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Edama M, Tanaka Y, Shirai T, Takano Y, Sakamoto K, Osanami H, Yokota H, Hirabayashi R, Ishigaki T, Akuzawa H, Sekine C, Sato N. Dynamics of the suprapatellar bursa during knee joint extension. Surg Radiol Anat 2024:10.1007/s00276-024-03390-1. [PMID: 38856943 DOI: 10.1007/s00276-024-03390-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/16/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE The suprapatellar bursa is located in the proximal deep layer of the patella and is thought to reduce tissue friction by changing from a single-membrane structure to a double-membrane structure during knee joint motion. However, the dynamics of the suprapatellar bursa have only been inferred from positional relationships, and the actual dynamics have not been confirmed. METHODS Dynamics of the suprapatellar bursa during knee joint motion were observed in eight knees of four Thiel-fixed cadavers and the angle at which the bursa begins to show a double membrane was revealed. The flexion angles of knee joints were measured when the double-membrane structure of the suprapatellar bursa began to appear during knee joint extension. RESULTS The suprapatellar bursa changes from a single membrane to a double-membrane structure at 91 ± 4° of flexion, when the knee joint is moved from a flexed position to an extended position. CONCLUSION The suprapatellar bursa may be involved in limitations to knee joint range of motion and pain at an angle of approximately 90°. Further studies are needed to verify whether the same dynamics are observed in living subjects.
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Affiliation(s)
- Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, Niigata, 950-3198, Japan.
| | - Yudai Tanaka
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, Niigata, 950-3198, Japan
| | - Tatuki Shirai
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, Niigata, 950-3198, Japan
| | - Yuki Takano
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, Niigata, 950-3198, Japan
| | - Kodai Sakamoto
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, Niigata, 950-3198, Japan
| | - Haruki Osanami
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, Niigata, 950-3198, Japan
| | - Hirotake Yokota
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, Niigata, 950-3198, Japan
| | - Ryo Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, Niigata, 950-3198, Japan
| | - Tomonobu Ishigaki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, Niigata, 950-3198, Japan
| | - Hiroshi Akuzawa
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, Niigata, 950-3198, Japan
| | - Chie Sekine
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, Niigata, 950-3198, Japan
| | - Noboru Sato
- Division of Gross Anatomy and Morphogenesis, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Campbell TM, Westby M, Ghogomu ET, Fournier J, Ghaedi BB, Welch V. Stretching, Bracing, and Devices for the Treatment of Osteoarthritis-Associated Joint Contractures in Nonoperated Joints: A Systematic Review and Meta-Analysis. Sports Health 2023; 15:867-877. [PMID: 36691685 PMCID: PMC10606959 DOI: 10.1177/19417381221147281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
CONTEXT Many patients with osteoarthritis (OA) develop range of motion (ROM) restrictions in their affected joints (contractures), associated with worse outcomes and rising healthcare costs. Effective treatment guidance for lost ROM in OA-affected joints is lacking. OBJECTIVE A systematic review and meta-analysis evaluating the effectiveness of stretching and/or bracing protocols on native (nonoperated) joint ROM in the setting of radiographically diagnosed OA. DATA SOURCES Seven databases, English-language. STUDY SELECTION Studies including participants with radiographically diagnosed OA in any native joint evaluating the effect of stretching or bracing on ROM. STUDY DESIGN Systematic review and meta-analysis. LEVEL OF EVIDENCE Level 2. DATA EXTRACTION Two reviewers independently screened articles for inclusion and assessed risk of bias in included trials. Primary outcomes were ROM, pain, and adverse events (AEs). RESULTS We identified 6284 articles. A total of 9 randomized controlled trials, all evaluating the knee, met eligibility criteria. For stretching, 3 pooled studies reported total ROM, which improved by mean difference (MD) of 9.3° (95% CI 5.0°,13.5°) versus controls. Two pooled studies showed improved knee flexion ROM (MD 10.8° [7.3°,14.2°]) versus controls. Five studies were pooled for knee extension with mean improvement 9.1° [3.4°,14.8°] versus controls. Seven pooled studies showed reduced pain (standardized MD 1.9 [1.2,2.6]). One study reported improved knee extension of 3.7° [2.9°,4.5°] with use of a device. No studies used orthoses. One study reported on AEs, with none noted. Performance bias was present in all included studies, and only 3 studies clearly reported blinding of outcome assessors. Strength of evidence for primary outcomes was considered moderate. CONCLUSION There was moderate-quality evidence that stretching is an effective strategy for improving knee total, flexion and extension ROM, and pain. Our findings suggest that stretching to regain joint ROM in OA is not futile and that stretching appears to be an appropriate conservative intervention to improve patient outcomes as part of a comprehensive knee OA treatment plan before arthroplasty.
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Affiliation(s)
- T. Mark Campbell
- Department of Physical Medicine and Rehabilitation, Elisabeth Bruyère Hospital, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bone and Joint Laboratory, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- The Ottawa Hospital, Department of Medicine, Ottawa, Ontario, Canada
- University of Ottawa, Department of Cellular and Molecular Medicine, Ottawa, Ontario, Canada
| | - Marie Westby
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | | | - John Fournier
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | | | - Vivian Welch
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Rahyussalim AJ, Zufar MLL, Kurniwati T. A holistic approach for severe flexion contracture of bilateral hip, knee, and ankle joints in a neglected patient with prolonged knee-chest positioning on extreme undernourishment: a case report and review of the literature. J Med Case Rep 2022; 16:225. [PMID: 35610728 PMCID: PMC9128234 DOI: 10.1186/s13256-022-03439-y] [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: 05/21/2020] [Accepted: 03/09/2022] [Indexed: 11/30/2022] Open
Abstract
Background Flexion contracture in the lower extremity is a common finding in the patient with neuromusculoskeletal disorders. However, severe cases due to prolonged immobilization in knee–chest position are rarely established and remain underreported. This condition is associated with high morbidity and reduced quality of life, especially when it comes to neglected cases with missed injury and late presentation for adequate primary care and rehabilitative program. It remains a difficult challenge to treat, with no established treatment protocol. In addition, other factors related to psychological and socioeconomic conditions may interfere and aggravate the health state of such patients. Case presentation A 19-year-old Javanese man presented with flexion contracture of bilateral hip, knee, and ankle joints due to prolonged immobilization in knee–chest position for almost 2 years following a traffic accident and falling in the bathroom. The condition had persisted for the last 3 years due to irrecoverable condition and lack of awareness. In addition, the patient also presented with paraplegia at level L2–S1, dermatitis neglecta, multiple pressure ulcers, community-acquired pneumonia, and severe malnutrition. Prolonged and sustained passive stretching with serial plastering were performed in the patient. By the time of discharge, patient was able to move and ambulate using wheelchair. Progressive improvement of range of motion and good sitting balance were observed by 3-month follow-up. Conclusion A combination of surgery and rehabilitative care is required in the setting of severe flexion contracture. Passive prolonged stretching showed a better outcome and efficacy in the management of flexion contracture, whether the patient undergoes surgery or not. However, evaluation of residual muscle strength, changes in bone density and characteristic, and the patient’s general and comorbid conditions must always be considered when determining the best treatment of choice for each patient to achieve good outcome and result. A holistic approach with comprehensive assessment is important when treating such patients.
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Affiliation(s)
- Ahmad Jabir Rahyussalim
- Department of Orthopaedic and Traumatology, Cipto Mangunkusumo National Central General Hospital and Faculty of Medicine, Universitas Indonesia, Jl. Pangeran Diponegoro No.71, RW.5, Kenari, Kec. Senen, Kota Jakarta Pusat, Daerah Khusus Ibukota, Jakarta, 10310, Indonesia.
