[Therapy of arthrofibrosis after ligament reconstruction of the knee joint]

The development of arthrofibrosis in a serious complication of knee ligament injury or knee ligament surgery. The fibrosis is caused by a pathologic quantity or quality of collagen fiber formation in the knee or in the capsular structures, causing irreversible loss of range of motion, restricted patellar motion and finally patella baja with frank osteoarthritis of the patella. The major factors inducing fibrosis are notch impingement, development of a cyclops on an anterior cruciate ligament graft, scarring of the fat pad and the retinacula and adhesions in the recesses of the joint. Our therapeutic concept includes aggressive physiotherapy and an early arthroscopic procedure if conservative measures fail. A posterior capsulotomy is performed from a posteromedial arthrotomy in cases with flexion contracture persisting over a number of years. In 16 patients reviewed 17 months after arthroscopic treatment of arthrofibrosis the average improvement in range of motion was 13 degrees for extension and 25 degrees for flexion. A further 7 patients with chronic flexion contractures persisting for 1 year or more were treated with a posterior capsulotomy and reviewed 18 months after surgery. The average gain for extension was 15 degrees in these patients at follow-up.