Arthrofibrosis of the knee is a complication of injury or surgery where an excessive scar tissue response leads to painful restriction of knee motion.

normal knee, before onset of arthrofibrosis

Side view of section through a normal knee, where there are no adhesions locking up movement.

sites of arthrofibrosis in the knee

Adhesions developing in the suprapatellar pouch, posterior capsule and anterior interval may create flexion loss, extension loss or both.

Advanced arthrofibrosis of the knee

Matured scar tissue has contracted, closing the important spaces that normally allow movement, and pulling the kneecap right down.


Rehabilitation issues with arthrofibrosis

Early adhesions and later scar tissue form within the joint and soft tissue spaces, and persist despite increasing rehabilitation efforts. Early range of motion problems can be reversed with empathetic management - progressing patellar mobilisation and range of motion exercises in combination with adequate pain relief without pushing the joint into painful inflammation that makes things worse. Manipulation under anaesthesia may help to break adhesions before they become permanent scar tissue. Advanced arthrofibrosis with marked knee stiffness may need surgical lysis of adhesions to regain range of motion, in combination with specialist pain management and physiotherapy.


Arthrofibrosis and patella baja (patella infera)

As the soft tissues behind and below the kneecap (patella) become involved in the scar tissue process, the kneecap may be pulled into an abnormally low position (patella baja) which may result in considerable pain with walking.

Internal scarring

An overview of the common surgical managements for arthrofibrosis, and their effectiveness.

A clinician anonymously discusses their own experiences with arthrofibrosis after a knee injury.

Highlighting forum discussion about arthrofibrosis

An 'interpretation' of a 2011 publishing discussing how important it is to have a flexible approach when dealing with internal scarring after cruciate ligament surgery.

An 'interpretation' of a medical article published in the medical journals in 2011, discussing what it is that triggers soft tissues around a knee replacement to transform into bony tissue.

An 'interpretation' of a 2010 paper which is interesting, although the technique failed to prevent the recurrence of arthrofibrosis.




LOA & MUA round 2


Pathological mechanisms and therapeutic outlooks for arthrofibrosis. Usher KM, Zhu S, Mavropalias G, Carrino JA, Zhao J and Xu J . Bone Research volume 7, Article number: 9 (2019).

Open debridement and soft tissue release as a salvage procedure for the severely arthrofibrotic knee. Millett PJ, Williams RJ 3rd, Wickiewicz TL. Am J Sports Med. 1999 Sep-Oct;27(5):552-61.

The role of capsular distention in the arthroscopic management of arthrofibrosis of the knee: A technical consideration. Millett PJ, Steadman JR. Arthroscopy. 2001 Sep;17(7):E31.

Treatment of Knee Arthrofibrosis and Quadriceps Insufficiency after Patellar Tendon Repair: A Case Report Including Use of the Graston Technique. Black D. Int J Ther Massage Bodywork. 2010; 3(2): 14–21.

See also

list of surgeons with expertise in arthrofibrosis management

List - Who's Who in Arthrofibrosis Surgery?

A list developed by KNEEguru readers of surgeons who have acknowledged surgical experience in dealing with the problems of arthrofibrosis of the knee.

eBook on patella baja in relation to arthrofibrosis

eBook - Arthrofibrosis and patella baja

eBook explaining how the patella can become intimately involved in the arthrofibrosis process.

eBook about mobilising the patella to regain range of motion of the knee

eBook - How to perform Patellar Mobilisations

Practical hands-on illustrated eBook, showing how to perform patellar mobilisation exercises.