Have you been having knee stiffness for some time after a surgical procedure due to adhesions or arthrofibrosis and your doctor has suggested a knee arthrolysis or manipulation under anaesthesia?
Working as a radiographer, I frequently see these procedures performed and I was able to speak with one of the surgeons who performs knee arthrolysis who answered the commonly asked questions about the procedure.
In this article I share insights and knowledge on this topic, drawing upon clinical research results involving individuals who have undergone either forced manipulation or arthrolysis cure.
At the end of the article, you will find all the sources I rely on, as well as a comment section where you can share your thoughts or ask questions.
Happy reading:😀 and feel free to ask questions in the comments or share your own experience.🙏
Last updated: Dec, 2025. Written by Juliet Semakula, a diagnostic radiographer.
▶️What is arthrolysis of the knee?
Arthrolysis literally means ‘realise of the joint ‘, it’s a medical term aimed at freeing a stiff or fixed joint.
Arthrolysis of the knee is a surgical procedure to cut or release scar tissue that is limiting the knee’s range of motion, often caused by trauma or previous surgery.
It aims to debride the scar tissue and restore normal function by improving both flexion and extension, as well as patellar mobility.
During the procedure fibrosis, adhesive or scar tissue that has been formed within the joint, beneath the skin is eliminated through the process of arthrolysis.
There are different arthrolysis techniques used by surgeons. Here are the 3 main types of knees arthrolysis I normally see in theatre:
▶️Manipulation Under Anaesthesia (MUA):
Knee manipulation is often performed after a total knee replacement to break up scar tissue and free up the joint capsule, helping to reduce pain and stiffness.
Knee manipulation is a non-surgical procedure which involves a surgeon gently but forcefully moving the knee joint under anaesthesia to break up fibrous adhesions and restore range of motion.
It is more like a physical therapist might do during a therapy session though the force applied here is a bit more, that’s why we call it manipulation.
These procedures often take 15 to 30 minutes; the surgeon will gently but firmly move your knee joint through its full range of motion to stretch the surrounding tissues and break up any adhesions.
The surgeon normally injects local anaesthetic to help with post-operative pain.
I have seen patients go home the same day, you will be monitored as you recover, you will likely have swelling and soreness for which your doctor may prescribe ice and pain medication.
▶️Knee arthroscopic arthrolysis
It involves releasing fibrous bands and adhesions in various knee compartments, including the suprapatellar pouch and posterior capsule.
This procedure aims to improve the knee’s range of motion, often following knee surgery or trauma
This is a minimally invasive surgical technique (keyhole surgery) were
🟣An arthroscope (a tiny camera with a light) and small instruments are inserted into the joint through small incisions to directly visualize and remove scar tissue and adhesions.
🟣Local anaesthesia is used to help with pain during the procedure.
▶️Open arthrolysis of the knee involves
A larger incision opening, providing the surgeon with direct and broad access to the knee joint. Local anaesthesia is given to help with pain.
Blauth,1990
Image 1 showing adhesion to the suprapatellar fat pad, image 2 shows release of adhesion to the suprapatellar fat pad, image 3 shows the contracture of the patellar retinaculum and image 4 shows release of the posterior joint capsule. (images from Pujol,2015)
▶️When will your doctor recommend knee arthrolysis?
Normally when you have severe knee stiffness (arthrofibrosis) caused by excessive scar tissue formation or other factors, your doctor may recommend knee arthrolysis.
It is always important to determine the source of the stiffness, as this information will determine which knee surgery should be performed.
Most patients I see who undergo knee arthrolysis normally have:
🔵Knee stiffness which can persists despite dedicated, non-surgical efforts (such as physical therapy, rest, and anti-inflammatory medications) for typically at least 3 to 6 months
🔵Post-operative stiffness after fractures such as tibial plateau, patella and tibia and fibula or femur
🔵Mechanical blocks confirmed by imaging: In some cases, imaging can confirm specific mechanical issues like a “cyclops lesion” (a type of fibrous mass) or bone spurs that physically impede movement
▶️What is adhesion in the knee?
