International consensus on the definition and classification of fibrosis of the knee joint.
OBJECTIVE
The aim of this consensus was to develop a definition of post-operative fibrosis of the knee.


METHODS
An international panel of experts took part in a formal consensus process composed of a discussion phase and three Delphi rounds.


RESULTS
Post-operative fibrosis of the knee was defined as a limited range of movement (ROM) in flexion and/or extension, that is not attributable to an osseous or prosthetic block to movement from malaligned, malpositioned or incorrectly sized components, metal hardware, ligament reconstruction, infection (septic arthritis), pain, chronic regional pain syndrome (CRPS) or other specific causes, but due to soft-tissue fibrosis that was not present pre-operatively. Limitation of movement was graded as mild, moderate or severe according to the range of flexion (90° to 100°, 70° to 89°, < 70°) or extension deficit (5° to 10°, 11° to 20°, > 20°). Recommended investigations to support the diagnosis and a strategy for its management were also agreed.


CONCLUSIONS
The development of standardised, accepted criteria for the diagnosis, classification and grading of the severity of post-operative fibrosis of the knee will facilitate the identification of patients for inclusion in clinical trials, the development of clinical guidelines, and eventually help to inform the management of this difficult condition. Cite this article: Bone Joint J 2016;98-B:1479-88.
Newcastle University, NE2 4HH, UK.
N S
NS
Kalson
Newcastle University, Newcastle upon Tyne NE2 4HH, UK.
L A
LA
Borthwick
Newcastle University, Newcastle upon Tyne NE2 4HH, UK.
D A
DA
Mann
Freeman Hospital, Newcastle Hospitals NHS Trust, High Heaton, Newcastle upon Tyne, NE7 7DN, UK.
D J
DJ
Deehan
South Australian Health and Medical Institute, Adelaide, South Australia, Australia.
P
P
Lewis
Norfolk and Norwich University NHS Trust, Norwich, UK.
C
C
Mann
Cleveland Clinic , Cleveland, Ohio, USA.
M A
MA
Mont
University Hospital Llandough, Cardiff, UK.
R
R
Morgan-Jones
Institute of Sport, Exercise and Health, University College London Hospitals, 235 Euston Road, London NW1 2BU, UK.
S
S
Oussedik
King's College London, St Thomas' Hospital, London SE1 7EH, UK.
F M K
FM
Williams
Royal Devon and Exeter Hospital, Exeter, UK.
A
A
Toms
Sainte-Marguerite Hospital, Aix-Marseille University, Marseille, France.
J N
JN
Argenson
ZOL Hospitals Genk, Belgium.
J
J
Bellemans
Sinai Hospital, Baltimore, Maryland, USA.
A
A
Bhave
University of Bergen, Bergen, Norway.
O
O
Furnes
Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität, Ismaninger Str. 22, 81675 Munich, Germany.
H
H
Gollwitzer
University College London Hospitals, 235 Euston Road, London NW1 2BU, UK.
F S
FS
Haddad
LKH Stolzalpe Hospital & Teaching Hospital University Clinic Graz, Austria.
S
S
Hofmann
MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik, Trier, Germany.
V
V
Krenn
D000465:Algorithms; D032921:Consensus; D005355:Fibrosis; D006801:Humans; D007719:Knee Joint / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D016059:Range of Motion, Articular; D012042:Registries; D012720:Severity of Illness Index
Arthroplasty; Fibrosis; Knee