Arthrofibrosis - a 12-part course by Frank Noyes, MD

Stiffness of the knee due to scarring in the normally mobile tissues in and around the knee. Dr Noyes is an authority on this subject and his team in Cincinnati are very experienced in arthrofibrosis management.

Part 1 - Arthrofibrosis - Introduction

• Defining Arthrofibrosis
• What makes the knee vulnerable to arthrofibrosis?
• How common is arthrofibrosis?

Part 2 - The knee - range of motion

• What is a normal range of motion?
• ROM required for activities of daily living

Part 3 - Arthrofibrosis - anatomic classification

• The articulating surfaces
• The extensor mechanism
• The infrapatellar fat pad
• Cruciate ligaments, femoral notch and menisci
• Flexion loss and the all-important soft tissue spaces
• Extension loss

Part 4 - What triggers arthrofibrosis?

• Normal healing response after joint injury or surgery
• Abnormal healing response in arthrofibrosis

Part 5 - Early signs and symptoms

• Normal Expectations after Surgery or Injury
• High Index of Suspicion
• Alert Signals
• Objective alerts on serial measurement
• Key Message
• Caveat - Remember that a limitation of ROM may have causes other than arthrofibrosis

Part 6 - Established arthrofibrosis - options for management

• Adhesions inside the joint spaces
• Exuberant fibrosis affecting joint structures and obliteration of synovial pouches
• Scar tissue contraction and consequences outside the joint

Part 7 - Arthroscopic surgery

• Arthroscopic Lysis of Adhesions and Removal of Scar Tissues

Part 8 - Open debridement and soft tissue release

• Open z-plasty, medial-lateral retinacular tissues
• Posterior Medial-Lateral Capsulotomy

Part 9 - Rehabilitation After Operative Procedures for Arthrofibrosis

• In-Patient Physical Therapy Program

Part 10 - Surgery for chronic patella infera

• Treating Early Patella Infera
• Treating Chronic Patella Infera

Part 11 - Preventing arthrofibrosis

• Magnitude of the injury
• Preoperative issues
• Technical factors at surgery
• Postoperative issues: Restore knee motion and quadriceps muscle function
• Mobilize the kneecap immediately following surgery
• Patient compliance with rehabilitation
• Infection
• Intervene early when ROM progress ceases

Part 12 - The tragedy of arthrofibrosis