Join us for an insightful episode of the Sports Congress Podcast 2025, where leading experts discuss the latest advancements in sports medicine, physiotherapy, and orthopaedics. Listen here or read the transcript below.
Host
🗣️ Nicolas Mathiesen – Physiotherapist, Copenhagen, Denmark
Guests
🔹 Prof. Kristoffer Barfod, Orthopaedic Surgeon, University of Copenhagen, Unit of Sports Traumatology, Bispebjerg Hospital, Denmark
🔹 Sebastiano Nutarelli, Physiotherapist, Lugano, Switzerland & International Arthrofibrosis Association
🔹 Kayley Usher, PhD, University of Western Australia & International Arthrofibrosis Association
🗣️ Hello everybody and welcome to this special episode of the Sports Congress Podcast. We've just tried out a new format, which is three speakers from the Congress discussing a subject. Today it was knee arthrofibrosis, and we really hope you enjoy it. If you're planning to join us next year at the Sports Congress and you think the format is nice, then we hope that you'll reach out if you want to do something similar. We hope you enjoy the episode. So, welcome, you three. We're going to have a podcast episode about arthrofibrosis in the knee today. And to start it off, you guys need to introduce yourselves. So we're going to start off with you, Kristoffer.
KB. Thank you very much. My name is Kristoffer Barfod. I'm an orthopaedic surgeon, specialized in sports surgery, and a professor at Copenhagen University and Bispebjerg Hospital.
NM. And Sebastiano.
SN. Thank you. My name is Sebastiano Nutarelli. I'm a physical therapist and biomechanist, and a PhD candidate in ACL rehabilitation. I see a lot of patients with knee arthrofibrosis. We have a centre in Switzerland called the European Knee Arthrofibrosis Centre, where we receive many of these cases.
KU. Thank you. My name is Kayley Usher. I'm a researcher at the University of Western Australia and founder of the International Arthrofibrosis Association.
🗣️ Very nice, you guys. So, we just talked before we pressed record. What is arthrofibrosis exactly? And I think we're going to start off with you, Sebastiano.
SN. Yeah, from a clinical perspective, a patient presenting with this pathology complains of certain things quite routinely. So, it's a stiff knee, if you want to simplify the clinical presentation of the patient, after an insult—usually surgery, but it can also be traumatic in nature. But I would say safely that at least 90-95% have undergone some level of orthopaedic procedure, even a minor one. They complain of a knee that is not regaining range of motion as it should, as it’s expected to do. The knee is clinically more inflamed, more reactive, the temperature of the knee is higher, and overall, this situation tends to stretch out over time for weeks, sometimes months. And then it becomes clear—also evident to the clinicians—that something is not going in the right direction, the patella gets stiff, and we have a problem with function, obviously. And you have something to add about that, Kayley, I know.
KU. Yeah, at a cellular level, arthrofibrosis is a dysregulated healing response. So, there's excessive production of scar tissue, adhesions, and contractions, and that results in a loss of function. And there's a whole lot of growth factors, cytokines, and cell types involved in that, with the main specialized healing cell called the myofibroblast, which is supposed to disappear after its job is done, but in fibrosis, it remains there and continues to cause pathology.
🗣️ I was thinking, do we know anything about the prevalence or the incidence of this particular problem? Because I would imagine that it is probably difficult to catch all of the cases. How do we define it and stuff like that? How would you answer that?
SN. Yeah, actually, we do have data, even published quite a long time ago, more than 10 years ago. Again, the diagnosis is clinical at this point. There are two classifications published. The first one by Dr. Donald Shelbourne, which always included some level of missing extension. And then there is another publication in the last decade by Kalson and colleagues, which is more reliable and fits the majority of patients into the classification. They are either losing extension in flexion or just flexion. Checking this and using it as a classification, we have studies on ACL-reconstructed patients. We have an incidence that is above 11% in adult patients and above 8% in paediatric patients. Quite good numbers, actually—the samples were above 200 and 300 patients in both publications. Then we have other studies on total knee replacements, and the situation seems to repeat. For sure, we are lacking data, so we are not intercepting all the patients, meaning the actual numbers are probably higher, but that's what we have at the moment.
KB. That seems high to me, Sebastiano.
KU. That's pretty supported, actually, by the evidence.
KB. Yeah, okay, but again, it depends on what you include in the diagnosis of arthrofibrosis because we don't have 10% of ACL patients struggling with knee stiffness for a long period of time. I cannot recognize that.
