p.gfoeller@gelenkpunkt.com.
authors.forename: Peter
authors.initials: P
authors.lastname: Gföller
authors.affiliation: Gelenkpunkt - Center for Sports and Joint Surgery, Olympiastraße 39, 6020 Innsbruck, Austria; Research Unit for OSMI, UMIT/ISAG, Eduard-Wallnöfer-Zentrum 1, 6060 Hall in Tirol, Austria. Electronic address: c.fink@gelenkpunkt.com.
authors.forename: Christian
authors.initials: C
authors.lastname: Fink
authors.affiliation: Gelenkpunkt - Center for Sports and Joint Surgery, Olympiastraße 39, 6020 Innsbruck, Austria. Electronic address: c.hoser@gelenkpunkt.com.
authors.forename: Christian
authors.initials: C
authors.lastname: Hoser
mesh_terms: D000293:Adolescent; D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries / Q000150:complications / Q000601:surgery; D059549:Anterior Cruciate Ligament Reconstruction / Q000009:adverse effects*; D015331:Cohort Studies; D003286:Contracture / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D057913:Joint Capsule Release; D065466:Lysholm Knee Score; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D016896:Treatment Outcome; D055815:Young Adult
keywords: ACL; Arthroscopic release; Capsulotomy; Extension deficit; Flexion contracture