Recognizing Arthrofibrosis: Stages, Scar Sites, Signs and Grades

Normally inflammation settles two to three weeks after surgery. In arthrofibrosis the knee stays the same or worsens, and the window for effective treatment is the first two to three months. If there is no progress by about eight to ten weeks, the speaker refers to an expert. Tibial plateau and patellar fractures carry about a 50 percent risk, and complex multi-structure surgery and long immobilization raise it further. Scar tissue can obliterate the suprapatellar pouch and gutters, fill the anterior interval and notch, and involve the fat pad. Active arthrofibrosis is painful and ongoing and must not be forced. Residual arthrofibrosis is established, stiff and less painful. One year after ACL reconstruction, a third of patients lack at least three degrees of extension. Signs include restricted motion, a warm thickened knee often mistaken for swelling, quadriceps wasting and patella infera, with a Caton-Deschamps index below 0.4 likely needing surgery. Grading into mild, moderate and severe depends mainly on extension, but 30 to 40 percent of patients do not fit it.