Adhesion in the knee is a condition called arthrofibrosis, which involves the formation of scar tissue bands that bind together tissues that are normally separate.
When someone has a very stiff knee following a prosthesis, fracture, or knee surgery, it is often suspected that it is due to adhesions or fibrosis in the knee, under the skin. This is also called “arthrofibrosis” or “joint fibrosis.”
This causes the knee to feel stiff, painful, and can limit its range of motion after an injury or surgery.
The condition is a result of the body’s natural repair response to trauma or surgery.
▶️How do you know if you have adhesions in your knee?
Patients I see in radiology after surgery are always told to watch out for stiff knees following surgery or trauma which lasts for a few weeks, such stiffness is called knee adhesion.
The primary indicator of knee adhesions is a persistent limited range of motion that does not improve with standard physical therapy
Most people always have these key symptoms:
♦️A prominent feeling of tightness or restricted movement in the knee joint.
♦️Inability to fully straighten or bend the knee often resulting in a bent-knee gait or a noticeable limp.
♦️Pain that persists ranging from a dull ache to sharp pain when moving the leg and often gets worse over time instead of improving after an injury or surgery.
♦️ Ongoing inflammation or swelling around the knee joint, warm to touch.
♦️The joint may feel as if something is physically preventing movement, a feeling of catching or blocked sensation.
♦️Grating or crunching sensations (crepitus) noises or feelings when moving the knee.
♦️Weakness in the quadriceps large muscle at the front of the thigh may atrophy due to the inability to fully use the leg.
Having these symptoms does not normally confirm that you have adhesions, you will have to consult an orthopaedic specialist or surgeon for a proper diagnosis.
Scans such as ultrasound and MRI are normally done to better visualise these adhesions. However, they do not determine the treatment option you may have.
▶️How to avoid or prevent knee adhesions?
There are different methods that are prescribed to people with stiff knees that are thought to help prevent knee adhesions.
For example:
♦️Consistently performing prescribed range of motion such as heel slides, seated kicks and standing marches as soon as your doctor permits.
♦️Stretching exercises from your physio are known to help break up scar tissue. Using devices like an exercise bike, if you can’t pedal all the way around, you can use it to move your leg forward and back to assist with the motion.
♦️Gentle scar massage on the knee if you have one, however I do not think there’s any benefit to massaging the scar to prevent adhesions, but it may make you feel better, and it has no harm.
♦️You may consider aquatic therapy is known to improve flexibility and mobility while reducing stiffness.
It is crucial to start these exercises early in your recovery and to follow your physical therapist’s or doctor’s guidance to prevent excessive scar tissue build up.
▶️Can arthrolysis treat knee adhesions?
Yes, in theory arthrolysis is known to effectively treat knee adhesions, particularly when the cause is stiffness. It is most effective when performed early after the onset of stiffness (Pujol,2015)
Success is significantly influenced by the timing of the surgery and the underlying cause of the stiffness.
▶️Research studies about how successful is knee arthrolysis?
To answer this question, I rely primarily on data from clinical studies that have followed up people who have had knee arthrolysis.
Different researchers have analysed the effectiveness of arthroscopic arthrolysis of the knee joint.
Case study:
A total of 27 patients who had undergone knee arthroscopic arthrolysis were assessed over periods ranging from 2 days to 1 year after the procedure.
The arthroscopic procedure included removal of fibrous adhesions within the suprapatellar pouch, restoration of medial and lateral gutters, and lateral retinacular release of the patella.
The recovery of knee joint range of motion across these follow-up periods (Zhunussov,2025)
Results from the study:
To evaluate the quality of restoration of knee joint motion, the Knee Society Score was utilized. The follow-up period ranged from 2 to 5 years.
Pain and functional outcomes were evaluated using Knee Society Score (KSSs).
🔀Clinical improvements were evident in 26 cases.
🔀Pain scores improved from 30 to 41.
