SURGICAL AND BIOLOGICAL MANAGEMENT OF SEVERE POST-SURGICAL KNEE ARTHROFIBROSIS: PREDICTORS OF FAILURE IN ARTHROSCOPIC RELEASE

Abstract

Introduction: Severe post-surgical knee arthrofibrosis has been characterized as a debilitating complication marked by excessive intra-articular fibrous tissue formation, resulting in significant loss of range of motion, persistent pain, and functional impairment. This condition has shown a higher incidence following ligament reconstructions, arthroplasties, and trauma-orthopedic procedures, and is associated with an exacerbated inflammatory response, fibroblast activation, disorganized collagen deposition, and alterations in tissue remodeling. Management of this complication has involved combined strategies, including arthroscopic release, manipulation under anesthesia, intensive rehabilitation protocols, and biological approaches aimed at modulating fibrosis. However, some patients have experienced a recurrence of joint stiffness, indicating the presence of predictors of treatment failure related to the degree of fibrosis, time to intervention, persistent inflammation, and individual patient characteristics. The objective of this systematic literature review was to analyze scientific evidence regarding the surgical and biological management of severe post-surgical knee arthrofibrosis, identifying key predictors associated with arthroscopic release failure and factors linked to better functional outcomes. Methodology: The systematic review was conducted in accordance with the PRISMA checklist, utilizing scientific articles published over the last 10 years in the PubMed, SciELO, and Web of Science databases. The descriptors used were: “knee arthrofibrosis,” “arthroscopic release,” “postoperative fibrosis,” “biological therapy,” and “predictors of failure.” Clinical studies, scientific reviews, and research involving patients with post-surgical knee arthrofibrosis were included. Duplicate studies, works without full-text access, and publications that did not address therapeutic interventions or prognostic factors were excluded. Results: The studies analyzed demonstrated that arthroscopic release remained an effective approach for restoring mobility; however, it carried a higher risk of failure in patients with advanced fibrosis, delayed intervention, multiple prior surgeries, and inadequate inflammatory control. Biological strategies involving modulation of the fibroproliferative response, cell-based therapies, and antifibrotic agents were identified as promising alternatives for reducing recurrence and improving healing. Conclusion: Evidence indicated that treating severe knee arthrofibrosis required an individualized approach combining early surgical intervention, structured rehabilitation, and control of the biological mechanisms underlying fibrosis. Identifying predictors of failure proved crucial for refining patient selection and enhancing the effectiveness of therapeutic strategies.