What is arthrofibrosis?
Arthro” means joint and “fibrosis” means the formation of scar tissue. Therefore, arthrofibrosis is an abnormal or excessive growth of scar tissue.
Cause of Arthrofibrosis
- Arthrofibrosis most commonly occurs in the knee after ACL reconstruction when the patient does not achieve normal hyperextension immediately after surgery.
- It can also occur when the ACL graft is not placed properly to allow the graft to fit perfectly in the intercondylar notch where it belongs, or when the graft is too large to fit in the intercondylar notch.
- Arthrofibrosis can also occur after other knee surgeries as well (knee replacement, arthroscopy).
- Knees that develop arthrofibrosis and a loss of range of motion, will never feel normal to the patient.
What are the symptoms?
Symptoms of arthrofibrosis include:
- Loss or knee range of motion with a mechanical block to full knee extension that is usually painful and cannot be resolved with proper rehabilitation.
- Decreased knee flexion can also occur in combination with loss of knee extension.
- Walking with a bent knee gait since the knee will not fully extend.
- Weak quadriceps, the large muscle at the front of the thigh that helps you extend your leg.
How is it treated?
Appropriately directed rehabilitation (both before and after a surgery) can prevent the occurrence of arthrofibrosis. However, when scar tissue builds up in the joint, it can be difficult to treat without surgery.
Physical Therapy for Arthrofibrosis of The Knee
- The non-operative treatment of arthrofibrosis focuses on rehabilitation to regain range of motion.
- An Elite Seat, Flexion Seat, or Ideal Stretch device may be prescribed for daily treatments at home to regain your full range of motion.
- The approach to treatment is to maximize knee extension before introducing exercises to increase knee flexion.
- Milder forms of arthrofibrosis can successfully be treated with rehabilitation only.
- Physical therapy often decreases pain and improves function enough that surgery isn’t necessary.
- If surgery is necessary, the physical therapy helps ensure a better result and a faster recovery.
Surgery for Arthrofibrosis of The Knee
- If range of motion is not regained through non-operative treatment methods, surgery may be needed to remove the mechanical block.
- The scar tissue can be removed during a minimally-invasive knee arthroscopy. Arthroscopy lets orthopedic surgeons see inside the knee without making a large cut (incision) in the knee. The surgeon operates through a few small incisions—each about the size of a buttonhole.
- A tiny camera inserted through one incision shows the inside of the knee on a high-definition video monitor. The orthopedic surgeon looks at the inside of the knee and does the procedure using tiny instruments inserted into the other incisions.
Physical Therapy After Surgery
After surgery, you’ll do physical therapy. This will help you:
- Control swelling.
- Maintain full straightening of your knee (extension) that was obtained during surgery.
- Regain full bending of your knee (flexion).
- Return to full knee strength.
You’ll do most of your exercises at home, but you’ll come back to the office for some physical therapy visits. You’ll continue to work with your personal physical therapist or athletic trainer.
Outcomes After Treatment for Arthrofibrosis
We have successfully treated over 180 patients who had varying degrees of arthrofibrosis. Patients had improvements in both knee extension and flexion that resulted in improved function and reduced symptoms. You can find a list of our published articles about arthrofibrosis here.