Arthrofibrosis After Total Knee Arthroplasty: Biological Mechanisms, Diagnosis, and Treatment: An International Consensus Symposium.

Abstract

Arthrofibrosis following total knee arthroplasty (TKA) is a challenging complication that contributes to failure to achieve functional range of motion and results in physical impairment, pain, and revision surgery. Despite increasing recognition of arthrofibrosis as a biological disease process rather than a purely mechanical complication, there is no single document that integrates current evidence on diagnosis, surgical management, and preventive strategies. In June 2025, the Stavros Niarchos Foundation Complex Joint Reconstruction Center at Hospital for Special Surgery convened an international symposium to address arthrofibrosis following TKA. Invited experts in orthopedic surgery, basic science, biomechanics, and outcomes research were organized into 3 panels focused on (1) basic science, diagnosis, and risk stratification; (2) surgical management and postoperative rehabilitation; and (3) prevention strategies and adjunctive therapies. Each panel reviewed the literature, addressed predefined clinical questions, and developed consensus through structured discussion. This summary describes the recommendations from each panel, emphasizing early, multispecialty evaluation, stage-specific intervention, and procedure-specific rehabilitation strategies. Gaps in the evidence and priorities for future research are highlighted. These recommendations aim to standardize care, guide clinical decision-making, and shift the focus from late salvage toward early identification and prevention of arthrofibrosis following TKA. Level of Evidence: Level V: expert opinion.