|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.
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.
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