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Kaneguchi A, Yamaoka K, Ozawa J. The Effects of Corticosteroid Administration and Treadmill Exercise on Marrow Adipose Tissue and Trabecular Bone after Anterior Cruciate Ligament Reconstruction in Rats. Acta Histochem Cytochem 2024; 57:47-55. [PMID: 38463208 PMCID: PMC10918434 DOI: 10.1267/ahc.23-00068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/22/2024] [Indexed: 03/12/2024] Open
Abstract
We aimed to investigate the effects of short-term corticosteroid administration after anterior cruciate ligament (ACL) reconstruction on marrow adipose tissue (MAT) and trabecular bone mass, as well as to examine whether treadmill exercise can mitigate MAT increase and trabecular bone deterioration caused by corticosteroid. ACL-reconstructed rats were divided into groups: no intervention, daily treadmill exercise (60 min/day), administration of the steroidal drug dexamethasone (250 μg/kg on days 0-5, 7, and 9 post-operatively), or dexamethasone administration combined with treadmill exercise. Untreated rats were served as controls. At day 10 or 30 post-operatively, histological assessments were performed in the proximal tibial epiphysis. MAT accumulation and trabecular bone loss were observed after ACL reconstruction. Dexamethasone promoted MAT accumulation at day 10 post-operatively but did not affect the trabecular bone loss. The MAT accumulation caused by dexamethasone reversed within 21 days after discontinuation. Treadmill exercise did not influence the changes in the MAT and trabecular bone areas. Short-term corticosteroid administration after ACL reconstruction promoted MAT accumulation while not affecting trabecular bone area. The MAT accumulation resulting from corticosteroid administration was reversible after discontinuation. Treadmill exercise could not mitigate the accumulation of MAT caused by corticosteroid administration and did not affect trabecular bone area.
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Affiliation(s)
- Akinori Kaneguchi
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555–36, Higashi-Hiroshima, Hiroshima, Japan
| | - Kaoru Yamaoka
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555–36, Higashi-Hiroshima, Hiroshima, Japan
| | - Junya Ozawa
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555–36, Higashi-Hiroshima, Hiroshima, Japan
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Sebastian AS, Sathikumar AS, Thomas AB, Varghese J. Arthroscopic Arthrolysis of Knee: Timing, Technique and Results. Indian J Orthop 2024; 58:210-216. [PMID: 38312902 PMCID: PMC10830982 DOI: 10.1007/s43465-023-01081-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/04/2023] [Indexed: 02/06/2024]
Abstract
Aim To evaluate the functional outcomes of patients undergoing arthroscopic arthrolysis of the knee and find the ideal timing for arthrolysis to achieve maximum range of motion (ROM) of the knee. Methods All patients who underwent arthroscopic arthrolysis for post-operative joint stiffness following surgery for injuries around knee joint at a tertiary care centre from 2009 to 2023 were included in this study. The patients' details such as primary injury, time interval between the index surgery and arthrolysis, improvement in knee range of ROM and Lysholm score from prior to arthrolysis to last follow-up post arthrolysis were retrieved from hospital database and analysed. Results Total of 42 patients who underwent arthroscopic arthrolysis of knee from 2009 to 2023 were included in this study. Follow-up range was 6 months to 6 years. ROM after arthrolysis significantly improved in the early and delayed arthrolysis groups as compared to late arthrolysis groups (mean 126.25 and 115.62 vs 106.3, p < 0.05). Patients treated with early arthroscopic arthrolysis (within 3 months) showed significant increase in post operative Lysholm score compared to other groups (p < 0.05). ROM of 120° and beyond was achieved in 75% of cases in early arthrolysis group compared to 62.8% and 39% in delayed and late arthrolysis group (p < 0.05). Conclusions Arthroscopic arthrolysis done within 6 months (with maximum effect when done within 3 months) after the primary surgery leads to significant improvement in ROM and functional scores as compared to those with late arthrolysis group.
