Aspiration of the Knee Prior to Anterior Cruciate Ligament Reconstruction Delays the Onset of Arthrofibrosis

Introduction: Aspiration of a posttraumatic hemarthrosis has been postulated to improve pain and reduce the burden of proinflammatory cytokines and chemokines that accumulate in the aftermath of an acute anterior cruciate ligament injury. However, the clinical implications of routine aspiration have not been fully investigated. The purpose of this study was to determine the effect of routine preoperative aspiration on (1) the development of arthrofibrosis and (2) overall revision surgery rate following ACL reconstruction (ACLr). Methods: The population of interest for this study was individuals with an isolated (ie, without notable concurrent ligamentous or chondral injury) ACL rupture indicated for ACLr, with or without concurrent meniscal pathology. Patients were randomized to either routine preoperative care or in-office aspiration of their traumatic effusion upon initial presentation. Patients underwent routine diagnostic arthroscopy at the time of ACLr to evaluate for concurrent chondral or meniscal pathology. Patients underwent standard postoperative rehabilitation and follow-up care. Results: Eighty-seven patients were enrolled in this study, with 46 patients (53%) undergoing preoperative aspiration. At a mean follow-up of 2.54 ± 1.34 years, 14 of 87 patients (16%) underwent revision surgery for any reason and 10 patients (11.5%) underwent débridement of arthrofibrosis. Preoperative aspiration was not markedly associated with a decreased rate of revision surgery or arthrofibrosis. However, aspiration was markedly associated with a longer time to débridement for arthrofibrosis (125 vs. 457 days; P = 0.0029). Conclusion: Preoperative aspiration does not modify rates of subsequent surgery following ACLr. Arthrofibrosis developed markedly later in patients who were aspirated preoperatively, possibly as a result of decreased intra-articular inflammation.