| | - Muhammad Luqman Labib Zufar
- Department of Orthopaedic and Traumatology, Cipto Mangunkusumo National Central General Hospital and Faculty of Medicine, Universitas Indonesia, Jl. Pangeran Diponegoro No.71, RW.5, Kenari, Kec. Senen, Kota Jakarta Pusat, Daerah Khusus Ibukota, Jakarta, 10310, Indonesia
| | - Tri Kurniwati
- Stem Cell and Tissue Engineering, IMERI Universitas, Jakarta, Indonesia
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Wegner E, Slotina E, Mickan T, Truffel S, Arand C, Wagner D, Ritz U, Rommens PM, Gercek E, Drees P, Baranowski A. Pleiotropic Long-Term Effects of Atorvastatin on Posttraumatic Joint Contracture in a Rat Model. Pharmaceutics 2022; 14:pharmaceutics14030523. [PMID: 35335899 PMCID: PMC8950153 DOI: 10.3390/pharmaceutics14030523] [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: 01/15/2022] [Revised: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 11/19/2022] Open
Abstract
The antifibrotic effect of atorvastatin has already been demonstrated in several organ systems. In the present study, a rat model was used to investigate the effect of atorvastatin on posttraumatic joint contracture. Forty-eight Sprague Dawley rats were equally randomized into an atorvastatin group and a control group. After initial joint trauma, knee joints were immobilized for intervals of 2 weeks (n = 16) or 4 weeks (n = 16) or immobilized for 4 weeks with subsequent remobilization for another 4 weeks (n = 16). Starting from the day of surgery, animals received either atorvastatin or placebo daily. After euthanasia at week 2, 4 or 8, joint contracture was determined, histological examinations were performed, and gene expression was assessed. The results suggest that the joint contracture was primarily arthrogenic. Atorvastatin failed to significantly affect contracture formation and showed a reduction in myofibroblast numbers to 98 ± 58 (control: 319 ± 113, p < 0.01) and a reduction in joint capsule collagen to 60 ± 8% (control: 73 ± 9%, p < 0.05) at week 2. Gene expression of α-smooth muscle actin (α-SMA), collagen type I, transforming growth factor β1 (TGF-β1) and interleukin-6 (IL-6) was not significantly affected by atorvastatin. Atorvastatin decreases myofibroblast number and collagen deposition but does not result in an improvement in joint mobility.
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Lam K, Kwan JSK, Kwan CW, Chi I. Factors Associated with Development of New Joint Contractures in Long-Term Care Residents. J Am Med Dir Assoc 2021; 23:92-97. [PMID: 34175292 DOI: 10.1016/j.jamda.2021.05.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Limb contractures are associated with poor outcomes and quality of life in long-term care (LTC) residents. This study examined the rate of developing new joint contracture in the LTC residents and associated risk factors to formulate effective interventions in this critical but understudied area. DESIGN This is an observational study with data obtained from the Hong Kong Longitudinal Study on LTC Residents between 2005 and 2016. SETTING AND PARTICIPANTS Trained assessors (nurses, social workers, and therapists) used the Minimum Data Set Resident Assessment Instrument (MDS-RAI 2.0) to collect the data of the residents from 9 residential LTC facilities. MEASURES Limb contractures were defined as a functional limitation in the range of motion involving the upper or lower limbs. Primary outcomes included annual prevalence of joint contractures and factors that were associated with the development of new joint contractures. RESULTS We analyzed the data for 1914 older residents (674 males, mean age 83.4 years). During the first 5 years since admission, the annual prevalence of upper limb contractures increased from 29.8% to 36.5%, and lower limb contractures increased from 41.5% to 57.4%. Overall, the increment of the prevalence rate of joint contractures per year ranged from 0.7% to 3.2% for the upper limbs and 0.3% to 6.0% per year for the lower limbs. Impaired mobility, presence of neurologic diseases, and older age were the leading independent risk factors for the development of new joint contractures. CONCLUSIONS AND IMPLICATIONS Joint contractures are highly prevalent among residents admitted to the LTC facilities, and many residents develop new contractures during the first 5 years of their admission. Immobility appears to be the main modifiable risk factor. Further studies are needed to identify potential strategies to prevent new contractures in this vulnerable group.
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Affiliation(s)
- Kuen Lam
- Department of Medicine and Geriatrics, Shatin Hospital, Hong Kong, China.
| | - Joseph S K Kwan
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Chi Wai Kwan
- Department of Statistics and Actuarial Science, The University of Hong Kong, Hong Kong, China
| | - Iris Chi
- Suzanne Dwork-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
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Thomovsky SA. The Physiology Associated With "Bed Rest" and Inactivity and How It May Relate to the Veterinary Patient With Spinal Cord Injury and Physical Rehabilitation. Front Vet Sci 2021; 8:601914. [PMID: 33778033 PMCID: PMC7994754 DOI: 10.3389/fvets.2021.601914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/05/2021] [Indexed: 11/13/2022] Open
Abstract
In the twentieth century, bed rest was commonly prescribed by human healthcare professionals as a treatment for a variety of ailments including spinal cord injury and disease. With time, the negative impact of bed rest was recognized as a source of slow and even reduced patient healing. As treatment paradigms shifted, the utility and importance of physical rehabilitation (PR) as a critical adjunctive treatment for human patients with spinal cord injury became fully recognized. Today, standardized PR protocols exist for humans with the spinal cord disease, but the same cannot be said for our veterinary patients with spinal cord injury. The purpose of this manuscript is to discuss the effects of inactivity on the musculoskeletal system and to explore how and why PR can play a critical role in improved mobility and overall health in the veterinary patient with spinal cord injury. Research with a focus on the effects of inactivity, in the form of cage rest, for the veterinary patient with spinal cord injury is lacking.
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Affiliation(s)
- Stephanie A Thomovsky
- Department of Veterinary Clinical Sciences, Purdue University, West Lafayette, IN, United States
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Ding Z, Cong S, Xie Y, Feng S, Chen S, Chen J. Location of the Suture Anchor in Hill-Sachs Lesion Could Influence Glenohumeral Cartilage Quality and Limit Range of Motion After Arthroscopic Bankart Repair and Remplissage. Am J Sports Med 2020; 48:2628-2637. [PMID: 32804547 DOI: 10.1177/0363546520945723] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND No study has reported clinical evidence for cartilage change in the glenohumeral joint or the cause of loss in range of motion (ROM) after arthroscopic Bankart repair with remplissage technique (BR). PURPOSE To investigate the postoperative features of glenohumeral joint cartilage, ROM, and anchor placement for remplissage at a minimum of 2 years of follow-up after BR and to analyze the correlations. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A total of 21 patients who underwent BR received follow-up for a minimum of 2 years. At both preoperative assessment and final follow-up, passive shoulder ROM, Oxford Shoulder Instability Score, Simple Shoulder Test score, and Single Assessment Numerical Evaluation score were assessed. All patients underwent 3.0-T magnetic resonance imaging (MRI) examination at final follow-up. The clinical outcomes, glenohumeral cartilage or Hill-Sachs lesion-related MRI parameters, and their potential correlations were analyzed. RESULTS The mean follow-up was 55.0 months (range, 24-119 months). Compared with preoperative assessment, all functional scores significantly improved (P < .001). At the final follow-up, a significant ROM loss (>15°) of external rotation (ER) at the side (ER0) was found in 12 patients, among whom 8 patients had significant ROM loss of ER at 90° of abduction as well. Further, 12 patients with decreased ER had significantly higher signal intensity of cartilage on the anterior, middle, and posterior humeral head (anterior, P = .002; middle, P < .001; posterior, P < .001) than 9 patients with normal ER. The ratio of the width of the remplissage anchor to the diameter of the humeral head (w:d ratio) was significantly greater (P = .031) in the decreased ER group than in the normal ER group. Correlation analysis showed that signal intensity on the posterior humeral head and ER0 loss (ΔER0) had a significantly positive correlation (r = 0.516; P = .034), while the w:d ratio and ΔER0 had a significantly positive correlation (r = 0.519; P = .039). CONCLUSION At a minimum of 2 years of follow-up, patients who underwent BR showed significant clinical improvement compared with preoperative assessment, except for limitations in ER. The glenohumeral cartilage degeneration (higher signal intensity) after BR had a significantly positive correlation with the postoperative ER loss, which was found to be associated with a relatively medial placement of the remplissage anchor.
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Affiliation(s)
- Zheci Ding
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Shuang Cong
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Yuxue Xie
- Department of Radiology, Huashan Hospital, Shanghai, China
| | - Sijia Feng
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Jiwu Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
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Mechanical adaptation of synoviocytes A and B to immobilization and remobilization: a study in the rat knee flexion model. J Mol Histol 2020; 51:605-611. [PMID: 32778991 DOI: 10.1007/s10735-020-09902-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 07/29/2020] [Indexed: 10/23/2022]
Abstract
The objective of this study was to quantify the in vivo response of synoviocytes type A and B in the posterior joint capsule to knee immobilization and remobilization. Also, to correlate the immunohistochemical data with selected mRNA expression in the posterior joint capsule. Forty-two adult male Sprague-Dawley rats had one knee joint immobilized in flexion for durations of 1-4 weeks. Fifteen were harvested after immobilization and 15 were remobilized for 4 weeks. They were analyzed immunohistochemically with CD68 and CD55 antibodies as markers for synoviocytes type A and type B, respectively. Controls were 15 age-matched rats. The remaining 12 rats had their posterior capsule harvested and synoviocyte-specific CD68, CD55, and uridine diphosphoglucose dehydrogenase (UDPGD) mRNA expression was measured. Controls were 12 sham-operated knees. Knee immobilization for 2 weeks significantly increased synoviocytes A:B staining ratio compared to controls (3.88 ± 1.39 vs. 1.83 ± 0.76; p < 0.05). Remobilization for 4 weeks abolished the increase. Remobilization of knees that were immobilized for 1 week also significantly lowered the synoviocytes A:B staining ratios compared to immobilized-only knees (0.66 ± 0.23 vs. 2.19 ± 0.54; p < 0.05) and to controls (0.66 ± 0.23 vs. 1.32 ± 0.29; p < 0.05). Consistent with the immunohistochemistry, mRNA expression of synoviocyte type B-specific CD55 and UDPGD genes were significantly lower in the capsules immobilized for 2 weeks (both p < 0.05). Knee immobilization and remobilization significantly modulated synoviocytes in vivo, stressing their mechanosensitive nature and possible contribution to immobility-induced changes of the joint capsule.
