Knee arthrofibrosis is a painful and disabling condition that results from excessive scar tissue formation around the knee joint. It commonly occurs after knee surgery or trauma and leads to limited range of motion (ROM), stiffness, and persistent pain. If left untreated, arthrofibrosis can result in long-term loss of joint function.
This in-depth guide covers everything you need to know about knee arthrofibrosis, including its causes, symptoms, diagnosis, treatment options, and prevention strategies.
What is Knee Arthrofibrosis?
Arthrofibrosis of the knee is a condition where scar tissue (fibrosis) builds up inside and around the joint, causing abnormal stiffness and reducing joint mobility. It is often referred to as “frozen knee” and typically follows knee surgeries such as:
Total knee replacement (TKR)
Anterior cruciate ligament (ACL) reconstruction
Meniscus repair
Fracture surgeries
Scar tissue restricts the movement of ligaments, tendons, and joint capsules, resulting in severe knee stiffness and limited flexibility.
Phases of Knee Arthrofibrosis
Knee arthrofibrosis usually develops in two distinct phases:
1. Active Inflammatory Phase
This phase is driven by:
Ongoing inflammation
Excess extracellular matrix (ECM) formation
Overactive myofibroblasts and immune cells
This results in a cycle of inflammation and scar tissue buildup, causing pain, swelling, and joint stiffness.
2. Residual Fibrotic Phase
After inflammation subsides, the knee remains stiff due to:
Mature scar tissue
Reduced ROM
No active inflammation, but permanent fibrosis
Although pain may decrease, the joint’s flexibility is still severely impaired, impacting daily activities like walking, squatting, or climbing stairs.
Common Causes of Knee Arthrofibrosis
Understanding the causes and risk factors helps in early prevention and management. The most common causes include:
● Post-Surgical Complications
Knee arthroplasty
Improper rehabilitation after surgery
● Knee Injuries
Fractures
Dislocations
Ligament tears
● Prolonged Immobilization
Use of braces or splints for extended periods
Inadequate post-operative movement
● Poor Physical Therapy Compliance
Skipping or delaying rehab
Limited guided knee exercises
● Inflammatory Response
Excess production of cytokines and growth factors
Autoimmune triggers
Signs and Symptoms of Arthrofibrosis in the Knee
Recognizing early symptoms of knee arthrofibrosis can lead to timely intervention and better outcomes.
Top Symptoms Include:
Chronic knee stiffness
Painful knee movement
Reduced knee ROM
Swelling and warmth
Inability to fully bend or straighten the knee
A feeling of tightness or “binding”
If you notice these symptoms weeks after knee surgery or injury, consult a specialist immediately to prevent progression.
Diagnosis: How is Knee Arthrofibrosis Identified?
Early and accurate diagnosis of arthrofibrosis is essential to avoid permanent joint damage. Diagnostic methods include:
● Physical Examination
Measuring joint ROM
Palpation to detect stiffness or tightness
Assessment of gait and balance
● Imaging Tests
X-rays: To rule out bone complications
MRI: Reveals soft tissue scarring, inflammation, and joint capsule thickening
CT Scan: Detailed imaging for complex cases
● Arthroscopic Evaluation
Direct visualization of scar tissue
Assessment of synovial and ligament structures
Best Treatment Options for Knee Arthrofibrosis
Treatment for knee arthrofibrosis aims to restore joint mobility, reduce inflammation, and prevent recurrence. Options vary based on the severity and duration of the condition.
1. Non-Surgical Treatment Options
● Physical Therapy
Passive and active ROM exercises
Stretching and strengthening programs
Use of Continuous Passive Motion (CPM) machines
● Medications
NSAIDs (e.g., ibuprofen) to reduce inflammation
Corticosteroids for severe inflammation
Pain relief medications for mobility support
● Manual Therapy
Scar tissue massage
Myofascial release
Soft tissue mobilization
2. Minimally Invasive Procedures
● Manipulation Under Anesthesia (MUA)
Performed when conservative treatment fails
Knee is manipulated under general anesthesia to break adhesions
● Arthroscopic Lysis of Adhesions
Minimally invasive surgery to remove scar tissue
Improves ROM with lower complication rates
3. Open Surgery
Reserved for severe and chronic cases with significant fibrosis:
Open lysis of adhesions
Synovectomy (removal of inflamed synovium)
Post-surgical rehabilitation is critical to avoid recurrence.
Post-Treatment Rehabilitation: Key to Recovery
The success of treatment heavily relies on postoperative rehabilitation and consistent physical therapy.
Important Rehabilitation Goals:
Early mobilization to prevent fibrosis recurrence
Controlled exercises to regain strength and flexibility
Pain management using heat/cold therapy and medications
Personalized physical therapy based on surgical intervention
A multi-disciplinary team including orthopedic surgeons, physiotherapists, and pain specialists is ideal for managing recovery.
Long-Term Prognosis
The prognosis for knee arthrofibrosis depends on several factors, including:
Time of diagnosis
Extent of fibrosis
Adherence to rehab protocols
Type of treatment used
Better Outcomes Are Likely If:
Diagnosed early
Treated with a structured rehab plan
Patient follows physiotherapy consistently
Poor Prognosis May Occur If:
The condition is ignored for months
Scar tissue becomes fully matured
The patient is unable to participate in rehab
Prevention Tips: How to Avoid Knee Arthrofibrosis
Preventing knee arthrofibrosis is always better than managing it later. Key prevention strategies include:
● Post-Surgery Care
Begin gentle movement early (as guided)
Use CPM machines if advised
Keep pain under control to allow movement
● Follow a Rehab Plan
Commit to physical therapy
Avoid prolonged immobility
Gradually increase joint activity
● Reduce Inflammation
Take prescribed anti-inflammatory medications
Use cold packs and elevation
● Regular Monitoring
Schedule follow-up visits
Report any stiffness or pain early
Research & Future Innovations
Innovations in treatment and prevention of arthrofibrosis are continuously evolving. Current research focuses on:
● Anti-Fibrotic Agents
Targeting TGF-β and other fibrosis mediators
● Genetic Risk Profiling
Identifying individuals predisposed to arthrofibrosis
● Improved Rehabilitation Tools
Smart sensors and AI-guided physiotherapy
These advancements promise improved outcomes and lower recurrence rates.
When to See a Knee Specialist
Visit an orthopedic or rehabilitation specialist if you notice:
Persistent knee stiffness
Limited ROM weeks after surgery or injury
Swelling or tightness that does not improve
Pain that interferes with normal activities
Knee arthrofibrosis is a serious but manageable complication, especially when identified early. With proper diagnosis, a structured treatment plan, and consistent rehabilitation, most patients can regain knee mobility and resume daily activities.
If you’re dealing with unexplained knee stiffness after surgery or an injury, don’t wait. Early treatment can make a significant difference in your recovery and quality of life.
Need Help?
Visit Sparsh Diagnostic Centre for expert consultation and personalized treatment for knee joint stiffness, arthrofibrosis, and post-surgical rehabilitation.
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No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
