HSS Journal ®

, Volume 7, Issue 2, pp 130–133 | Cite as

Arthroscopic Arthrolysis for Arthrofibrosis of the Knee after Total Knee Replacement

  • Alaa M. HegazyEmail author
  • Mohamed A. Elsoufy
Original Article



Arthrofibrosis is an uncommon but potentially debilitating complication following total knee replacement which can result in chronic pain and poor recovery of range of motion. The treatment of this condition remains difficult and controversial.

Questions/aims of study

We reviewed our results of arthroscopic arthrolysis of arthrofibrosis of the knee after total knee replacement to assess the potential for this technique to improve range of motion and provide improvement in knee function and pain as measured by the Knee Society Score (KSS).


Eight patients were treated for arthrofibrosis after total knee replacement with arthroscopic management. The patients included five females and three males. The average age was 67.4 years. Initial rehabilitation efforts, which included manipulation under anesthesia, had failed. Arthroscopic arthrolysis was performed to release fibrous bands in the suprapatellar pouch and to reestablish the medial and lateral gutters. Lateral release of the patellar retinaculum was performed. Intensive physiotherapy and continuous passive motion began immediately post-operatively. The average follow-up was 37.4 months. The KSS was used for assessment of pain and function before arthroscopy and at the latest follow-up.


Six of the eight patients experienced improvement in the KSS. The average functional score showed improvement from 68 points pre-operatively to 86 at the time of final follow-up. The average pain scores improved from 30 points pre-operatively to 41 at the time of final follow-up.


Arthroscopic management can be beneficial for patients suffering from arthrofibrosis following total knee replacement. Pain and KSS clinical scores can markedly improve.


arthrofibrosis total knee replacement arthroscopic management knee stiffness 


  1. 1.
    Alfredo SP, Simone C, Michele V and Mario T. Stiffness in total knee arthroplasty. J Orthopaed Traumatol (2009) 10:111–118.CrossRefGoogle Scholar
  2. 2.
    Bocell JR, Thorpe CD, Tullos HS (1991) Arthroscopic treatment of symptomatic total knee arthroplasty. Clin Orthop 271:125–134.Google Scholar
  3. 3.
    Campbell ED Jr. Arthroscopy in total knee replacements. Arthroscopy. 1987;3:31–35.CrossRefGoogle Scholar
  4. 4.
    Christensen CP, Crawford JJ, Olin MD, Vail TP (2002) Revision of stiff total knee arthroplasty. J Arthroplasty 17:409–415CrossRefGoogle Scholar
  5. 5.
    Diduch DR, Scuderi GR, Scott WN, et al. The efficacy of arthroscopy following total knee replacement. Arthroscopy. 1997;13:166–171CrossRefGoogle Scholar
  6. 6.
    Hutchinson JRM, Parish EN, Cross MJ. Results of open arthrolysis for the treatment of stiffness after total knee replacement. J Bone Joint Surg. 2005;87(10):1357.CrossRefGoogle Scholar
  7. 7.
    Insall JN, Lawrence DD, Richard DS, and Norman S. Rationale of The Knee Society Clinical Rating System. Clin Orthop. 1989 Nov;(248):13–14.Google Scholar
  8. 8.
    Jane K, Charles LN, Paul AL. Stiffness after total knee arthroplasty: prevalence of the complication and outcomes of debridement. Journal of Bone and Joint Surgery. 2004;86(7):1479.CrossRefGoogle Scholar
  9. 9.
    Jerosch J, Aldawoudy AM. Arthroscopic treatment of patients with moderate arthrofibrosis after total knee replacement. Knee Surg Sports Traumatol Arthrosc. 2007;15:71–7.CrossRefGoogle Scholar
  10. 10.
    Kim J, Nelson CH, Lotke PA (2004) Stiffness after total knee arthroplasty: prevalence of complication and outcome of revision. J Bone Joint Surg 86:1479–1484CrossRefGoogle Scholar
  11. 11.
    Kurosaka M, Yoshiya S, Mizuno K, et al. Maximizing flexion after total knee arthroplasty: the need and the pitfalls. J Arthroplast 2002;17(4 Suppl 1):59.CrossRefGoogle Scholar
  12. 12.
    Matthew R. Bong M, and Paul E. Di Cesare, MD. Stiffness after total knee arthroplasty Journal of American Academy of Orthopaedic Surgeons May/June 2004 2004;12(3):8.Google Scholar
  13. 13.
    Mont MA, Seyler TM, Marulanda GA, Delanois RE, A B. Surgical treatment and customized rehabilitation for stiff knee arthroplasties . Clinical Orthopaedics and Related Research. 2006;446:193–200CrossRefGoogle Scholar
  14. 14.
    Nicholls DW, Dorr LD (1990) Revision surgery for stiff total knee arthroplasty. J Arthroplasty 5:269–281CrossRefGoogle Scholar
  15. 15.
    Parvizi J, Tarity TD, Steinbeck MJ, Politi RG, Joshi A, Purtill JJ, Sharkey PF: Management of stiffness following total knee arthroplasty. Journal of Bone and Joint Surgery 2006, 88:175–181.PubMedGoogle Scholar
  16. 16.
    Ries MD, Badalamente M. Arthrofibrosis after total knee arthroplasty. Clin Orthop 2000;380:177–183CrossRefGoogle Scholar
  17. 17.
    Scranton PE Jr (2001) Management of knee pain and stiffness after total knee arthroplasty. J Arthroplasty 16:428–435.CrossRefGoogle Scholar
  18. 18.
    Thorsten MS, David RM, Anil B, Johannes FP, German AM, Peter MB, Ronald ED and Michael AM . Arthroplasty Functional Problems and Arthrofibrosis Following Total Knee. J Bone Joint Surg Am. 2007;89:59–69.Google Scholar
  19. 19.
    Williams RJ III, Westrich GH, Siegel J, et al. Arthroscopic release of the posterior cruciate ligament for stiff total knee arthroplasty. Clin Orthop. 1996;331:185–191.CrossRefGoogle Scholar

Copyright information

© Hospital for Special Surgery 2011

Authors and Affiliations

  1. 1.The Department of Orthopedic Surgery, Faculty of MedicineZagazig UniveristyCairo-Naser CityEgypt

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