Arthrofibrosis
Encyclopedia
Arthrofibrosis is 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.
, 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.
Patients who are recognized as developing arthrofibrosis may improve motion with appropriately-directed physical therapy
, corticosteroid
injections, non-steroidal anti-inflammatory drug
s, 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 release
s may be indicated and utilized to great success, in the hands of an appropriately trained specialist.
Trauma (medicine)
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
where an excessive scar tissue
Fibrosis
Fibrosis is the formation of excess fibrous connective tissue in an organ or tissue in a reparative or reactive process. This is as opposed to formation of fibrous tissue as a normal constituent of an organ or tissue...
response leads to painful restriction of joint motion, with scar tissue forming within the joint and surrounding soft tissue
Soft tissue
In anatomy, the term soft tissue refers to tissues that connect, support, or surround other structures and organs of the body, not being bone. Soft tissue includes tendons, ligaments, fascia, skin, fibrous tissues, fat, and synovial membranes , and muscles, nerves and blood vessels .It is sometimes...
spaces and persisting despite rehabilitation exercises and stretches. Scarring adhesions has been described in most major joints, including knees, shoulders, hips, ankles, and wrists.
Arthrofibrosis of the Knee
Arthrofibrosis of the knee has been one of the more studied joints as a result of its frequency of occurrence. Beyond origins such as knee injury and traumaTrauma (medicine)
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
, arthrofibrosis of the knee has been associated with degenerative arthritis. Scar tissues
Fibrosis
Fibrosis is the formation of excess fibrous connective tissue in an organ or tissue in a reparative or reactive process. This is as opposed to formation of fibrous tissue as a normal constituent of an organ or tissue...
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
Range of motion
Range of motion , is the distance that a movable object may normally travel while properly attached to another object. It is also called range of travel, particularly when talking about mechanical devices and in mechanical engineering fields...
(i.e. flexion
Flexion
In anatomy, flexion is a position that is made possible by the joint angle decreasing. The skeletal and muscular systems work together to move the joint into a "flexed" position. For example the elbow is flexed when the hand is brought closer to the shoulder...
, extension
Extension (kinesiology)
In kinesiology, extension is a movement of a joint that results in increased angle between two bones or body surfaces at a joint. Extension usually results in straightening of the bones or body surfaces involved. For example, extension is produced by extending the flexed elbow. Straightening of...
, or both) may be affected. Symptoms experienced as a result of arthrofibrosis of the knee include stiffness, pain, limping, heat, swelling, crepitus
Crepitus
Crepitus is a medical term to describe the grating, crackling or popping sounds and sensations experienced under the skin and joints.-Causes:...
, and/or weakness. Clinical diagnosis may also include the use of magnetic resonance imaging (or MRI)
Magnetic resonance imaging
Magnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...
to visualize the knee compartments affected.
The consequent pain
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
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.
Patients who are recognized as developing arthrofibrosis may improve motion with appropriately-directed physical therapy
Physical therapy
Physical therapy , often abbreviated PT, is a health care profession. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment/intervention,and rehabilitation...
, corticosteroid
Corticosteroid
Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. Corticosteroids are involved in a wide range of physiologic systems such as stress response, immune response and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte...
injections, non-steroidal anti-inflammatory drug
Non-steroidal anti-inflammatory drug
Nonsteroidal anti-inflammatory drugs, usually abbreviated to NSAIDs or NAIDs, but also referred to as nonsteroidal anti-inflammatory agents/analgesics or nonsteroidal Anti-inflammatory medicines , are drugs with analgesic and antipyretic effects and which have, in higher doses, anti-inflammatory...
s, and cryotherapy
Cryotherapy
Cryotherapy is the local or general use of low temperatures in medical therapy or the removal of heat from a body part. The term "cryotherapy" comes from the Greek cryo meaning cold and the word therapy meaning cure...
. In many instances, however, as fibrosis
Fibrosis
Fibrosis is the formation of excess fibrous connective tissue in an organ or tissue in a reparative or reactive process. This is as opposed to formation of fibrous tissue as a normal constituent of an organ or tissue...
has set in, surgical intervention is necessary. Specialized arthroscopic
Arthroscopy
Arthroscopy is a minimally invasive surgical procedure in which an examination and sometimes treatment of damage of the interior of a joint is performed using an arthroscope, a type of endoscope that is inserted into the joint through a small incision...
lysis of adhesions knee procedures such as anterior interval release
Anterior interval release
Anterior interval release is a type of arthroscopic knee surgery performed to alleviate pain and associated symptoms caused by scar tissue accumulation in the anterior region of the knee, behind and under the knee cap , in a condition called arthrofibrosis...
s may be indicated and utilized to great success, in the hands of an appropriately trained specialist.
External links
- Arthrofibrosis Part 1, Frank Noyes (course in several parts)