🔀Only one patient did not experience positive outcomes following the procedure.
The table below illustrates improvement in knee stiffness before and after the procedure.
The table shows Range of motion recovery in the knee joint following arthroscopic arthrolysis (Zhunussov,2025)
Conclusion:
♦️The mean functional scale of motion in the knee joint demonstrated substantial improvement from a preoperative average of 153 degrees flexion to 70 degrees at the final evaluation at one year.
♦️Pain scores similarly showed improvement, increasing from an average of 30 points preoperatively to 41 points postoperatively.
Another clinical case:
A 62-year-old female patient underwent total right knee arthroplasty one year prior to her presentation.
Initially, postoperative recovery was uneventful; however, eight months after surgery she began experiencing pain along the lateral aspect of the knee joint and a progressive reduction in range of motion, particularly with knee flexion (Zhunussov,2025)
♦️Upon clinical examination pain was localized beneath the patella along its lateral border.
♦️Knee flexion was restricted to no more than 110 degrees, while knee extension was complete at 180 degrees.
solution: Patient underwent arthroscopic revision of the right knee joint using standard access with a 30-degree arthroscope.
Intraoperative findings:
♦️Included impingement syndrome between the lateral border of the patella and the lateral aspect of the femoral component, accompanied by marked synovial hyperplasia.
♦️The hypertrophic synovial tissue had adhered to Hoffa’s fat pad and was entrapped between the polyethylene insert and prosthetic components during knee flexion.
Results:
♦️Adhesive tissues were eliminated using an open arthrolysis and treated the impinging patellar surface using a mechanical shaver, subsequently smoothing it via electrocoagulation.
It was concluded that the cause of the patient’s patellar impingement and pain syndrome was an inadequate rotational alignment of the femoral component, which ideally should have been rotated at least 3 degrees relative to the mechanical axis of the knee joint during the first operation.
The patient underwent follow-up examinations at 3, 6, and 12 months postoperatively, reporting no further complaints
♦️The range of motion in right knee joint had fully recovered, achieving flexion of 70 degrees and extension of 180 degrees at the 1-year follow-up
A systematic review by (Haffar et al 2022) was performed to compare the outcomes of:
♦️Manipulation under anaesthesia (21 studies found)
♦️Arthroscopic lysis of adhesions (7 studies found)
♦️Open knee revision for arthrofibrosis and stiffness following total knee replacement (14 studies found).
Here are its main results
🔀The median or average value of knee flexion after the operation was equal to or greater than 90°.
🔀In 30% of studies on knee manipulation under anaesthesia.
🔀In 71% of studies on arthrolysis.
🔀In 70% of studies on prosthesis intake.
🔀Scores on tests assessing knee pain and function were better for people who had undergone mobilization or arthrolysis.
🔀43% of people who had a revision of the prosthesis had to have further care afterwards, compared to 25% of those who were mobilized, and 17% of those who had knee arthrolysis.
Source: Haffar et al 2022:
| What can we conclude from these studies:Arthroscopic arthrolysis or mobilization under anaesthesia appears to be a safe and effective technique for managing specific complications of total knee replacement, particularly those involving mixed contracture and patellofemoral impingement syndrome.But they are not “miracle cures” for knee stiffness. More than half of people have less than 90° of knee flexion. |
▶️What are the possible complications and risks of knee arthrolysis?
Knee arthrolysis is generally a safe procedure, but it carries potential complications and risks, though many are rare (less than 1 in 100 people).
Complications are more frequent after knee arthrolysis than after mobilization under anesthesia. However, they remain rare
These can be broadly categorized into general surgical risks and specific knee-related issues and can make the situation worse afterward.
Like any surgical procedure, arthrolysis involves general risks including:
🔴Infection: Superficial wound infections or deep joint infections (septic arthritis), which may require further treatment like antibiotics or surgical washout.
🔴Bleeding/Hemarthrosis: Bleeding into the joint, causing swelling and pain.
