Arthroscopic Arthrolysis (Lysis of Adhesions)
If physical therapy and MUA fail, arthroscopic removal of scar tissue (arthrolysis or lysis of adhesions) is considered.
This procedure is preferably performed between 3 and 6 months after total knee replacement. The results are better if it is done between 3 to 6 months. The effectiveness of arthroscopic arthrolysis progressively declines after 6 months.
In this procedure, the scar tissue from the inside of the knee joint is removed using arthroscopic instruments. As much scar tissue as possible is removed and adhesions are released from all the compartments of the knee joint. If the posterior cruciate ligament is present and is tight, it could also be released.
Arthroscopic arthrolysis may be helpful in arthrofibrosis involving a portion of the knee joint (localized arthrofibrosis) as well as arthrofibrosis involving the whole knee joint (diffuse arthrofibrosis). But some investigators believe that the use of arthroscopic arthrolysis should be restricted only to localized arthrofibrosis. Removal of all the scar tissue may not be necessary and it can be selective focusing only on scar tissue that is causing symptoms.
Arthroscopic arthrolysis is useful only for removal of scar tissue from the inside of the knee joint (intra-articular fibrosis). It is not helpful is removing scar tissue involving the soft tissue outside the knee joint capsule (extra-articular fibrosis) like scar tissue involving quadriceps (quadriceps fibrosis).