Arthrofibrosis (AF) is characterized by abnormal internal scarring within the knee joint as well as in the extra-articular structures.
It is a complication of injury or surgery (even a minor procedure, such a partial meniscectomy) where an exaggerated inflammatory response leads to excessive and abnormal scar tissue formation therefore to painful restriction of knee range of motion (ROM).
This clinical condition then can evolve in muscle atrophy, patellar tendon shortening, and a localized or generalized scarring in and outside the knee joint, therefore involving the whole joint capsule which becomes thickened. The shortened patellar tendon and the scarred fat pad that often gets ‘sticky' pulling the tendon itself towards the center of the knee may results in a patella baya (infera) condition and the combination of the above-named factors tights up the whole joint that becomes stiff with potentially minimal to no patellar mobility in the most severe cases of knee AF. Lack of full extension and patella infera can ultimately lead to cartilage damage.
With this pathology highly specialized rehabilitation is always the first approach and therefore pivotal. Specialized physical therapy for knee AF requires a great deal of expertise and focuses on gentle restoration of ROM, inflammation and swelling management via rehabilitative strategies and the adequate pharmaceutical support, and pain normalization as this aspect is often the result of either a peripheral or central nervous system sensitization.
A team of trained Physical Therapists is mandatory to recognize early onset of knee AF in time and immediately adapt the rehabilitation plan and, when this switch proves not to be enough, to rapidly contact back the orthopaedic surgeon (and the very few experts in dealing with knee AF we cooperate with worldwide) in order to add a pharmaceutical support and sometimes plan a dedicated surgical intervention.
Strengthening is not the focus in case of knee AF. Pushing the knee through aggressive rehabilitation to recover the lacking flexion and/or extension would only aggravate the situation.
Efforts focus upon adequate pain relief while recovering ROM and making adhesions and scarring more pliable and elastic, ultimately leading to their evolution via plastic deformation and (if possible) partial/complete reabsorption without further inflaming the knee. Treating ROM deficits requires a high level of patient compliance and adherence to a specialized program to be followed both in physical therapy and at home, recurring to the utilization of some dedicated device if necessary.
The Sports Rehab team is specialized in the management of this knee potentially devastating pathology and strive to offer patients the best overall care taking care of all the needed aspects.
Part of our team spent long time dealing with this often undiagnosed knee pathology in some of the very best Sports Medicine and Orthopaedic Clinics in the United States, such as the Steadman Clinic (Vail, CO), the Cincinnati SportsMedicine & Orthopaedic Center/Dr. Noyes Knee Clinic (Cincinnati, OH), the Andrews institute (Gulf Breeze, FL), and some others therefore developing an in depth understanding of the mechanisms, causes, complications and approaches.
Multi-disciplinarity is crucial in this complex process, for this reason our team work closely with knee orthopeadic surgeons and some specialists all over the world to manage each knee AF case. When symptoms, stiffness and disability worsen despite the high-quality physical therapy, it becomes time for Physical Therapist to refer back the patient to the physician and discuss together with him and the patient the best options available.
Surgery, in case, has to be performed by a knee surgeon which has developed expertise in dealing with knee AF, since the surgical techniques are very peculiar.
In case surgery is performed to restore ROM of the knee and the patella, release scar tissues, etc. we start our specialized physical therapy regimen from right after the surgical procedure, in bed, with Continue Passive Motion machine, ice and compression, and potentially extension splinting. Rehabilitation has to be done every day, with a strict program, of which target #1 is to regain and maintain ROM while quieting the knee down reaching its homeostasis for the first 6-8 weeks, depending on the cases. Our skilled Physical Therapists will guide you through the process if you're dealing with knee AF.
Informative material on knee AF: