At present, there is no pharmacological or biological treatment available to prevent or cure arthrofibrosis.
The main treatment approaches currently available to treat arthrofibrosis following total knee replacement include,
(1). Physical Therapy & Rehabilitation
(2). Manipulation under Anesthesia (MUA)
(3). Arthroscopic Removal of Scar Tissue (Arthroscopic Arthrolysis or Arthroscopic Lysis of Adhesions)
(4). Open Removal of Scar Tissue (Open Arthrolysis or Open Lysis of Adhesions)
(5). Revision Knee Replacement (Revision Arthroplasty)
Each treatment approach can be repeated or combined with another one as needed. For example, MUA can be repeated at appropriate time intervals as needed or if the first revision knee replacement fails a second revision knee replacement (re-revision) may be considered as needed. Similarly, MUA may be done in the postoperative period after revision as needed. The timing and the effectiveness of the various currently available treatment methods for arthrofibrosis following total knee replacement are controversial.
Other potential options include accepting the condition, knee fusion (arthrodesis) and amputation but we do not have much literature evidence in favor of these approaches. These options may be considered after the failure of all other treatment options for patients with severe, painful, diffuse arthrofibrosis involving the whole knee with significant flexion contracture along with significantly decreased range of flexion.
Few patients have reported success with augmented soft tissue mobilization techniques like Graston Technique, Astym Therapy, Myofascial Releaser Ellipse Pro and deep tissue massage. Patients have also used utensils and rolling pin to accomplish this.
There are published reports on novel techniques like hydraulic distension of knee, Botulinum toxin injection into muscles behind the thigh (hamstrings) for stiffness due to muscle spasm, and blocking the nerves with medications (sympathetic block) with variable results.
Treatments like injection of biological agents (Anakinra, Rosiglitazone, gamma-interferon) into knee joint are still in research stage.
Different patients have tried different treatment approaches. These include losing weight, prolonged bed rest, staying off the affected knee for a prolonged period of time (10-12 months) with continuous passive motion machine on, avoiding aggressive or painful physical therapy, anti-inflammatory diet, NSAID creams like Diclofenac Sodium, anti-inflammatory medicines, anti-gout medicines prescribed by rheumatologist, oral steroids like dosepac, repeated corticosteriod injections into knees, anti-allergy medications, high doses of vitamin C, cryotherapy (ice packs or Game Ready), heating pad, aquatherapy (water therapy), swimming, aqua jogging and exercising in pool, ultrasound, laser, shockwave, bike, stationary bike, rowing machine, floor pedal machine, flexion/extension brace like Dynasplint or JAZ brace, needling, acupuncture, chiropractic active release therapy, naturopathy, Ilizarov method, amniotic membrane insertion, stem cell therapy, and PRP injection. Other than anectodal positive results, none of them has given consistent and predictable results so that a specific modality could be recommended as a standard treatment approach.
Exactly when scar tissue matures is variable and remains a topic of debate. Fibrous tissue progressively matures and becomes resistant to more conservative treatment approaches with time.
The severity and duration of scar tissue and the presence of new bone formation within the soft tissue (heterotopic ossification) may affect the prognosis following treatment. Also, generalized arthrofibrosis leads to more severe stiffness and inferior prognosis than localized arthrofibrosis.
Sometimes, following any type of treatment for arthrofibrosis (Physical Therapy, MUA, arthroscopic or open arthrolysis and revision knee replacement), the pain and stiffness of arthrofibrosis may recur or even worsen after a short period of improvement or rarely immediately.