Extension deficit after anterior cruciate ligament reconstruction: Is arthroscopic posterior release a safe and effective procedure?

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 capailotomy. 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 34 years (range: 17 to 49 years) were included in the study. The median follow-up period was 25 months (range: 14 to 69 months). 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. Level of evidence: Level IV. (C) 2016 Elsevier B.V. All rights reserved.