Ed: Dr Noyes has made the first 19 pages free to download here.


Knee arthrofibrosis

The first chapter of this eBook is free. It has some useful illustrations.

When a person first experiences a knee problem, it may be difficult to work out what is wrong or whether or not the symptoms are serious enough to warrant an appointment with the doctor.

Knee arthrofibrosis is a complication in which an excessive amount of scar tissue forms that limits the knee's normal amount of flexion (how far the knee bends) and extension (how far the knee straightens). This problem occurs when the body's normal healing process after an injury or operation is greatly exaggerated and an excessive amount of scar tissue is produced. If untreated, arthrofibrosis eventually causes permanent dysfunction of the limb and severe arthritis.

There are many conditions or factors that may cause arthrofibrosis. These include a serious injury to the knee (fracture or dislocation), an infection, an operation that has been done incorrectly, poor or non-existent physical therapy, and so on. Arthrofibrosis triggered by these conditions or problems is referred to as secondary arthrofibrosis because the scarring is a local problem that occurred from a specific cause and is not part of a generalized healing disorder. The vast majority of patients treated for arthrofibrosis are in this category. However, in rare cases, arthrofibrosis occurs without an inciting event in patients who have a general problem with scar tissue biology, and who tend to normally produce excessive scar tissue in response to any injury or surgery anywhere in the body. This problem is referred to as primary arthrofibrosis.

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Prevent this disaster

Permanent arthrofibrosis is a disaster because patients suffering from this complication never have a knee that resembles normal. Trying to deal with arthrofibrosis is extremely time-consuming and affects all portions of a patient’s life. The loss of the ability to participate even in low impact activities brings on depression and tremendous anxiety. Fortunately, knee arthrofibrosis can be prevented 80-90% of the time because the majority of cases are secondary in nature. This complication is certainly easier to prevent than it is to treat, especially when it becomes a chronic condition. The early detection of excessive scarring leads to successful resolution in most (but not all) patients, provided the treatment is done correctly and the patient complies with the rehabilitation program.