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Physical Therapy For Contractures After Knee Surgery – Information, Exercises, and More

You’ve recently had knee surgery and you’re experiencing pain and stiffness that is preventing you from regaining your full mobility. 

These symptoms are likely due to contractures and are somewhat common after knee surgery. We understand the frustration that comes with them. 

And we’re here to help.

In this guide, we’re discussing everything you need to know about knee contractures including symptoms, causes, exercises, and more.

What Are Contractures After Knee Surgery?

Contractures occur when your tendons, joints, muscles, or other tissues shorten or tighten, resulting in a deformity or stiffness. They develop due to the failure of your knee flexors to lengthen alongside the bone. 

The envelope of the knee—the capsule—becomes rigid and stiffens, making the knee unable to move the way it should. 

Contractures are also referred to as flexion deformities, or sometimes, arthrofibrosis of the knee—the contractures are actually the hardening and shortening of the muscles and connective tissues.

What Causes Contractures After Knee Surgery?

Knee contractures happen due to excessive scar tissue forming within the joints and soft tissues of your knee. 

Knee contractures are most commonly seen after total knee arthroscopies (TKA) or after anterior cruciate ligament reconstruction surgeries. In fact, knee contractures are one of the most common total knee replacement complications.

Knee contractures after knee surgery may also be caused by: 

  • Insufficient pain control
  • Poor motion prior to surgery
  • Excessive scar formation

Certain risk factors may increase your chances of knee contractures.

Knee Contractures Risk Factors

There are many factors that may put you at a higher risk for knee contractures. Some risk factors of contractures include: 

  • Inherited disorders—ie: muscular dystrophy
  • Reduced usage or lack of mobility 
  • Nerve damage
  • Stroke
  • Tenosynovitis
  • Muscle or bone injuries
  • Scarring after injuries or burns

No matter the cause, contractures occur after your body’s natural response to trauma—whether from injury or surgery—to make scar tissue. But sometimes your body doesn’t get the message to stop healing itself so it continues to make scar tissue. 

Because scar tissue is dense and fibrous, an abundance of it can bind down your joints and prevent a normal range of motion of the knee.   

Symptoms of Contractures After Knee Surgery

The most common symptoms associated with contractures are:

  • Pain
  • Morning stiffness
  • Decreased knee flexion
  • Loss of knee extension abilities 
  • Walking with a bent knee
  • Weak quadriceps—this is the muscle at the front of your thigh that helps you extend your leg.

Treatment for Contractures After Knee Surgery

Several treatment options are available for contractures after knee surgery including: 

  • Physical therapy (PT)
  • Manipulation under anesthesia 
  • Arthroscopic arthrolysis 
  • Open debridement
  • Revision surgery

Proper treatment will depend on the cause of the stiffness and the time that has passed since your knee surgery—your doctor will suggest the best treatment for your unique situation.

Post-Total Knee Replacement Arthroscopic Arthrolysis

Your surgeon may recommend an arthroscopic arthrolysis if you’re experiencing… 

  • Knee pain
  • Swelling
  • Redness, or
  • Loss of motion—contractures 

that isn’t improving over time. 

Using a very small tool known as an arthroscope, your surgeon will pass through an incision in the skin. The surgeon will look for any issues, like dense fibrous tissue, that could be the cause of your contractures.

 If this tissue is present, he/she will insert small tools through the arthroscope to remove the tissue. 

Manipulation Under Anesthesia

Another effective treatment for contractures after knee surgery is manipulation under anesthesia

Prior to the procedure, your doctor will give you general anesthesia to keep you asleep and pain-free. Then your doctor will move your knee in different directions multiple times.

This movement will help break up any scar tissue and increase your range of motion.

Open Debridement

During this procedure, your doctor will remove dead or infected tissue that could play a role in your knee contractures.

Revision Knee Replacement

Revision surgery is done as a last resort when all other treatment options fail. 

Your surgeon will adjust the bone cuts and the size of the new replacement to allow for better range of motion of your knee.

Physical Therapy For Contractures After Knee Surgery – Will PT Help?

Whether you’re looking for an alternative to another surgery for the contractures you’ve been experiencing after knee surgery or you’re looking for rehabilitation options after surgery to correct knee contractures — physical therapy can absolutely be the answer. 

Occupational and physical therapy are two of the most common treatments for contractures. 

These therapies can help you increase your range of motion and strengthen the muscles of the knee.

Best Exercises for Contractures After Knee Surgery

Physical therapy exercises for contractures can help increase your range of motion and decrease the pain you’re experiencing. 

Your Doctor of Physical Therapy will advise you on the best exercises to meet your rehabilitation goals.  

Lateral Leg Flexion/Extensions

Start by sitting on the edge of a chair. 

Increasing Flexion: Cross your ankles and place your uninjured/unaffected leg on top of your injured/affected leg. Pull your legs back under the chair using the unaffected leg.

Increasing Extension: Cross your ankles and place your uninjured/unaffected leg under your injured/affected leg. Slowly straighten your leg using your unaffected leg. 

Prone Knee Hang Exercises

Knee hang exercises improve range-of-motion when extending your knee. 

Lay belly down on the edge of a bed with a towel rolled and resting above your knee cap on your affected leg. Let gravity extend your knee downward and hold this position for thirty seconds. 

Repeat this exercise in four sets at least three times a day.

How In Motion O.C. Can Help With Contractures After Knee Surgery

In Motion O.C. has helped dozens of patients overcome contractures after knee surgery.  We understand the importance of proper rehabilitation and healing in order to get back to living a pain-free life. 

As the #1 Physical Therapist in the entire country on Yelp! and Google, our mission is to give hope, healing, confidence, and joy to others. 

And we’re ready to help you get back to living pain-free.

*This information about physical therapy for contractures after knee surgery was reviewed by Dr Natalie Thomas, PT, DPT. If you have any questions, please don’t hesitate to contact us here.

In Motion O.C.