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, whereas late presentations often require surgical intervention. Arthroscopic lysis of adhesions (aLOA) has emerged as a reliable treatment when non-operative measures fail. The procedure involves thorough arthroscopic debridement followed by gentle manipulation and immediate rehabilitation. Published literature has demonstrated that aLOA consistently improves knee ROM by approximately 20 to 60 degrees, with corresponding gains in Knee Society Scores and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) indices, and reductions in pain. Although overall complication rates are rare, large database analyses warn of non-trivial 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.

Keywords

arthrofibrosis - lysis of adhesions - total knee arthroplasty complications - stiffness - arthroscopic lysis of adhesions

Publikationsverlauf

Eingereicht: 30. September 2025

Angenommen: 23. Dezember 2025

Accepted Manuscript online:
26. Dezember 2025

Artikel online veröffentlicht:
20. Januar 2026

• References

• 1 Bong MR, Di Cesare PE. Stiffness after total knee arthroplasty. J Am Acad Orthop Surg 2004; 12 (03) 164-171
• 2 Fitzsimmons SE, Vazquez EA, Bronson MJ. How to treat the stiff total knee arthroplasty?: A systematic review. Clin Orthop Relat Res 2010; 468 (04) 1096-1106
• 3 Kalson NS, Borthwick LA, Mann DA. et al. International consensus on the definition and classification of fibrosis of the knee joint. Bone Joint J 2016; 98-B (11) 1479-1488
• 4 Thomas NP, Liu C, Varady N, Iban YC, Schwab PE, Chen AF. High complication rate associated with arthroscopic lysis of adhesions versus manipulation under anesthesia for arthrofibrosis after total knee arthroplasty. J Am Acad Orthop Surg 2023; 31 (04) e216-e225
• 5 Cheuy VA, Foran JRH, Paxton RJ, Bade MJ, Zeni JA, Stevens-Lapsley JE. Arthrofibrosis associated with total knee arthroplasty. J Arthroplasty 2017; 32 (08) 2604-2611
• 6 Yayac MF, Albana MF, Braithwaite HC. et al. A decade of experience with arthroscopic lysis of adhesions for arthrofibrosis after total knee arthroplasty. J Arthroplasty 2025; 40 (10) 2525-2530
• 7 Thompson R, Novikov D, Cizmic Z. et al. Arthrofibrosis after total knee arthroplasty: Pathophysiology, diagnosis, and management. Orthop Clin North Am 2019; 50 (03) 269-279
• 8 Williams III RJ, Westrich GH, Siegel J, Windsor RE. Arthroscopic release of the posterior cruciate ligament for stiff total knee arthroplasty. Clin Orthop Relat Res 1996; (331) 185-191
• 9 Middleton AM, Ziegele MJ, Vetter CS, Edelstein AI. Arthroscopic lysis of adhesions with manipulation for management of late-presenting stiffness after total knee arthroplasty. Arthroplast Today 2020; 6 (04) 761-765
• 10 Enad JG. Arthroscopic lysis of adhesions for the stiff total knee arthroplasty. Arthrosc Tech 2014; 3 (05) e611-e614
• 11 Boucher T, Barbera J, Gladstone JN, Kantrowitz DE. Arthroscopic lysis of adhesions for arthrofibrosis after total knee arthroplasty. AAOS Now Video. Published January 31, 2024. Accessed September 19, 2025 at: https://www.aaos.org/videos/video-detail-page/?id=27023__Videos
• 12 Jerosch J, Aldawoudy AM. Arthroscopic treatment of patients with moderate arthrofibrosis after total knee replacement. Knee Surg Sports Traumatol Arthrosc 2007; 15 (01) 71-77
• 13 Saltzman BM, Dave A, Young A, Ahuja M, Amin SD, Bush-Joseph CA. Prolonged epidural infusion improves functional outcomes following knee arthroscopy in patients with arthrofibrosis after total knee arthroplasty: A retrospective evaluation. J Knee Surg 2016; 29 (01) 40-46
• 14 Cohen JS, Gu A, Kapani N. et al. Efficacy of arthroscopic arthrolysis in the treatment of arthrofibrosis: A systematic review. J Knee Surg 2021; 34 (12) 1349-1354
• 15 Haffar A, Goh GS, Fillingham YA, Torchia MT, Lonner JH. Treatment of arthrofibrosis and stiffness after total knee arthroplasty: An updated review of the literature. Int Orthop 2022; 46 (06) 1253-1279
• 16 Schwarzkopf R, William A, Deering RM, Fitz W. Arthroscopic lysis of adhesions for stiff total knee arthroplasty. Orthopedics 2013; 36 (12) e1544-e1548
• 17 Diduch DR, Scuderi GR, Scott WN, Insall JN, Kelly MA. The efficacy of arthroscopy following total knee replacement. Arthroscopy 1997; 13 (02) 166-171
• 18 Mont MA, Seyler TM, Marulanda GA, Delanois RE, Bhave A. Surgical treatment and customized rehabilitation for stiff knee arthroplasties. Clin Orthop Relat Res 2006; 446 (446) 193-200
• 19 Hegazy AM, Elsoufy MA. Arthroscopic arthrolysis for arthrofibrosis of the knee after total knee replacement. HSS J 2011; 7 (02) 130-133
• 20 Bodendorfer BM, Kotler JA, Zelenty WD, Termanini K, Sanchez R, Argintar EH. Outcomes and predictors of success for arthroscopic lysis of adhesions for the stiff total knee arthroplasty. Orthopedics 2017; 40 (06) e1062-e1068
• 21 Tjoumakaris FP, Tucker BC, Post Z, Pepe MD, Orozco F, Ong AC. Arthroscopic lysis of adhesions for the stiff total knee: Results after failed manipulation. Orthopedics 2014; 37 (05) e482-e487
• 22 Arbuthnot JE, Brink RB. Arthroscopic arthrolysis for the treatment of stiffness after total knee replacement gives moderate improvements in range of motion and functional knee scores. Knee Surg Sports Traumatol Arthrosc 2010; 18 (03) 346-351
• 23 Lovro LR, Kang HP, Bolia IK, Homere A, Weber AE, Heckmann N. Knee arthroscopy after total knee arthroplasty: Not a benign procedure. J Arthroplasty 2020; 35 (12) 3575-3580
• 24 Niknam K, Lezak BA, Mercer NP. et al. Rates of periprosthetic joint infection and revision increase after arthroscopic lysis of adhesions subsequent to primary TKA. J Bone Joint Surg Am 2025; 107 (10) e49
• 25 Wahlig BD, Shirley MB, Hadley ML. et al. Knee arthroscopy following total knee arthroplasty is not associated with an elevated risk of infection. J Arthroplasty 2024; 39 (8S1): S290-S293
• 26 Heaven S, de Sa D, Simunovic N, Bedair H, Naudie D, Ayeni OR. Knee arthroscopy in the setting of knee arthroplasty. J Knee Surg 2017; 30 (01) 51-56