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Hello all. Happy to have found this group and looking for any support or insight. I had an ACLR 5/2022 and 11/2022 had a second surgery for LOA, ended up with CRPS in my recovery. Fast forward and 11/2024 after much debate had another LOA. I had descent ROA and most of my scarring was medial/inferior and in Hoffa's fat pad. I had significant pain from a medial scar that was causing a bony defect in the femur. My surgeon (for this last surgery) is very familiar with arthrofibrosis and took an appropriate multidisciplinary approach. I felt well for the first few months and have taken recovery very slow (6 wk crutches, CPM 8 wk, gentle PT and slow progression with weight training/load) but unfortunatley over the last month (with no inciting event) I feel that my symptoms are returning (pain/stiffness, loss of extension, increased swelling). This happened last time and it was not recognized or validated (I was told to keep getting stronger). Now I feel at a loss and have few specific quetions:

1. Can arthrofibrosis "recur" or "restart".? As in I feel like this is immediate post op all over again after it seemed to be healing well.

2. If so, is there a role to treat this as I did initially (back off again in exercise/strengthening), decrease walking, etc

3. Is there a role for using the CPM again at this point?

4. I have also checked my cytokine panel and have elevated TNF -alpha .... any thoughts? Considering discussing Humira with my surgeon.

5. We did initially use intrarticular Anakinra (maybe helped?) any role for using again?

6. My knee was also aspirated weekly for the first month post op and I sent the synovial fluid for cytokines - it was incredibly elevated in IL-6 and serum elevation was more mild... not sure if this is valuable at all?

Any insight/thoughts/questions greatly appreciated. This is a lonely process to navigate.