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Atluri K, Brouillette MJ, Seol D, Khorsand B, Sander E, Salem AK, Fredericks D, Petersen E, Smith S, Fowler TP, Martin JA. Sulfasalazine Resolves Joint Stiffness in a Rabbit Model of Arthrofibrosis. J Orthop Res 2020; 38:629-638. [PMID: 31692083 DOI: 10.1002/jor.24499] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 10/06/2019] [Indexed: 02/04/2023]
Abstract
Joint stiffness due to fibrosis/capsule contracture is a seriously disabling complication of articular injury that surgical interventions often fail to completely resolve. Fibrosis/contracture is associated with the abnormal persistence of myofibroblasts, which over-produce and contract collagen matrices. We hypothesized that intra-articular therapy with drugs targeting myofibroblast survival (sulfasalazine), or collagen production (β-aminopropionitrile and cis-hydroxyproline), would reduce joint stiffness in a rabbit model of fibrosis/contracture. Drugs were encapsulated in poly[lactic-co-glycolic] acid pellets and implanted in joints after fibrosis/contracture induction. Capsule α-smooth muscle actin (α-SMA) expression and intimal thickness were evaluated by immunohistochemistry and histomorphometry, respectively. Joint stiffness was quantified by flexion-extension testing. Drawer tests were employed to determine if the drugs induced cruciate ligament laxity. Joint capsule fibroblasts were tested in vitro for contractile activity and α-SMA expression. Stiffness in immobilized joints treated with blank pellets (control) was significantly higher than in non-immobilized, untreated joints (normal) (p = 0.0008), and higher than in immobilized joints treated with sulfasalazine (p = 0.0065). None of the drugs caused significant cruciate ligament laxity. Intimal thickness was significantly lower than control in the normal and sulfasalazine-treated groups (p = 0.010 and 0.025, respectively). Contractile activity in the cells from controls was significantly increased versus normal (p = 0.001). Sulfasalazine and β-aminopropionitrile significantly inhibited this effect (p = 0.005 and 0.0006, respectively). α-SMA expression was significantly higher in control versus normal (p = 0.0021) and versus sulfasalazine (p = 0.0007). These findings support the conclusion that sulfasalazine reduced stiffness by clearing myofibroblasts from fibrotic joints. Statement of clinical significance: The results provide proof-of-concept that established joint stiffness can be resolved non-surgically. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:629-638, 2020.
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Affiliation(s)
- Keerthi Atluri
- Department of Pharmaceutical Sciences and Experimental Therapeutics, University of Iowa, Iowa City, Iowa, 52242
| | - Marc J Brouillette
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa, 52242
| | - Dongrim Seol
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa, 52242
| | - Behnoush Khorsand
- Department of Pharmaceutical Sciences and Experimental Therapeutics, University of Iowa, Iowa City, Iowa, 52242
| | - Edward Sander
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, 52242
| | - Aliasger K Salem
- Department of Pharmaceutical Sciences and Experimental Therapeutics, University of Iowa, Iowa City, Iowa, 52242
| | - Douglas Fredericks
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa, 52242
| | - Emily Petersen
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa, 52242
| | - Sonja Smith
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa, 52242
| | - Timothy P Fowler
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa, 52242
| | - James A Martin
- Department of Pharmaceutical Sciences and Experimental Therapeutics, University of Iowa, Iowa City, Iowa, 52242.,Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa, 52242.,Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, 52242
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Effects of Immobilization and Re-Mobilization on Knee Joint Arthrokinematic Motion Quality. J Clin Med 2020; 9:jcm9020451. [PMID: 32041248 PMCID: PMC7074294 DOI: 10.3390/jcm9020451] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/18/2020] [Accepted: 02/05/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Knee immobilization is a common intervention for patients with traumatic injuries. However, it usually leads to biomechanical/morphological disturbances of articular tissues. These changes may contribute to declining kinetic friction-related quality of arthrokinematics; however, this phenomenon has not been analyzed in vivo and remains unrecognized. Thus, the aim of the present study is to investigate the effect of immobilization and subsequent re-mobilization on the quality of arthrokinematics within the patellofemoral joint, analyzed by vibroarthrography (VAG). METHODS Thirty-four patients after 6-weeks of knee immobilization and 37 controls were analyzed. The (VAG) signals were collected during knee flexion/extension using an accelerometer. Patients were tested on the first and last day of the 2-week rehabilitation program. RESULTS Immobilized knees were characterized by significantly higher values of all VAG parameters when compared to controls (p < 0.001) on the first day. After 2 weeks, the participants in the rehabilitation program that had immobilized knees showed significant improvement in all measurements compared to the baseline condition, p < 0.05. However, patients did not return to normal VAG parameters compared to controls. CONCLUSION Immobilization-related changes within the knee cause impairments of arthrokinematic function reflected in VAG signal patterns. The alterations in joint motion after 6 weeks of immobilization may be partially reversible; however, the 2-week physiotherapy program is not sufficient for full recovery.
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Dehail P, Gaudreault N, Zhou H, Cressot V, Martineau A, Kirouac-Laplante J, Trudel G. Joint contractures and acquired deforming hypertonia in older people: Which determinants? Ann Phys Rehabil Med 2019; 62:435-441. [DOI: 10.1016/j.rehab.2018.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 10/28/2018] [Accepted: 10/29/2018] [Indexed: 01/05/2023]
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Abstract
Upper extremity contractures in the spastic patient may result from muscle spasticity, secondary muscle contracture, or joint contracture. Knowledge of the underlying cause is critical in planning successful treatment. Initial management consists of physical therapy and splinting. Botulinum toxin can be helpful, as a therapeutic treatment in relieving spasticity and as a diagnostic tool in determining the underlying cause of the contracture. Surgical management options include release or lengthening of the causative muscle/tendon unit and joint capsular release, as required. Postoperative splinting is important to maintain the improved range of motion and protect any associated tendon lengthening or transfer.
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Affiliation(s)
- Kristi S Wood
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, 5th Floor, New York, NY 10021, USA
| | - Aaron Daluiski
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, 5th Floor, New York, NY 10021, USA; Department of Hand and Upper Extremity, Hospital for Special Surgery, 523 East 72nd Street, 4th Floor, New York, NY 10021, USA.
