Differential diagnoses = alternative causes
Other clinical pictures must be distinguished from arthrofibrosis, which can also lead to a loss of knee joint function. Rehabilitation deficit (frequent): Inadequate postoperative follow-up treatment and too long immobilization can lead to capsule shrinkage of the knee joint, resulting in a persistent restriction of movement. The reasons for this are insufficient postoperative pain elimination, whereby progress in physiotherapy is made more difficult due to pain, and a lack of motivation and education of the patient about the importance of postoperative physiotherapy, physical therapy, medical training therapy, etc. Sudeck’s disease (rare):Painful dystrophy (nutritional disorder) and atrophy (shrinkage) of the soft tissues (muscles, skin) and bones of the extremities with typical stage-like course. The etiology of this disease is still largely unexplained.
MRI of the knee joint
The imaging procedure of choice for the knee joint is the standard X-ray. This allows the joint and possible changes in the joint space to be assessed. If the cartilage, meniscus or capsule-ligament apparatus are to be better assessed, an MRI (magnetic resonance imaging) is the method of choice. This makes an MRI rather an additional diagnostic option. In the case of arthrofibrosis of the knee joint, it is particularly good that the joints and possible changes can be well depicted in the MRI and thus a diagnosis can usually be made with great certainty.
How can arthrofibrosis be prevented?
Prophylaxis of arthrofibrosis in cruciate ligament surgery: Due to the difficult therapy of arthrofibrosis once it has occurred, the prophylaxis of this disease is of particular importance. In particular, the study examined which precautionary measures can minimize the risk of arthrofibrosis after cruciate ligament replacement. Prophylactic measures can be divided into preoperative, intraoperative and postoperative measures (modified according to et al.
(1999):Choice of the time of surgery:After traumatic cruciate cruciate ligament rupture, surgery should not be performed too early. Several studies have shown that the risk of developing arthrofibrosis was significantly increased in the first 3 weeks after the accident when a cruciate ligament replacement operation was performed. A general “joint irritation” (acute traumatic inflammatory reaction) caused by the trauma is seen as the cause for this, with the risk of transition to chronic joint inflammation due to additional surgical traumatisation.
A recovery period of about 6 weeks before the operation is recommended. At the time of surgery, the knee joint should be freely movable and “non-irritant” (painless, no joint effusion). Accompanying injuries (especially injuries to the inner ligament) should have been treated beforehand.
If the knee joint is free of irritation, physiotherapy can be started preoperatively. Patient education: The patient must be informed about the severity of the injury and the consequences resulting from it, especially postoperative follow-up treatment, and motivated to cooperate. Surgical misplacement of the cruciate ligament graft must be avoided at all costs.
A frequent error is a too far forward (ventrally) placed tibial drill channel. Other possible errors are too traumatic or long surgery, incorrect placement of the femoral drill channel and incorrect graft fixation. Physiotherapy should be started immediately after the operation.
Adequate elimination of pain with suitable analgesics is necessary for this. Active and passive (motor splint) movement exercises and exercises for patella mobilization are used. The patient must be motivated to cooperate.