Risk Factors for Arthrofibrosis in Schenck KD 3 and 4 Multiligament Knee Injury Patients
Cailan L Feingold1, Eric H Lin1, Pranit Kumaran1
1Keck School of Medicine of USC, Los Angeles, California, USA.
Orthopaedic Journal of Sports Medicine
|October 28, 2025
Summary
Arthrofibrosis affects one-third of patients undergoing surgery for severe multiligament knee injuries (MLKIs). Younger age, poor preoperative knee flexion, and delayed weight-bearing are key risk factors for developing this complication.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Reconstructive Surgery
Background:
- Multiligament knee injuries (MLKIs) are severe, limb-threatening conditions requiring surgical reconstruction.
- Arthrofibrosis is a frequent complication following multiligament knee reconstruction (MLKR), particularly in serious cases like Schenck knee dislocation (KD) grades 3 and 4.
Purpose of the Study:
- To identify specific risk factors contributing to the development of arthrofibrosis in patients with Schenck KD 3 and 4 MLKIs.
- To inform clinical practice and potentially improve patient outcomes by understanding predictors of postoperative stiffness.
Main Methods:
- A retrospective case-control study involving 71 patients who underwent MLKR for Schenck KD 3 or 4 MLKIs.
- Data collected included patient demographics, injury details, surgical procedures, and postoperative recovery, with arthrofibrosis defined by specific range-of-motion or manipulation criteria.
- Statistical analyses, including univariate, chi-square, and logistic regression, were employed to identify significant risk factors (P < .05).
Main Results:
- Arthrofibrosis developed in 32.4% of the studied patients.
- Identified risk factors for arthrofibrosis included younger patient age, worse preoperative knee flexion, and a longer time to return to weight-bearing.
- Higher median household income was also associated with increased risk, while factors like sex, BMI, and injury mechanism showed no significant difference.
Conclusions:
- Approximately one-third of patients with severe MLKIs (Schenck KD 3-4) develop postoperative arthrofibrosis.
- Younger age, poorer preoperative knee flexion, and delayed weight-bearing are significant risk factors.
- Interventions such as prehabilitation or early manipulation under anesthesia may help mitigate risks associated with time to weight-bearing and preoperative flexion.
