Lysis of Adhesions (LOA) Doctor

Do you have a stiff knee, or have you been diagnosed with stiff knee syndrome or arthrofibrosis? Arthrofibrosis can occur after knee surgery or after a traumatic injury. Arthroscopic knee surgeon, Doctor Riley J. Williams can treat stiff knee syndrome for patients in Manhattan, Brooklyn, New York City and surrounding areas, using a treatment called lysis of adhesions. This very specialized surgery should be done by an expert. For an evaluation of your knee stiffness and to see if you can be helped by this procedure, contact Dr. Williams’ team today!

What is knee arthroscopy lysis of adhesions (LOA)?

Knee arthroscopy lysis of adhesions is a minimally invasive surgery that uses small incisions and surgical tools to remove scar tissue and tightness in the knee. Lysis of adhesions involves cutting bands of abnormal tissue called adhesions. Scar tissue can form in the knee joint after an injury or prior surgery. Severe cases of scar tissue formation can lead to the development of arthrofibrosis (global knee scarring). Soft tissue adhesion and scar tissue can restrict movement in the joint, cause pain, and limit range of motion. The goal of lysis of adhesions is to restore near normal knee function and kinematics by removed all abnormal soft tissue connections and scar tissue. A deep understanding of knee anatomy and mechanics is necessary to treat knee dysfunction associated with adhesions, scar tissue and arthrofibrosis. Dr. Riley J. Williams, orthopedic knee surgeon, serving Manhattan, Brooklyn, New York City, NY and surrounding areas, has extensive experience in performing knee arthroscopy lysis of adhesions procedures.

Why is knee arthroscopy LOA performed?

Knee arthroscopy lysis of adhesions is performed on individuals who have exhausted conservative treatment methods for knee stiffness or arthrofibrosis (stiff knee syndrome). Knee arthrofibrosis can occur after a traumatic injury or surgery (i.e. ACL reconstruction or knee replacement). Stiff knee syndrome limits mobility because scar tissue entraps the knee joint structures. In this condition, the synovium (joint lining) becomes globally inflamed and thickens as a natural response to trauma. Arthrofibrosis causes muscle and connective tissue in the knee to shorten and stiffen. If physical therapy is unsuccessful in treating knee stiffness, lysis of adhesions (LOA) may be the next step in treatment.

How is knee arthroscopy LOA performed?

Sedation with regional anesthesia is most often used for this procedure.  Knee arthroscopy lysis of adhesions uses surgical tools and a small camera called an arthroscope. The knee is inflated with fluid to provide greater space and access within the joint for the procedure. Small incisions are made in the knee which allows for the arthroscope to project images of the injury onto a monitor. Adhesions are identified and then debrided with a surgical device called an arthroscopic shaver. Any areas of abnormal constraint or connection are released. Often an arthroscopic radiofrequency device is used for soft tissue release and vessel cautery during LOA. A lateral retinaculum release may be done as part of an LOA. This means the ligaments on the outer side of the knee are loosened for patients who experience limited patellar (kneecap) mobility. Improved patella mobility and excursion is a major goal of lysis of adhesions. Upon completion of the needed soft tissue releases, the knee is manipulated to confirm increased range of motion and normal stability.

As a note, more severe cases of arthrofibrosis may require a small incision to fully excise all of the scar tissue present. This is a judgment call that is determined by findings at the time of surgery. Fortunately, the need for open surgery does not change the postoperative management of affected patients.

What are the risks of lysis of adhesion surgery?

Knee arthroscopy lysis of adhesions is a simple procedure but the aftercare is important to maximize clinical results. The outcome of the surgery can be highly dependent on how quickly the surgery was performed after the onset of the arthrofibrotic condition. In the most severe cases, full knee range of motion may not be achievable even after surgery. Compliance with physical therapy is crucial to a successful outcome. The patient should expect swelling and soreness temporarily afterward the procedure. Other issues such as infection, bleeding, blood clots and continued stiffness are possible but rare.

How long does it take to recover from lysis of adhesions surgery?

Patients treated with lysis of adhesions go home the day of surgery. Range of motion exercises should be started the day following the procedure; physical therapy starts 3-5 days after surgery and continues 2-3 times per week for approximately eight weeks. After six weeks, improved range of motion and patella excursion should be observed. Pain medications, such as narcotics as well as NSAIDs (non-steroidal anti-inflammatory) medications will be necessary immediately following surgery. Crutches are recommended for the first three days after the procedure for swelling reduction and stability.

For additional resources on knee arthroscopy lysis of adhesions or to have your knee pain evaluated, please contact the office of Dr. Riley J. Williams, MD, orthopedic knee surgeon serving Manhattan, Brooklyn, New York City, NY and surrounding areas.