Arthroscopic Lysis of Adhesions for the Management of Arthrofibrosis Following Total Knee Arthroplasty.

Abstract

Arthrofibrosis remains a challenging complication to manage following total knee arthroplasty (TKA). Early arthrofibrosis, occurring within 12 weeks of TKA, is more responsive to manipulation under anesthesia (MUA), whereas late presentations often require surgical intervention. Arthroscopic lysis of adhesions (aLOA) has emerged as a reliable treatment when nonoperative measures fail. The procedure involves thorough arthroscopic debridement followed by gentle manipulation and immediate rehabilitation. Published literature has demonstrated aLOA consistently improves knee ROM by approximately 20-60°, with corresponding gains in Knee Society Scores and WOMAC indices, and reductions in pain. Although overall complication rates are rare, large database analyses warn of nontrivial risks, including recurrent stiffness, surgical site infection, and periprosthetic joint infection, with outcomes influenced by factors such as younger age, higher comorbidity burden, poor baseline ROM, and elevated body mass index. Careful patient selection, preoperative exclusion of mechanical or infectious causes of stiffness, and intensive postoperative rehabilitation are critical to the success of this procedure. When applied in appropriately selected patients, aLOA offers meaningful improvement in motion and function, and represents a key therapeutic option in the management of arthrofibrosis.