DOES POST OPERATIVE SWELLING PREDICT THE DEVELOPMENT OF STIFFNESS FOLLOWING ACL RECONSTRUCTION?

Abstract

Range of motion, degree of hemarthrosis and leg circumference was prospectively recorded in one hundred and eighteen consecutive isolated ACL reconstructions. A higher grade of hemarthrosis at one week was associated with a flexion deficit at eight weeks (P=0.002, relative risk 1.93). Increased leg circumference at one week was also associated with a flexion deficit at eight weeks (P=0.007, relative risk 1.37). An extension deficit was not associated with a hemarthrosis (P=0.47) or increased circumference (P=0.07). This prospective review identifies a risk factor for clinicians to be aware of after ACL Reconstruction. These patients merit closer observation and possibly a modified rehabilitation protocol.

To determine if increased swelling in the early post operative period is predictive of difficulty in regaining full range of motion after ACL reconstruction.

Increased swelling, at one-week post op (presence of a large hemarthrosis or a measured circumference greater than 1.5cm more than the control limb) is associated with flexion loss at eight weeks post surgery. These patients merit closer observation and possibly a modified rehabilitation protocol.

Patients with a higher grade of hemarthrosis at one week were more likely to have a flexion deficit at eight weeks (P=0.002, relative risk 1.93). Increased circumference was also associated with a flexion deficit at eight weeks (P=0.007, relative risk 1.37). The presence of a large hemarthrosis was not associated with an extension deficit at (P=0.47) although there was a trend for increased circumference to be associated with extension deficit (P=0.07).

One hundred and eighteen consecutive patients were prospectively assessed post ACL reconstruction. Range of motion was measured by goniometer at week one, four and eight. A deficit greater than 10° of flexion or 5° of extension (compared to normal leg) at the eight-week mark was defined as significant. The grade of hemarthrosis and circumference of the leg at the level of the patella were recorded at the same intervals. All patients underwent endoscopic, primary, ACL reconstruction with a standardized post op physio protocol. Exclusion criteria included previous surgery on either knee, significant effusion at the time of surgery or associated ligament injuries.