Lysis of adhesions is the surgical procedure of breaking down the strands of material which can form inside the joint if the knee is inflamed; these strands are called 'adhesions'.

common sites for adhesions in the knee When adhesions form, they tie down certain common areas - the suprapatellar pouch above the kneecap, the anterior interval below the fat pad in the region of the patellar tendon, and the capsular folds at the back of the knee.


Natural history of adhesions

Adhesions are initially just sticky strands, and can fairly easily be broken with stretches and mobilisation massages around the patella. If they become more intractable, it may be possible to break them with a manipulation under anaesthesia (MUA). If the knee continues to be inflamed and the adhesions are not broken, they may become more fibrous and turn into scar tissue that can contract and pull the soft tissue areas together too firmly to be broken with manipulations. At this stage they might yet be amenable to 'lysis of adhesions', where surgical methods are employed to break down the scar tissue.

Q&A-style article all about arthrofibrosis.

Patellar mobilisations

Simple but very important to prevent stiff knee after surgery.


A very popular and comprehensive coverage of the topic of arthrofibrosis (internal scarring in the knee joint) from Dr Frank Noyes of the Cincinnati Sportsmedicine and Orthopaedic Center.

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



Arthroscopic Lysis of Adhesions for Treatment of Post-traumatic Arthrofibrosis of the Knee Joint. Stiefel EC and McIntyre L. Arthrosc Tech. 2017 Aug; 6(4): e939–e944.

See also -


eBook on patella baja or infera

eBook - Arthrofibrosis and patella baja

Easy-to-read eBook explaining how the scarring of arthrofibrosis results in the patella being pulling into a lower painful position.