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Sotobayashi D, Kawahata H, Anada N, Ogihara T, Morishita R, Aoki M. Therapeutic effect of intra-articular injection of ribbon-type decoy oligonucleotides for hypoxia inducible factor-1 on joint contracture in an immobilized knee animal model. J Gene Med 2018; 18:180-92. [PMID: 27352194 DOI: 10.1002/jgm.2891] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 06/09/2016] [Accepted: 06/26/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Limited range of motion (ROM) as a result of joint contracture in treatment associated with joint immobilization or motor paralysis is a critical issue. However, its molecular mechanism has not been fully clarified and a therapeutic approach is not yet established. METHODS In the present study, we investigated its molecular mechanism, focusing on the role of a transcription factor, hypoxia inducible factor-1 (HIF-1), which regulates the expression of connective tissue growth factor (CTGF) and vascular endothelial growth factor (VEGF), and evaluated the possibility of molecular therapy to inhibit HIF-1 activation by ribbon-type decoy oligonucleotides (ODNs) for HIF-1 using immobilized knee animal models. RESULTS In a mouse model, ROM of the immobilized knee significantly decreased in a time-dependent manner, accompanied by synovial hypertrophy. Immunohistochemical studies suggested that CTGF and VEGF are implicated in synovial hypertrophy with fibrosis. CTGF and VEGF were up-regulated at both the mRNA and protein levels at 1 and 2 weeks after immobilization, subsequent to up-regulation of HIF-1 mRNA and transcriptional activation of HIF-1. Of importance, intra-articular transfection of decoy ODNs for HIF-1 in a rat model successfully inhibited transcriptional activation of HIF-1, followed by suppression of expression of CTGF and VEGF, resulting in attenuation of restricted ROM, whereas transfection of scrambled decoy ODNs did not. CONCLUSIONS The present study demonstrates the important role of HIF-1 in the initial progression of immobilization-induced joint contracture, and indicates the possibility of molecular treatment to prevent the progression of joint contracture prior to intervention with physical therapy. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Daisuke Sotobayashi
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan
| | - Hirohisa Kawahata
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan
| | - Natsuki Anada
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan
| | - Toshio Ogihara
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan
| | - Ryuichi Morishita
- Department of Clinical Gene Therapy, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Motokuni Aoki
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan
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Maezawa T, Tanaka M, Kanazashi M, Maeshige N, Kondo H, Ishihara A, Fujino H. Astaxanthin supplementation attenuates immobilization-induced skeletal muscle fibrosis via suppression of oxidative stress. J Physiol Sci 2017; 67:603-611. [PMID: 27714500 PMCID: PMC10718026 DOI: 10.1007/s12576-016-0492-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 09/21/2016] [Indexed: 12/14/2022]
Abstract
Immobilization induces skeletal muscle fibrosis characterized by increasing collagen synthesis in the perimysium and endomysium. Transforming growth factor-β1 (TGF-β1) is associated with this lesion via promoting differentiation of fibroblasts into myofibroblasts. In addition, reactive oxygen species (ROS) are shown to mediate TGF-β1-induced fibrosis in tissues. These reports suggest the importance of ROS reduction for attenuating skeletal muscle fibrosis. Astaxanthin, a powerful antioxidant, has been shown to reduce ROS production in disused muscle. Therefore, we investigated the effects of astaxanthin supplementation on muscle fibrosis under immobilization. In the present study, immobilization increased the collagen fiber area, the expression levels of TGF-β1, α-smooth muscle actin, and superoxide dismutase-1 protein and ROS production. However, these changes induced by immobilization were attenuated by astaxanthin supplementation. These results indicate the effectiveness of astaxanthin supplementation on skeletal muscle fibrosis induced by ankle joint immobilization.
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Affiliation(s)
- Toshiyuki Maezawa
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe-shi, Hyogo, 654-0142, Japan
| | - Masayuki Tanaka
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe-shi, Hyogo, 654-0142, Japan
- Department of Physical Therapy, Faculty of Human Sciences, Osaka University of Human Sciences, 1-4-1 Shojaku, Settsu-shi, Osaka, 566-8501, Japan
| | - Miho Kanazashi
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, 1-1 Gakuen-cho, Mihara-shi, Hiroshima, 723-0053, Japan
| | - Noriaki Maeshige
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe-shi, Hyogo, 654-0142, Japan
| | - Hiroyo Kondo
- Department of Food Science and Nutrition, Nagoya Women's University, Nagoya, 4-21 Shioji-cho, Mizuho-ku, Nagoya-shi, Aichi, 467-8611, Japan
| | - Akihiko Ishihara
- Laboratory of Cell Biology and Life Science, Graduate School of Human and Environmental Studies, Kyoto University, Yoshida-nihonmatsu-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8501, Japan
| | - Hidemi Fujino
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe-shi, Hyogo, 654-0142, Japan.
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15
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Sasabe R, Sakamoto J, Goto K, Honda Y, Kataoka H, Nakano J, Origuchi T, Endo D, Koji T, Okita M. Effects of joint immobilization on changes in myofibroblasts and collagen in the rat knee contracture model. J Orthop Res 2017; 35:1998-2006. [PMID: 27918117 DOI: 10.1002/jor.23498] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 11/16/2016] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to examine the time-dependent changes in the development of joint capsule fibrosis and in the number of myofibroblasts in the joint capsule after immobilization, using a rat knee contracture model. Both knee joints were fixed in full flexion for 1, 2, and 4 weeks (immobilization group). Untreated rats were bred for each immobilization period (control group). Histological analysis was performed to evaluate changes in the amount and density of collagen in the joint capsule. The changes in type I and III collagen mRNA were examined by in situ hybridization. The number of myofibroblasts in the joint capsule was assessed by immunohistochemical methods. In the immobilization group, the amount of collagen increased within 1 week and the density of collagen increased within 2 weeks, as compared with that in the control group. Type I collagen mRNA-positive cell numbers in the immobilization group increased at all time points. However, type III collagen mRNA-positive cell numbers did not increase. Myofibroblasts in the immobilization group significantly increased compared with those in the control group at all time points, and they increased significantly with the period of immobilization. These results suggest that joint capsule fibrosis with overexpression of type I collagen occurs and progresses within 1 week after immobilization, and an increase in myofibroblasts is related to the mechanism of joint capsule fibrosis. The findings suggest the need for a treatment targeting accumulation of type I collagen associated with an increase in myofibroblasts. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1998-2006, 2017.
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Affiliation(s)
- Ryo Sasabe
- Department of Locomotive Rehabilitation Science, Unit of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8520, Japan.,Department of Rehabilitation, Nagasaki University Hospital, Sakamoto 1-7-1, Nagasaki, 852-8520, Japan
| | - Junya Sakamoto
- Department of Physical Therapy Science, Unit of Physical and Occupational Therapy Sciences, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8520, Japan
| | - Kyo Goto
- Department of Locomotive Rehabilitation Science, Unit of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8520, Japan.,Department of Rehabilitation, Nagasaki Memorial Hospital, 1-11-54 Fukahori, Nagasaki, 851-0301, Japan
| | - Yuichiro Honda
- Department of Rehabilitation, Nagasaki University Hospital, Sakamoto 1-7-1, Nagasaki, 852-8520, Japan
| | - Hideki Kataoka
- Department of Rehabilitation, Nagasaki Memorial Hospital, 1-11-54 Fukahori, Nagasaki, 851-0301, Japan
| | - Jiro Nakano
- Department of Physical Therapy Science, Unit of Physical and Occupational Therapy Sciences, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8520, Japan
| | - Tomoki Origuchi
- Department of Locomotive Rehabilitation Science, Unit of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8520, Japan
| | - Daisuke Endo
- Department of Histology and Cell Biology, Unit of Basic Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8520, Japan
| | - Takehiko Koji
- Department of Histology and Cell Biology, Unit of Basic Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8520, Japan
| | - Minoru Okita
- Department of Locomotive Rehabilitation Science, Unit of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8520, Japan
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16
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He R, Wang Z, Lu Y, Huang J, Ren J, Wang K. Chaperonin containing T-complex polypeptide subunit eta is a potential marker of joint contracture: an experimental study in the rat. Cell Stress Chaperones 2015; 20:959-66. [PMID: 26220476 PMCID: PMC4595434 DOI: 10.1007/s12192-015-0624-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 07/15/2015] [Accepted: 07/17/2015] [Indexed: 11/26/2022] Open
Abstract
Joint contracture is a fibroproliferative disorder that restricts joint mobility, resulting in tissue degeneration and deformity. However, the etiology of joint contracture is still unknown. Chaperonin containing T-complex polypeptide subunit eta (CCT-eta) is reported to increase in fibrotic diseases. The purpose of this study was to investigate whether CCT-eta is implicated in joint contracture and to determine the role of CCT-eta in the progression of joint contracture by analyzing a rat model. We immobilized the left knee joint of rat by internal fixation for 8 weeks. The non-immobilized right leg served as a control. The range of motion (ROM) of the knee was investigated. Fibroblasts were obtained from the posterior joint capsule of the joints. The outcome was followed by quantitative real-time polymerase chain reaction (qRT-PCR), Western blot, fibroblast migration assay, and collagen assay. The effect of CCT-eta on the functions of fibroblasts was observed by utilizing a short inhibitory RNA (siRNA) targeting CCT-eta. The ROM of the immobilized joints was significantly limited compared to the contralateral joints (p < 0.05). Fibroblasts derived from the contractive joints showed higher mRNA and protein expressions of CCT-eta in parallel with alpha-smooth muscle actin (α-SMA) compared to the cells from the contralateral knees (p < 0.05). siRNA-mediated downregulation of CCT-eta inhibited the expressions of both CCT-eta and α-SMA. Moreover, the reduction of CCT-eta also significantly decreased fibroblast functions such as cell mobility and collagen synthesis (all p < 0.05). Our findings indicate that CCT-eta appears to be a potential marker of joint contracture disease.
