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Author Topic: Does knee arthrofibrosis/adhesive capsulitis ever spontaneously resolve?  (Read 845 times)

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Offline Douglas Firs

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I know that adhesions in the shoulder capsule which produce the condition known as 'Frozen Shoulder' very commonly resolve on their own after 2 or so years, and full ROM is restored to the shoulder.

I know this because I developed Frozen Shoulder a few years ago and it gradually went away after about 24 months. This was 2 years before I had a TPF-V surgery in June 2017, which has left me with a 'frozen knee', which my OS says can only be treated by a posterior capsule release that mimics the capsular releases often performed on Frozen Shoulders.

Has anyone ever heard of adhesive capsular knee stiffness going away after a few years?
« Last Edit: May 26, 2020, 08:41:50 AM by Douglas Firs »
June 2017: TPF V, 7 screws, 1 plate
December 2017: ended PT with +7 extension
May 2020: +7 extension, limping, searching for solution

Offline DogfacedGirl

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Hi Douglas,

Yes, it is common for frozen shoulder to improve around the 18 month mark, however, the literature suggests that some residual stiffness usually remains.

I have heard of one case in which a man developed limited knee ROM following a TKR. After a number of years this improved and his ROM is now OK. I think the key point here is whether the arthrofibrosis is "active" or not. If it's active AF the knee will be inflamed and painful (at least some of the time), and while it is like this ROM is unlikely to improve. However, it seems that if the knee is painless you might get better ROM over years, especially if you do gentle stretches daily (be careful not to tear anything or cause pain).

If you have residual arthrofibrosis (no inflammation or pain) I suggest that you give it time rather than having surgery unless it is a serious problem for daily living. Surgery causes a great deal of inflammation that can give you active AF and can make matters worse.

Kay
1999 Osteoarthritis both knees, chondroplasty
2004 MACI graft L knee
2005 MACI graft both knees
2007 MACI graft R knee
2007 Patella baja
2011 TKR both knees
2011 arthrofibrosis

Offline Douglas Firs

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Hi DFG (I love your screename. btw),

Thanks a lot for your informative response.

Yes, I found that after my Frozen Shoulder 'thawed', I got gradual improvement of ROM over several months,  ultimately regaining almost full ROM after a  year or so (it's currently probably a bit stiffer than before the Frozen Shoulder, but who's to say that's not just age-related general stiffness I would have regardless).

Your comment about Arthrofibrosis is very interesting to me.

It seems that there are different forms of AF: All post-operative scar tissue/adhesion is technically 'arthrofibrosis,' so anyone with residual scar tissue after an operation is technically suffering arthrofibrosis.  But there is a second group of people who have a more severe or 'active' form of AF, where the joint is 'hot' and painful and activity causes inflammation and increased scar tissue formation, etc.

I believe I fall into the first category.  I am stiff and there is a hard block at +7 extension and about 110 flexion, but the knee  is not 'hot' or painful in the way that many AF sufferers describe.  I also have fairly mobile patellar movement.  My knee feels strong and 'ready to go', but I just have this hard BLOCK at extension/flexion end range, like my joint is filled w/ rubber cement, preventing full ROM.

So, I think perhaps I simply have a case of contracture caused by too much scar formation post-surgery, but not an ongoing AF formation problem. 

I agree with you that avoiding surgery is ideal.  I just don't want to walk around for 3 more years (my TPF surgery was in June 2017) on my +7 flexed knee, for fear that I am harming the joint irreversibly.

I think what I should do is begin a DETERMINED course of daily stretching, as you mentioned, and see if  I can detect any increase in extension.  I have not attempted any committed physical therapy since my rehab ended in 2017, because I was told that it was impossible to regain ROM after 6 months post-surgery.

Maybe I can test that idea.  I just need to be extra careful and not push things too hard, and not aggravate my knee, as you mentioned.

Thank you Kay/DFG for your kind response and good advice.
« Last Edit: May 29, 2020, 07:55:11 AM by Douglas Firs »
June 2017: TPF V, 7 screws, 1 plate
December 2017: ended PT with +7 extension
May 2020: +7 extension, limping, searching for solution

Offline DogfacedGirl

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Hi Douglas Firs,

Thanks :) I like your screename too, and wondered if you've read The Overstory?

That's interesting about your frozen shoulder. And yes, arthrofibrosis (fibrosis of a joint) affects people much more than has been credited, although specialists are aware of the scar tissue. Actually, the effect of fibrosis in many forms of disease has been underappreciated and is referred to by different names including heart, kidney, lung and liver disease.

I'm glad to hear that your AF is most likely residual. If you would like to read more about active and residual AF, see this paper at https://www.nature.com/articles/s41413-019-0047-x

Regarding stretching exercises, if you live in the US you can possibly buy or hire an Extensionater (https://www.ermi-motion.com/program/knee/), which helps to straighten the leg. As you said, you need to be careful to to tear anything while doing any type of exercise, or overdo it. Go to the point of discomfit, but not into pain. With stretching its better to do two shorter sessions at the start and end of the day rather than one long session, and morning stretching is possibly more important since the tissues have contracted overnight. It may take a while to notice a gain ROM because your scar tissue will be strongly cross-linked.

All the best with it,

Kay


1999 Osteoarthritis both knees, chondroplasty
2004 MACI graft L knee
2005 MACI graft both knees
2007 MACI graft R knee
2007 Patella baja
2011 TKR both knees
2011 arthrofibrosis

Offline MichaelF

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Interesting topic. Curious is use of device to stretch can work to increase flexion after 6-9 mo with a stiff knee?

Offline DogfacedGirl

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Hi Michael,
There isn't any research about this, but I think that you will at least maintain the ROM you have with a stretching device used carefully and frequently (once or twice a day), and in time it's likely you will slowly increase ROM. The more often you use it, the more benefit there is. There is more explanation about stretching at https://arthrofibrosis.info under "Key Points".
Kay
1999 Osteoarthritis both knees, chondroplasty
2004 MACI graft L knee
2005 MACI graft both knees
2007 MACI graft R knee
2007 Patella baja
2011 TKR both knees
2011 arthrofibrosis















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