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Author Topic: Arthrofibrosis pictures during a scar resection procedure  (Read 3272 times)

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Offline shade

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Arthrofibrosis pictures during a scar resection procedure
« on: July 03, 2006, 01:15:07 AM »

I've never seen pictures of this condition before & seeing the condition helps explain the treatment difficulties.

Here's the article.....

The procedure of arthroscopically removing internal knee joint scar is often long and tedious. Sometimes the joint is packed so thickly with scar tissue that removing it is akin to a slow, meticulous archeological excavation process. The normal internal joint anatomy must be carefully exposed, millimeter by millimeter, as the scar tissue is gradually cut away and removed. All of the internal joint spaces that are normally present should be opened up and restored in this fashion prior to attempting knee manipulation (see FIGURES 1a, 1b, 1c). The lateral retinaculum (capsular envelope ligament just to the outer side of the kneecap) is often especially contracted and tight, and usually must be surgically released (divided) at the same time.

 -1a-Arthroscopic view during an early stage of a scar resection procedure in a patient with severe knee arthrofibrosis. This patient's entire internal joint space was filled up with tough, fibrous scar tissue (the white, fluffy/fibrous material seen in this photo), which is nearly all that can be seen here! An arthroscopic tissue resector instrument has removed some scar already, creating a small, open "working space", which is where the lens of the arthroscope was situated when this picture was taken. The resector is then used to progressively remove more and more scar tissue, gradually enlarging the working space, until an anatomic landmark (such as one of the femoral condyles) is uncovered.

 - 1b-Arthroscopic view of the same patient's knee, but further along in the procedure. In the background you can see that the arthroscopic scar resector (shiny metal object to the left) has uncovered a portion of the smooth, white femoral condylar surface, marked with an "F". Once such a landmark is identified, the surgeon can then more safely and effectively "excavate" the rest of the knee joint's anatomy out from the mass of scar tissue that has engulfed it. The goal is to open up all of the internal joint spaces to normal or near-normal dimensions, fully exposing the normally free and unencumbered intra-articular joint structures. 
 - 1c-Arthroscopic view of the same patient's medial joint compartment at the conclusion of the case. The normal, internal joint space has been restored and the medial femoral condyle has been completely released from its enveloping scar tissue cocoon. Similar work has also been done in other knee compartments, in combination with a retinacular release. At this point, the knee is tested to see what free range of motion it has, and if necessary, joint manipulation and stretching are performed to restore the range of motion to normal. With almost all of the internal scar tissue that was formerly restricting the joint removed, the joint manipulation procedure will require significantly less applied force to regain the same range of motion, thus reducing the chance of an inadvertent femoral or tibial fracture.
July '05 (RK) - LR/debridement
Mar '06 (RK) - Open LR + Allograft w/OBI TruFit Plug + Fulkerson TTT
 Feb '07 (LK) - LR + Fulkerson TTT

Offline Melissa1

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Re: Arthrofibrosis pictures during a scar resection procedure
« Reply #1 on: August 30, 2006, 05:19:57 PM »
How long does it take for "scar tissue" to become significantly present (affecting ROM)?
6/96-4/98  4 dislocations
4/98   unsuccessful microfracture
10/98 Severe Dislocation, torn cartilage
11/98 Debris removal
12/00 Debris/Fluid Removal
5/04 Dislocation, 6 mos PT
5/06 Dislocation
8/06 L knee MPFL reconstruction and arthroscopy, debris removal

Offline hottubpam

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Re: Arthrofibrosis pictures during a scar resection procedure
« Reply #2 on: August 31, 2006, 01:15:41 AM »
Scar tissue can develop and inhibit ROM as soon as a few days/weeks post op or post trauma.  For me it has usually been about 3 weeks post op.

There is an excellent tutorial on this web site by Dr. Noyes regarding arthrofibrosis (scar tissue).  I highly recommend that you read (and re-read) it.  If you do have arthrofibrosis, I can't emphasize enough how important it is that you get timely appropriate treatment by an orthopedic surgeon that has a successful record in dealing with scar tissue.

ACLR, Menisectomy 3/04; ACL resection, Cyclops lesion removal, LOA & MUA 10/04; LOA, LR & AIR 12/29/04;#4&5 surgery on 2/9/05 & 3/2/05 debridement, irrigation & lavage, portal closure; #6  LOA, AIR, LR & other releases 12/9/05; #7 surgery 1/18/06 portal closure, lavage, debrid etc #8 skin graft 3/06