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Affiliation(s)
- Ronghan He
- Department of Orthopedic Surgery, The Third Affiliated Hospital of Sun Yat-sen University, 510000, Guangzhou, China
| | - Zhe Wang
- Department of Orthopedic Surgery, The Third Affiliated Hospital of Sun Yat-sen University, 510000, Guangzhou, China
| | - Yunxiang Lu
- Department of Orthopedic Surgery, The Third Affiliated Hospital of Sun Yat-sen University, 510000, Guangzhou, China
| | - Junqi Huang
- Division of Biomedical Cell Biology, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Jianhua Ren
- Department of Orthopedic Surgery, The Third Affiliated Hospital of Sun Yat-sen University, 510000, Guangzhou, China
| | - Kun Wang
- Department of Orthopedic Surgery, The Third Affiliated Hospital of Sun Yat-sen University, 510000, Guangzhou, China.
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17
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Nepomuceno BRV, Martinez BP, Gomes Neto M. [Impact of hospitalization in an intensive care unit on range of motion of critically ill patients: a pilot study]. Rev Bras Ter Intensiva 2015; 26:65-70. [PMID: 24770691 PMCID: PMC4031890 DOI: 10.5935/0103-507x.20140010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 01/21/2014] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To evaluate the joint range of motion of critically ill patients during hospitalization in the intensive care unit. METHODS This work was a prospective longitudinal study conducted in a critical care unit of a public hospital in the city of Salvador (BA) from September to November 2010. The main variable evaluated was the passive joint range of motion. A goniometer was used to measure the elbows, knees and ankles at the time of admission and at discharge. All patients admitted in the period were included other than patients with length of stay <72 hours and patients with reduced joint range of motion on admission. RESULTS The sample consisted of 22 subjects with a mean age of 53.5±17.6 years, duration of stay in the intensive care unit of 13.0±6.0 days and time on mechanical ventilation of 12.0±6.3 days. The APACHE II score was 28.5±7.3, and the majority of patients had functional independence at admission with a prior Barthel index of 88.8±19. The losses of joint range of motion were 11.1±2.1°, 11.0±2.2°, 8.4±1.7°, 9.2±1.6°, 5.8±0.9° and 5.1±1.0°, for the right and left elbows, knees and ankles, respectively (p<0.001). CONCLUSION There was a tendency towards decreased range of motion of large joints such as the ankle, knee and elbow during hospitalization in the intensive care unit.
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18
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Wong K, Trudel G, Laneuville O. Noninflammatory Joint Contractures Arising from Immobility: Animal Models to Future Treatments. BIOMED RESEARCH INTERNATIONAL 2015; 2015:848290. [PMID: 26247029 PMCID: PMC4515492 DOI: 10.1155/2015/848290] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 05/07/2015] [Indexed: 01/17/2023]
Abstract
Joint contractures, defined as the limitation in the passive range of motion of a mobile joint, can be classified as noninflammatory diseases of the musculoskeletal system. The pathophysiology is not well understood; limited information is available on causal factors, progression, the pathophysiology involved, and prediction of response to treatment. The clinical heterogeneity of joint contractures combined with the heterogeneous contribution of joint connective tissues to joint mobility presents challenges to the study of joint contractures. Furthermore, contractures are often a symptom of a wide variety of heterogeneous disorders that are in many cases multifactorial. Extended immobility has been identified as a causal factor and evidence is provided from both experimental and epidemiology studies. Of interest is the involvement of the joint capsule in the pathophysiology of joint contractures and lack of response to remobilization. While molecular pathways involved in the development of joint contractures are being investigated, current treatments focus on physiotherapy, which is ineffective on irreversible contractures. Future treatments may include early diagnosis and prevention.
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Affiliation(s)
- Kayleigh Wong
- Bone and Joint Research Laboratory, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada K1H 8M5
| | - Guy Trudel
- Bone and Joint Research Laboratory, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada K1H 8M5
- Department of Medicine, Bone and Joint Research Laboratory, The Ottawa Hospital Rehabilitation Centre, 505 Smyth Road, Ottawa, ON, Canada K1H 8M2
| | - Odette Laneuville
- Bone and Joint Research Laboratory, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada K1H 8M5
- Department of Biology, Faculty of Science, University of Ottawa, 30 Marie Curie, Ottawa, ON, Canada K1N 6N5
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19
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Wong K, Sun F, Trudel G, Sebastiani P, Laneuville O. Temporal gene expression profiling of the rat knee joint capsule during immobilization-induced joint contractures. BMC Musculoskelet Disord 2015; 16:125. [PMID: 26006773 PMCID: PMC4443538 DOI: 10.1186/s12891-015-0588-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 05/18/2015] [Indexed: 01/29/2023] Open
Abstract
Background Contractures of the knee joint cause disability and handicap. Recovering range of motion is recognized by arthritic patients as their preference for improved health outcome secondary only to pain management. Clinical and experimental studies provide evidence that the posterior knee capsule prevents the knee from achieving full extension. This study was undertaken to investigate the dynamic changes of the joint capsule transcriptome during the progression of knee joint contractures induced by immobilization. We performed a microarray analysis of genes expressed in the posterior knee joint capsule following induction of a flexion contracture by rigidly immobilizing the rat knee joint over a time-course of 16 weeks. Fold changes of expression values were measured and co-expressed genes were identified by clustering based on time-series analysis. Genes associated with immobilization were further analyzed to reveal pathways and biological significance and validated by immunohistochemistry on sagittal sections of knee joints. Results Changes in expression with a minimum of 1.5 fold changes were dominated by a decrease in expression for 7732 probe sets occurring at week 8 while the expression of 2251 probe sets increased. Clusters of genes with similar profiles of expression included a total of 162 genes displaying at least a 2 fold change compared to week 1. Functional analysis revealed ontology categories corresponding to triglyceride metabolism, extracellular matrix and muscle contraction. The altered expression of selected genes involved in the triglyceride biosynthesis pathway; AGPAT-9, and of the genes P4HB and HSP47, both involved in collagen synthesis, was confirmed by immunohistochemistry. Conclusions Gene expression in the knee joint capsule was sensitive to joint immobility and provided insights into molecular mechanisms relevant to the pathophysiology of knee flexion contractures. Capsule responses to immobilization was dynamic and characterized by modulation of at least three reaction pathways; down regulation of triglyceride biosynthesis, alteration of extracellular matrix degradation and muscle contraction gene expression. The posterior knee capsule may deploy tissue-specific patterns of mRNA regulatory responses to immobilization. The identification of altered expression of genes and biochemical pathways in the joint capsule provides potential targets for the therapy of knee flexion contractures.
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Affiliation(s)
- Kayleigh Wong
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada.
| | - Fangui Sun
- Department of Biostatistics, Boston University School of Public Health, Medical Campus, 801 Massachusetts Ave., Crosstown 3rd floor, Boston, MA, 02118, USA.
| | - Guy Trudel
- The Ottawa Hospital Rehabilitation Centre, 505 Smyth Rd., Ottawa, ON, K1H 8M2, Canada. .,Bone and Joint Research Laboratory, Faculty of Medicine, 451 Smyth Rd., Ottawa, ON, K1H 8M5, Canada.
| | - Paola Sebastiani
- Department of Biostatistics, Boston University School of Public Health, Medical Campus, 801 Massachusetts Ave., Crosstown 3rd floor, Boston, MA, 02118, USA.
| | - Odette Laneuville
- Department of Biology, Faculty of Science, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N 6N5, Canada.
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20
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Campbell TM, Trudel G, Laneuville O. Knee flexion contractures in patients with osteoarthritis: clinical features and histologic characterization of the posterior capsule. PM R 2014; 7:466-73. [PMID: 25511691 DOI: 10.1016/j.pmrj.2014.12.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 11/15/2014] [Accepted: 12/01/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To (1) identify demographic and clinical factors associated with knee flexion contracture (KFlC) in the setting of osteoarthritis (OA) and (2) histologically compare the posterior knee capsule of patients with OA with and without KFlC. DESIGN Cross-sectional study. SETTING Primary care, including private and institutional practice. PATIENTS Thirteen patients with primary OA and KFlC and 8 patients with primary OA without KFlC. METHODS We compared the KFlC and non-KFlC groups to identify demographic and clinical factors associated with KFlC. We examined the histology of the posterior knee capsules of 9 patients with KFlC and 6 without. MAIN OUTCOME MEASUREMENTS Patient demographic and clinical factors. For histology we measured the proportional composition of collagenous, adipose, and synovial tissues; fibroblast and adipocyte cellularity; and synovial thickness. RESULTS Patients with contracture had longer duration of OA, reduced flexion of the surgical knee, and reduced extension of the contralateral knee (P = .04, <.01, and <.01 respectively). Histologically, there was a greater proportion of collagenous tissue and a lower proportion of adipose and synovial tissues in the contracture group than in the noncontracture group; however, the differences were not statistically significant. Cellularity was similar between the 2 groups. CONCLUSIONS Longer duration of knee OA, reduced surgical knee flexion, and reduced contralateral, nonsurgical knee extension were associated with KFlC in the OA knee undergoing total arthroplasty. Monitoring bilateral knee range of motion in patients with longer-duration OA could allow earlier intervention, reducing functional loss. Capsular tissue composition analysis may indicate a fibrotic disease process. Further research in which a larger sample size is used will help clarify these novel findings.
