Arthrofibrosis (from Greek: arthro- joint, fibr- fibrous and -osis abnormality) is an inflammatory condition that leads to the production of an excessive scar tissue in or around major joints. Arthrofibrosis can be caused by the initial injury to the joint or from surgical complications. Infections and bleeding into the joint are believed to be major causes or contributing factors involved in the disease. Arthrofibrosis is one of the major complications of ACL surgery and is one of the most difficult to treat. Whatever the cause, the excess scar tissue limits range of motion (“ROM”) and functionality. The condition can be quite painful and debilitating. The treatment of Arthrofibrosis requires very specialized care and only a handful of orthopedic surgeons in the world have a significant amount of experience treating this condition.
There is disagreement about the likelihood of developing Arthrofibrosis. There is evidence that the severity of a joint injury, the extensiveness of related surgery, the length of time the joint is immobilized, and infections increase the risk of Arthrofibrosis. However, not everyone who sustains a major joint injury or who undergoes major surgery will develop the condition. A number of studies indicate that some people are genetically predisposed to develop Arthrofibrosis. Some studies also indicate that the timing of surgery, the condition and ROM of the joint and the post-op protocol also impact the likelihood of developing Arthrofibrosis.
Symptoms include joint stiffness, pain, redness, heat, swelling, crepitus, and lack of ROM. Clinical diagnosis may include the use of magnetic resonance imaging (“MRI”) to visualize the joint compartments affected.
Most orthopedic surgeons agree the best treatment for Arthrofibrosis is prevention. There is evidence that delaying surgery until the joint has regained full ROM and until there is no swelling in the joint helps prevent Arthrofibrosis. Moving the joint as quickly as possible following surgery also helps prevent scar tissue from building up. Given that there is a genetic predisposition to the disease and infections are a primary cause of Arthrofibrosis, it is not possible to prevent all cases.
In general, Arthrofibrosis is first conservatively treated with physical therapy, ice, elevation, anti-inflammatory and gentle exercise designed to increase ROM. If conservative treatment fails, an arthroscopic surgical procedure called Lysis of Adhesions (“LOA”) is indicated. During an LOA, the surgeon removes the scar tissue in and around the joint. After an LOA, a very specific and time consuming physical therapy protocol must be followed to minimize scar tissue formation after the surgery.
Manipulation Under Anesthesia is a surgical procedure used to break up scar tissue. The patient is placed under anesthesia while the surgeon forces the knee to bend and straighten. MUA is not a recommended procedure for Arthrofibrosis.
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