What causes lead to arthrofibrosis
While secondary arthrofibrosis is usually caused by manual surgical errors, the cause of primary arthrofibrosis is still not fully understood. Different research results are contrasted with each other. It seems certain, however, that several factors are responsible for triggering and maintaining primary arthrofibrosis.
In secondary arthrofibrosis following cruciate ligament replacement surgery, manual surgical errors are decisive for a persistent restriction of knee joint movement. For example, incorrect graft placement can lead to the graft being trapped (impingement) on the roof of the knee joint when the knee is extended. This problem, which can be observed quite frequently, is caused by a tibial drill channel placed too far forward.
Repeated incarcerations during knee extension continuously damage the graft, which can ultimately lead to spherical scarring on the graft (cyclops syndrome). The ability to stretch the knee joint is limited. In the area of the ankle joint, a capsule/ligament tear in the context of a twist trauma (accident event) occasionally leads to intra-articular (in the joint) scarring in the area of the injured structure or, alternatively, generalized scarring.
In this respect, the transition from secondary arthrofibrosis to primary arthrofibrosis can be fluid. Primary arthrofibrosis is characterized by scarring that involves the entire joint (multiplication of connective tissue). This quantitative component is accompanied by the fact that the connective tissue formed is also altered in its composition.
Connective tissue fibres are literally cross-linked with each other, which further reduces joint mobility. The following causes of excessive scar formation are discussed: Activation and proliferation of fibroblasts (connective tissue cells) during an initial inflammatory process. To date, it has not been clarified by which stimuli and in which patients primary arthrofibrosis occurs.
However, retrospective observations after cruciate ligament arthroplasty could identify risk factors, which led to concrete recommendations for the prophylaxis of arthrofibrosis. – Chronic inflammatory reaction in the context of an immunoreactive process. – Dysbalances between pro- and contrainflammatory cytokines (inflammatory messengers).
- Hypoxia – reperfusion damage – theory(circulatory disorder)
- Genetic factors
- Chronic inflammatory reaction within the framework of an immunoreactive process. – Dysbalances between pro- and contra-inflammatory cytokines (inflammatory messengers). – Hypoxia – reperfusion damage – theory(circulatory disorder)
- Genetic factors
Arthrofibrosis in the knee joint is a relatively common consequence after surgical interventions on the knee joint (arthroscopic interventions).
Such operations also include knee TEP (total endoprosthesis of the knee joint). With a knee TEP, the knee joint is replaced by an artificial knee joint. This can lead to arthrofibrosis as a result of the operation.
This means that increased scar tissue is formed, which limits the function of the knee joint. A few days to weeks after the operation, the knee joint stiffens up, causing increased pain and difficulty under stress or insufficient mobility in the knee joint. There are various forms of treatment to maintain or promote the mobility of the knee.
Firstly, regular exercise therapy should be carried out as a preventive measure. The movement and load on the joint reduces the strong formation of scar tissue after the operation. If severe scarring and limited movement have already occurred, therapy can be carried out as in other cases of arthrofibrosis (physiotherapy, anaesthetic mobilisation, surgical removal of scar tissue).