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Affiliation(s)
- Thomas Mark Campbell
- Department of Medicine, The Ottawa Hospital Rehabilitation Centre, University of Ottawa, Ottawa, ON, Canada(∗).
| | - Guy Trudel
- Department of Medicine, The Ottawa Hospital Rehabilitation Centre, University of Ottawa, Ottawa, ON, Canada(†)
| | - Odette Laneuville
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada(‡)
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21
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Trudel G, Laneuville O, Coletta E, Goudreau L, Uhthoff HK. Quantitative and temporal differential recovery of articular and muscular limitations of knee joint contractures; results in a rat model. J Appl Physiol (1985) 2014; 117:730-7. [DOI: 10.1152/japplphysiol.00409.2014] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Joint contractures alter the mechanical properties of articular and muscular structures. Reversibility of a contracture depends on the restoration of the elasticity of both structures. We determined the differential contribution of articular and muscular structures to knee flexion contractures during spontaneous recovery. Rats (250, divided into 24 groups) had one knee joint surgically fixed in flexion for six different durations, from 1 to 32 wk, creating joint contractures of various severities. After the fixation was removed, the animals were left to spontaneously recover for 1 to 48 wk. After the recovery periods, animals were killed and the knee extension was measured before and after division of the transarticular posterior muscles using a motorized arthrometer. No articular limitation had developed in contracture of recent onset (≤2 wk of fixation, P > 0.05); muscular limitations were responsible for the majority of the contracture (34 ± 8° and 38 ± 6°, respectively; both P < 0.05). Recovery for 1 and 8 wk reversed the muscular limitation of contractures of recent onset (1 and 2 wk of fixation, respectively). Long-lasting contractures (≥4 wk of fixation) presented articular limitations, irreversible in all 12 durations of recovery compared with controls (all 12 P < 0.05). Knee flexion contractures of recent onset were primarily due to muscular structures, and they were reversible during spontaneous recovery. Long-lasting contractures were primarily due to articular structures and were irreversible. Comprehensive temporal and quantitative data on the differential reversibility of mechanically significant alterations in articular and muscular structures represent novel evidence on which to base clinical practice.
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Affiliation(s)
- Guy Trudel
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Bone and Joint Research Laboratory, University of Ottawa, Ottawa, Ontario, Canada
| | - Odette Laneuville
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
| | - Elizabeth Coletta
- Bone and Joint Research Laboratory, University of Ottawa, Ottawa, Ontario, Canada
| | - Louis Goudreau
- Biomedical Engineering, The Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario, Canada; and
| | - Hans K. Uhthoff
- Bone and Joint Research Laboratory, University of Ottawa, Ottawa, Ontario, Canada
- Division of Orthopedic Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
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22
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Kunz RI, Coradini JG, Silva LI, Bertolini GRF, Brancalhão RMC, Ribeiro LFC. Effects of immobilization and remobilization on the ankle joint in Wistar rats. ACTA ACUST UNITED AC 2014; 47:842-9. [PMID: 25140815 PMCID: PMC4181219 DOI: 10.1590/1414-431x20143795] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 06/06/2014] [Indexed: 12/26/2022]
Abstract
A sprained ankle is a common musculoskeletal sports injury and it is often treated by immobilization of the joint. Despite the beneficial effects of this therapeutic measure, the high prevalence of residual symptoms affects the quality of life, and remobilization of the joint can reverse this situation. The aim of this study was to analyze the effects of immobilization and remobilization on the ankle joint of Wistar rats. Eighteen male rats had their right hindlimb immobilized for 15 days, and were divided into the following groups: G1, immobilized; G2, remobilized freely for 14 days; and G3, remobilized by swimming and jumping in water for 14 days, performed on alternate days, with progression of time and a series of exercises. The contralateral limb was the control. After the experimental period, the ankle joints were processed for microscopic analysis. Histomorphometry did not show any significant differences between the control and immobilized/remobilized groups and members, in terms of number of chondrocytes and thickness of the articular cartilage of the tibia and talus. Morphological analysis of animals from G1 showed significant degenerative lesions in the talus, such as exposure of the subchondral bone, flocculation, and cracks between the anterior and mid-regions of the articular cartilage and the synovial membrane. Remobilization by therapeutic exercise in water led to recovery in the articular cartilage and synovial membrane of the ankle joint when compared with free remobilization, and it was shown to be an effective therapeutic measure in the recovery of the ankle joint.
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Affiliation(s)
- R I Kunz
- Laboratório de Biologia Estrutural e Funcional, Universidade Estadual do Oeste do Paraná, Cascavel, PR, Brasil
| | - J G Coradini
- Laboratório do Estudo das Lesões e Recursos Fisioterapêuticos, Universidade Estadual do Oeste do Paraná, Cascavel, PR, Brasil
| | - L I Silva
- Laboratório do Estudo das Lesões e Recursos Fisioterapêuticos, Universidade Estadual do Oeste do Paraná, Cascavel, PR, Brasil
| | - G R F Bertolini
- Laboratório do Estudo das Lesões e Recursos Fisioterapêuticos, Universidade Estadual do Oeste do Paraná, Cascavel, PR, Brasil
| | - R M C Brancalhão
- Laboratório de Biologia Estrutural e Funcional, Universidade Estadual do Oeste do Paraná, Cascavel, PR, Brasil
| | - L F C Ribeiro
- Laboratório de Biologia Estrutural e Funcional, Universidade Estadual do Oeste do Paraná, Cascavel, PR, Brasil
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23
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Matsuzaki T, Yoshida S, Kojima S, Watanabe M, Hoso M. Influence of ROM Exercise on the Joint Components during Immobilization. J Phys Ther Sci 2014; 25:1547-51. [PMID: 24409017 PMCID: PMC3885836 DOI: 10.1589/jpts.25.1547] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 06/27/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to clarify the effects of the ROM exercise on joint
components according to histopathological analysis. [Subjects and Methods] In total,
twenty-six 9-week-old adult male Wistar rats were used in this study. The rats were
randomly divided into three groups, the immobilization group (n=10), exercise group
(n=10), and control group (n=6). The immobilization group and exercise group were
anaesthetized and operated on under sterile conditions. The right knee joints in the
immobilization group and exercise group were immobilized with external fixation at 120
degrees of flexion. Range of motion exercise was started from the day after
immobilization. ROM exercise was performed in the exercise group once a day for 3 minutes,
6 days a week, for 2 weeks. [Result] The joint capsule in the immobilization group and
exercise group showed narrowing of the collagen bundles in interstitial spaces but was
less dense in the control group. In the immobilized group, a hyperplastic reaction was
associated with infiltration into the articular cavity and adhesion to the surface of the
articular cartilage. Conversely, in the exercise group, hyperplasia of tissue was
localized to the synovial membrane. [Conclusion] This finding may suggest that ROM
exercise induces some changes within the joint components and tissue metabolism.
