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I wore a knee brace after ACL surgery and then developed arthrofibrosis. Now the surgeon is recommending manipulation. Will I just be adding insult to injury? Can this really help?

The use of a rehabilitation brace after ACL reconstruction is a topic of ongoing debate and discussion. At the present time, bracing after ACL repair is common. A recent survey showed that 85 per cent of surgeons used bracing for their ACL patients. Bracing is used an average of four weeks after the operation.

Some new studies have shown that bracing isn't needed, while others report bracing for at least three weeks helps prevent loss of knee extension.

With or without bracing, some patients develop enough scarring to cause loss of motion, a condition called arthrofibrosis. Significant loss of flexion or extension may require surgical intervention. Manipulation is the moving of a joint through its full motion while the patient is anesthetized.

Manipulation under anesthesia is done with the aid of an arthroscope. This device makes it possible for the surgeon to see inside the joint during the procedure. Using this technique, any nodules or loose fragments of cartilage or other tissue can be seen and removed. This process is called debridement.

The surgeon can determine how much of the joint is involved. The exact location of the problem can also be identified. This makes for more accurate and successful treatment with fewer problems afterwards.

Arthroscopic manipulation and debridement can be a very successful operation. Restoration of full and normal motion is the ideal outcome. In cases of severe arthrofibrosis, multiple surgical procedures are sometimes needed.

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