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Review
. 2022 Mar 1;30(1):29-41.
doi: 10.1097/JSA.0000000000000324.

Arthrofibrosis Nightmares: Prevention and Management Strategies

Dustin R Lee  1 , Erik Therrien, Bryant M Song, Christopher L Camp, Aaron J Krych, Michael J Stuart, Matthew P Abdel, Bruce A Levy
Affiliations
Review

Arthrofibrosis Nightmares: Prevention and Management Strategies

Dustin R Lee et al. Sports Med Arthrosc Rev. .

Abstract

Arthrofibrosis (AF) is an exaggerated immune response to a proinflammatory insult leading to pathologic periarticular fibrosis and symptomatic joint stiffness. The knee, elbow, and shoulder are particularly susceptible to AF, often in the setting of trauma, surgery, or adhesive capsulitis. Prevention through early physiotherapeutic interventions and anti-inflammatory medications remain fundamental to avoiding motion loss. Reliable nonoperative modalities exist and outcomes are improved when etiology, joint involved, and level of dysfunction are considered in the clinical decision making process. Surgical procedures should be reserved for cases recalcitrant to nonoperative measures. The purpose of this review is to provide an overview of the current understanding of AF pathophysiology, identify common risk factors, describe prevention strategies, and outline both nonoperative and surgical treatment options. This manuscript will focus specifically on sterile AF of the knee, elbow, and shoulder.

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Conflict of interest statement

Disclosure: C.L.C. reports personal fees and nonfinancial support from Arthrex, nonfinancial support from Zimmer Biomet, nonfinancial support from Stryker Corporation. A.J.K. reports grants from Aesculap/B.Braun, other from American Journal of Sports Medicine, personal fees and other from Arthrex Inc., grants from Arthritis foundation, grants from Ceterix, grants from Histogenics, other from International Cartilage Repair Society, other from International society of Arthroscopy, Knee surgery, and orthopaedic sports medicine, other from Minnesota Orthopedic society, personal fees and other from Musculoskeletal Transplant Foundation, personal fees from Vericel, personal fees from DePuy, personal fees from JRF, grants from Exactech, grants from Gemini Medical, personal fees from Responsive Arthroscopy. M.J.S. reports involvement in the editorial or governing board for the American Journal of Sports Medicine, grants and personal fees from Arthrex Inc., grants from Stryker. M.P.A. reports involvement in the board or committee member of AAOS, publishing royalties, financial or material support from Springer, and IP royalties from Stryker. B.A.L. reports personal fees from Arthrex Inc.: IP royalties; Paid consultant, grants from Biomet: Research support, editorial or governing board for Clinical Orthopaedics and Related Research, Journal of Knee Surgery, Knee Surgery, Sports Traumatology, Arthroscopy, Orthopedics Today; grants and personal fees from Smith & Nephew: Paid consultant; Research support, grants from Stryker: Research support, personal fees from Linvatec: Faculty/speaker, personal fees from COVR Medical LLC. The remaining authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.
Preoperative clinical photos of right knee showing (A) −10 degrees extension and (B) 45 degrees flexion. Postoperative range of motion (ROM) assessment under anesthesia shows (C) full extension and (D) complete flexion after lysis of adhesions (LOA) followed by manipulation under anesthesia (MUA).
Figure 2.
Figure 2.
The arthroscope is placed in the anterolateral portal of the left knee. (A) View of the suprapatellar pouch prior to release demonstrating restricted patellofemoral space. (B) Following release of adhesions and complete capsulotomy using radioablation device. (C) View of the intercondylar notch showing dense adhesions surrounding the anterior cruciate ligament (ACL). (D) ACL is preserved following complete release of scar tissue. (E) Arthroscopic field of view prior to posteromedial release. (F) Following complete posteromedial capsulotomy. The posteromedial knee is accessed through the intercondylar notch using the Gillquist maneuver.
Figure 3.
Figure 3.
Right knee LOA. (A) The arthroscope is placed in the anterolateral portal and the shaving device is accessing the knee from the anteromedial portal with the knee in flexion demonstrating abundant adhesions of the anterior aspect of the knee limiting access to the suprapatellar pouch. (B) View of the suprapatellar pouch from the anteromedial portal. Note the adhesion which can contribute to patellar mobility restriction. (C) The anterior interval is viewed from the anteromedial portal with the knee in flexion. Notice the patellar tendon attaching to the tibial tubercle, indicating complete release of the anterior interval.
Figure 4.
Figure 4.
Right knee posterior release. Arthroscopic field of view (A) before and (B) after posterior medial capsule release. The release is continued until the medial gastrocnemius tendon is visualized.
Figure 5.
Figure 5.
Right elbow LOA. (A) Arthroscopic field of view from the proximal anteromedial portal demonstrating extensive adhesions limiting view of the elbow joint. (B) Same view following progressive lysis of anterior adhesions proximal to the capitellum, using the electrocautery device from the midlateral portal. (C) LOA has been completed and viewed from the proximal anteromedial portal and the (D) midlateral portal.
Figure 6.
Figure 6.
Left shoulder ROM examination under anesthesia. Preoperative assessment showing restricted (A) abduction, (B) external rotation at 90 degrees abduction, and (C) forward flexion. Significant improvements attained in (D) abduction, (E) external rotation at 90 degrees abduction, and (F) forward flexion following capsular release and MUA.
Figure 7.
Figure 7.
Left shoulder arthroscopic images. (A) View of the rotator interval and anterior capsule through the posterior portal. (B) The rotator interval is released to the upper border of the subscapularis and the (C) middle glenohumeral ligament is identified prior to release. View of the posterior capsule from the anterior portal (D) before and (E) after capsulotomy is completed.
See this image and copyright information in PMC

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