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Affiliation(s)
- Taro Matsuzaki
- Division of Health Science, Kanazawa University Graduate School of Medical Science, Japan
| | | | - Satoshi Kojima
- Department of Medical Health Science, Kinjo University, Japan
| | - Masanori Watanabe
- Department of Rehabilitation Science, Nagoya Gakuin University, Japan
| | - Masahiro Hoso
- Division of Health Science, Kanazawa University Graduate School of Medical Science, Japan
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Moriyama H, Tobimatsu Y, Ozawa J, Kito N, Tanaka R. Amount of torque and duration of stretching affects correction of knee contracture in a rat model of spinal cord injury. Clin Orthop Relat Res 2013; 471:3626-36. [PMID: 23893364 PMCID: PMC3792286 DOI: 10.1007/s11999-013-3196-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 07/17/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Joint contractures are a common complication of many neurologic conditions, and stretching often is advocated to prevent and treat these contractures. However, the magnitude and duration of the stretching done in practice usually are guided by subjective clinical impressions. QUESTIONS/PURPOSES Using an established T8 spinal cord injury rat model of knee contracture, we sought to determine what combination of static or intermittent stretching, varied by magnitude (high or low) and duration (long or short), leads to the best (1) improvement in the limitation in ROM; (2) restoration of the muscular and articular factors leading to contractures; and (3) prevention and treatment of contracture-associated histologic alterations of joint capsule and articular cartilage. METHODS Using a rat animal model, the spinal cord was transected completely at the level of T8. The rats were randomly assigned to seven treatment groups (n = 4 per group), which were composed of static or intermittent stretching in combination with different amounts of applied torque magnitude and duration. We assessed the effect of stretching by measuring the ROM and evaluating the histologic alteration of the capsule and cartilage. RESULTS Contractures improved in all treated groups except for the low-torque and short-duration static stretching conditions. High-torque stretching was effective against shortening of the synovial membrane and adhesions in the posterosuperior regions. Collagen Type II and VEGF in the cartilage were increased by stretching. CONCLUSIONS High-torque and long-duration static stretching led to greater restoration of ROM than the other torque and duration treatment groups. Stretching was more effective in improving articular components of contractures compared with the muscular components. Stretching in this rat model prevented shortening and adhesion of the joint capsule, and affected biochemical composition, but did not change morphologic features of the cartilage. CLINICAL RELEVANCE This animal study tends to support the ideas that static stretching can influence joint ROM and histologic qualities of joint tissues, and that the way stretching is performed influences its efficacy. However, further studies are warranted to determine if our findings are clinically applicable.
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Affiliation(s)
- Hideki Moriyama
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Tomogaoka 7-10-2, Suma-ku, Kobe, Hyogo, 654-0142, Japan,
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Yabe Y, Hagiwara Y, Suda H, Ando A, Onoda Y, Tsuchiya M, Hatori K, Itoi E. Joint immobilization induced hypoxic and inflammatory conditions in rat knee joints. Connect Tissue Res 2013; 54:210-7. [PMID: 23496380 DOI: 10.3109/03008207.2013.786056] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to examine the hypoxic and inflammatory conditions after immobilization in the joint capsule of rat knees. The unilateral knee joints of adult male rats were immobilized with an internal fixator (Im group) for 1 day, 3 days, and 1, 2, 4, 8, and 16 weeks. Sham-operated animals had holes drilled in the femur and tibia and screws inserted without a plate (control group). The number of cells and blood vessels in the capsule were histologically examined. The hypoxic condition in the capsule was histologically examined with a Hypoxyprobe™-1. The gene expressions related to the hypoxic (hypoxia inducible factor-1α, vascular endothelial growth factor, and fibroblast growth factor 2) and inflammatory conditions [interleukin-6 (IL-6), IL-1α, IL-1β, tumor necrosis factor-α, and tumor necrosis factor-β] were evaluated by quantitative reverse transcription polymerase chain reaction. The number of cells was unchanged at 1 day in the two groups; however, the number significantly increased at 3 days in the Im group. The number of blood vessels in the Im group gradually decreased. Strong immunostaining of Hypoxyprobe™-1 around the blood vessels was observed in the Im group. The gene expressions of hypoxia inducible factor-1α and fibroblast growth factor 2 were significantly higher in the Im group compared with those in the control group. The gene expressions of IL-6, IL-1α, IL-1β, and tumor necrosis factor-β were significantly higher in the Im group compared with those in the control group. These data indicated that joint immobilization induced hypoxic and inflammatory conditions in the joint capsule, which might be an initiating factor for joint contracture.
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Affiliation(s)
- Yutaka Yabe
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan
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26
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Ando A, Suda H, Hagiwara Y, Onoda Y, Chimoto E, Itoi E. Remobilization does not restore immobilization-induced adhesion of capsule and restricted joint motion in rat knee joints. TOHOKU J EXP MED 2012; 227:13-22. [PMID: 22510696 DOI: 10.1620/tjem.227.13] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Joint immobilization, which is used in orthopaedic treatments and observed in bedridden people, usually causes restricted joint motion. Decreased joint motion diminishes activities of daily living and increases burden of nursing-care. The purpose of this study was to clarify the reversibility of immobilization-induced capsular changes and restricted joint motion in rat knee joints. The unilateral knee joints of adult male rats were immobilized with an internal fixator for 1, 2, 4, 8, and 16 weeks as a model of immobilization after surgery or disuse of the joint. After the fixation devices were removed, the rats were allowed to move freely for 16 weeks. Sham-operated rats were used as controls. Sagittal sections at medial midcondylar regions were made and assessed with histological, histomorphometric, and immunohistochemical methods. Joint motion was measured using a custom-made device under x-ray control after removal of the periarticular muscles. In the 1/16-week and 2/16-week immobilization-remobilization (Im-Rm) groups, cord-like structures connecting the superior and inferior portions of the posterior capsule (partial adhesion) were observed without restricted joint motion. In the 4/16-, 8/16-, and 16/16-week Im-Rm groups, global adhesion of the posterior capsule and restricted joint motion were observed. The restricted joint motion was not completely restored after incision of the posterior capsule. These data indicate that immobilization alone causes irreversible capsular changes and arthrogenic restricted joint motion. Besides the joint capsule, other arthrogenic factors such as ligaments might influence the restricted joint motion. Prolonged immobilization over 4 weeks should be avoided to prevent irreversible joint contracture.
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Affiliation(s)
- Akira Ando
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.
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27
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Kitade I, Hoso M, Matsuzaki T, Yoshida S, Kamijyo A, Araki Y, Takahashi I. Histopathological Changes in Surrounding Tissue of the Sciatic Nerve after Spinal Cord Injury in Rats. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ippei Kitade
- Division of Rehabilitation Medicine, University of Fukui Hospital
| | - Masahiro Hoso
- Division of Health Sciences, Kanazawa University Graduate School of Medical Science
| | - Taro Matsuzaki
- Division of Health Sciences, Kanazawa University Graduate School of Medical Science
| | - Shinya Yoshida
- Department of Rehabilitation Medicine, Kanazawa University Hospital
| | - Akio Kamijyo
- Department of Rehabilitation Medicine, Azumino Red Cross Hospital
| | - Yoshitaka Araki
- Department of Rehabilitation Medicine, Kanazawa Cranial Nerve Surgery Hospital
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28
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Kitade I, Hoso M, Matsuzaki T, Inaoka PT, Kamijyo A, Araki Y, Takahashi I. Histopathological Changes in Knee Joint Components after Spinal Cord Injury in Rats. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.31] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ippei Kitade
- Division of Physical Therapy and Rehabilitation Medicine, University of Fukui Hospital
- Division of Health Sciences, Kanazawa University Graduate School of Medical Science
| | - Masahiro Hoso
- Division of Health Sciences, Kanazawa University Graduate School of Medical Science
| | - Taro Matsuzaki
- Division of Health Sciences, Kanazawa University Graduate School of Medical Science
| | | | - Akio Kamijyo
- Department of Rehabilitation Medicine, Azumino Red Cross Hospital
| | - Yoshitaka Araki
- Department of Rehabilitation Medicine, Kanazawa Cranial Nerve Surgery Hospital
| | - Ikufumi Takahashi
- Division of Health Sciences, Kanazawa University Graduate School of Medical Science
- Department of Rehabilitation Medicine, Houju Memorial Hospital
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29
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Does the source of hemarthrosis influence posttraumatic joint contracture and biomechanical properties of the joint? Clin Biomech (Bristol, Avon) 2011; 26:790-5. [PMID: 21420211 DOI: 10.1016/j.clinbiomech.2011.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 02/19/2011] [Accepted: 02/21/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Posttraumatic joint contracture is a common complication of intraarticular injuries and an associated traumatic hemarthrosis could be of importance for its development. The purpose of this investigation was to determine whether the source of the hemarthrosis (peripheral blood vs. bleeding from the bone marrow) affects the amount of contracture and its reversibility and biomechanical properties. METHODS 46 New Zealand White rabbits were divided in 6 groups and 33 underwent 8 weeks immobilization with either hemarthrosis from bone marrow or peripheral blood. 16 rabbits underwent remobilization for another 8 weeks. 7 animals had only hemarthrosis (bone marrow) for 8 weeks, while 6 were used as controls. Analysis included mean contracture angle and biomechanical variables. FINDINGS The immobilized animals had an increased contracture angle, the knee angle vs. force curve had a greater hysteresis and showed higher initial stiffness. There was no difference in biomechanical properties of the knee between the different types of hemarthroses. After 8 weeks remobilization most biomechanical properties were not different from control. INTERPRETATION The origin of hemarthrosis, and therewith the presence of marrow-derived factors and pluripotential cells from bone marrow, does not seem to affect the severity of joint contractures nor their reversibility.