SN. Yeah, I think that’s a very good point, actually. There are, I believe, three phenomena to analyse to answer your question. The first one is the fact that some of these patients—one-third, or one out of three—are lacking more than three degrees of extension after an ACL reconstruction. This is another study we have.
This is already a problem because if you do not extend, think of it physically—your momentum is toward flexion, which means you cannot relax your quad ever, and you will simply degenerate your patellofemoral joint. So that's still arthrofibrosis, and it doesn't mean that these patients come back to you, or maybe they're happy with the way they play. We have athletes playing in the Champions League, and they're missing three or four degrees.
KB. But that gets back to the definition of arthrofibrosis because some of these patients for sure have, for instance, a cyclops. A cyclops, to me, is not arthrofibrosis. It's a thing lying in front of the knee—fibers from the ACL that have fallen down. When they're removed, you get back to full extension. Or they have a misplaced ACL, and due to that, you have changed the biomechanics of the joint and increased stiffness. So, there are biomechanical things that block the knee from extension, and I think that's a different situation than an inflammatory process.
KU. Certainly. The diagnosis of arthrofibrosis is a diagnosis of exclusion, so you rule out the mechanical aspects of the misplaced ACL. But the cyclops lesion is caused by scar tissue formation and myofibroblasts on the tendon, so it can affect any of the soft tissues in the joint. If it's within the joint and it's fibrosis—i.e., it's arthrofibrosis—if it's restricting range of motion, causing pain, etc., then you can give a definition. And in treating those symptoms, you would need to consider that pathology.
But going back to what you're saying about the rates, I think it's very underreported because there's a lot of misunderstanding. A lot of people with it are never given a diagnosis; they’re just told, "You've got a problem, I don't know what it is," so there's a lot of underreporting.
SN. I agree with you in the end, Kristoffer. I mean, arthrofibrosis—if we want to reach a consensus between the three of us—affects the whole joint, so it's spread throughout. I agree that a lump of scar tissue at the base of the ACL after reconstruction is different because if you fix it surgically and the next day it extends, then it's a completely different story. Yet the origin, as Kayley was correctly saying, is the same, but it’s fixable. The point is, worldwide, it depends on the clinical skills to diagnose it. And also, I have to be quite critical toward our group as physical therapists. Sometimes we keep patients in physiotherapy forever until they diagnose the cyclops lesion. If the knee is not extending and, after a month, it is clearly not inflamed and not acute, then it's either a cyclops or I have to suspect a cyclops. That’s my first call—I have to call you back and say, "Let’s MRI this patient because we probably have a cyclops." Also, it’s different in nature—painful extension, but the rest progresses well. And that was the second phenomenon. The third phenomenon is that a lot of these patients just fall into the category of those who don’t refer back to you but to another clinician, and we see this happen. They jump from one doctor to another or from one physio to another, and the situation gets worse and worse because sooner or later, someone operates on them again. So yeah, all the surgeons are working with them and saying these numbers are too high, but then we have dozens and dozens of new patients per week, so they’re probably out there.
🗣️ Let's jump to a scenario where a patient gets sent back to you after some type of knee surgery, for example. How do you suspect an onset of knee arthrofibrosis? What does the patient tell you that makes you think that could be a problem?
KB. Yeah, it's mainly the restriction in range of motion if they're coming with that. So that's a rather clear problem, I would say. But what is also interesting—and a thing that I don't know how to get around—is that you tell me that often the patients feel it right away. So, already the day after surgery, they feel something is wrong in the knee. And how do we get that? So, how do we distinguish the normal physiological response after surgery from this different response? And is it possible to catch it somehow?
SN. Well, to reply, I think these are the patients that are already arthrofibrotic. These are the patients that you operate on for lysis of adhesions and anterior interval release, so they undergo surgery because in PT they cannot improve. They have arthrofibrosis, and day one post-op, they tell you—or literally within the first week—they tell you, "It's not fixed, it's back again," or "Even worse, I feel exactly the same," because they know what it is, because they went through the experience. Being a former patient myself, I didn't know it was arthrofibrosis. I just knew something was wrong. But it was my first procedure; obviously, the surgeon told me, "It's all good, it’s just the acute phase," and I trusted the process. And then, you know, when the number was three months, I was doing this, and it was nine months... and then it became evident. Also, the fact that a lot of us are not trained to recognize symptoms. So, I believe that your point is in relation to the patient who already experienced arthrofibrosis. That's why they know.
