COLUMBUS, Ohio -- Proper timing of surgery and rigorous post-operative therapy can virtually eliminate the common and debilitating complication of knee stiffness after anterior cruciate ligament (ACL) reconstruction, a recent study suggests.

The anterior cruciate ligament stabilizes the knee as it flexes and extends. Rupture or tearing of the ACL is a common high-impact sports injury.

Researchers here reviewed the records of 188 patients who had ACL reconstruction surgery between 1987 and 1991. They found that those patients who delayed surgery for three weeks after their injury and who started an aggressive rehabilitation program immediately after surgery were the least likely to develop arthrofibrosis -- a stiffness of the knee caused by accumulation of scar tissue in and around the joint.

"The two most important things for a good result are delaying surgery until the acute inflammatory phase begins to subside and beginning aggressive physical therapy immediately

after surgery, including immediate knee motion," said Andrew J. Cosgarea, assistant professor of orthopedic surgery at Ohio State University and lead author of the study.

Arthrofibrosis is one of the most significant complications of ACL reconstruction surgery and can have devastating effects, Cosgarea said.

"There's some belief that it can lead to premature arthritis," he said. "However, more definite and short-term consequences are a loss of motion, stiffness, knee pain and the inability to run or squat, which can be more disabling than the original injury. Patients with post-operative arthrofibrosis often need prolonged physical therapy; frequently they need surgical intervention."

Cosgarea conducted this research with Wayne J. Sebastianelli, director of athletic medicine and assistant professor of orthopedic surgery at Pennsylvania State University, and Kenneth E. DeHaven, director of sports medicine and professor of orthopedic surgery at the University of Rochester. The group's work was published in a recent issue of The American Journal of Sports Medicine .

For their study, Cosgarea and his colleagues reviewed the medical records of 188 patients who had ACL reconstruction surgery at the University of Rochester Medical Center between 1987 and 1991. They noted each patient's age, gender, time interval between injury and surgery, range of knee motion before surgery, post-operative motion regimen and post-operative pain medication. The researchers then gathered information about each patient's current range-of-motion; patients who demonstrated significant knee motion deficits were asked to come in for a physical examination.

The researchers found no relationship between age, gender and development of arthrofibrosis.

However, they did find that patients who had ACL reconstruction surgery within three weeks of their injuries were significantly more likely to develop arthrofibrosis than those who delayed surgery for a longer interval.

Further, they found that those patients who were allowed no knee motion for a week after surgery had a significantly higher risk of developing arthrofibrosis than those patients allowed knee motion after one or two days. In fact, of those patients allowed motion on the first day after surgery, only 2.7 percent developed arthrofibrosis. Of those immobilized for a week, 23 percent developed the condition.

"Based on our findings, we advise delaying ACL reconstruction surgery until at least three weeks after the injury or until the patient has achieved nearly normal knee motion," Cosgarea said. "Also, our findings suggest that a rehabilitation program consisting of post-operative splinting in full extension with immediate knee motion is the single most important factor in preventing arthrofibrosis."

Cosgarea said these findings highlight the need for both patience and determination among those undergoing ACL reconstruction surgery.

"Many people still don't understand why it's necessary to delay surgery," Cosgarea said. "It's important to be patient. By delaying surgery for a few weeks, you actually facilitate recovery."

"The single most important thing after surgery is to get knee motion back, particularly extension," he added. "It's crucial to work hard at that."

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Contact: Andrew J. Cosgarea, (614) 293-8293

Written by Kelly McConaghy Kershner, (614) 292-8308