Arthrofibrosis After Knee Replacement Surgery
The term “scar tissue” can be a scary or dreaded word when it comes to recovering from a knee surgery such as a knee replacement or ACL reconstruction. The reason for this is that too much scar tissue formation can result in a condition called arthrofibrosis.
What is Arthrofibrosis?
Arthrofibrosis is characterized by pain, stiffness, swelling and decreased range of motion of the affected joint. Of the roughly 720,000 knee replacements performed every year in the United States, arthrofibrosis occurs after approximately 6% of these surgeries.
Is Arthrofibrosis Permanent?
As a result, the severe swelling and knee stiffness can cause long term loss of function and chronic pain, severely impacting one’s quality of life.
What is Scar Tissue?
Formation of scar tissue is a normal part of the tissue healing process be it after an injury, surgery, etc. Scar tissue is actually collagen tissue that forms during the healing process.
Three Stages of Tissue Repair
There are three stages of tissue healing: inflammatory stage, proliferation stage, and remodeling stage.
Inflammation Stage
The inflammation stage occurs for the first 7 days after surgery. During this stage, there is a vascular and cellular response that releases required chemicals for the healing process and allows for an increase in blood flow to the area.
Proliferation Stage
The next stage is the proliferation stage. This stage begins a few days after the surgery and lasts for about the first 6 weeks. It is during this stage that most of the collagen tissue/scar tissue is formed. From a rehabilitation standpoint, it is imperative to work diligently on joint range of motion during this phase to help prevent too much collagen/scar tissue from forming which could lead to the formation of adhesions and ultimately arthrofibrosis.
Remodeling Stage
The third and final healing stage is the remodeling stage. It is during this stage the healing tissues become strengthened and organized.
How to Prevent Arthrofibrosis
Flexion and Extension
When rehabilitating from a total knee arthroplasty or ACL reconstruction, it is crucial to regain most, if not all, ranges of motion (both flexion and extension) in the first six weeks postoperatively. After the first six weeks, the collagen tissues enter the remodeling stage and become much stronger, making it very difficult to regain any further ranges of motion without more invasive interventions.
Active and Passive Range of Motion
Both active and passive range of motion exercises should be utilized early in the postoperative course. These exercises and activities should be done on a frequent - multiple times per day - basis in an effort to regain knee range of motion early and prevent the formation of excess scar tissue.
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About The Author
Kevin Brown, Certified Physician Assistant
Kevin Brown is a certified physician assistant who has been practicing in general orthopedics and orthopedic surgery for the past twelve years. Prior to his physician assistant career, Kevin was an orthopedic physical therapist for 4 years. He resides in Charlotte, NC with his wife and two sons.
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