Arthrofibrosis

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Arthrofibrosis (from Greek: arthro- joint, fibr- fibrous and -osis abnormality) 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.[1][2]

Arthrofibrosis of the knee[edit]

Arthrofibrosis of the knee has been one of the more studied joints as a result of its frequency of occurrence.[3][4] Beyond origins such as knee injury and trauma, arthrofibrosis of the knee has been associated with degenerative arthritis.[5] 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.[6] Symptoms experienced as a result of arthrofibrosis of the knee include stiffness, pain, limping, heat, swelling, crepitus, and/or weakness.[4] Clinical diagnosis may also include the use of magnetic resonance imaging (or MRI) to visualize the knee compartments affected.[7]

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.[8]

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.[5]

References[edit]

  1. ^ Maloney MD, Sauser DD, Hanson EC, Wood VE, Thiel AE. Adhesive capsulitis of the wrist: arthrographic diagnosis. Radiology. 1988 Apr;167(1):187-90.
  2. ^ Millett PJ, Williams RJ 3rd, Wickiewicz TL. (1999 Sep-Oct;27(5):552-61.). "Open debridement and soft tissue release as a salvage procedure for the severely arthrofibrotic knee". Am J Sports Med. 27 (5): 552–61. PMID 10496569. 
  3. ^ Paulos LE, Wnorowski DC, Greenwald AE (1994). "Infrapatellar contracture syndrome. Diagnosis, treatment, and long-term followup". Am J Sports Med 22 (4): 440–9. doi:10.1177/036354659402200402. PMID 7943507. 
  4. ^ a b Fisher SE, Shelbourne KD (1993). "Arthroscopic treatment of symptomatic extension block complicating anterior cruciate ligament reconstruction". Am J Sports Med 21 (4): 558–64. doi:10.1177/036354659302100413. PMID 8368417. 
  5. ^ a b Steadman JR (2009). "Arthroscopic treatment of arthrofibrosis of the knee". In Gill TJ. Arthroscpic Techniques of the Knee: A Visual Guide (Visual Arthroscopy). Slack. ISBN 1-55642-858-8. 
  6. ^ Kim DH, Gill TJ, Millett PJ. Arthroscopic treatment of the arthrofibrotic knee. Arthroscopy. 2004 Jul;20 Suppl 2:187-94.
  7. ^ Steadman JR, Dragoo JL, Hines SL, Briggs KK (September 2008). "Arthroscopic release for symptomatic scarring of the anterior interval of the knee". Am J Sports Med 36 (9): 1763–9. doi:10.1177/0363546508320480. PMID 18753680. 
  8. ^ Cosgarea AJ, DeHaven KE, Lovelock JE. The surgical treatment of arthrofibrosis of the knee. Am J Sports Med. 1994 Mar-Apr;22(2):184-91.

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