Open Arthrolysis, Extra-articular Lysis of Adhesions and Soft Tissue Releases
If arthroscopic arthrolysis fails, open removal of scar tissue (open arthrolysis or open lysis of adhesions) can be considered.
This procedure is performed between 6 months and 1 year after total knee replacement.
In this procedure, the knee joint is surgically opened and the scar tissue within the joint (intra-articular fibrosis) is removed. This procedure is also helpful in removing the scar tissue that is present outside the knee joint (extra-articular fibrosis) like quadriceps fibrosis.
The adherent scar tissue limiting mobility of the muscles in the front of the thigh (quadriceps) and the bone (femur) can be released (adhesiolysis) and the quadriceps can be lengthened (quadricepsplasty) using a variety of techniques. Scarred and contracted soft tissue structures in and around the knee joint can also be released as needed.
The plastic component between the two metal components of the total knee replacement (tibial polyethylene) can be replaced with a thinner one (downsizing) to improve motion. Rarely, aggressive removal of scar tissue can result in instability of the knee joint and in such cases, the polyethylene can be replaced with a thicker one (upsizing) to improve stability.