2005 - Arthrofibrosis: Evaluation, Prevention, and Treatment.

[no-lexicon]Creighton RA and Bach BR. [/no-lexicon]Arthrofibrosis: [no-lexicon]Evaluation, Prevention, and Treatment.Techniques in Knee Surgery. 2005;4:163-172.

This is the editor's interpretation of the above paper published in the orthopaedic literature in 2005 - our attempt to make relevant medical articles accessible to lay readers. If you want to read the original it is easy to ask your librarian to obtain a reprint for you from any medical library [or click here for open access]. [/no-lexicon]

These authors briefly review much of the established literature and go into detail of management from a surgeon perspective, outlining their own surgical practice and their own recommendations in some detail. The paper touches on the essentials of rehabilitation. They agree with others before them that the best treatment of arthrofibrosis is prevention, and they state categorically that "before any surgical procedure is performed around the knee, the patient should be educated about this potential complication".

Recommendations for cruciate surgery

The authors tabulate a useful list of dos and don'ts for cruciate procedures - from the surgeon's perspective - which we paraphrase here -

1. Avoid operating in the early days when the knee is still inflamed 
2. Before surgery is undertaken, get the patient to try and regain full range of motion (ROM) 
3. Before surgery is undertaken, get the patient to try and rebuild quads strength 
4. Check that any loss of extension is not due to a torn meniscus 
5. If there is pain behind the patellar tendon when the knee is forced into extension, consider that this may be due to a 'cyclops lesion' 
6. If rehab is slow, make sure that there is not a concomitant torn medial collateral lligament (MCL) 
7. Ensure that any graft is properly placed, as poor placement can prevent return to full ROM and can also stress the graft and make it break 
8. Ensure that the knee is fully extended when the graft is tensioned and fixed in place 
9. If patient initially sees the surgeon because the knee is locked by a torn meniscus, and at the same time a torn cruciate ligament is found, the surgeon should deal with the meniscus and come back at a later date to deal separately with the ligament 
10. If the surgeon puts a stitch to try and heal a meniscus tear, then again the knee must be fully extended when the stitch is tightened 
11. After surgery they recommend that the knee is braced in full extension with a 'drop lock' brace 
12. Night splints should be considered after surgery to keep the knee extended 
13. By 10 days after a cruciate reconstruction the patient should be able to fully extend the knee. If he/she cannot, then this needs attention 
14. If ROM is not progressing as it should be 10-14 days postop then the surgeon should see the patient weekly 
15. If at 6 weeks there is still a problem then consider a 'Medrol Dose Pack', ie methylprednisolone (a steroid course) 
16. Any effusion (tense fluid in the joint) in the first few days after surgery should be syringed out 
17. If ROM fails to improve then consider surgery to deal with the scarring 
18. Always get a set of X-rays before such surgery 
19. EDUCATE THE PATIENT PREOP AND POSTOP [our capitals] 
20. If there is a lot of pain, ensure that this is not due to infection or complex regional pain syndrome (aka CRPS or RSD)