An algorithmic approach to rehabilitation following arthroscopic surgery for arthrofibrosis of the knee

Loss of knee range of motion (ROM) has been reported as the most common complication following anterior cruciate ligament reconstruction (ACLR). Arthrofibrosis of the knee, or specifically Cyclops syndrome, has been described as the formation of a scar tissue nodule adjacent to the tibial tunnel of the anterior cruciate ligament (ACL) graft. This lesion often results in loss of knee extension ROM, pain, and impaired function.

Three consecutive patients were referred to physical therapy following arthroscopic knee surgery for lysis of adhesions of a Cyclops lesion from a previous ACLR. Arthroscopic debridement was performed between 3 and 12 months post ACLR. An algorithmic progression of extension ROM was the initial focus of physical therapy, which then advanced to strengthening, neuromuscular reeducation, and sport specific training.

Following knee surgery for debridement of the Cyclops lesion, mean knee joint ROM at the initial physical therapy evaluation was 7.0° ± 8.6° to 118.3° ± 7.6° that progressed to -1.0° ± 1.7° to 127° ± 2.6° at discharge. Mean numeric pain rating improved from 3.0 ± 1.0 at the evaluation to 0.7 ± 1.1 at discharge. Mean Lower Extremity Functional Scale (LEFS) improved from 56.3 ± 13.6 to 77.0 ± 4.3 at discharge.

Arthroscopic debridement of knee joint arthrofibrosis after ACLR in conjunction with a postoperative physical therapy algorithmic approach to maximizing knee joint extension ROM can be beneficial in gaining symmetrical knee extension range of motion and improved function. Further studies may help to understand the optimal mode, frequency, and duration of stretching to achieve full symmetrical knee extension in this population.