European Knee Arthrofibrosis Center

European Knee Arthrofibrosis Center

Arthrofibrosis is characterised by an abnormal scarring within the knee joint as well as in the peri- and extra-articular structures.
It is a complication of injury or surgery (even coming from minor procedures, such as a partial meniscectomy) where an exaggerated inflammatory response leads to excessive and abnormal scar tissue formation therefore to painful restriction of the knee range of motion (ROM).

This clinical condition then can evolve in muscle atrophy, patellar tendon shortening, and a localized or generalized scarring inside and outside the knee joint, therefore involving the whole joint capsule which becomes thickened. The shortened patellar tendon and the scarred fat pad that often gets 'sticky' pulling the tendon itself towards the center of the knee may results in a patella baya (infera) condition and the combination of the above-named factors tights up the whole joint that becomes stiff with potentially minimal to no patellar mobility in the most severe cases of knee arthrofibrosis. Lack of full extension and patella baya can ultimately lead to cartilage damage due to the increased compression forces on the patello-femoral joint.

With this pathology a highly specialized rehabilitation is always the first and pivotal approach. Specialized physical therapy for knee arthrofibrosis requires a great deal of expertise and focuses on gentle restoration of ROM, inflammation and swelling management via rehabilitative strategies, the adequate pharmaceutical support, and pain normalization. This aspect, when pian is not under control and the knee is hypersensitive, is often the result of either a peripheral or central nervous system sensitization.

A team of trained Physical Therapists is mandatory to recognize an early onset of knee arthrofibrosis and immediately adapt the rehabilitation plan. Furthernoire, when this switch proves not to be enough, to rapidly contact back the orthopaedic surgeon (who needs to be skilled in dealing with such pathology) in order to add a pharmaceutical support and sometimes plan a tailored surgical intervention.

Strengthening is not the focus in case of knee arthrofibrosis. Pushing the knee through aggressive rehabilitation to recover the lacking flexion and/or extension would only aggravate the situation.
Efforts focus upon adequate pain relief while recovering ROM and making adhesions and scarring more pliable and elastic, ultimately leading to their evolution via plastic deformation and (if possible) partial/complete reabsorption without further inflaming the knee. Treating ROM deficits requires a high level of patient compliance and adherence to a specialized program that has to be followed both in physical therapy and at home, recurring to the utilization of some specific devices if necessary.

The Sports Rehab team is specialized in the management of this knee potentially devastating pathology and strives to offer patients the best overall care taking care of all the needed aspects.

Part of our team spent long time dealing with this often undiagnosed knee pathology in some of the top-notch Sports Medicine and Orthopaedic Clinics in the United States, such as the Steadman Clinic (Vail, CO), the Cincinnati SportsMedicine & Orthopaedic Center/Dr. Noyes Knee Clinic (Cincinnati, OH), the Andrews institute (Gulf Breeze, FL), and some others, hence developing an in depth understanding of the mechanisms, causes, complications and approaches.

Multi-disciplinarity is crucial in this complex process, for this reason our team work closely with knee orthopeadic surgeons and some specialists all over the world to manage each knee arthrofibrosis case at its best. When symptoms, stiffness and disability worsen despite the high-quality physical therapy, it comes time for the Physical Therapy team to refer back the patient to the physician and discuss together with him and the patient the best available options.

Surgery, in case, has to be performed by a knee surgeon who has developed xpertise in dealing with knee arthrofibrosis, since the surgical techniques and the immediate post-operative care are very peculiar.

In case surgery is performed to restore ROM of the knee and the patella, release scar tissues, etc. we start our specialized physical therapy regimen from right after the surgical procedure, in bed, with Continue Passive Motion machine, ice and compression, and potentially extension splints. Rehabilitation has to be performed every day, with a strict program. The target #1 of which is to regain and maintain ROM while quieting the knee down reaching its homeostasis for the first 6-8 weeks, depending on the cases. Our skilled Physical Therapists will guide you through the process if you're dealing with knee arthrofibrosis.

We cooperate with the International Arthrofibrosis Association (IAA) and website in helping patients dealing with knee AF from all over Europe (see our co-founder profiles as member of the IAA Committee and member of the KNEEguru Clinical Advisory Board).

Informative material on knee AF:

Visit the European Knee Arthrofibrosis Center website

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