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Key Points About Manipulation Under Anesthesia (MUA) and Postoperative Stiffness

Key Points About Manipulation Under Anesthesia (MUA) and Postoperative Stiffness

  1. Why Stiffness Occurs After Surgery
  • Postoperative stiffness (arthrofibrosis) and algoneurodystrophy (complex regional pain syndrome, CRPS) are common complications after knee surgery.
  • Scar tissue formation, inflammation, pain, or fear of movement can limit joint mobility. CRPS adds nerve-related pain and hypersensitivity, worsening stiffness.
  1. What MUA Aims to Do
  • Break adhesions: The surgeon gently forces the knee into flexion/extension under anesthesia to mechanically break scar tissue.
  • Complementary arthroscopy: Cleaning the joint (debriding scar tissue or debris) may further improve mobility.
  • Immediate gains: Many patients see improved range of motion (ROM) right after MUA, but maintaining it requires aggressive rehab.
  1. Will the Knee Bend Easily After MUA?
  • Short-term improvement: Most patients regain significant ROM immediately after MUA.
  • Long-term success depends on:
    • Rehab compliance: Daily physiotherapy is critical to prevent scar tissue from reforming.
    • CRPS management: If algoneurodystrophy is active, pain control (e.g., medications, nerve blocks) and desensitization therapy are key.
    • Timing: Earlier MUA (within 3–6 months post-op) tends to yield better results.
  1. Risk of « Going Back to Square One »
  • If rehab is inconsistent or CRPS isn’t controlled, stiffness can return. However, MUA combined with arthroscopy and a strict rehab plan often provides lasting improvement.
  • Studies show ~70–80% of patients maintain gains if they follow post-MUA protocols rigorously.

Critical Steps to Maximize Success

  • Post-MUA physiotherapy: Start within 24–48 hours to maintain the new ROM. Expect exercises like:
  • Passive/active flexion stretches.
  • Continuous Passive Motion (CPM) machines.
  • Strengthening for quadriceps and hamstrings.
  • Pain and CRPS management:
  • Medications (e.g., gabapentin for nerve pain).
  • Sympathetic nerve blocks if CRPS persists.
  • Mirror therapy or graded motor imagery.
  • Avoid immobilization: Keep the knee moving gently to prevent scar tissue recurrence.

Questions to Ask Your Surgeon

  1. “What specific rehab protocol do you recommend post-MUA?”
  2. “Are there signs my CRPS is improving, and how can we address it?”
  3. “What is the long-term outlook if stiffness recurs?”

Realistic Expectations

MUA is a tool to “reset” your knee’s mobility, but your effort in rehab determines long-term success. CRPS complicates recovery but is manageable with a multidisciplinary team (pain specialist, physiotherapist, surgeon).

Wishing you the best for your procedure and recovery! Stay proactive with rehab—it makes all the difference. 🌟

Disclaimer: This is general guidance. Always follow your medical team’s advice.