Arthrofibrosis in the knee

Synonyms in a broader sense

  • Joint scarring
  • Intra-articular scarring
  • “painful restriction of movement in the knee”
  • Cyclops Syndrome
  • Infrapatellar contracture syndrome /Patella baja
  • Generalized inflammatory joint reaction


Arthrofibrosis is a dreaded, in its aetiology largely unexplained joint disease following surgery or injury, resulting in a more or less severe, sometimes painful restriction of joint mobility. A distinction is made between the following: Most studies in the literature deal with the development of arthrofibrosis of the knee joint after injuries and cruciate ligament plastic surgery. From a clinical point of view, arthrofibrosis of the knee joint is defined by a permanent restriction of movement of > 10° for extension and <125° for flexion. – Primary arthrofibrosis, which is characterized by generalized scarring in the joint. – Secondary arthrofibrosis, in which local mechanical irritations are the cause of movement restriction.


A characteristic feature of arthrofibrosis is the restriction of movement of the affected joint. If a local mechanical problem is the cause of the movement restriction, symptoms sometimes occur as pinching symptoms (scar impingement) with shooting pain. Overall, however, no uniform pain pattern can be described for arthrofibrosis.

Except for an obligatory restriction of movement, the joint can be completely free of pain. In primary arthrofibrosis, pain is usually experienced when an attempt is made to overcome the scarred, fixed final position of the joint. Less frequently, patients also complain of pain at rest of the joint as an indication of an ongoing inflammatory process of the joint.

Overall, the clinical picture (symptoms and complaints) of arthrofibrosis is therefore very heterogeneous (diverse). Pain usually occurs in connection with arthrofibrosis of the knee joint. In most cases, the patient can also assign the pain precisely to the knee joint and, after more specific examinations, specify more precisely in which area the pain occurs.

Sometimes, however, pain radiates. Similarly, pain in the hip can occur as a result of a relieving posture or incorrect weight bearing and one must look more specifically for the cause in the knee joint and not in the hip. The pain is often motion-dependent, which means that the pain is more likely to occur when the knee is loaded, for example when standing or walking.

In relaxed positions when sitting or lying down, when the knee is not moved, the pain does not occur or occurs less in comparison. Often the pain responds well to the use of painkillers, so that the pain can be relieved with appropriate medication. The therapy of secondary arthrofibrosis is surgical.

Individual scar strands can be easily removed arthroscopically, thus removing the mechanical obstacle. In cruciate ligament surgery, space can be made available for the misplaced graft by expanding the knee roof (emergency plastic surgery), thereby preventing the graft from striking again. The therapy of primary arthrofibrosis is far more difficult and less successful.

In contrast to secondary arthrofibrosis, it often cannot be repaired arthroscopically. In the worst case, multiple arthroscopic operations in particular can lead to further activation of the chronically occurring inflammatory processes. The use of arthroscopic surgery in symptomatic conservative therapy is one of the most important aspects of arthroscopic surgery:

  • Physiotherapy / physiotherapy
  • NSAIDs (non-steroidal anti-rheumatic drugs)
  • Physical therapy (heat, cold, electrotherapy, ultrasound etc.)