Arthrofibrosis Following ACLR in Pediatric and Adolescent Patients: A Delphi Consensus Study
Year: 2026
Type: article
Abstract: Background Arthrofibrosis of the knee is a challenging postoperative complication with variable definitions and management strategies. Purpose To establish expert consensus on the definition, prevention, treatment, postoperative management, and outcomes of knee arthrofibrosis following Anterior Cruciate Ligament reconstruction (ACLR) in pediatric and adolescent patients using a Delphi process. Study Design Delphi consensus study; Level of evidence, 5. Methods Twenty-six high-volume pediatric ACL surgeons participated in three rounds of a Delphi survey. Statements were evaluated for consensus on definition, diagnosis, prevention, treatment, postoperative management, and outcomes. Results Consensus was achieved on a standardized definition of arthrofibrosis (extension loss ≥10°, flexion loss ≥25° relative to preinjury baseline or the contralateral knee, with persistent motion loss >3 months having potentially negative effect on clinical outcomes or function). Preoperative prevention included achieving near-full knee ROM prior to ACL reconstruction. Routine in-office manipulation was discouraged. MUA ± LOA was recommended for persistent motion deficits ≥12 weeks. Multimodal pain management and early PT (1–2 days) were endorsed postoperatively. Predictors of outcomes lacked consensus. Conclusion This Delphi consensus provides a clinical definition and structured guidance for managing knee arthrofibrosis, while highlighting areas for future research. Key Concepts 1. Establish definition of arthrofibrosis 2. Analyze postoperative stiffness management following ACLR for pediatric patients 3. Achieve consensus on and identify areas of controversy regarding management of postoperative arthrofibrosis in pediatric patients
Authors: Emily L. Niu, Graham Andre, Keinan Agonias, Aristides Cruz, Molly Meadows, Henry B. Ellis, John Arvesen, Soroush Baghdadi, Jennifer Beck, Jennifer Brey, Matthew J. Brown, Charles Chan, Christian Clark, Eric E. Edmonds, Matthew Ellington, Peter D. Fabricant, Craig J. Finlayson, Jeremy Frank, Daniel Green, J. Todd R. Lawrence, Alfred Mansour, Scott McKay, Matthew D. Milewski, Donna Pacicca, Shital N. Parikh, Neeraj Patel, Brian Piazza, Gregory A. Schmale, Matthew R. Schmitz, Stephen Storer, Jeffrey Vaughn, Drew Warnick, Philip L. Wilson
Institution: Children's National
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,500
OpenAlex ID: W7224960345