Arthroscopic Lysis of Adhesions for Arthrofibrosis After Anterior Cruciate Ligament Reconstruction.

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Abstract

[Indexed for MEDLINE] 11. Am J Sports Med. 2025 Aug;53(10):2370-2378. doi: 10.1177/03635465251352180. Epub 2025 Jul 7. Patient and Operative Risk Factors for Subsequent Knee Arthroplasty After Primary Anterior Cruciate Ligament Reconstruction: A Cohort Study of 52,222 Patients. Ding DY(1), Prentice HA(2), Reyes C(2), Paxton EW(2), Chen F(3), Maletis GB(4). Author information: (1)Department of Orthopedic Surgery, The Permanente Medical Group, San Francisco, California, USA. (2)Medical Device Surveillance & Assessment, Southern California Permanente Medical Group, San Diego, California, USA. (3)Department of Orthopedic Surgery, Washington Permanente Medical Group, Seattle, Washington, USA. (4)Department of Orthopedic Surgery, Southern California Permanente Medical Group, Baldwin Park, California, USA. BACKGROUND: Knee arthroplasty in patients who have undergone anterior cruciate ligament reconstruction (ACLR) has been associated with a high risk of infection, arthrofibrosis, and longer operative time due in part to difficulty with exposure and retained hardware. Patients who undergo ACLR are at a higher risk of undergoing knee arthroplasty and are at risk earlier than the general population. As patients with ACLR age and as ACLR surgery becomes more prevalent in the older athlete, the rates of knee arthroplasty after ACLR will only increase. PURPOSE: To determine the incidence of knee arthroplasty after ACLR, as well as identify patient and operative risk factors for knee arthroplasty after ACLR. STUDY DESIGN: Cohort study; Level of evidence 3. METHODS: Data from Kaiser Permanente's ACLR Registry and Total Joint Replacement Registry were used to conduct a cohort study. Patients with primary ACLR were identified (2005-2022). Patient factors considered included age, body mass index (BMI), sex, race/ethnicity, smoking status, American Society of Anesthesiologists classification, activity at the time of injury, and medical comorbidities. Time from injury to ACLR, concomitant meniscal or chondral injuries, multiligament injury, graft type, and drilling technique were procedure factors evaluated. Postoperative factors included revision surgery, ipsilateral reoperation, and contralateral operation during follow-up. The outcome of interest was a subsequent knee arthroplasty. Patients were followed until the outcome of interest unless censored for membership disenrollment, death, or study end date (December 31, 2022). Multivariable Cox proportional hazards regression was used to determine factors associated with knee arthroplasty after ACLR using a P value