Arthrofibrosis
Arthrofibrosis (from Greek: arthro- joint, fibrosis - scar tissue formation) has been described in most joints like knee, hip, ankle, foot joints, shoulder, elbow, wrist, hand joints as well as spinal vertebrae.[1][2] In the knee, it can happen after knee injury or surgery. There is excessive scar tissue formation within the joint and surrounding soft tissues leading to painful restriction of joint motion that persists despite physical therapy and rehabilitation. The scar tissue can involve only a part of the knee joint or the whole knee. The scar tissue may be located inside the knee joint or may involve the soft tissue structures around the knee joint. Arthrofibrosis may arise without an obvious cause or it may follow a known cause.
Arthrofibrosis of the knee (Frozen Knee)
Arthrofibrosis of the knee, also called as "Frozen Knee", has been one of the more studied joints as a result of its frequency of occurrence.[3][4] Arthrofibrosis can follow knee injury and knee surgeries like arthroscopic knee surgery or knee replacement. Scar tissues can cause structures of the knee to become contracted, restricting normal motion. Depending on the site of scarring, knee cap mobility and/or joint range of motion (i.e. flexion, extension, or both) may be affected.[5] Symptoms experienced as a result of arthrofibrosis of the knee include stiffness, pain, limping, heat, swelling, crepitus, and/or weakness.[4] Clinical diagnosis may also include the use of magnetic resonance imaging (or MRI) to visualize the knee compartments affected.[6] The consequent pain may lead to the cascade of quadriceps weakness, patellar tendon shortening and scarring in the tissues around the knee cap—with an end stage of permanent patella infera—where the knee cap is pulled down into an abnormal position where it becomes vulnerable to joint surface damage.[7]
Arthrofibrosis after knee injury, knee arthroscopy or other surgeries
The first step in treating arthrofibrosis is appropriately directed physical therapy. If physical therapy fails, manipulation under anaesthesia (MUA) can be considered. If MUA fails, the next step would be Arthroscopic lysis of adhesions. If Arthroscopic lysis fails, open lysis of adhesions may be helpful.
Arthrofibrosis after knee replacement
Arthrofibrosis can occur after total knee replacement or even partial knee replacement. There is stiffness in the knee involving both the knee extension and knee flexion. The characteristic symptoms are pain, flexion contracture and decreased range of flexion resulting in decreased range of motion and decreased arc of motion. Before making a final diagnosis of arthrofibrosis, other causes of stiffness following knee replacement should be excluded. For arthrofibrosis following knee replacement, though the timing of different treatments is controversial, physical therapy is considered within 6 weeks of knee replacement, manipulation under anaesthesia (MUA) is considered within 3 months of knee replacement, arthroscopic lysis of adhesions is considered between 3 and 6 months of knee replacement, and open lysis of adhesions is considered between 6 and 12 months of knee replacement. If physical therapy, MUA, arthroscopic and open lysis of adhesions fail, a revision knee replacement can be considered after one year.
References
- Maloney MD, Sauser DD, Hanson EC, Wood VE, Thiel AE (April 1988). "Adhesive capsulitis of the wrist: arthrographic diagnosis". Radiology. 167 (1): 187–90. doi:10.1148/radiology.167.1.3347720. PMID 3347720.
- Millett PJ, Williams RJ, Wickiewicz TL (1999). "Open debridement and soft tissue release as a salvage procedure for the severely arthrofibrotic knee". The American Journal of Sports Medicine. 27 (5): 552–61. doi:10.1177/03635465990270050201. PMID 10496569.
- Paulos LE, Wnorowski DC, Greenwald AE (1994). "Infrapatellar contracture syndrome. Diagnosis, treatment, and long-term followup". The American Journal of Sports Medicine. 22 (4): 440–9. doi:10.1177/036354659402200402. PMID 7943507.
- Fisher SE, Shelbourne KD (1993). "Arthroscopic treatment of symptomatic extension block complicating anterior cruciate ligament reconstruction". The American Journal of Sports Medicine. 21 (4): 558–64. doi:10.1177/036354659302100413. PMID 8368417.
- Kim DH, Gill TJ, Millett PJ (July 2004). "Arthroscopic treatment of the arthrofibrotic knee". Arthroscopy. 20 Suppl 2: 187–94. doi:10.1016/j.arthro.2004.04.036. PMID 15243457.
- Steadman JR, Dragoo JL, Hines SL, Briggs KK (September 2008). "Arthroscopic release for symptomatic scarring of the anterior interval of the knee". The American Journal of Sports Medicine. 36 (9): 1763–9. doi:10.1177/0363546508320480. PMID 18753680.
- Cosgarea AJ, DeHaven KE, Lovelock JE. "The surgical treatment of arthrofibrosis of the knee". The American Journal of Sports Medicine. 22 (2): 184–91. doi:10.1177/036354659402200206. PMID 8198185.