Frequently Asked Questions
Please contact us if you have a question. The responses are not intended to be medical advice, but are intended to provide information based on the best available evidence for individuals to make informed decisions.
How important is surgical technique, and can I avoid getting more scar tissue after surgery by choosing the right surgeon?
There is no clear answer to this question, however, it appears that surgical technique is important for the best possibility of a good outcome. The practices of an experienced arthrofibrosis surgeon are:
No use of a tourniquet during surgery unless absolutely necessary.
“Releasing” scar tissue not “removing” it with very little use of the arthroscopic shaver, preferring the use of a cautery tool to release scar tissue and prevent bleeding.
Preserving the fat pad. Cutting the fat pad strongly promotes further fibrosis.
Liberal use of local pain anaesthetics to ensure adequate post-op pain control.
When is it too late for a cure?
This is an important question about which, unfortunately, there has been no proper research. Anecdotally, the first 6 months after the onset of arthrofibrosis (post operation or injury) is the easiest time to stop arthrofibrosis, and for the period of up to a year it may still be possible to do this.
After a year the collagen that makes up the scar tissue is thought to become strongly cross-linked with strong bonds that are particularly difficult for the body to break. This means that the scar tissue can remain in the body long term, instead of being broken down and removed.
Feedback processes between the inflammatory and fibrosis systems of the body become well established, and these processes feed and reinforce each other.
Surgery may re-set the body by removing the scar tissue and some of the special cells (myofibroblasts) that create it, permitting recovery.
However, surgery powerfully stimulates inflammation and wound healing processes. It is these factors that cause arthrofibrosis, and surgery sometimes makes symptoms worse in the long term as the body’s processes become yet more dysregulated.
We can’t predict yet who will benefit from surgery, and who will have a worse outcome. Those that have a lot of inflammation and pain may be at the greatest risk of having worse outcomes, and controlling inflammation should always be a priority.
Your article “Pathological Mechanisms…” mentions that influenza can activate or reactivate arthrofibrosis. I’m wondering if you would recommend for or against a flu shot?
As you say, it’s not possible to know what caused your arthrofibrosis to flare up again. The most likely explanation is stress, as this causes an increase in cortisol and other inflammatory markers, and it has a powerful effect on healing.
However, we can look at the possibilities you mentioned.
Flu vaccine: this will cause a temporary increase in inflammation, however, it will be very limited in duration and intensity, so it’s unlikely that this is what caused your decreasing ROM, unless you had a particularly bad reaction. However, even if you did react badly to the vaccine, I suggest that you continue to be vaccinated, since your reaction to the actual flu virus will be much more powerful and longer-lasting if you haven’t developed the immunity that the vaccine provides. The same argument applies to covid vaccines.
Can collagen-rich foods (like bone broth) feed scar tissue development?
This is unlikely to be the cause of decreasing ROM. Bone broth, for example, contains large amounts of collagen in the form of gelatine, which has a lot of protein (amino acids) in it. Collagen is highly digestible and is broken down into the individual amino acids by the stomach and intestines. However, the collagen (scar tissue) formed in arthrofibrosis is made from proteins that are eaten every day in different types of food. The body decides what type of collagen to make, and where, based on signals from cells that indicate where it’s needed.
The materials presented in this site are provided voluntarily as a public service. It is of a general nature, based on the scientific literature. The information and advice provided is made available in good faith but is provided solely on the basis that readers will be responsible for managing their own assessment of the matters discussed herein and that they should verify all relevant representations, statements and information. Please consult your doctor.