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Affiliation(s)
- Abin S. Sebastian
- Division of Joint Replacement and Sports Medicine, VPS Lakeshore Hospital, Ernakulam, India
| | - Aravind Sai Sathikumar
- Division of Joint Replacement and Sports Medicine, VPS Lakeshore Hospital, Ernakulam, India
| | - Appu Benny Thomas
- Division of Joint Replacement and Sports Medicine, VPS Lakeshore Hospital, Ernakulam, India
| | - Jacob Varghese
- Division of Joint Replacement and Sports Medicine, VPS Lakeshore Hospital, Ernakulam, India
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Kaneguchi A, Takahashi A, Shimoe A, Hayakawa M, Yamaoka K, Ozawa J. The combined effects of treadmill exercise and steroid administration on anterior cruciate ligament reconstruction-induced joint contracture and muscle atrophy in rats. Steroids 2023; 192:109183. [PMID: 36690288 DOI: 10.1016/j.steroids.2023.109183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/28/2022] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
Rehabilitation protocols to treat joint contracture and muscle atrophy following anterior cruciate ligament (ACL) reconstruction have not been established. In this study, we examined the combined effects of exercise therapy and steroid administration on joint contracture and muscle atrophy following ACL reconstruction. Rats received ACL transection and reconstructive surgery in one knee. After surgery, they were divided into four groups: no intervention, treadmill exercise (started from day three post-surgery, 12 m/min, 60 min/d, 6 d/week), treatment with the steroidal drug dexamethasone (250 μg/kg on days 0-5, 7, and 9 post-surgery), and dexamethasone treatment plus treadmill exercise. Age-matched untreated rats were used as controls. At day 10 or 30 post-surgery, we assessed ACL-reconstruction-induced joint contracture, joint capsule fibrosis, osteophyte formation, and muscle atrophy of the rectus femoris and gastrocnemius. Treadmill exercise after ACL reconstruction improved several indicators of muscle atrophy in both muscles, but it did not have positive effects on joint contracture. Dexamethasone treatment after ACL reconstruction improved joint contracture and joint capsule fibrosis at both timepoints and partially attenuated osteophyte formation at day 10 post-surgery, but delayed recovery from atrophy of the rectus femoris at day 30 post-surgery. The two treatments combined improved both joint contracture and atrophy of the rectus femoris and gastrocnemius. Exercise therapy combined with steroid administration may therefore be a novel therapeutic strategy for joint contracture and muscle atrophy following ACL reconstruction.
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Affiliation(s)
- Akinori Kaneguchi
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima 739-2695, Japan.
| | - Akira Takahashi
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima 739-2695, Japan
| | - Atsuhiro Shimoe
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima 739-2695, Japan
| | - Momoka Hayakawa
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima 739-2695, Japan
| | - Kaoru Yamaoka
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima 739-2695, Japan
| | - Junya Ozawa
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima 739-2695, Japan
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Kaneguchi A, Ozawa J, Minamimoto K, Yamaoka K. Low-level laser therapy attenuates arthrogenic contracture induced by anterior cruciate ligament reconstruction surgery in rats. Physiol Res 2022; 71:389-399. [PMID: 35616040 DOI: 10.33549/physiolres.934796] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Therapeutic approaches to treat joint contracture after anterior cruciate ligament (ACL) reconstruction have not been established. Arthrofibrosis accompanied by joint inflammation following ACL reconstruction is a major cause of arthrogenic contracture. In this study, we examined whether anti-inflammatory treatment using low-level laser therapy (LLLT) can prevent ACL reconstruction-induced arthrogenic contracture. Rats underwent ACL transection and reconstruction surgery in their right knees. Unoperated left knees were used as controls. After surgery, rats were reared with or without daily LLLT (wavelength: 830 nm; power output: 150 mW; power density: 5 W/cm2; for 120 s/day). We assessed the passive extension range of motion (ROM) after myotomy at one and two weeks post-surgery; the reduction in ROM represents the severity of arthrogenic contracture. ROM was markedly decreased by ACL reconstruction at both time points; however, LLLT partially attenuated the decrease in ROM. One week after ACL reconstruction, the gene expression of the proinflammatory cytokine interleukin-1beta in the joint capsule was significantly upregulated, and this upregulation was significantly attenuated by LLLT. Fibrotic changes in the joint capsule, including upregulation of collagen type I and III genes, shortening of the synovium, and thickening were caused by ACL reconstruction and seen at both time points. LLLT attenuated these fibrotic changes as well. Our results indicate that LLLT after ACL reconstruction could attenuate the formation of arthrogenic contracture through inhibition of inflammation and fibrosis in the joint capsule. Thus, LLLT may become a novel therapeutic approach for ACL reconstruction-induced joint contracture.