KB. So, if I may follow up on that: when should we, as doctors and physios, catch it? Is there a timeframe where, at that point in time, we should catch it?
KU. That’s a very interesting question, and I think, yes, in terms of CPM use, continuous passive motion, we know the general population probably doesn't benefit from CPM post-op, but people with arthrofibrosis seem to have a very positive benefit, so if you can put them straight on the CPM, it can be beneficial. And going back to your question, how do we know? I've heard that a lot of patients in the immediate post-op period have a lot of inflammation, a lot of fibrotic response, and a lot of adhesions of the tissues. So, as they’re lying now in the hospital bed, not moving for some 5-10 minutes, they move position and the tissues are already adhered in that very short time. As they move, those tissues shear and cause pain. So, the longer they don't move for, the worse the pain when they do move. So, this is very disruptive to their sleep and general comfort. And to me, this is one of the warning signs: if you're still for a period and then move the affected limb and you get a sharp pain—the tearing of the tissues when you move—that's perhaps one of the warning signs.
KB. So, is it six weeks? I think that would be around six weeks in our practice that if the physio can’t move them—so somewhere six, eight weeks—they'll send them back to me. Or should we catch it already at two weeks? Can we catch it at two weeks?
SN. Yeah, I think your question raises a good point, which is we should think that, in practice, every knee operated on can potentially evolve into arthrofibrosis. This means you don't leave this knee at home for a week. We do see a lot of patients with arthrofibrosis, and when we ask them, “Tell me your story,” they say, “Well, the first week I was at home resting, and then I started the physio”—that’s already a problem. Or they immobilized the knee, and there is no real reason, aside from new evidence, but even old studies show that ACL patients don’t need a brace, for instance, unless you did something else in the OR or there’s a problem during the procedure. So, if we apply the best possible approach, we mobilize their patella, their soft tissues around, make sure that they’re experiencing flexion, and they live in gravity—not immobilized. Gravity is bringing their knees into extension. If everything goes well after a week, that’s okay; it’s going to go well. But if you sort of try to see arthrofibrosis, I think it's us. I think we’re just doing a poor job, and a lot of them try to evolve into arthrofibrosis and just go through the process, becoming arthrofibrotic because we don’t catch them, we don’t prevent it. And it’s easy, actually, if you do the right thing in the first two weeks. The majority of them never evolve into that state. You see those knees that are a bit angrier, but in the end, they resolve. So, I would say two to six weeks. Two weeks is probably a bit early, six weeks is a bit late, but it's very subjective. So, I don’t think there’s a specific answer.
🗣️ What I'm hearing you guys say here is that physios and orthopedic surgeons, for that matter, should be thinking more about the diagnosis of knee arthrofibrosis post-surgery than they are today, and that will probably lead to us catching these cases earlier than we do today. Would that be fair?
KU. Yeah.
SN. I would say particularly, I think, especially physios. Well, surgeons should tell the patient, unless there is a specific contraindication, to start physio the following day or the day after discharge, or even the same day. As soon as they are discharged from the hospital, after whatever procedure, if you do the right thing for the first two to three weeks, the cases drop. They drop because you don’t leave room for it. And if you do, the ones that really evolve into arthrofibrosis, regardless of what we do, are probably the ones that are genetically predisposed. I don't think it’s a surgeon failing, but the surgeon probably should push a little bit more for the early beginning of rehabilitation. They want post-op, whatever the procedure, the more invasive the procedure, the earlier the rehabilitation should start. The physio should actually do the right things rather than just, you know, using modalities or massaging the quad because the patient says it’s sore. We need to move that knee, we need to move the patella and do easy things. It's not rocket science.
🗣️ So, I want to follow up on what you just said about moving the knee and starting physio early. Because Kayley, what causes arthrofibrosis? Is it just moving the knee or not moving the knee? Is that it?
KU. We know that immobilization is one of the biggest risk factors. They can cause it in healthy young animals experimentally. That’s their go-to model. They operate on a leg of an animal and immobilize it for some weeks, and that reliably causes fibrosis regardless of the genetics of the animal or the age of the animal. So, we know that immobilization is a very big risk factor, and that movement counteracts that. So, if we can have someone who's at very high risk, we can put them on the CPM in the early phases and keep them on it, maybe 24 hours a day if they need it. They can sleep on it, have that leg constantly moving, preventing adhesions and contractions of the tissues. That effectively deactivates the cells that cause it.
