Risk factors, presentation, and management of arthrofibrosis in post-arthroscopic knee surgery: a systematic review

Abstract

Arthrofibrosis is a severe complication following arthroscopic knee surgery, particularly anterior cruciate ligament (ACL) reconstruction, leading to joint stiffness, pain, and functional limitations. Despite advancements in surgical and rehabilitation strategies, it remains a significant challenge in orthopedic practice. This systematic review examines the risk factors, clinical presentation, and management strategies for arthrofibrosis after arthroscopic knee surgery. A comprehensive literature search was conducted across PubMed, Embase, Scopus, Cochrane Library, and Web of Science following PRISMA guidelines. Studies addressing arthrofibrosis risk factors, diagnosis, and treatment outcomes were included. Relevant data were extracted and analyzed. Five studies met the inclusion criteria. Risk factors were categorized into surgical (graft malposition, prolonged tourniquet use, concomitant procedures), patient-related (prior surgery, systemic inflammation, genetic predisposition), and rehabilitation-associated (delayed mobilization, inadequate pain control). Clinically, arthrofibrosis presents as progressive stiffness, restricted range of motion, and quadriceps inhibition, often requiring imaging for confirmation. Management strategies range from early rehabilitation and pharmacological approaches to surgical interventions in refractory cases. Arthrofibrosis is a multifactorial condition requiring early recognition and targeted intervention. Preventive strategies focusing on optimized surgical techniques, patient selection, and rehabilitation protocols are essential. Further research is needed to develop novel antifibrotic therapies and improve functional outcomes.