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Twenty-five studies met the inclusion criteria. Injury pattern, timing of surgery, surgical technique, treatment of AF, rehabilitation programs and PROMS were inquired. Risk of bias and quality of evidence were assessed using the Coleman methodological score.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Twenty-five studies with a total of 709 patients with a mean age of 33.6\u2009\u00b1\u20094.8\u00a0years were included and followed 47.2\u2009\u00b1\u200932.0\u00a0months. The majority of studies (22\/25) used imprecise and subjective definitions of AF. A total of 86 patients were treated for AF, resulting in an overall prevalence of 12.1% (range 2.8\u201357.1). Higher-grade injuries (Schenck III\u2013IV), acute treatment and ROM (range of motion) limiting rehabilitation programs were potential risk factors for AF. The time from index surgery to manipulation anesthesia (MUA) and arthroscopic lysis of adhesions (LOA) averaged at 14.3\u2009\u00b1\u20098.8 and 27.7\u2009\u00b1\u200912.8\u00a0weeks. Prior to MUA and LOA, the ROM was 51.7\u00b0\u2009\u00b1\u200923.5 and 80.2\u00b0\u2009\u00b1\u200917.0, resulting in a total ROM gain after intervention of 65.0\u00b0\u2009\u00b1\u200919.7 and 48.0\u00b0\u2009\u00b1\u200910.6, respectively; with no reports of any complication within the follow-up. The overall methodological quality of the studies was poor as measured by the Coleman score with average 56.3\u2009\u00b1\u200912.5 (range 31\u201384) points.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>AF is a common but poorly defined complication particularly in high-grade MLKI. Early postoperative and intensified physiotherapy is important to reduce the risk of AF. MUA and LOA are very effective treatment options and result in good clinical outcome. Prospective studies with bigger study population are needed to optimize treatment algorithms of further patients after MLKI.<\/jats:p>\n                <jats:p>The protocol of this systematic review has been prospectively registered with PROSPERO (CRD42021229187, January 4th, 2021).\n<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00402-022-04730-9","type":"journal-article","created":{"date-parts":[[2022,12,15]],"date-time":"2022-12-15T13:04:53Z","timestamp":1671109493000},"page":"5117-5132","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":45,"title":["Arthrofibrosis is a common but poorly defined complication in multiligament knee injuries: a systematic review"],"prefix":"10.1007","volume":"143","author":[{"given":"Hendrik","family":"Fahlbusch","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas","family":"Krivec","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"M\u00fcller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alonja","family":"Reiter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl Heinz","family":"Frosch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7345-6506","authenticated-orcid":false,"given":"Matthias","family":"Krause","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,12,15]]},"reference":[{"key":"4730_CR1","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.otsr.2014.11.001","volume":"101","author":"FJ Angelini","year":"2015","unstructured":"Angelini FJ, Helito CP, Bonadio MB, da Mota EARF, Pecora JR, Camanho GL (2015) Surgical management of knee dislocations with ligament reconstruction associated with a hinged external fixator. 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