Conservative treatment of knee arthrofibrosis according to a cellular cytokine-based model : A retrospective pilot evaluation.

Abstract

Background: Arthrofibrosis (AF) is a relatively frequent complication after knee surgery, leading to painful limitation of joint mobility. Currently, intense stretching is performed in many patients, without improvements in mobility. A novel concept, established on a cellular, cytokine-based model, advocates to consider the warning function of pain and to terminate forced joint mobilization to disrupt the cycle of arthrofibrosis. Based on these findings, our clinic developed a comprehensive antifibrotic treatment protocol. The aim of this analysis was to evaluate the patients treated so far.

Methods: Patients treated at the Clinic Donaustadt, an academic teaching hospital of the Medical University of Vienna, Austria, according to the clinic's AF protocol, were evaluated by reviewing their records. Patellar mobility, range of motion, tightness, overheat, pain, general mobility, assistive devices, working status and the necessity of additional surgery were assessed at baseline, after 2 months and after 12 months (follow-up).

Results: Four patients were treated according to the AF protocol. After two months, patellar mobility and range of motion clearly increased in three out of four patients. At the follow-up examination, patella mobility further increased, extension was complete, flexion at least 120°, and symptoms such as tightness, overheating, nocturnal pain and pain after activity had disappeared in three out of four patients. None of the patients had analgesics or walking aids and three out of four patients had returned to work. Out of the four patients, three expressed high satisfaction with the AF protocol and reported no limitations in daily life, including recreational activities.

Conclusion: Based on this pilot evaluation, the comprehensive conservative AF program seems to have high potential. Therefore, larger future studies should be conducted to validate this concept.