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Affiliation(s)
- A Kaneguchi
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashi-Hiroshima, Hiroshima, Japan.
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Kaneguchi A, Ozawa J, Minamimoto K, Yamaoka K. Formation process of joint contracture after anterior cruciate ligament reconstruction in rats. J Orthop Res 2021; 39:1082-1092. [PMID: 32667709 DOI: 10.1002/jor.24800] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/04/2020] [Accepted: 06/30/2020] [Indexed: 02/04/2023]
Abstract
Knee joint contracture is often induced by anterior cruciate ligament reconstruction (ACLR). However, the temporal and spatial arthrofibrotic changes following inflammatory events, which occur in parallel with the formation of joint contractures after ACLR, are unknown. This study aimed to reveal: (a) time-dependent changes in myogenic and arthrogenic contractures; and (b) the process of arthrofibrosis development after ACLR. ACLR was performed on knees of rats unilaterally. Passive ranges of motions (ROMs) before and after myotomy, as well as inflammatory and fibrotic reactions, were examined before and after the surgery at various periods up to 56 days. Both ROMs before and after myotomy exhibited their lowest value on day 7 and increased thereafter in a time-dependent manner; nevertheless, significant restrictions remained by day 56. Myotomy partially increased ROMs at all time points, indicating contribution of the myogenic component to ACLR-induced contracture. Inflammatory and fibrotic reactions peaked on day 7. Arthrofibrosis, characterized by the thickening of the joint capsule and the shortening of the synovial length, was established by day 7 and was not completely resolved by day 56. Our results indicate that: (a) both myogenic and arthrogenic contractures generated through ACLR develop maximally by day 7 after surgery and subside thereafter, but persist at least until day 56; and (b) arthrofibrosis is established by day 7 after surgery and is not completely resolved by day 56. These findings suggest that treatment and intervention for preventing joint contracture after ACLR should be performed within the first 7 days after surgery.
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Affiliation(s)
- Akinori Kaneguchi
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashi-Hiroshima, Hiroshima, Japan
| | - Junya Ozawa
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashi-Hiroshima, Hiroshima, Japan
| | - Kengo Minamimoto
- Major in Medical Engineering and Technology, Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University, Higashi-Hiroshima, Hiroshima, Japan
| | - Kaoru Yamaoka
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashi-Hiroshima, Hiroshima, Japan
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Greif DN, Emerson CP, Allegra P, Arizpe A, Mansour KL, Cade WH, Baraga MG. Supplement Use in Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Systematic Review. Arthroscopy 2020; 36:2537-2549. [PMID: 32438028 DOI: 10.1016/j.arthro.2020.04.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/25/2020] [Accepted: 04/25/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess whether a standardized dietary supplementation can help to decrease postoperative muscle atrophy and/or improve rehabilitation outcomes in patients who underwent anterior cruciate ligament reconstruction (ACLR). METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). MEDLINE, Scopus, and Cochrane Library databases were searched, and articles that examined protein or amino acid, vitamin, or any other type of supplementation in ACLR were reviewed. Two independent reviewers conducted the search using pertinent Boolean operations. RESULTS A total of 1818 articles were found after our database search. Ten studies fulfilled our inclusion criteria and only assessed patients undergoing ACLR. Four studies assessed protein-based supplementation. One study assessed creatine as a supplement. Four studies assessed vitamin-based supplementation. One study assessed testosterone supplementation. Protein and amino acid supplementation showed potential benefits; multiple authors demonstrated a combination of improved achievement of rehabilitation benchmarks, graft maturation, muscular hypertrophic response, and peak dynamic muscle strength. When we examined creatine, vitamin, or hormone-based protocols, none demonstrated results, suggesting these factors may attenuate muscle atrophy after surgery. Vitamin C and E demonstrated potentially increased local inflammation in skeletal muscle, which runs contrary to the belief that antioxidant vitamin-based supplementation may decrease the inflammatory response that plays a role in the post injury/operative period. CONCLUSIONS Protein-based supplementation may play a role in mitigating muscle atrophy associated with ACLR, as multiple authors demonstrated a combination of improved achievement of rehabilitation benchmarks, thigh hypertrophic response, and peak dynamic muscle strength. However, based on current literature, it is not possible to recommend a specific protein-based supplementation protocol at this time for patients undergoing ACLR. Limited evidence suggests no benefit for creatine, vitamin, or hormone-based protocols. LEVEL OF EVIDENCE II, a systematic review of level I-II studies.
