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Key Points

Specialised approaches are required for treating arthrofibrosis

Although arthrofibrosis is a relatively common disease that affects between 5 and 15 percent of people who have had joint surgery or suffered joint trauma, awareness and understanding of the disease remains poor, even among medical and sporting professionals. It’s common for professionals treating arthrofibrosis to provide the same therapies for people with arthrofibrosis and for those who are healing in a healthy way, but this is often a mistake. Specialised approaches are required for treating arthrofibrosis. Perhaps the most important word to keep in mind is “gentle”, particularly in regard to exercise and stretching. Never permit the frustration of slow progress to alter the plan, and never try to force range of motion or exercise therapy. Everybody progresses at their own pace. If the joint reacts with increased symptoms after therapy then the plan needs to be altered. Further trauma, including micro-tears from forced stretching, must be avoided.

Freiwillige Gruppe

DO

  • Exercise very carefully in the pain-free zone. Exercising other parts of the body is the safest option.

  • Elevate and ice if your joint is swollen, hot or red.

  • Passive stretching/Continuous Passive Motion – should be used carefully every day to maintain and increase range of motion.

  • Tests:

    • Infection – Culture and molecular test of synovial fluid withdrawn by needle aspiration.

    • Inflammatory cytokines – blood test, can also test synovial fluid.

    • Autoimmune diseases and other – blood test.

    • Nutritional status – blood test for iron, Vitamin D, potassium etc, and iodine in urine.

  • Diet – caloric restriction (fasting) and diets high in vegetables, fruit, nuts and legumes (eg the Mediterranean diet) are known to reduce inflammation. In general, a low sugar, high fibre diet is recommended.

  • Supplements – take nutrients shown to be deficient (eg Vit D). Avmacol and fish oil have anti-inflammatory properties. Note: use these as appropriate for an individual’s medical condition and medications, consult a doctor.

  • Anti-inflammatory medications (see Oral Medications)

  • Stress reduction and meditation regularly.

DON'T

  • ​“Push through the pain” while exercising or stretching.

  • Have poor sleep hygiene and untreated sleep apnoea – good sleep is essential for proper immune system functioning.

  • Permit anxiety and stress. Stress has a powerful effect on the immune system and increases inflammation.

  • Have untreated gum disease – good mouth hygiene is important. Bleeding gums allow bacteria into the bloodstream, and these can travel to joints and remain there, creating inflammation.

  • Continue with any activity that upsets the joint (pain, swelling, heat).

  • Continue with long term non-steroidal anti-inflammatory medications (NSAIDS).

Decision Tree

for Treating Arthrofibrosis

Starting with a diagnosis of arthrofibrosis on the left hand side, chance outcomes and outcomes resulting from treatment decisions lead to branching of the tree. On the right hand side the treatment decisions have been followed, resulting in either the resolution of arthrofibrosis or persistence.

The treatment of active arthrofibrosis (where inflammation is present) requires a multi-disciplinary team consisting of specialists from the areas of orthopaedic surgery, physiotherapy and rheumatology. Professional psychological support may also be helpful particularly if arthrofibrosis becomes chronic, since the impact on quality of life can be significant. Specialists need training in the pathology of arthrofibrosis in order to adapt traditional approaches in a manner appropriate to this disease, since some traditional approaches may be detrimental.

Test for Inflammation

  • Pain after standing / exercise

  • Imaging with tracer

  • Inflammatory cytokine panel

  • PET/CT with fluorescent tracer

  • Clinical signs may be absent

Test for Infection

  • Culture & PCR of synovial fluid

  • PET/CT with fluorescent tracer

  • Clinical symptoms

Consult Rheumatologist

  • Anti-fibrotic e.g. Metformin, Losartan, Relaxin

  • Anti-inflammatory e.g. PPS, cytokine monoclonal antibody JAK inhibitor, low dose aspirin, omega 3 fatty acids, Avmacol 

  • Nerve medication e.g. Pregabalin, Vagus nerve stimulation

  • Test for autoimmune disease

  • Analysis of gut microbiome

Quality of Life

  • Probiotics

  • Low sugar, high fiber diet

  • Sleep hygiene

  • Essential nutrients

  • Stress reduction

  • Exercise non-affected areas, affected areas with caution

  • Psychological support

  • Meditation

Diagnostics

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Treatment

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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.

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