Knee Manipulation Advantages and Disadvantages

Knee Manipulation

Knee manipulation is a medical procedure performed to improve the range of motion in a knee joint that has become stiff or has limited mobility. Knee manipulation is typically considered when a patient has developed significant knee stiffness after surgery or due to certain medical conditions, such as knee replacement surgery, arthrofibrosis, or scar tissue formation.

During knee manipulation, the patient is usually put under anesthesia to ensure they are comfortable and to prevent pain during the procedure. The surgeon then manually moves and bends the knee joint to break up adhesions, scar tissue, or other factors limiting its movement.

While knee manipulation can be effective in improving knee joint mobility, it is not without risks. Complications may include injury to the knee or surrounding structures, infection, or a recurrence of stiffness over time.

In this article, we discuss the advantages and disadvantages of Knee Manipulation.

Advantages of Manipulation

  • Improved Knee Mobility: The primary advantage of knee manipulation is the potential for significantly improved knee mobility. It can help patients regain the ability to bend and straighten their knee, making daily activities and rehabilitation exercises more effective.
  • Non-Invasive: Knee manipulation is a non-invasive procedure. It does not require additional incisions or major surgery, which means shorter recovery times and reduced risk of complications associated with invasive surgeries.
  • Avoids Another Surgery: For patients who have already undergone knee surgery, such as knee replacement, and experience stiffness afterward, knee manipulation can often provide relief without the need for a second surgery.
  • Prompt Relief: Many patients experience immediate relief from knee stiffness after the procedure. This quick response can be particularly beneficial for those struggling with pain and limited mobility.
  • Part of a Comprehensive Treatment Plan: Knee manipulation is often part of a broader treatment plan. After the procedure, physical therapy and exercises can be more effective, helping patients regain strength and function in the knee.
  • Customized Approach: The procedure can be tailored to individual needs. The surgeon can adjust the degree of manipulation based on the patient’s specific condition and limitations.

Disadvantages of Manipulation

  • Risk of Complications: While knee manipulation is generally safe, there is a risk of complications. These can include damage to the knee joint or surrounding structures, infection, and the potential for recurrent stiffness over time.
  • Pain and Discomfort: Post-procedure pain and discomfort are common. Patients may experience soreness and swelling in the knee area, which can be challenging during the initial recovery period.
  • Anesthesia Risks: The procedure requires anesthesia, which carries its own set of risks. Anesthesia-related complications, although rare, can occur and should be discussed with the anesthesia team.
  • Variable Outcomes: The degree of improvement in knee mobility can vary from person to person. Not all patients experience significant or long-lasting benefits from knee manipulation.
  • Temporary Solution: Knee manipulation may provide temporary relief, but it does not always address the underlying cause of the stiffness. Some patients may require additional treatments or interventions in the future.
  • Recovery Time: While it is less invasive than surgery, knee manipulation still involves a recovery period. Patients should follow their surgeon’s recommendations for post-operative care, which may include physical therapy and exercises.

Knee Manipulation Procedure

Patient Evaluation

Before proceeding with knee manipulation, the patient undergoes a comprehensive evaluation. This typically includes a physical examination, a review of their medical history, and often imaging studies such as X-rays or MRI scans to assess the knee joint’s condition.


Knee manipulation is typically performed under general anesthesia, ensuring that the patient is pain-free and comfortable throughout the procedure.

Patient Positioning

The patient is positioned on an operating table, usually lying on their back. The affected knee is exposed and prepared to maintain a sterile environment.


With the patient under anesthesia, the surgeon gently and gradually manipulates the knee joint. They work to bend and straighten the knee, applying controlled pressure to disrupt any adhesions or scar tissue that may be restricting movement.


Throughout the procedure, the patient’s vital signs, including heart rate and blood pressure, are closely monitored to ensure their safety.

Post-Procedure Care

Following knee manipulation, the patient is carefully observed in a recovery area. Pain management and swelling control are important aspects of post-procedure care, and the patient may be prescribed pain-relieving medications and anti-inflammatory drugs.

Physical Therapy

After knee manipulation, physical therapy plays a vital role in the recovery process. A physical therapist collaborates with the patient to help them regain strength and mobility in the knee joint. Rehabilitation exercises are tailored to the patient’s specific needs and goals.

Recovery Time

Recovery time can vary from person to person. While some patients experience immediate improvements in knee mobility, others may take several weeks to notice significant gains. Consistency with physical therapy exercises and adhering to the surgeon’s recommendations are key to a successful recovery.

Tips for an Effective Knee Manipulation

Your surgeon might recommend incorporating a daily exercise regimen of approximately 20 minutes, either two or three times a day. Even a 30-minute walk, taken two or three times daily, can significantly contribute to expediting your recovery.

During the initial weeks of your recuperation, it is crucial to adhere to the prescribed exercise, icing, elevating, and resting routine as previously explained. This protocol plays a pivotal role in alleviating the wearisome recovery process.

In some cases, surgeons may suggest employing a Continuous Passive Motion (CPM) machine for up to three weeks following your knee manipulation procedure. Additionally, using a pedal exerciser resembling a compact stationary bicycle can be beneficial during this rehabilitation phase.

Should your progress not meet your expectations, your doctor may also propose the use of a dynamic splint, a mechanical hinge that aids in alleviating stress on the affected joint.


A 2011 study conducted by the US National Institute of Health, involving 78 patients who underwent knee manipulation, reported only five complications. Consequently, this procedure is generally considered safe. You can further assist your recovery by ensuring your knee remains active and healthy through a variety of exercises. Ultimately, the outcome partially depends on your proactive efforts as well.


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