The development of excessive scar tissue in and around the knee joint, called arthrofibrosis, leads to painful stiffness and a limited range of motion (ROM). This restriction impairs the ability to fully bend or straighten the leg, affecting daily activities like walking or climbing stairs. Arthrofibrosis results from the body’s natural healing response becoming overactive, forming dense, fibrous tissue known as adhesions. Restoring knee function requires understanding the mechanism and exploring effective management strategies, from self-care to surgery.
Understanding Knee Scar Tissue Formation
Scar tissue (fibrosis) is a dense connective tissue composed primarily of collagen fibers produced by the body to repair damaged areas. In the knee, arthrofibrosis frequently occurs after major procedures like total knee replacement or anterior cruciate ligament (ACL) reconstruction. It can also follow a significant injury or prolonged immobilization. This excessive scarring can form within the joint (intra-articular) or in the surrounding soft tissues (extra-articular).
The formation process begins with inflammation, which activates fibroblasts, transforming them into myofibroblasts. These cells generate and deposit excessive collagen, forming thick bands of scar tissue, or adhesions, that essentially glue surfaces together. In the knee, these adhesions physically block the smooth gliding motion of the joint surfaces, leading to characteristic stiffening and loss of range of motion. This restricted movement often results in a painful, hard endpoint when attempting to move the knee.
Self-Managed Techniques for Mobility
Addressing knee scar tissue at home requires a consistent, gentle approach focused on restoring range of motion. Early and frequent movement is a primary strategy, helping prevent the initial formation of dense scar tissue. Low-impact activities, such as stationary cycling or walking, maintain joint flexibility and encourage circulation, aiding the healing process.
Specific active and passive range of motion exercises are effective in stretching the adhesions. Common exercises include the heel slide, where you lie on your back and slowly slide your heel toward your buttocks, bending the knee as far as comfortable. Another technique is wall slides, using the wall to assist in bending or straightening the knee. These movements should be performed slowly and held at the point of maximum stretch for a sustained period to encourage tissue elongation.
Manual techniques applied directly to the scar area also support mobility. Cross-friction massage involves using firm pressure to rub the scar perpendicular to the incision line. This action helps realign the collagen fibers within the superficial scar tissue, making it more pliable. Applying heat before exercises increases tissue elasticity, and using cold therapy afterward helps manage the inflammation that stretching may provoke.
Professional Physical Therapy and Specialized Medical Treatments
When self-managed care is insufficient, professional physical therapy provides advanced, hands-on treatment to regain function. Therapists utilize high-grade joint mobilization, applying controlled, passive movements to the joint surfaces. This stretches the capsule and breaks down adhesions too deep for self-massage. This specialized stretching elongates shortened tissue without causing excessive inflammation.
Advanced physical therapy often incorporates modalities like therapeutic ultrasound or heat therapy to improve blood flow and tissue extensibility before manual techniques. Clinicians may also use dry needling to target muscle trigger points that develop due to altered movement patterns caused by stiffness. The combination of specialized stretching, manual therapy, and strengthening exercises is tailored to the individual’s deficits, focusing on restoring motion before building strength.
To manage the pain and inflammation associated with arthrofibrosis, a physician may administer medical treatments. Corticosteroid injections are sometimes used directly into the joint to reduce the localized inflammation that drives scar tissue formation. Injections of hyaluronan, a substance mimicking natural joint fluid, may also be considered to improve lubrication and smooth movement. These interventions create a therapeutic window that maximizes the effectiveness of the concurrent physical therapy program.
When Surgical Intervention Becomes Necessary
Surgical intervention is typically considered only after intensive, non-operative treatment, often lasting three to six months, has failed to restore an acceptable range of motion. The decision is based on the severity of functional loss and the persistence of stiffness despite rehabilitation efforts. The goal of surgery is to mechanically remove or release the fibrous bands preventing movement.
Two main procedures treat severe knee arthrofibrosis. The first is Manipulation Under Anesthesia (MUA), where the patient receives general anesthesia to relax muscles, allowing the surgeon to forcibly move the knee and break the adhesions. The second, often performed with MUA, is Arthroscopic Lysis of Adhesions (LOA). This minimally invasive procedure uses a camera and small instruments to visualize and cut away the dense scar tissue inside the joint. Both procedures require an immediate, aggressive post-operative physical therapy regimen to maintain the motion gained and prevent the recurrence of scar tissue.