German Congress of Orthopaedics and Traumatology (DKOU 2025)
Outcomes of arthroscopic lysis of adhesions in knee stiffness: A comparative analysis of arthrofibrotic and non-arthrofibrotic patients
2BG Clinic Hamburg, Hamburg, Deutschland
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Objectives and questions: Postoperative knee stiffness, encompassing arthrofibrosis (AFoK) and non-arthrofibrosis (nAFoK), significantly affects patient mobility and quality of life after knee surgery. Arthroscopic lysis of adhesions (aLOA) is a commonly employed intervention, but comparative data on outcomes for AFoK and nAFoK patients remain limited. This study aimed to evaluate aLOA efficacy in improving range of motion (ROM) and functional outcomes, with emphasis on postoperative rehabilitation strategies.
Material and methods: A retrospective analysis of 46 patients with postoperative knee stiffness (15 AFoK, 31 nAFoK) was conducted. Classification into AFoK or nAFoK was based on established criteria: (1) significant ROM loss, (2) stiffness persisting beyond three months post-surgery, (3) absence of mechanical blockade or infection, and (4) limited ROM improvement despite intensive physiotherapy. Patients meeting all criteria were classified as AFoK, while those with knee fibrosis who did not were classified as nAFoK. Outcomes included ROM, International Knee Documentation Committee (IKDC) scores, and the influence of physiotherapy frequency, stretching to the ROM limit (SRL), and continuous passive motion (CPM) device use. Statistical analysis was performed using t-test.
Results: Both groups achieved significant ROM improvements post aLOA (p < 0.001). AFoK patients exhibited more severe preoperative motion loss but greater ROM gains than nAFoK patients (p < 0.01). IKDC scores at follow-up were significantly lower in the AFoK group (p < 0.001). Patients with a flexion of less than 100° at discharge showed worse functional outcomes at follow-up (p < 0.01). Frequent physiotherapy and SRL were associated with improved IKDC scores, particularly in nAFoK patients (p < 0.01). CPM use improved functional outcomes in AFoK patients (p = 0.02) but not in nAFoK patients.
Discussion and conclusions: Arthroscopic LOA effectively improves ROM in both AFoK and nAFoK patients. Functional outcomes vary between groups, influenced by distinct rehabilitation strategies. Tailored rehabilitation, including intensive physiotherapy, SRL, and CPM use, may optimize recovery and address subgroup-specific needs, highlighting the necessity of personalized treatment approaches.
