Extension deficit after ACL reconstruction: Is open posterior release a safe and efficient procedure?

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Knee Reconstruction

Background:

• Extension loss is a significant complication following anterior cruciate ligament reconstruction (ACLR).
• While anterior arthroscopic release is common, chronic flexion contractures may necessitate posterior open release.
• The efficacy of combined anterior arthroscopic and posterior open release, particularly with posteromedial and posterolateral approaches, remains understudied.

Purpose of the Study:

• To analyze the midterm outcomes and complications of a combined anterior arthroscopic debridement and posterior open capsulotomy for chronic extension deficits post-ACLR.
• To describe the surgical technique for posterior open release utilizing both posteromedial and posterolateral approaches.

Main Methods:

• Retrospective cohort study including twelve patients with a chronic flexion contracture of 10° or more after ACLR.
• Patients underwent open posterior arthrolysis, with an average follow-up of 38 months.
• Clinical examinations included range of motion (ROM) analysis, International Knee Documentation Committee (IKDC) scores, and Knee injury and Osteoarthritis Outcome Scores (KOOS).

Main Results:

• 93% of patients achieved complete extension post-operatively, with only one patient retaining a 5° flexion deformity.
• Significant improvement in ROM was observed, from 96° pre-operatively to 14.3° post-operatively (p<0.001).
• High functional scores were reported: mean subjective IKDC 86.4, KOOS scores for pain (93.8), symptoms (88), ADL (96.8), sports (83.6), and quality of life (82.9), with mean patient satisfaction of 9.25/10. No complications were recorded.

Conclusions:

• Open posterior release, employing both posteromedial and posterolateral approaches, is a safe and effective treatment for persistent flexion contracture after ACLR.
• The procedure yields substantial gains in range of motion and functional outcomes.
• High patient satisfaction supports its utility as an additional intervention for refractory post-ACLR knee stiffness.