One reason for lack of extension post-operatively can be the development of
a cyclops lesion on the graft which in essence blocks the movement
intra-articularly. Many surgoens perform a notchplasty when doing an ACLR
anyway and the rehab is the same. If it feels like there is a mechanical
block to the movement an early arthroscopic assessment is useful inorder
for rehab to continue. As my colleagues suggested prevention of extension
deformities is probably more important than regaining flexion - this comes
with time anyway. We occassionally - shock horror! - still use braces
locked in extension for a couple of weeks, althoough this is now the
exception rather than the norm and just start early closed chain rehab. CPM
is never really required.
Alison Dakin
Leicester General, England
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