Following surgery, Dr. Bryan Penalosa will prescribe a medication called Losartan to help prevent the formation of post-operative scar tissue. Dr. Bryan Penalosa will also recommend aggressive physical therapy right from the start of your post-operative recovery in order to optimize your outcome.
Knee
Stiff Knee (Arthrofibrosis)
What is knee arthrofibrosis?
Knee arthrofibrosis is a condition characterized by the excessive formation of scar tissue (fibrosis) within the knee joint. This excessive scar tissue can lead to a reduction in the normal range of motion of the knee, causing stiffness and decreased flexibility. The scar tissue can limit the normal gliding of the joint surfaces and restrict movement.
What causes knee arthrofibrosis?
Knee arthrofibrosis can be caused by various factors, such as trauma, surgery (especially ACL or knee replacement surgery), prolonged immobilization of the knee joint, infection, or inflammation. These factors can lead to excessive scar tissue formation, which restricts normal knee joint movement.
How common is knee arthrofibrosis?
The occurrence rate of knee arthrofibrosis varies, but it is relatively uncommon. However, it is more commonly seen in certain populations, such as individuals who have undergone knee surgeries or experienced severe knee injuries.
What are the symptoms of knee arthrofibrosis?
- Pain
- Stiffness
- Swelling
- Limited range of motion
- A feeling of tightness or pulling in the knee joint.
- Difficulty straightening or bending the knee.
- Instability while walking or performing physical activities
How do you diagnose knee arthrofibrosis?
The combination of a detailed history, including your past surgical history, and comprehensive physical examination is the key to a successful diagnosis of knee arthrofibrosis. Dr. Bryan Penalosa and his team will perform a comprehensive physical exam to assess the range of motion in your knee joint, look for signs of inflammation or swelling, and feel for areas of tenderness or crepitus (grating or grinding sensations). Your gait (the way you walk) will also be evaluated to identify any abnormalities.
In addition to the physical examination, Dr. Bryan Penalosa may order diagnostic imaging, such as x-rays or an MRI of the knee, to further evaluate post-surgical changes and hardware placement from your previous surgery if applicable.
Stiff Knee (Arthrofibrosis) Non-Surgical Treatment
In some cases, non-surgical treatments can be effective in managing knee arthrofibrosis, especially during the initial 2-3 months following a knee surgery. For patients who are candidates for conservative treatment, the focus of care will be on reducing pain, swelling, and inflammation, while also strongly emphasizing range of motion.
Rest and Activity Modification:
It is essential to rest the knee and avoid activities that worsen the pain or lead to episodes of stiffness.
Oral Anti-Inflammatories, Ice, and Compression:
Oral anti-inflammatory and pain-relieving medications, such as Meloxicam, Naproxen, Advil, or Ibuprofen, may help to manage the pain and reduce inflammation of the knee. Additionally, Dr. Bryan Penalosa may prescribe a short-term oral steroid course called a Medrol Dose Pak to further help mitigate inflammation within the knee joint. Applying ice packs and compression to the knee can also help reduce swelling and inflammation. Remember to use a cloth or towel between the ice pack and your skin to avoid frostbite.
Physical Therapy:
A structured physical therapy program is extremely important in the treatment of knee arthrofibrosis. Dr. Bryan Penalosa will recommend attending PT as frequently as you can, even daily if possible. It is important to complete any home exercises that your physical therapist provides to you multiple times per day in order to optimize your recovery.
Intra-Articular Knee Injections:
The goal of an intra-articular injection is to manage pain and inflammation of the knee. Therefore, injections may be used as a short-term measure to manage these symptoms following an injury and promote further range of motion progression.
Continuous Passive Motion (CPM) Machine and Flexionater/Extensionater
These are medical devices that are used to promote range of motion progression at home by working the knee through passive range of motion. These devices can help further one’s range of motion and breakdown post-operative scar tissue. Dr. Bryan Penalosa’s office will submit an order for these devices to a medical device company called Graymont Medical. Graymont Medical will then contact you to help coordinate delivery of the device(s) to your home.
Stiff Knee (Arthrofibrosis) Surgical Treatment
What are the surgical treatment options for knee arthrofibrosis?
When range of motion of the knee continues to be significantly limited and affects overall function despite conservative treatment, surgical intervention is reasonable. The surgery recommended for a stiff knee is a knee arthroscopy, lysis of adhesions (LOA), and manipulation under anesthesia (MUA). During this procedure, Dr. Bryan Penalosa will use a minimally invasive arthroscopic technique to remove the excessive scar tissue through 2-3 small incisions. Following the debridement of the excessive scar tissue, Dr. Bryan Penalosa will then work the knee through extensive range of motion, further breaking up additional scar tissue. This is called a manipulation under anesthesia. In some cases when patients cannot achieve full extension (get their knees straight) a capsulotomy can be performed. This means releasing some of the attachments on the back of the knee that may be contractured to allow for better motion.
What are the success rates of surgery for knee arthrofibrosis?
The success rates of surgery for knee arthrofibrosis can vary depending on several factors, such as the severity of the condition and the underlying cause. Generally, the success rates are quite high, especially when surgery is combined with post-operative physical therapy. It is critical that one attends aggressive physical therapy immediately following surgery for knee arthrofibrosis. Studies have shown that approximately 80-90% of patients experience improved range of motion and reduced pain after surgical intervention.
Recovering from Stiff Knee (Arthrofibrosis) Surgery
What is the recovery time after surgery for knee arthrofibrosis?
Physical therapy will play a crucial role in rehabilitation, helping to restore strength and range of motion in the knee joint. Dr. Bryan Penalosa will recommend that you begin physical therapy as soon as possible following surgery, even the same day as your surgery if scheduling allows. The initial 2 weeks following surgery are the opportune time for acquiring the most success in range of motion restoration. During this prime window of opportunity for improvement, Dr. Bryan Penalosa recommends attending physical therapy daily, completing home exercises multiple times per day, and using the CPM/flexionater/extensionater as prescribed.
You will be able to put weight on the operative leg as tolerated by pain immediately following surgery. No brace will be required after surgery unless the purpose of surgery was to restore extension of the knee (ability to straighten the knee).
The recovery time after surgery for knee arthrofibrosis can vary depending on the extent of the surgery and the individual’s healing capacity. In most cases, patients can expect a recovery period of several weeks to a few months.
Effects of Untreated Knee Arthrofibrosis
What are the long-term effects of an untreated knee arthrofibrosis?
If left untreated, knee arthrofibrosis can lead to long-term complications and limitations. The excessive scar tissue can continue to restrict movement in the knee joint, causing chronic pain, stiffness, and functional impairment. This can significantly impact an individual’s ability to perform daily activities, participate in sports or physical activities, and may even lead to the development of secondary joint problems, such as osteoarthritis. Therefore, it is important to seek medical attention and proper treatment to prevent long-term complications.