Orthopedics Hip & Knee ACL Injury Arthrofibrosis With Joint Pain and Stiffness By Jonathan Cluett, MD Jonathan Cluett, MD LinkedIn Twitter Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery. Learn about our editorial process Updated on March 04, 2021 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Stuart Hershman, MD Medically reviewed by Stuart Hershman, MD LinkedIn Stuart Hershman, MD, is a board-certified spine surgeon. He specializes in spinal deformity and complex spinal reconstruction. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Symptoms Causes Diagnosis Treatment Prevention Arthrofibrosis is a condition in which you have a buildup of scar tissue around a joint, usually after a traumatic injury or surgical procedure. It's especially common in the knee. Arthrofibrosis can be debilitating, limiting your range of motion and causing substantial pain. Jan-Otto / Getty Images Arthrofibrosis Symptoms The primary symptoms of arthrofibrosis include: Pain, which can be severe and constant Stiffness in the joint Diminished range of motion You may also develop: An inability to straighten your leg, resulting in a limp An inability to bend your leg Swelling or warmth in the joint A grating sound or sensation when you move the joint (called crepitus) Symptoms can become more debilitating than the original injury or the problem that prompted surgery, making it difficult to walk, drive, or get in and out of a chair. 2:03 Click Play to Learn How to Break Up Scar Tissue in Your Knee This video has been medically reviewed by Oluseun Olufade, MD. Causes Arthrofibrosis is a common complication of procedures such as anterior cruciate ligament (ACL) reconstruction surgery and total knee arthroplasty (TKA). The condition is caused by inflammation and the creation of excess of scar tissue. Your body's natural response to trauma, such as from an injury or surgery, is to make scar tissue. Some people tend to make too much, especially if they have an infection at the site or another problem that complicates healing. According to a 2019 study, that may be due to a disruption in the healing process. Essentially, your body doesn't get the message to stop the healing process even after the trauma is repaired, so it just keeps making scar tissue. Scar tissue is dense and fibrous. When it forms in abundance, it can bind down the joint and prevent the normal range of motion. The process also can cause your muscles and connective tissues to shorten and harden (called contractures.) Diagnosis When you go to the healthcare provider with symptoms of arthrofibrosis, your healthcare provider will generally give you a physical examination and ask about your history of injury or surgery. They'll also look at your ability to flex your knee. To confirm the diagnosis and get a feel for the extent of the problem, you'll likely be sent for magnetic resonance imaging (MRI) and X-ray. According to current diagnostic criteria, arthrofibrosis can be diagnosed when the limited range of motion in the joint is persistent despite conservative treatments. However, some researchers question whether this is a valid criterion because some confirmed cases have involved minimal range-of-motion loss but have still been considerably painful and disabling. Treatment The first treatment for arthrofibrosis is rest, ice, and anti-inflammatory medications to reduce the pain and swelling. You'll likely be advised to start gentle range-of-motion exercises to increase flexibility. You may also be referred to physical therapy to improve your use of the joint. If that doesn't solve the problem, then you have the option of two common procedures: manipulation under anesthesia or surgical removal of scar tissue. Both are performed in the operating room under anesthesia, and they can be performed in combination in some cases. In the non-surgical option, you're put under general anesthesia and the healthcare provider forcefully bends your leg to break up scar tissue. The surgical option, in which the healthcare provider goes in and removes the scar tissue, is more common. It's typically performed arthroscopically (with small incisions). Following surgery, it is important to have physical therapy to regain strength and motion as well as to prevent further formation of scar tissue. Prevention Preventing arthrofibrosis after surgery is best accomplished with early range of motion rehabilitation. Arthrofibrosis used to be much more common after ACL surgery when healthcare providers used to restrict patients' mobility to allow the ligament to heal. Now, due to advances in surgical techniques and rehabilitation, most surgeons are instructing their patients to move the joint within hours or days of surgery, and that's lowered the likelihood of arthrofibrosis. A 2019 study cautions against "aggressive" physical therapy, though, because exercise can trigger inflammation and in some cases worsen the problem. Was this page helpful? Thanks for your feedback! Dealing with joint pain can cause major disruptions to your day. Sign up and learn how to better take care of your body. Click below and just hit send! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 6 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Usher KM, Zhu S, Mavropalias G, Carrino JA, Zhao J, Xu J. Pathological mechanisms and therapeutic outlooks for arthrofibrosis. Bone Res. 2019;7:9. doi:10.1038/s41413-019-0047-x Frye BM, Floyd MW, Pham DC, Feldman JJ, Hamlin BR. Effect of femoral component design on patellofemoral crepitance and patella clunk syndrome after posterior-stabilized total knee arthroplasty. J Arthroplasty. 2012;27(6):1166–1170. doi:10.1016/j.arth.2011.12.009 Ekhtiari S, Horner NS, de Sa D, Simunovic N, Hirschmann MT, Ogilvie R, Berardelli RL, Whelan DB, Ayeni OR. Arthrofibrosis after ACL reconstruction is best treated in a step-wise approach with early recognition and intervention: A systematic review. Knee Surg Sports Traumatol Arthrosc. 2017;25(12):3929-3937. doi:10.1007/s00167-017-4482-1 Cheuy VA, Foran JR, Paxton RJ, Bade MJ, Zeni JA, Stevens-Lapsley JE. Arthrofibrosis associated with total knee arthroplasty. The Journal of Arthroplasty. 2017;32(8):2604-2611. doi:10.1016/j.arth.2017.02.005 Lawrence SE, Shelbourne KD. Treatment and rehabilitation of arthrofibrosis of the knee. in: Giangarra CE, Manske RC. Clinical Orthopaedic Rehabilitation, A Team Approach. Elsevier. Shelbourne Knee Center. Arthrofibrosis of the knee.