When to Refer for Surgery and How to Rehab After It

A plateau of four to six weeks despite good physiotherapy in a calm knee is the time to discuss surgery with a specialized surgeon who works closely with a specialized physiotherapy team. Manipulation under anesthesia is discouraged because mature scar tissue resists it and it can cause patellar fractures and tendon tears. Release should use radiofrequency rather than a shaver, do the minimum needed, and not try to restore normal anatomy, which will never fully return. After surgery, physiotherapy starts on day one. Continuous passive motion runs 8 to 12 hours a day, with ice, compression and elevation, non-weight bearing on crutches, and the same home program of heel slides, low-load prolonged stretch and patellar mobilization, taught before the operation. New scar tissue will form, and movement shapes how it matures. The focus stays on the joint rather than muscle until the knee settles. Mood swings and depression are common, and about 1 percent of all patients may develop arthrofibrosis despite the best care.