[Posttraumatic ankle arthrofibrosis : Diagnosis, prevention and treatment]

Posttraumatic arthrofibrosis is a rare cause of painful motion loss after injury or surgery, with limited available evidence.

Posttraumatic arthrofibrosis is characterized by painful, progressive stiffness with more than 30% loss of motion and no major radiographic abnormality. Reported rates range from 2% to 10% after ankle injuries to up to 73% after surgically treated fractures, while ankle-specific data on risk factors remain limited. The pathogenesis appears to involve transforming growth factor (TGF)-β, interleukin (IL)-1, and hypoxia-mediated capsular fibrosis. Arthrography remains the diagnostic gold standard according to the Goldman criteria. Magnetic resonance imaging may show capsular thickening ≥ 3 mm and stage-dependent signal changes. First-line treatment comprises physiotherapy, mobilization, and dynamic or static progressive orthoses. A mean 17° gain in total range of motion was reported with static progressive orthoses. In refractory stiffness, arthroscopic capsular release may be beneficial, with improvement of the American Orthopaedic Foot and Ankle Society (AOFAS) score from 63.8 to 88.6, dorsiflexion from 1 to 19°, and acceptable motion in more than 80% of patients.

Posttraumatic arthrofibrosis of the ankle is rare, underdiagnosed, and treatable. Early recognition and stepwise conservative treatment, followed by arthroscopic capsular release, may restore function. The evidence is based mainly on small level IV studies. Prospective studies are required.