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Imagine you've been through a common orthopedic surgery, and you've completed your follow-up care, but your knee (or elbow or ankle or shoulder) continues to hurt, and your range of motion is getting more and more limited. Your surgeon isn't interested, physical therapy is excruciating, and no one seems to be able or willing to explain what's going on. This is the experience of many people with arthrofibrosis. WHAT IS ARTHROFIBROSIS? Arthrofibrosis is a condition involving the manufacture of excessive extracellular matrix (ECM) inside and around joints because of dysregulation of the inf lammatory and healing processes. This causes a buildup of connective tissue: mostly collagen, but heterotopic ossification—bone-like material in soft tissues—is possible too. And all this typically happens in and around a major synovial joint: a knee, an elbow, a shoulder (where it might be identified as adhesive capsulitis or frozen shoulder). It is often triggered by a surgery or injury, but it could be related to other factors too. When it occurs as a complication of knee surgery, it has this definition: ". . . a limited ROM (range of motion) in extension and/or f lexion, measured by active f lexion and extension, which was not caused by infection or other specific causes." 1 Another definition is a bit simpler: "Arthrofibrosis is defined as joint pain and stiffness that does not allow functional range of motion and is commonly due to adhesions, scarring, and contracture of the joint." 2 This description suggests arthrofibrosis must be very common. But searches of well-respected sources of information about diseases and conditions (e.g., the National Institute of Arthritis and Musculoskeletal and Skin Diseases, and Emedicine.com) yield little or no discussion about this condition. One obstacle to understanding arthrofibrosis is that it has no consistently-used diagnostic criteria. Some resources suggest it should only be diagnosed when the situation is severe enough to require surgical 70 m a s s a g e & b o d y wo r k m ay/ j u n e 2 0 2 3 critical thinking | PATHOLOGY PERSPECTIVES Arthrofibrosis The Most Common Problem You've Never Heard Of By Ruth Werner TAKEAWAY: Arthrofibrosis is common and can be debilitating. But because it doesn't have an agreed-upon diagnostic criteria, many professionals don't acknowledge or understand how important it is.