Key Points About Manipulation Under Anesthesia (MUA) and Postoperative Stiffness
Key Points About Manipulation Under Anesthesia (MUA) and Postoperative Stiffness
- 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.
- 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.
- 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.
- 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
- “What specific rehab protocol do you recommend post-MUA?”
- “Are there signs my CRPS is improving, and how can we address it?”
- “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.