Arthrofibrosis is defined as a complication of injury or trauma where an excessive scar tissue response leads to painful restriction of joint motion, with scar tissue forming within the joint and surrounding soft tissue spaces and persisting despite rehabilitation exercises and stretches. Scarring adhesions has been described in most major joints, including knees, shoulders, hips, ankles, and wrists.
Excessive Scar Tissue:
Excessive scar tissue is a serious medical condition that can occur from a number of causes and can affect a variety of parts of the human body. Scar tissue consists of contracted connective tissue that is fibrous as well as dense. When someone suffers from an excess in the build up of scar tissue, they can experience extreme pain, immobility and arthritis in the joints. Excessive scar tissue can cause limping, heat, swelling, popping, grating or weakness. And sometimes the fibrosis only occurs in part of the joint, so pain and stiffness may only be felt during certain activities. This condition which is still a large mystery to the medical community can cause silent problems and no pain at all, which complicate matters even more.
Unfortunately, arthrofibrosis is a condition which is poorly visualized by imaging techniques such as MRI scanning, so while it may be used to confirm whether scar tissue has built up on the soft tissue in the joint, surgeons are more likely to study the movement and history in their diagnosis.
Postarthroscopic Arthrofibrosis of the Shoulder:
Arthrofibrosis after shoulder surgery can be challenging to treat. Certain factors, including diabetes and history of keloid formation, predispose patients to the development of postoperative arthrofibrosis. Etiologies include rotator cuff repair, labral repair, capsulorrhaphy, shoulder arthroplasty, and proximal humerus fracture fixation. Systematic evaluation with thorough history and physical examination is essential to determine the proper treatment and to counsel patients on expectations for recovery. Nonoperative treatment focused on physical therapy is the first step in management. Manipulation under anesthesia may be an effective treatment for failure of physical therapy regimens in idiopathic adhesive capsulitis, however it is less successful in cases of postsurgical adhesions. In cases of postoperative stiffness, treatment options include arthroscopic and open capsular releases. Adequate postoperative pain control and adherence to a rigorous physical therapy regimen are integral to the success of surgical release. Surgical treatment is effective in the majority of patients with postsurgical arthrofibrosis.
Arthrofibrosis of the Knee:
Arthrofibrosis of the knee has been one of the more studied joints as a result of its frequency of occurrence.
Arthrofibrosis is one of the most common complications after total knee arthroplasty with an overall incidence of approximately 10%. Nevertheless, published data are rare and clinical trials mostly include small and heterogeneous patient series resulting in controversial conclusions.
Beyond origins such as knee injury and trauma, arthrofibrosis of the knee has been associated with degenerative arthritis. 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. Symptoms experienced as a result of arthrofibrosis of the knee include stiffness, pain, limping, heat, swelling, crepitus, and/or weakness. Clinical diagnosis may also include the use of magnetic resonance imaging (or MRI) to visualize the knee compartments affected.
The consequent pain may lead to the cascade of quadriceps weakness, patellar tendon adaptive 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.
Prevention and Treatment:
Patients who are recognized as developing arthrofibrosis may improve motion with appropriately directed physical therapy, corticosteroid injections, non-steroidal anti-inflammatory drugs, and cryotherapy. In many instances, however, as fibrosis has set in, surgical intervention is necessary. Specialized arthroscopic lysis of adhesions knee procedures such as anterior interval releases may be indicated and utilized to great success, in the hands of an appropriately trained specialist.
Prevention of arthrofibrosis by sufficient analgesia and early physiotherapy remains the best treatment option for painful stiffness after knee arthroplasty.
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