🗣️ Alright, so we've just been talking about catching arthrofibrosis early. Why is that important?
KU. Essentially, it’s caused by these specialized healing cells called myofibroblasts, and after a certain period of time, they become senescent. They start to feed themselves with their own factors, which promote their survival. So, if we can intervene early enough, there’s a good chance we can resolve that, and the myofibroblasts will disappear, and we’ll go back to a healthier healing situation. But after about six to twelve months, it varies with the individual, those myofibroblasts become self-reinforcing, and the whole system with the immune system becomes self-reinforcing. Then we have a very, very difficult situation on our hands.
🗣️ All right, let's say that we don't catch it early, and the patient doesn’t get referred back to the surgeon, and we don’t try to fix it in any way. How does the patient look when too much time has gone by? What is their situation?
SN. Well, that's probably when we no longer have the first, let's say, the first presentation of knee arthrofibrosis. It’s no longer active; it’s no longer happening. We're not catching it when the inflammation is spiking, and it's still producing scar tissue because of all the underpinning biology, pathobiology. It’s, let’s say, residual. So, we are dealing with the result of the deposit of extracellular matrix, in the end, scar tissues. It's a knee that is colder, that is, paradoxically speaking, more stable. This means it’s a steady state, but it’s just highly unfunctional. It’s really subjective. Sometimes patients are just missing 20 degrees of flexion, which is something you can function with. You can play sport if you don’t bend more than 120 degrees of flexion, but yet they are not satisfied with that. The point is that the window of opportunity to modify the situation is limited or absent in the acute phases of active arthrofibrosis. Yet, we can try to interact with the process, deviate the trajectory. In this case, especially one year after surgery, when the healing is mostly there, you sometimes try and see what happens. In certain patients, you do obtain incredible results with no understanding of why. With the majority of them, you have to talk with the surgeon and say, “Unfortunately, this is established, and in my scope of practice, I don’t know how to help these patients. I know there is a higher risk in surgery, but if we don’t break the scar tissue surgically, maybe we cannot help them.” So, it’s when you have to refer them to surgery.
KB. And when is that? I just spoke to one of the most, how do you say that, skilled and experienced physiotherapists after the session we just had, and she was saying, “I still often stand with a patient six to eight weeks after surgery, and I cannot move them.” And I'd like to send them to surgery there. And that, I think, you opposed to?
KU. Yeah, so early on after surgery, if you've got arthrofibrosis, you’re going to have a lot of inflammation and a highly reactive knee. So, if you go in and cause more tissue damage by operating again, more myofibroblasts, more inflammation—there’s a very high risk that you’ll make that knee worse, not better.
KB. So, if you’re standing there as a skilled physiotherapist with years of experience and you cannot move that knee... it’s hard. You have a hard block. Should you then just wait because you cannot manipulate it further? Or is it, even though it’s only six months or eight months past surgery—sorry, not months—weeks past surgery, is it then time to go in and...
SN. No, I agree with Kayley, but this is based on a lot of expertise collected between multiple centers. We know that they don’t have higher chances to get worse. They do get worse. The majority of them, 90% of them. And that’s a story characterizing all these patients. You see these patients, they had initial surgery—ACL reconstruction, meniscal suture, it doesn’t matter. And then the whole thing became real—scar tissue. They operated on them. Then, because they didn’t succeed, they re-operated on them anyway. They have every three months a scope of these knees, and it’s a vicious cycle. They just get worse and worse. To answer your question...
KB. But that is probably a sub-population of those who get worse and worse, which you see there. So if you have this primary situation where you have this patient, and you cannot move...
SN. No, it’s exactly referring to these patients. It is highly contraindicated. What usually happens with surgeons is, “Well, I don’t want to do surgery, let’s do a manipulation under anaesthesia,” which is absolutely contraindicated. We have plenty of—let’s say, all the patients, probably with the exclusion of one or two percent of them—that underwent a manual MUA without scoping the knee first to release scar tissue. They created some level of high iatrogenic damage: tore the patella tendon, broke the head of the fibula, or the patella. This said, obviously, you have to answer to your skilled physio and say, “Hey, what do you do after six, eight weeks with this patient for more, let’s say, for the three, four months?” The point is, skilled in what? There is no training in how rehabilitation of these patients should be. So, I’ve been training physical therapists in this position for a while now, and also the most skilled ones, some of them are better than me in their role as physios, they do not know how to intervene with these patients because the approach is completely different. You just go for another round.
