Arthrofibrosis and Joint Pain and Stiffness

Scar Tissue Formation Around a Joint Following Injury or Surgery

knee bend range
Measuring the arc of motion of the knee joint. Jan-Otto / Getty Images

Arthrofibrosis is a condition that leads to scar tissue formation around a joint. This condition often follows a traumatic injury or surgical procedure. It limits the range of motion and can be painful. Often seen after procedures such as ACL reconstruction surgery, arthrofibrosis is due to inflammation and proliferation of scar tissue.

Causes

Arthrofibrosis can develop after an injury to the knee or infection.

Your body makes scar tissue in response to an injury. Often it is seen following knee surgery, including ACL reconstruction surgery and total knee arthroplasty (TKA). Following surgery, it may develop if you are prone to producing excess scar tissue or it may develop because there was an infection or a local problem that didn't allow uncomplicated healing. This can lead to contractures as well as scar tissue.

When arthrofibrosis occurs, dense fibrous tissue forms in abundance. This can bind down the joint and prevent normal range of motion.

Prevention of arthrofibrosis is best accomplished with early motion following surgery. Arthrofibrosis used to be much more common after ACL surgery when doctors used to restrict patients mobility. Now, most surgeons are instructing their patients to move the joint within hours of surgery, and arthrofibrosis is much less common. This accelerated rehab progression has lowered the likelihood of arthrofibrosis.

Signs and Symptoms

The symptoms are a pain, stiffness, and loss of the full range of motion in your knee. You may not be able to straighten your leg. You may also notice swelling, redness, and heat in the joint. You may hear or feel crepitus. You may develop a limp.

Diagnosis

Your doctor will give you a physical examination and discuss your history of injury and surgery.

You will have an MRI and X-ray to diagnose arthrofibrosis and the extent of the problem. Your ability to flex your knee will also be graded.

Treatment

The first treatment for arthrofibrosis is rest, ice, and anti-inflammatory medications to reduce the pain and swelling. Gentle range-of-motion exercises are used to increase flexibility. Physical therapy is started to improve your use of the joint.

If the problem of arthrofibrosis cannot be solved with aggressive therapy, then surgery may be necessary to improve joint movement. The two options are either a manipulation under anesthesia or surgical dissolving or removal of the scar tissue. A manipulation is a non-surgical procedure where your physician forcefully bends the joint while the patient is under anesthesia to break the scar formation.

Surgery to remove scar tissue is more common, and typically this can be performed as an arthroscopic surgery, dissolving the adhesions rather than doing an open debridement. Following surgery, it is important to begin an aggressive physical therapy to regain motion. This is aimed at preventing further formation of scar tissue.

In a review of arthrofibrosis after ACL reconstruction, it was noted that half of the patients were successfully treated without surgery, pointing to the success of nonsurgical methods when used first.

Sources:

Cheuy VA, Foran JR, Paxton RJ, Bade MJ, Zeni JA, Stevens-Lapsley JE. Arthrofibrosis Associated With Total Knee Arthroplasty. The Journal of Arthroplasty. 2017;32(8):2604-2611. doi:10.1016/j.arth.2017.02.005.

Ekhtiari S, Horner NS, Sa DD, et al. Arthrofibrosis after ACL reconstruction is best treated in a step-wise approach with early recognition and intervention: a systematic review. Knee Surgery, Sports Traumatology, Arthroscopy. April 2017. doi:10.1007/s00167-017-4482-1.

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