🔴Deep vein thrombosis (DVT) in the leg, with a rare risk of a portion of the clot traveling to the lungs (pulmonary embolism), which can be fatal.
🔴Anaesthesia Risks: Allergic reactions or breathing difficulties related to the aesthesia.
🔴Wound Healing Issues: Problems with the surgical incisions.
▶️Specific Knee-Related Complications
Specific risks associated with the knee joint, and the procedure itself include:
🔴Remaining or Recurrent Stiffness: The primary risk is that the stiffness (arthrofibrosis) may not be fully resolved or could return after the surgery.
🔴Nerve or Vascular Damage: Damage to nearby nerves or blood vessels is a potential, though rare.
🔴The surgical instruments could potentially damage existing cartilage, the meniscus, or ligaments during the adhesion removal process.
🔴In patients who have had a prior total knee replacement, there is a risk of a bone fracture (e.g., distal femoral or periprosthetic fracture), especially if the knee is forced.
Source Kylies,2025
▶️What is the recovery time for arthrolysis of the knee?
Recovery time for knee arthrolysis, or arthroscopic lysis of adhesions, varies from one week to several months, depending on the individual and the complexity of the procedure.
Here are proposed timelines being observed from people who have had these kinds of operations.
| Phase | Timeline |
| ⚫Focus on rest, pain management. ⚫Reducing swelling with ice and elevation. | Initial phase (first 1–2 weeks) |
| ⚫Pain should start to decrease. ⚫Gentle exercises will increase, and you may be able to resume some more strenuous activities. ⚫To return to activities that involve heavy lifting or strenuous work. | Intermediate phase (2–6 weeks) 6-12 weeks |
| ⚫Most individuals can gradually return to almost all desired activities. ⚫Full strength and movement should be restored, although some may need several months for complete recovery from more complex repairs. ⚫The timeline can be significantly longer for strenuous physical jobs. | Long-term recovery (6 weeks and beyond) |
▶️What are some of the factors that influence recovery?
⚫Job type: The physical demands of your job are a major factor.
⚫Individual progress: Recovery is different for everyone and depends on the starting point and goals.
⚫Surgery complexity: A simple procedure will have a shorter recovery than one involving extensive tissue repair.
⚫Adherence to rehabilitation: Consistent physical therapy and following your doctor’s instructions are crucial for success.
What rehabilitation after knee arthrolysis?
After knee arthrolysis, rehabilitation involves an intensive and structured physiotherapy program focused on:
♦️Immediately restoring and maintaining a full range of motion.
♦️Strengthening the surrounding muscles.
♦️Managing pain and swelling.
Normally postoperative rehabilitation begins in the recovery room, displaying the motion gain to you and family while your pain is still controlled.
Here are some rehabilitation guidelines normally given to patients after surgery. Remember different protocols are proposed depending on the surgical or rehabilitation team:
These protocols will depend on individual cases, some doctors prescribe arthromotor device, physiotherapy sessions and sometimes no physio is prescribed but you are encouraged to maintain knee flexion or extension exercise at home
▶️How to manage pain and swelling:
1️⃣You are normally prescribed pain medication by your doctor.
2️⃣You will be instructed to elevate the leg above heart level.
3️⃣For swelling, applying ice packs for 15-20 minutes every two hours (with a towel barrier to the skin) is ideal for some people.
Early Mobilization:
1️⃣Passive mobilization often begins immediately in the recovery room, sometimes with a Continuous Passive Motion (CPM) machine, to maintain the range of motion achieved during surgery.
2️⃣Full weight bearing is normally encouraged immediately in the recovery room. You may be given crutches to help you move around.
Simple leg Exercises:
1️⃣You will be encouraged to try ankle Pumps moving your ankles up and down to promote circulation and prevent blood clots.
2️⃣Or quadriceps Sets by tightening the thigh muscle with the leg straight, pushing the back of the knee into the bed. Hold for 5 seconds and repeat frequently.
3️⃣Gently slide the heel toward the buttocks to bend the knee, then straighten the leg again, within comfort levels.
