TREATMENT OF ARTHROFIBROSIS FOLLOWING KNE E LIGAMENT SURGERY

The development of arthrofibrosis is a serious complication of knee li gament injury or knee ligament surgery. The fibrosis is caused by a pa thologic quantity or quality of collagen fiber formation in the knee o r in the capsular structures, causing irreversible loss of range of mo tion, restricted patellar motion and finally patella baja with frank o steoarthritis of the patella. The major factors inducing fibrosis are notch impingement, development of a cyclops on an anterior cruciate li gament graft, scarring of the fat pad and the retinacula and adhesions in the recesses of the joint. Our therapeutic concept includes agress ive physiotherapy and an early arthroscopic procedure if conservative measures fail. A posterior capsulotomy is performed from a posteromedi al arthrotomy in cases with flexion contracture persisting over a numb er of years. In 16 patients reviewed 17 months after arthroscopic trea tment of arthrofibrosis the average improvement in range of motion was 13 degrees for extension and 25 degrees for flexion. A further 7 pati ents with chronic flexion contractures persisting for 1 year or more w ere treated with a posterior capsulotomy and reviewed is months after surgery. The average gain for extension was 15 degrees in these patien ts at follow-up.