Arthrofibrosis Nightmares: Prevention and Management Strategies

Abstract

Arthrofibrosis (AF) is an exaggerated immune response to a proinflammatory insult leading to pathologic periarticular fibrosis and symptomatic joint stiffness. The knee, elbow, and shoulder are particularly susceptible to AF, often in the setting of trauma, surgery, or adhesive capsulitis. Prevention through early physiotherapeutic interventions and anti-inflammatory medications remain fundamental to avoiding motion loss. Reliable nonoperative modalities exist and outcomes are improved when etiology, joint involved, and level of dysfunction are considered in the clinical decision making process. Surgical procedures should be reserved for cases recalcitrant to nonoperative measures. The purpose of this review is to provide an overview of the current understanding of AF pathophysiology, identify common risk factors, describe prevention strategies, and outline both nonoperative and surgical treatment options. This manuscript will focus specifically on sterile AF of the knee, elbow, and shoulder.

Arthroscopic Posterior Capsular Release Effectively Reduces Pain and Restores Terminal Knee Extension in Cases of Recalcitrant Flexion Contracture

“…Unfortunately, 0.5-11% of patients fail to achieve satisfactory return of range of motion (ROM) despite appropriate nonoperative treatments, including physical therapy for range of motion, quadriceps training, and extension orthosis bracing. 1 , 2 , 3 , 4 , 5 , 6 Modifiable risk factors include surgical technique, preoperative ROM, concomitant or multiple procedures, pain management, and BMI, 7 though even with a prevention-first approach, those who go on to experience a persistent extension deficit remain difficult to treat.…”

Artrofibrosis de rodilla en cirugía ortopédica pediátrica

“…19 Transforming growth factor beta (TGF-β) is pivotal in arthrofibrosis pathophysiology, regulating immune responses and wound healing. 20 It stimulates myofibroblast proliferation, increases disorganized extracellular matrix production, inhibits myofibroblast apoptosis, and impedes collagen degradation. 19 Other factors also play a role, including TNF-α, platelet-derived growth factor, and IL-1,6,17.…”

“…21 Early intervention targeting these genetic variants could enhance patient outcomes. 20 A better understanding of the pathophysiology of arthrofibrosis, along with the discovery of genetic involvement, promises to refine management strategies, especially in pediatric cases where heightened awareness and tailored management techniques are paramount.…”

Knee extension contracture with fixed anterior tibia subluxation treated with PCL release and quadricepsplasty: a case report

“…In most cases, extensive arthroscopic arthrolysis of intra-articular adhesions, accompanied with manipulation under anesthesia (MUA), is sufficient to restore knee flexion. However, in cases of greater extension contracture, procedures involving tendon or ligament may be necessary [ 1 , 2 ]. What is more, the role of fixed tibial subluxation with incorrect joint congruence and subsequent “hinge-like” knee movement has not been well-described in literature to authors’ knowledge [ 3 ].…”