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Affiliation(s)
- Dylan N Greif
- University of Miami Sports Medicine Institute, Coral Gables, Florida, U.S.A..
| | | | - Paul Allegra
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Azael Arizpe
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Kailey L Mansour
- University of Miami Sports Medicine Institute, Coral Gables, Florida, U.S.A
| | - William H Cade
- University of Miami Sports Medicine Institute, Coral Gables, Florida, U.S.A
| | - Michael G Baraga
- University of Miami Sports Medicine Institute, Coral Gables, Florida, U.S.A.; Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
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Nadarajah V, Roach R, Ganta A, Alaia MJ, Shah MR. Primary anterior cruciate ligament reconstruction: perioperative considerations and complications. PHYSICIAN SPORTSMED 2017; 45:165-177. [PMID: 28276989 DOI: 10.1080/00913847.2017.1294012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Anterior cruciate ligament (ACL) injuries are among the most commonly studied orthopaedic injuries. Despite having an excellent prognosis, complications do occur. The timely recognition and management of complications is imperative to ensure the success of reconstruction. Avoiding such complications requires thorough preoperative planning, proficient technical skills to properly manage intraoperative complications, and an extensive knowledge of possible postoperative complications.
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Affiliation(s)
- Vidushan Nadarajah
- a Department of Orthopaedic Surgery , SUNY Downstate Medical Center , Brooklyn , NY , USA
| | - Ryan Roach
- b Department of Orthopaedic Surgery , New York University Langone Medical Center, Hospital for Joint Diseases , New York , NY , USA
| | - Abhishek Ganta
- b Department of Orthopaedic Surgery , New York University Langone Medical Center, Hospital for Joint Diseases , New York , NY , USA
| | - Michael J Alaia
- b Department of Orthopaedic Surgery , New York University Langone Medical Center, Hospital for Joint Diseases , New York , NY , USA
| | - Mehul R Shah
- b Department of Orthopaedic Surgery , New York University Langone Medical Center, Hospital for Joint Diseases , New York , NY , USA
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Brown CA, Magnussen RA, Lawrence JT, Toth AP. Intra-articular Anakinra for the Treatment of Persistent Inflammation and Arthrofibrosis following Anterior Cruciate Ligament Reconstruction. ACTA ACUST UNITED AC 2011. [DOI: 10.5005/jp-journals-10017-1008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
ABSTRACT
Purpose
Postoperative inflammation and arthrofibrosis remain difficult problems following ACL reconstruction. Interleukin-1 (IL-1) is a potent driver of intra-articular inflammation and arthrofibrosis following injury and surgery. Anakinra (Kineret, Amgen, Thousand Oaks, CA) is an IL-1 receptor antagonist. We hypothesize that postoperative intra-articular anakinra use decreases inflammation and subsequent arthrofibrosis, reducing the need for arthroscopic debridement and manipulation under anesthesia.
Methods
Four patients (ages 15-56) who were treated with anakinra for persistent postoperative inflammation and scarring within 4 months of ACL reconstruction were retrospectively reviewed. Anakinra was utilized when patients were unable to obtain full extension and at least 90° of flexion 1 month postoperatively in association with persistent effusions or decreased patellar mobility.
Results
Anakinra injection was performed between 36 and 97 days postsurgery. All four reported improvements in range of motion and decreased pain and effusions within 10 days of injection. One patient, who did not receive anakinra until more than 3 months postsurgery, required eventual arthroscopic debridement of a cyclops lesion but none of the patients required frank lysis of adhesions or manipulation under anesthesia. No adverse reactions to anakinra occurred.
Conclusion
Based on previous experience, we believe that all of these patients would have required arthroscopic debridement of scar tissue and manipulation under anesthesia to regain motion were not for the anakinra treatment. Clearly, the concept of IL-1 inhibition in the postoperative knee requires further research, but early results are promising for this unique treatment of a difficult clinical problem.
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