🗣️ Yeah, and I want to dive into that because, for example, we have a range of motion problem in the knee. Should we just keep stretching and putting it into end range even if it hurts, for example?
SN: No, that's exactly what usually happens, with, you know, the target to help the patients, with the best intentions, what we have been told—and I’ve been in PT school myself—is that, in the end, we need to gain some range of motion. So, sooner or later we need to try to catch up. Also, every time you see the letter from the surgeon when there is a follow-up, the surgeon says, “Well, force through pain if you need it because your flexion is absolutely not good.” And the physiotherapist, when we talk with the physiotherapist, says, “Hey, the surgeon called me and said I had to push through, so I did it.” And in the end, that's how we’ve been educated. In these patients, the more you push, the more you trigger the knee, and in the end, everything started, remember, with an insult. So, we are insulting over another insult. We are just creating more reaction.
🗣️ But we also just established that it's really, really important to move the knee through full range of motion a lot.
KU: Non-traumatic.
SN: The available range of motion.
KU: Yeah, non-traumatic is the key there.
NM: So, can you just follow up on the previous question? When would be the earliest that you would recommend surgery for arthrofibrosis after a primary intervention?
KU: When the knee is cold.
SN: Yeah, I would say again, it's a good question in relation to the nature, but I’m going to answer. It's not time-driven, it is criteria-driven, again. You have to have a knee that is clearly not in an acute phase. And the majority of these—I see surgeons, and this happens to us—we evaluate this patient at three and a half months post-op, four months, telling me that the knee is cold, there is no reaction. If the patient is biking or doing some level of activity, the knee clearly does not react to anything. We also can test, you can prescribe some NSAIDs, Celebrex for instance, no reaction, which means there is no inflammatory driver. Well, you might consider having surgery, but it’s an exception. In reality, the majority of these patients, to digest the overall situation, have taken at least six months. And this is what we’ve seen in practice. And again, six months is completely theoretical. Let’s say, on average, earlier than six months, these patients are not ready. And again, sometimes they are, and in other cases, it takes nine months. It is clearly not the time to operate. And the point is, we see how the evolution of these cases is, because sometimes a patient, you tell them, “Listen to us, your knee is not ready, we would wait, we are just trying to help you out.” They search for other, correctly, obviously, they search for a second opinion, they undergo surgery, and then they explode. Just massive reaction. Then we have to deal with the consequences. Was that a fault of the other surgeon? Obviously not. Everybody was trying to help. But you can spot the signs and the symptoms, especially the signs in a knee.
KU: So, I think we need to say that our understanding at this point is that there's an active phase of fibrosis and there's a residual phase. So, the active phase is the one we're familiar with. There's a lot of pain, inflammation, there's some heat and swelling. Sometimes even not very much heat, but it's still an active process. You still have a reactive knee. And in that sort of phase, it's quite dangerous to operate or do aggressive exercise on that limb. But then, as the knee starts to heal, hopefully, eventually it will go into, we hope, a residual phase where those inflammatory processes, the specialized healing cells, are all quieted down, they've gone away, and it is cold, as Sebastiano was saying. But, you still have that scar tissue there that might be blocking the range of motion, for example. And sometimes that can be released, and range of motion can be regained.
🗣️ Is that the primary solution to a situation where there is arthrofibrosis in the knee and the inflammatory phase, so to speak, is gone or over? Is that to have some type of surgical intervention? Or what do we do with the stiff knee when it's gone cold, for example?
KU: It depends on how much it's compromising the function of the knee. So, if it's causing the person a lot of distress, then they might want that surgery. But if the person can cope with it, then, over time, that scar tissue should break down by itself, and they can manage with physiotherapy, they can slowly increase their range of motion, and, to my way of thinking, that's the least dangerous approach because every surgery is a risk that it will get worse again. So, that's my take on it.
