Hello,
I have been dealing with arthrofibrosis for over 3 years, and this is the first time I managed to get an appointment with a rheumatologist. Beyond a Cytokine Panel Blood Test, is there a recommended list of tests/examinations I should ask for? I’ve already read general descriptions on IAA website, but I’m looking for more detailed information on specific tests or a pointer on where to find it.
Thank you in advance.
Hii
About two and a half years ago, I underwent ACL reconstruction surgery and developed arthrofibrosis.
About a year and a half ago, I underwent an arthroscopic surgery to clean out the diffuse arthrofibrosis that was present in the knee.
The arthrofibrosis has returned again, and I was recommended to undergo another surgery for cleanup, and this time to take a medication called Losartan for six weeks following the surgery.
I would be happy to know:
Does an additional cleanup surgery pose too high a risk for another recurrence of the arthrofibrosis?
Hi Nabi,
Your question about surgery is a difficult one, and there is no easy answer. However, it's important to have scans to make sure that the ACL graft has been positioned correctly. It can be helpful to see a different surgeon who is not associated with the first, to get advice on the ACL graft positioning.
After the scans you might consider arthroscopic arthrofibrosis surgery. However, surgery stimulates the healing response again, and arthrofibrosis is a condition of over-healing. So, as you have experienced, the outcome might not be good, and might even be worse.
If the surgeon follows the methods that are outlined in the Surgical Checklist, especially not using a tourniquet and not using a mechanical shaver, that reduces the risk since there is less damage done, but we still can't predict the outcome. It seems that the Hoffa's fat pad is almost always inflamed and fibrotic, and cutting it is not advisable.
Losartan was shown to reduce arthrofibrosis for some people in some research, but other research has not found a positive response. An individual's reaction to it likely depends on the biological pathways that are dysregulated, which determines what will help.
If you can find a surgeon who is willing to consider the arthrofibrosis-aware surgical methods then you might decide the risk is worth it. We're happy to meet virtually with a surgeon if they want to discuss this, and we can also point you to a couple of experienced arthrofibrosis surgeons in Europe and the US.
Please feel free to ask more questions.
All the best,
Kayley
Hello, and thanks for your interest in the IAA. This is a courtesy note to inform you that the Directors are taking a short break until July 11th, and likely won't be able to respond to questions during this time. We hope this doesn't inconvenience you.
Kayley
Hello all, I’ve had arthrofibrosis for 6+ years now and am concerned that I have a dental infection that could go to the knee and require a revision. The thought of it is terrifying to me. I’ve been to the dentist, and he agreed that my concerns were legit and is sending me to an oral surgeon for a cone beam xray (CAT scan, basically called CBCT). Besides the pain in my tooth, my knee is only a little warm but is acting a bit more aggravated than usual. Every day that goes by I’m concerned that the infection may be getting worse. Any advice or do you have any knowledge of others’ experience with this?
Hi Gardener,
I agree that infections in the mouth are a real risk for joints, especially when you have a prosthesis. I can't give medical advice, but I hope that your dentist has prescribed oral antibiotics that target the specific bacteria causing the infection. They may need to test what type of bacteria are there.
If you're taking antibiotics this should control the infection so it doesn't disperse in your blood and travel to your knee. However, if your knee develops more symptoms then it would be a good idea to have a needle aspiration of the synovial fluid in the joint, which is then tested for infection.
Your knee may feel worse for a while in any case, because your body's "army" (immune system) is fighting the infection in your mouth, and the "ammo" (inflammatory cytokines and cells) travel in your blood to your knee.
I hope that helps,
Kayley
I went finally meet Dr Noyes. He never took any blood. He just looked at my X- ray and said I know what you have. He explained what it was and honestly said he could do surgery with 80% success. That is better than what the doctors didn’t offer me for my three years. Just waiting for him to call me to come back for the procedure.