Manipulation under anaesthesia or arthroscopic release: which fixes a stiff knee after surgery?

The short verdict

Timing and the cause of the stiffness usually decide. In the first weeks to few months after a knee replacement or ligament reconstruction, scar tissue is still soft, and a manipulation can restore bending without incisions. When stiffness has lasted longer, scar tissue is thicker and a careful release from inside the joint is safer and more effective. Sometimes both are done in the same session.

How they compare

• What is done: manipulation moves the knee through its range under anaesthetic; arthroscopic release removes or divides scar tissue through small incisions
• Usual timing: manipulation is most effective early, usually within about three months; release suits stiffness that is established or late
• Loss of straightening: a knee that will not straighten fully, for example from a scar nodule after ACL surgery, usually needs arthroscopy rather than manipulation
• Risks: manipulation carries a small risk of fracture or tendon injury, higher with weak bone or late timing; arthroscopy has the usual small surgical risks
• Recovery: both need intensive physiotherapy starting immediately to keep the gained movement
• Specific causes: implant problems or infection must be excluded first, and some need a different operation

Who each option tends to suit

Manipulation tends to suit someone who is a few weeks to a few months after a knee replacement and cannot bend enough despite good physiotherapy. Arthroscopic release tends to suit someone with stiffness lasting many months, a block to straightening after ligament surgery, a scar nodule, or stiffness after a knee replacement that is too late for safe manipulation. Rarely, an open release or revision is needed.

When to see a knee surgeon in Doha

Do not wait for a stiff knee to free itself. If bending or straightening is not progressing in the weeks after surgery, or it is getting worse, contact your surgeon early, because earlier treatment is simpler. Dr. Gelber at Aman Hospital will measure your movement, check X-rays and blood tests to exclude other causes, and explain which approach fits your situation.