Association of the Graft Size and Arthrofibrosis in Young Patients After Primary Anterior Cruciate Ligament Reconstruction

Introduction: This study investigated the association of graft-related surgical factors and patient characteristics with the odds of arthrofibrosis after primary anterior cruciate ligament reconstruction (ACL-R). Methods: A retrospective case-control study assessed consecutive patients who underwent primary ACL-R in one tertiary pediatric hospital. Each arthrofibrosis case was matched to three controls for sex, calendar year, and age at the time of ACL-R, as well as the primary surgeon. Conditional multivariable logistic regression assessed the independent association of graft diameter, time from injury to ACL-R, concomitant knee pathologies, and body mass index. Results: Twenty arthrofibrosis cases of 1,121 ACL-R patients (incidence 1.8%) were matched to 60 controls resulting in the mean age of 14.5 years. An increase of 1 mm graft diameter was associated with 3.2-times increased odds of arthrofibrosis. Other variables were not independently associated with arthrofibrosis. Conclusion: For young patients, the decision on the graft size must consider the possibility of arthrofibrosis with a larger graft versus reinjury with a smaller graft.