Lysis of adhesions

When adhesions form, they tie down certain common areas - the suprapatellar pouch above the kneecap, the anterior interval below the fat pad in the region of the patellar tendon, and the capsular folds at the back of the knee.

In addition a cyclops lesion may form in the front part of the notch, further limiting extension.

What are adhesions?

Adhesions are initially just sticky strands, and can fairly easily be broken with stretches and mobilisation massages around the patella.

If they become more intractable, it may be possible to break them with a manipulation under anaesthesia (MUA). If the knee continues to be inflamed and the adhesions are not broken, they may become more fibrous and turn into scar tissue that can contract and pull the soft tissue areas together too firmly to be broken with manipulations. At this stage they might yet be amenable to 'lysis of adhesions', where surgical methods are employed to break down the scar tissue.

• Quote from peer-reviewed paper:

  "....in the early postoperative period [o]nce motion loss has been identified, it can be a challenging complication to manage........If motion loss is more severe or identified outside of the early postoperative period (>3 months), an arthroscopic surgical intervention should be considered"

  Citation: Stiefel EC, McIntyre L. Arthroscopic Lysis of Adhesions for Treatment of Post-traumatic Arthrofibrosis of the Knee Joint. Arthrosc Tech. 2017 Jul 3;6(4):e939-e944. doi: 10.1016/j.eats.2017.03.001. PMID: 29487783; PMCID: PMC5800957.

• Quote from peer-reviewed paper:

  Arthroscopic lysis of adhesions "...for knee arthrofibrosis significantly improves the knee ROM and functional outcomes...."

  Citation: Abdelghafour KM, S Elkalyoby A, H Amer M, Abdelaziz MK. Arthroscopic Lysis of Adhesions for Treatment of Post-Traumatic Knee Arthrofibrosis: A Prospective Study. Cureus. 2023 Jan 2;15(1):e33275. doi: 10.7759/cureus.33275. PMID: 36606104; PMCID: PMC9809041.

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Arthroscopic lysis of adhesions

There are two surgical ways to tackle adhesions.

• arthroscopic - The common way is via an ordinary arthroscopy which will reach most of the areas of adhesion, where the surgeon will use an instrument such as an arthroscopic shaver or a radio-frequency instrument to suck away or 'melt' the adhesions. But if there are adhesions in the musculotendinour part of the joint, then it may be necessary to do an open procedure, such as a quadricepsplasty, where a proper surgical incision has to be made rather than simply small arthroscopic portals.
• open - But if there are adhesions in the musculotendinous part of the joint, such as under the quadriceps tendon or patellar tendon, then it may be necessary to do an open procedure, such as a quadricepsplasty. In this case a proper surgical incision has to be made rather than simply small arthroscopic portals.

• Quote from peer-reviewed paper:

  "....The procedure is performed with a standard 30° arthroscope, 4.0-mm arthroscopic shaver, and arthroscopic ablator....The surgeon should use electrocautery in areas of highly vascular scar tissue and place a surgical drain to decrease the risk of postoperative hemarthrosis...."

  Citation: Stiefel EC, McIntyre L. Arthroscopic Lysis of Adhesions for Treatment of Post-traumatic Arthrofibrosis of the Knee Joint. Arthrosc Tech. 2017 Jul 3;6(4):e939-e944. doi: 10.1016/j.eats.2017.03.001. PMID: 29487783; PMCID: PMC5800957.

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Is lysis of adhesions painful?

Pain management is very significant both during and after the surgery, as the pain after lysis of adhesions can be severe but the patient must keep complying with physiotherapy to mobilise the tissues and avoid the adhesions forming again, until the inflammatory process becomes dormant.

• Quote from peer-reviewed paper:

  "....A multimodal pain control regimen should be used, including narcotics, nonsteroidal anti-inflammatory drugs, and an indwelling peripheral nerve block."

  Citation: Stiefel EC, McIntyre L. Arthroscopic Lysis of Adhesions for Treatment of Post-traumatic Arthrofibrosis of the Knee Joint. Arthrosc Tech. 2017 Jul 3;6(4):e939-e944. doi: 10.1016/j.eats.2017.03.001. PMID: 29487783; PMCID: PMC5800957.

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Forum discussions

• Sway's lysis of adhesions

  A patient gives her early experience of LOA.

• Re: knee manipulation

  A discussion of both manipulation under anaesthesia and lysis of adhesions.

• Advice needed on LOA/AIR after Vail visit.....

  An athlete finds his life upside down after adhesions complicate surgery.

• Compilation of Arthrofibrosis Success Stories Timelines

  A group of patients try to determine a timeline for recovery from knee arthrofibrosis.

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