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 sites of arthrofibrosis in the knee Advanced arthrofibrosis of the knee
Side view of section through a normal knee, where there are no adhesions locking up movement. Adhesions developing in the suprapatellar pouch, posterior capsule and anterior interval may create flexion loss, extension loss or both. 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.

Synonyms: 
Adhesions
Internal scarring
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An explanation of the need to calm the arthrofibrotic knee when new surgery is indicated.

Dr Peter Millett chats about arthrofibrosis, and why patients with established arthrofibrosis need to seek out a surgeon who is expert in this potentially devastating complication.

An 'interpretation' of a medical publication from 2005 where the authors offer surgeons a list of practical advice about arthrofibrosis of the knee.

An 'interpretation' of a 2004 medical publication evaluating the usefulness of sonography in identifying arthrofibrosis as a cause of knee stiffness after knee replacement.

The editor's interpretation of a 2004 article highlighting the important anatomy associated with arthrofibrosis of the knee.

An 'interpretation' of a 2004 medical publication discussing the possibility of genetic screening to identify those patients likely to develop aggressive arthrofibrosis after cruciate ligament reconstruction.

An 'interpretation' of an article from 2003 detailing the rehabilitation protocol practised in Vail at that time in managing the stiff arthrofibrotic knee.

Pages

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CLINICAL PUBLICATIONS

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

Who's Who in Arthrofibrosis Surgery?


eBook on patella baja in relation to arthrofibrosis

Arthrofibrosis and patella baja - ebook


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

How to perform Patellar Mobilisations - ebook


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Kindle eBook - Authors: Frank Noyes & Sue Barber-Westin

Knee Arthrofibrosis: Everything You Need to Know to Recognize, Treat, and Prevent Loss of Knee Motion After Injury or Surgery

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