Rehabilitation Phase (Weeks 1-6)
This phase focuses on restoring full motion and beginning strengthening exercises.
♦️Progressive Range of Motion: Gradually increase knee flexion and, most importantly, achieve full extension (straightening).
♦️Heel props (resting the heel on a rolled towel to let gravity aid extension) and supported knee bends are common.
Strengthening:
♦️Straight Leg Raises: Lift the entire straight leg off the bed to strengthen the quadriceps.
♦️Short Arc Lifts: With a towel roll under the knee, lift the foot to straighten the knee fully.
♦️Mini-Squats: Stand and slowly bend knees slightly, using a chair for balance.
Advanced Recovery (Weeks 6+)
The focus shifts to building functional strength, balance, and a gradual return to activity.
♦️Higher Intensity Strengthening: Introduce resistance training using ankle weights, resistance bands, leg presses, and lunges.
♦️Balance & Proprioception: Exercises like single leg stands help restore coordination and stability.
♦️Return to Sport/Work: A gradual return to physically demanding jobs or sports will be guided by your physiotherapist and surgeon, typically taking several months for a full recovery.
High-impact activities like running or jumping should be avoided until cleared by your medical team.
Throughout recovery, close cooperation between you, your surgeon, and your physiotherapist is essential to ensure a smooth and effective return to full function.
I have not observed in all the studies that recovery was significantly better or worse depending on the protocol followed, either in the short or long term.
We have come to the end of this article, questions are welcome, wishing you a quick recovery!
Here are other articles you may be interested in.
⚫3 exercises to regain flexibility in the knee.
⚫Is cold or hot therapy ,which is the best to us.
Sources:
Blauth W, Jaeger T. Die Arthrolyse des Kniegelenks [Arthrolysis of the knee joint]. Orthopade. 1990 Nov;19(6):388-99. German. PMID: 2277711.
Pujol N, Boisrenoult P, Beaufils P. Post-traumatic knee stiffness: surgical techniques. Orthop Traumatol Surg Res. 2015 Feb;101(1 Suppl):S179-86. doi: 10.1016/j.otsr.2014.06.026. Epub 2015 Jan 9. PMID: 25583236.
Zhunussov, Y.; Danenov, Y.; Alimbek, G. Arthroscopic Arthrolysis of the Knee Joint Following Total Knee Arthroplasty. J. Clin. Med. 2025, 14, 4917. https://doi.org/10.3390/jcm14144917
Hegazy AM, Elsoufy MA. Arthroscopic arthrolysis for arthrofibrosis of the knee after total knee replacement. HSS J. 2011 Jul;7(2):130-3. doi: 10.1007/s11420-011-9202-7. Epub 2011 May 19. PMID: 22754412; PMCID: PMC3145854.
Sebastian AS, Sathikumar AS, Thomas AB, Varghese J. Arthroscopic Arthrolysis of Knee: Timing, Technique and Results. Indian J Orthop. 2023 Dec 30;58(2):210-216. doi: 10.1007/s43465-023-01081-4. PMID: 38312902; PMCID: PMC10830982.
Knapp P, Weishuhn L, Pizzimenti N, Markel DC. Risk factors for manipulation under anaesthesia after total knee arthroplasty. Bone Joint J. 2020 Jun;102-B(6_Supple_A):66-72. doi: 10.1302/0301-620X.102B6.BJJ-2019-1580.R1. PMID: 32475279.
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 Jun;46(6):1253-1279. doi: 10.1007/s00264-022-05344-x. Epub 2022 Mar 18. PMID: 35301559.
Kylies J, Fahlbusch H, Brauneck E, Bannier D, Berninger MT, Frings J, Frosch K, Krause M. Arthroscopic Arthrolysis, a Minimally Invasive Approach to Treat Arthrofibrosis of the Knee,Arthroscopy Techniques, Volume 14, Issue 5,2025,103446,ISSN 2212-6287 https://doi.org/10.1016/j.eats.2025.103446.