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.

Synonyms: 
Adhesions
Internal scarring
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An 'interpretation' of a publication from 1999 describing how these surgeons managed knees that were severely locked up with arthrofibrotic scarring.

An 'interpretation' of a 1999 paper that gives a good overview of the subject of arthrofibrotic scarring in the knee.

An 'interpretation' of a 1994 article where the authors described their system of surgical management of arthrofibrotic scarring in the knee.

An 'interpretation' of a 1987 article where surgeons were understanding the role of scarring in entrapping the patella and drawing it into an abnormally low and painful position.

An 'interpretation' of a 1982 article, where the authors described their arthroscopic management of knee adhesions that were causing problems with range of movement.

Pages

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FORUM DISCUSSIONS

LOA & MUA round 2


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

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.