Scar tissue is a normal, expected part of healing after any surgery, including knee and shoulder procedures. Most of the time it causes little more than a visible mark. But for some patients, internal scar tissue can affect movement and cause ongoing stiffness. Here’s what’s normal, what isn’t, and when it’s worth raising with your surgeon.
What is surgical scar tissue?
When tissue is cut during surgery, whether that’s skin, muscle, or the joint capsule itself, the body repairs it by laying down new collagen fibres. This is scar tissue. It’s a necessary part of healing, but unlike the original tissue, scar tissue is less elastic and can restrict movement if it forms in excess, a process sometimes called fibrosis.
Where does scar tissue form after orthopaedic surgery?
- Skin. The visible scar at the incision site.
- Inside the joint. After procedures like ACL reconstruction or knee arthroscopy, scar tissue can form inside the joint itself, sometimes called arthrofibrosis when it becomes excessive.
- Around tendons and repairs. Scar tissue around a rotator cuff repair or tendon reconstruction can restrict how freely the tendon glides.
Is scar tissue after surgery normal?
Yes. Some scar tissue formation is a normal and necessary part of healing. Most patients experience mild stiffness in the weeks following surgery that improves steadily with movement and physiotherapy.
The distinction worth understanding is between normal, expected stiffness that improves week to week, and stiffness that plateaus or worsens, which can indicate excessive scar tissue is limiting the joint.
Signs scar tissue may be limiting your recovery
- Stiffness that isn’t improving despite consistent physiotherapy
- A noticeable loss of range of motion compared to what’s expected at that stage of recovery
- Pain that increases with attempted movement, rather than settling with use
- A sense that the joint feels “tight” or “blocked” rather than simply weak
If any of these sound familiar well into your recovery, it’s worth a conversation with your surgeon rather than assuming it will resolve on its own.
How is excess scar tissue managed?
Physiotherapy
The first-line approach for most patients. Consistent, guided movement in the early recovery window is one of the most effective ways to prevent excessive scar tissue from limiting the joint in the first place.
Manual therapy and stretching
Targeted stretching and manual therapy techniques can help address scar tissue that’s already causing restriction, particularly when caught early.
Manipulation under anaesthesia
For more significant stiffness that hasn’t responded to physiotherapy, a manipulation under anaesthesia can help break down restrictive scar tissue, performed under a general or regional anaesthetic.
Arthroscopic release
In more persistent cases, keyhole surgery can be used to remove or release scar tissue that’s mechanically blocking movement.
Can you prevent excess scar tissue after surgery?
Prevention largely comes down to early, guided movement. Patients who start physiotherapy promptly and stay consistent with it in the first six to twelve weeks generally have a lower risk of significant scar tissue restriction. This is one of the reasons early physio appointments matter as much as the surgery itself.
Common questions about surgical scar tissue
How long does scar tissue take to soften after surgery?
Internal scar tissue continues remodelling for months after surgery, and it’s common for stiffness to keep improving gradually for six months to a year, particularly with consistent physiotherapy.
Does massaging a scar help with scar tissue?
Gentle scar massage, once the incision has fully healed, is commonly recommended to help keep the skin and superficial tissue mobile. It’s a separate matter from internal joint stiffness, which needs a targeted physiotherapy approach.
When should I be concerned about stiffness after surgery?
If your range of motion has plateaued, or is getting worse rather than better, over two or more consecutive physiotherapy sessions, that’s a reasonable point to flag it with your surgeon.
Is arthrofibrosis common after knee surgery?
It’s a recognised complication, more common after ACL reconstruction than most other knee procedures, though it affects a minority of patients.
Concerned about stiffness after your surgery?
If your recovery isn’t tracking the way you expected, it’s worth having it assessed properly rather than waiting it out. Book a consultation with Dr Chris Bell at Bell Orthopaedics, Woolloongabba and Sunnybank, Brisbane.
Compliance note: No outcome guarantees, comparative claims, or testimonials included, in line with AHPRA advertising requirements. Recommend clinical review of all medical detail, particularly around manipulation under anaesthesia and arthroscopic release, before publishing.
