What is Arthrofibrosis?
This is a medical complication in which you have an excessive amount of scar tissue that forms in your knee. It limits how far your knee bends and straightens. How severe arthrofibrosis can be differs and can include anything from a small amount of scar tissue to severe scarring that can result in stiffness and chronic pain. Breaking down the word, arthro means joint and fibrosis means formation of scar tissue. Developing arthrofibrosis is very low with approximately one percent of all cases developing this medical complication.
Types of arthrofibrosis of the knee
- Primary arthrofibrosis – this type occurs without an inciting event in people who tend to normally produce excessive scar tissue in response to surgery or injury anywhere in their body or have a general problem with scar tissue biology. These are rare cases.
- Secondary arthrofibrosis – the scarring a local problem that was the result of a specific cause such as an infection and not a part of a generalized healing condition. Most people who have arthrofibrosis fall under this type.
- Limited ability to straighten your leg
- Loss of motion in your knee, which is one of the more prominent symptoms.
Arthrofibrosis is because of the contractures and/or scar tissue that have developed within your knee joint. Contractures are the chronic loss of joint motion because of structural changes in your non-bony tissue such as your muscles, tendons, and ligaments. When you have scar tissue inside your joint from a previous injury or surgery it can cause tightening and shrinkage of your knee joint’s capsule. It can also be a complication after having knee surgery and is not entirely preventable, requiring careful evaluation and treatment. It can also be the result of osteoarthritis over time and degenerative arthritis
Some of the other factors that could cause secondary arthrofibrosis can include:
- Serious injury to your knee such as a dislocation or fracture
- Incorrectly done operation
- Non-existent or poor physical therapy
The diagnosis will start with a thorough examination of your knee along with your complete medical history so the physician can see if there are any previous surgeries and/or injuries that might explain what is occurring with your knee. The physician will also have to have a MRI and x-ray taken in order to determine what caused your medical condition and the severity.
There are two types of motion that are use to assess knee arthrofibrosis, which are:
- Flexion contracture – this is the ability to straighten your knee out and if the contractures is more than seven or eight degrees when compared to the opposite normal knee have been shown to limit your function, cause secondary issues, lead to early arthritis.
- Inabilities to flex your knee – in order to function with the daily activities of living you need approximately one hundred ten to one hundred fifteen degrees of flexion.
The first course of treatment would be to try nonoperative measures that include rest, anti-inflammatory medications, physical therapy, and ice. If it is a severe case then you may need to have orthopedic knee surgery. It is very important that you treat this medical complication because if not treated it can cause severe arthritis and a permanent dysfunction of your limb.
Surgery and postoperative care
One surgical method that is used is called the arthroscopic method. With this method, once the surgeon is in your knee, they will use a small camera to gain complete visualization of the scar tissue including where it is located and how severe the scar tissue is. During this procedure the surgeon will release any scar tissue that has built up.
After you have had this type of surgery you will have a rehabilitation program designed by your physician and will include stretching and strengthening your knee to regain full range of motion. This type of therapy will be progressive and can take several weeks. Using progressive therapy will help to make sure that relapse does not occur. It is crucial to a successful recovery that you do physical therapy. With the physical therapy after surgery it is usually the first day with two sessions of two hours each for one to two weeks and then daily until the knee is better. After two to three weeks you should be able to regain normal extension and flexion of your knee or at least demonstrate a normal progression of motion.
The best way to help prevent arthrofibrosis after surgery or an injury to start to move your knee as soon as possible to prevent scar tissue from building up. If your physician wants you to start physical therapy you need to do it as soon as possible.