Arthroscopic Posterior Capsular Release Improves Range of Motion and Outcomes for Flexion Contracture After ACL Reconstruction in Athletes

Purpose The purpose of this study is to assess outcomes of arthroscopic posterior capsular release among athletes for loss of terminal extension following ACL reconstruction. Methods A retrospective review of prospectively collected data was performed for patients undergoing arthroscopic posterior capsular release for knee extension loss following ACL reconstruction between January 2014 and December 2019. Procedure indications included extension loss greater than 10° at least three months after ACL reconstruction that was refractory to physical therapy. Patients were included if they were involved in either high school or college athletics, had complete outcomes of interest, and had at least two years of follow up. Prospectively collected outcomes included preoperative and postoperative measurement of knee extension, international knee documentation committee (IKDC) score, Lysholm score, return to sport data, and complications. Results Eighteen athletes with minimum 2-years of follow up who underwent posterior capsular release following ACL reconstruction performed by a single surgeon were included in the analysis. Patients underwent surgery at an average of 16 weeks after ACL reconstruction. Knee extension improved an average of 13.8° at 2-years follow up (pre-release mean extension deficit 15.1°, post-release mean extension deficit 1.3°, p<0.005). Improvements in the IKDC score averaged 21.7 at 6 months and 35.0 at 24 months, both of which were statistically significant (p<0.001). Similarly, differences in Lysholm included a significant improvement of 23.0 and 34.2 at 6 months and 2 years, respectively (p<0.001). In total, 77.8% returned to sport at an average of 9.8 months from their primary ACL surgery, and 6.5 months following posterior capsular release surgery. No infections or neurovascular complications were observed. One patient required secondary release to achieve adequate extension. Conclusion For athletes with persistent knee extension loss after ACL reconstruction, knee extension was significantly improved at 2 years following arthroscopic posterior capsular release. Substantial improvements in patient-reported outcomes were also seen. In addition, subjects demonstrated a high rate of return to sport and return to pre-injury performance levels.