Imaging Findings in Arthrofibrosis of the Ankle and Foot

Abstract

Arthrofibrosis is defined as joint pain and stiffness that does not allow functional range of motion and is due to adhesions or contracture of the joint. Arthrofibrosis is characterized by an abnormal proliferation of fibrous tissue that may be focal or diffuse and intra-articular or extra-articular. Trauma and surgery are the most common etiological factors. In the ankle and foot symptomatic arthrofibrosis is not uncommonly seen in the talocrural joint, posterior subtalar joint, and the metatarsophalangeal joints. Imaging can assist with diagnosis and planning treatment, most commonly using MRI and occasionally ultrasound. Typical imaging findings consist of capsular and pericapsular thickening and scarring, best demonstrated on proton-density MR images but also demonstrable on ultrasound.

Keywords

arthrofibrosis - ankle - foot - magnetic resonance imaging - ultrasound

• References

• 1 Lee SK, Gargano F, Hausman MR. Wrist arthrofibrosis. Hand Clin 2006; 22 (4) 529-538 ; abstract vii
• 2 Barg A, Elsner A, Hefti D, Hintermann B. Haemophilic arthropathy of the ankle treated by total ankle replacement: a case series. Haemophilia 2010; 16 (4) 647-655
• 3 Harris JD, Siston RA, Brophy RH, Lattermann C, Carey JL, Flanigan DC. Failures, re-operations, and complications after autologous chondrocyte implantation—a systematic review. Osteoarthritis Cartilage 2011; 19 (7) 779-791
• 4 Strobel MJ. Manual of arthroscopic surgery. Berlin, Germany: Springer-Verlag; 2002: 718
• 5 Thomas B, Yeo JM, Slater GL. Chronic pain after ankle fracture: an arthroscopic assessment case series. Foot Ankle Int 2005; 26 (12) 1012-1016
• 6 Utsugi K, Sakai H, Hiraoka H, Yashiki M, Mogi H. Intra-articular fibrous tissue formation following ankle fracture: the significance of arthroscopic debridement of fibrous tissue. Arthroscopy 2007; 23 (1) 89-93
• 7 Lui TH. Arthroscopic subtalar release of post-traumatic subtalar stiffness. Arthroscopy 2006; 22 (12) 1364 , e1–e4
• 8 Lui TH. Arthroscopic release of first metatarsophalangeal arthrofibrosis. Arthroscopy 2006; 22 (8) 906 , e1–e4
• 9 Schuh R, Trnka HJ. Metatarsalgia: distal metatarsal osteotomies. Foot Ankle Clin 2011; 16 (4) 583-595
• 10 Paulos LE, Rosenberg TD, Drawbert J, Manning J, Abbott P. Infrapatellar contracture syndrome. An unrecognized cause of knee stiffness with patella entrapment and patella infera. Am J Sports Med 1987; 15 (4) 331-341
• 11 Enneking WF, Horowitz M. The intra-articular effects of immobilization on the human knee. J Bone Joint Surg Am 1972; 54 (5) 973-985
• 12 Cosgarea AJ, DeHaven KE, Lovelock JE. The surgical treatment of arthrofibrosis of the knee. Am J Sports Med 1994; 22 (2) 184-191
• 13 Evans EB, Eggers GW, Bulter JK , et al. Experimental immobilization and remobilization of rat knee joints. J Bone Joint Surg Am 1960; 42: 737-758
• 14 Noyes FR, Barber-Westin SD. Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation. Use of early protected postoperative motion to decrease arthrofibrosis. Am J Sports Med 1997; 25 (6) 769-778
• 15 Harner CD, Irrgang JJ, Paul J, Dearwater S, Fu FH. Loss of motion after anterior cruciate ligament reconstruction. Am J Sports Med 1992; 20 (5) 499-506
• 16 Shelbourne KD, Johnson GE. Outpatient surgical management of arthrofibrosis after anterior cruciate ligament surgery. Am J Sports Med 1994; 22 (2) 192-197
• 17 Robins AJ, Newman AP, Burks RT. Postoperative return of motion in anterior cruciate ligament and medial collateral ligament injuries. The effect of medial collateral ligament rupture location. Am J Sports Med 1993; 21 (1) 20-25