KB: I add a question to that. I had, just last week, a 25-year-old woman who had a wrongly placed MPFL reconstruction half a year back, so the knee was inflamed and everything hurt. So, we took away that MPFL two months ago, and the knee is still inflamed and hurting, and now we are then two months post the last surgical hit, and she comes to me, and her range of motion has improved, but she can still only bend until 90, and she can stretch fully. So, I’m telling her, and now comes my question. I'd like you to hear if you think that's correct or not. I’m telling her, you have a window of opportunity the next two months because this is closing, the scar tissue is forming. So, you have to push that range of motion because now is your window. And that's a little opposite to what you're saying, but on the other hand, I think it's correct, but of course, she shouldn’t push it too much, but if she does nothing, then it'll lock up. So how do you balance that?
SN: Which is between nothing and everything, right? There is a big difference. I have to say, and I will then come to your, let’s say, I will become your friend again after this sentence, I think that's wrong. I think that's wrong. That's correct in the sense that we have a window of opportunity, and we need to use it well, but you don't have to gain everything in two months, that's absolutely not correct. And this is what differentiates physical therapists from surgeons, also in training. You are exceptionally well-trained about the anatomy, but biomechanically speaking, probably we have a better understanding of certain things. That's why cooperating makes us all better. We can deform plastic tissues over time for months and months and months. So, in this patient, if you would refer the patient in physio, I would say, okay, let’s start as long as we are improving a certain amount of the degrees per month and we don’t hit a wall. There is no plateau for longer than six weeks, four to six weeks. We keep going because there is no risk in doing this. Obviously, obviously it depends. If the limitation is maybe as a professional athlete, many other factors can play a role, but I would not push for two months, trying to get everything in two months because otherwise you might push too much and aggravate the situation.
Coming back to what you said before, I think it's important to say that it’s not always black and white. Sometimes we have patients who have clear localized fibrosis signs, like they are just missing extension, or they are just missing flexion. And you might come to me and say, “Listen, I know you want to protect this knee, but clearly, I mean, we are bouncing at 90 degrees. This is coming back. This is not going to improve even in a year.” And I might agree that you have to scope the knee earlier. But it's, again, a complex evaluation between where are we with that knee. And sometimes you scope the knee four months after. It depends.
KB: So, I shouldn’t tell her you have two months, and you need to bend it to 130 or 140 within these next two months. I should tell her do as much as you can, without pain, and move within that range and then slowly push it. Then I would say it's okay to have pain while you do it, but the pain must subside in the evening and be gone by the next morning. Do you agree on that?
KU: I liken it with CPM, I liken it to pushing your finger backwards and you reach the end of range of motion, and you can push just a little bit further, and you can feel some discomfort. So, that's what we call discomfort, and that's a good gauge for the person on the CPM to regulate their CPM, and they should be in charge of the amount of degrees of flexion on that, and so a little bit of discomfort is a useful thing but never into pain because if you tear tissues, you're in big, big trouble.
SN: To comment on your question, I partially agree and agree with her in there are two ways. Physiologists used to say, "Listen, you shouldn't experience pain higher than 4 out of 10." And then the patient looks at you and says, "I have no idea what you mean." Because this stupid scale of, you know, 0 up to 10, it doesn't mean anything to me. Okay, listen again. What is it we want to do? We want to plastically deform tissues. It has to be permanent. So, if you have a t-shirt on, pull the t-shirt, keep it pushed. Okay, if you're pulling the t-shirt for two days, you're not exerting that much of a force, but you will deform the t-shirt plastically over time. This is what you want. You don’t want to gain everything all at once. You just want to provide little stimuli over time, multiple times, a million of times. Yeah, but it costs time. Or you can pick surgery now with other associated risks, or we need to make it happen over time.
🗣️ I'm going to have to stop us now because we've run out of time. On a final note, if you want to dive into this topic of arthrofibrosis, where would you guys, apart from coming to the Sports Congress, obviously, where should one look to gain more insights into this?
KU: So, we have a lot of scientifically referenced information on the International Arthrofibrosis Association, including blogs that are published regularly. They're all scientifically referenced and that's a good starting point for people.
🗣️ We'll put a link to that just below the episode here.
KB. And if you want to see Copenhagen and Denmark when the weather is better then, you should come on the second of May where Sebastian is giving a one-day course. You can find more information and that at our website at the Bispebjerg Hospital, the sports medicine unit. Thank you so much for your time.
All. Okay, thank you. (upbeat music) Go to www.arthrofibrosis.info for scientifically referenced information on arthrofibrosis or listen to the full podcast here.
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