• 18 Gillespie MJ, Friedland J, DeHaven KE. Arthrofibrosis: etiology, classification, histopathology and treatment. Oper Tech Sports Med 1998; 6 (2) 102-110
• 19 Skutek M, Elsner HA, Slateva K , et al. Screening for arthrofibrosis after anterior cruciate ligament reconstruction: analysis of association with human leukocytes antigen. Arthroscopy 2004; 20 (5) 469-473
• 20 Freeman TA, Parvizi JA, Dela Valle CJ, Steinbeck MJ. Reactive oxygen and nitrogen species induce protein and DNA modifications driving arthrofibrosis following total knee arthroplasty. Fibrogenesis Tissue Repair 2009; 2 (1) 5
• 21 Distler JHW, Jüngel A, Pileckyte M , et al. Hypoxia-induced increase in the production of extracellular matrix proteins in systemic sclerosis. Arthritis Rheum 2007; 56 (12) 4203-4215
• 22 Zeichen J, Haeder L, Jagodzinski M, Lobenhoffer P, Bosch U, Brand J. Localisation of TGF-beta and PDGF and their relevance for the pathogenesis of arthrofibrosis. [in German]. Unfallchirurg 2008; 111 (2) 79-84
• 23 Bonner JC. Regulation of PDGF and its receptors in fibrotic diseases. Cytokine Growth Factor Rev 2004; 15 (4) 255-273
• 24 Unterhauser FN, Bosch U, Zeichen J, Weiler A. α-smooth muscle actin containing contractile fibroblastic cells in human knee arthrofibrosis tissue. Winner of the AGA-DonJoy Award 2003. Arch Orthop Trauma Surg 2004; 124 (9) 585-591
• 25 Zeichen J, van Griensven M, Albers I, Lobenhoffer P, Bosch U. Immunohistochemical localization of collagen VI in arthrofibrosis. Arch Orthop Trauma Surg 1999; 119 (5–6) 315-318
• 26 Border WA, Noble NA. Transforming growth factor β in tissue fibrosis. N Engl J Med 1994; 331 (19) 1286-1292
• 27 Sebastianelli WJ, Gillespie MJ, Hicks DG, DeHaven KE, Cosgarea AJ. The histopathology of arthrofibrosis. Arthroscopy 1993; 9: 359-360
• 28 Murakami S, Muneta T, Furuya K, Saito I, Miyasaka N, Yamamoto H. Immunohistologic analysis of synovium in infrapatellar fat pad after anterior cruciate ligament injury. Am J Sports Med 1995; 23 (6) 763-768
• 29 Fisher SE, Shelbourne KD. Arthroscopic treatment of symptomatic extension block complicating anterior cruciate ligament reconstruction. Am J Sports Med 1993; 21 (4) 558-564
• 30 Jackson DW, Schaefer RK. Cyclops syndrome: loss of extension following intra-articular anterior cruciate ligament reconstruction. Arthroscopy 1990; 6 (3) 171-178
• 31 Mariani PP, Santori N, Rovere P, Della Rocca C, Adriani E. Histological and structural study of the adhesive tissue in knee fibroarthrosis: a clinical-pathological correlation. Arthroscopy 1997; 13 (3) 313-318
• 32 Marzo JM, Bowen MK, Warren RF, Wickiewicz TL, Altchek DW. Intraarticular fibrous nodule as a cause of loss of extension following anterior cruciate ligament reconstruction. Arthroscopy 1992; 8 (1) 10-18
• 33 Wojtys EM, Oakes B, Lindenfeld TN , et al. Patella infera syndrome: an analysis of the patellar tendon pathology. Instr Course Lect 1997; 46: 214-250
• 34 Lui TH, Chan WK, Chan KB. The arthroscopic management of frozen ankle. Arthroscopy 2006; 22 (3) 283-286
• 35 Glazebrook MA, Ganapathy V, Bridge MA, Stone JW, Allard JP. Evidence-based indications for ankle arthroscopy. Arthroscopy 2009; 25 (12) 1478-1490
• 36 Amendola A, Petrik J, Webster-Bogaert S. Ankle arthroscopy: outcome in 79 consecutive patients. Arthroscopy 1996; 12 (5) 565-573
• 37 Lui TH. Ankle arthroscopy with patient in prone position. Arch Orthop Trauma Surg 2008; 128 (11) 1283-1285
• 38 Bonnin M, Bouysset M. Arthroscopy of the ankle: analysis of results and indications on a series of 75 cases. Foot Ankle Int 1999; 20 (11) 744-751
• 39 Brown CA, Toth AP, Magnussen B. Clinical benefits of intra-articular anakinra for arthrofibrosis. Orthopedics 2010; 33 (12) 877