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30
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Lee S, Sakurai T, Ohsako M, Saura R, Hatta H, Atomi Y. Tissue stiffness induced by prolonged immobilization of the rat knee joint and relevance of AGEs (pentosidine). Connect Tissue Res 2010; 51:467-77. [PMID: 20604714 DOI: 10.3109/03008201003686941] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Joints, connective tissues consisting of extracellular matrix (ECM) with few blood vessels, transfer tension to the skeleton in response to environmental demand. Therefore, joint immobilization decreases active and passive mechanical stress, resulting in increased joint stiffness and tissue degeneration; however, the cause of joint stiffness is obscure. Using a rat knee immobilization model, we examined the relationship between range of motion (ROM) and cell numbers and ECM cross-links by accumulation of advanced glycation end products, pentosidine, in the posterior joint capsule of immobilized joints during 16 weeks of immobilization. The left knee joint was immobilized by internal fixation and compared with the non-immobilized right leg. As early as 2 weeks of immobilization, joint ROM and torque significantly decreased and in parallel, disordered alignment of collagen fiber bundles significantly increased, compared with non-immobilized joints. Those changes continued until 16 weeks of immobilization. Significant increases in pentosidine-positive areas after 8 weeks and significantly decreased cell numbers after 16 weeks of immobilization were also observed compared to the contralateral side. A significant negative correlation between tissue stiffness measured by restriction of ROM and accumulation of pentosidine was observed. This study is the first to show that immobilization of knee joints induces articular contracture associated with sequential changes of ECM alignment, influencing ROM and later pentosidine accumulation and decreased cell numbers during the 16-week immobilization period. Pentosidine appears to be an indicator toward a chronic tissue stiffness leading to decreased cell number rather than a cause of ROM restriction induced by joint immobilization.
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Affiliation(s)
- Sachiko Lee
- Department of Life Sciences, Graduate School of Arts and Sciences, University of Tokyo, Tokyo, Japan
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31
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Kanno A, Sano H, Itoi E. Development of a shoulder contracture model in rats. J Shoulder Elbow Surg 2010; 19:700-8. [PMID: 20452246 DOI: 10.1016/j.jse.2010.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 01/06/2010] [Accepted: 02/08/2010] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The capsular tissue is responsible for the pathogenesis of the shoulder contracture. MATERIALS AND METHODS The glenohumeral joint of Sprague-Dawley rats was immobilized using internal fixation (immobilized group). The control group underwent a sham operation (sham group). To assess the range of motion, the glenohumeral joint angle was measured repeatedly under same torque in 6 conditions: after removal from the trunk, after removal of the outer muscles other than rotator cuff after removal of the rotator cuff muscles, and after 3 types of partial capsulotomy. The abduction angle and total rotation angles were measured. The length of the synovial intima was measured with hematoxylin-eosin-stained specimens. Immunohistochemical study for type III collagen was also performed. RESULTS No significant differences were found in the range of motion until all the muscles were removed. The abduction angle increased significantly after serial capsulotomy in the immobilized group. Even after the capsulotomy, however, this angle remained significantly less than that in the sham group. There was a similar trend for the total rotation angle. There was morphological change in the synovium of the immobilized group; the significant decrease of synovial length and strong staining of type III collagen. DISCUSSION Our results show that capsule might play important role for contracture formation. Decrease of the synovial length might reflect synovial adhesion. Strong expression in Type III collagen might be related to joint stiffness. CONCLUSION A contracture model was successfully established. Changes in the capsule and synovium might play an important role in occurrence of contracture.
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Affiliation(s)
- Atsuko Kanno
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
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32
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Ando A, Hagiwara Y, Onoda Y, Hatori K, Suda H, Chimoto E, Itoi E. Distribution of Type A and B Synoviocytes in the Adhesive and Shortened Synovial Membrane during Immobilization of the Knee Joint in Rats. TOHOKU J EXP MED 2010; 221:161-8. [DOI: 10.1620/tjem.221.161] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Akira Ando
- Department of Orthopaedic Surgery, Tohoku University School of Medicine
| | - Yoshihiro Hagiwara
- Department of Orthopaedic Surgery, Tohoku University School of Medicine
- Department of Orthopaedic Surgery, Takeda General Hospital
| | - Yoshito Onoda
- Department of Orthopaedic Surgery, Tohoku University School of Medicine
| | - Kouki Hatori
- Division of Advanced Prosthetic Dentistry, Tohoku University School of Dentistry
| | - Hideaki Suda
- Department of Orthopaedic Surgery, Tohoku University School of Medicine
| | - Eiichi Chimoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine
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Trudel G, Zhou J, Uhthoff HK, Laneuville O. Four weeks of mobility after 8 weeks of immobility fails to restore normal motion: a preliminary study. Clin Orthop Relat Res 2008; 466:1239-44. [PMID: 18299947 PMCID: PMC2311487 DOI: 10.1007/s11999-008-0181-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Accepted: 02/05/2008] [Indexed: 01/31/2023]
Abstract
Prolonged immobilization reduces passive range of motion of joints creating joint contractures. Whether and to what extent these iatrogenic contractures can be reduced is unknown. We raised three questions using an animal model: What degree of contracture remains at the end of a defined remobilization period? Do contractures in sham-operated and immobilized joints differ? What is the contribution of the posterior knee capsule in limiting knee extension? We immobilized one knee of 11 adult male rats in flexion to induce a joint contracture; 10 control animals underwent a sham operation. After 8 weeks, the internal fixation device was removed, and the animals were allowed to resume unrestricted activity for 4 weeks at the end of which the knee range of motion was measured with standardized torques. The mean flexion contracture was higher in the immobilized group (51.9 degrees +/- 2.8 degrees ) than in the sham-operated group (18.9 degrees +/- 2.1 degrees ). Eighty-eight percent of the contractures remained in the immobilized group after dividing skin and muscle, suggesting an important contribution of the posterior knee capsule in limiting knee mobility. Based on our preliminary study the range of motion of rat knees immobilized for 8 weeks remained substantially reduced after a 4-week period of unassisted remobilization.
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Affiliation(s)
- Guy Trudel
- Bone and Joint Laboratory, University of Ottawa, Ottawa, ON Canada ,Division of Physical Medicine and Rehabilitation, University of Ottawa, Ottawa, ON Canada
| | - Jian Zhou
- Bone and Joint Laboratory, University of Ottawa, Ottawa, ON Canada
| | - Hans K. Uhthoff
- Bone and Joint Laboratory, University of Ottawa, Ottawa, ON Canada
| | - Odette Laneuville
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON Canada K1H 8M5
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Clavet H, Hébert PC, Fergusson D, Doucette S, Trudel G. Joint contracture following prolonged stay in the intensive care unit. CMAJ 2008; 178:691-7. [PMID: 18332384 DOI: 10.1503/cmaj.071056] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Prolonged immobility during a critical illness may predispose patients to the development of joint contracture. We sought to document the incidence of, the risk factors for and the reversibility of joint contractures among patients who stayed in a tertiary intensive care unit (ICU) for 2 weeks or longer. METHODS We conducted a chart review to collect data on the presence of and risk factors for joint contractures in the shoulders, elbows, hips, knees and ankles among patients admitted to the ICU between January 2003 and March 2005. RESULTS At the time of transfer out of the ICU, at least 1 joint contracture was recorded in 61 (39%) of 155 patients; 52 (34%) of the patients had joint contractures of an extent documented to impair function. Time spent in the ICU was a significant risk factor for contracture: a stay of 8 weeks or longer was associated with a significantly greater risk of any joint contracture than a stay of 2 to 3 weeks (adjusted odds ratio [OR] 7.09, 95% confidence interval (CI) 1.29-38.9; p = 0.02). Among the variables tested, only the use of steroids conferred a protective effect against joint contractures (adjusted OR 0.35, 95% CI 0.14-0.83; p = 0.02). At the time of discharge to home, which occurred a median of 6.6 weeks after transfer out of intensive care, 50 (34%) of the 147 patients not lost to follow-up still had 1 or more joint contractures, and 34 (23%) of the patients had at least 1 functionally significant joint contracture. INTERPRETATION Following a prolonged stay in the ICU, a functionally significant contracture of a major joint occurred in more than one-third of patients, and most of these contractures persisted until the time of discharge to home.
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Affiliation(s)
- Heidi Clavet
- Bone and Joint Laboratory, University of Ottawa, Ottawa, Ont
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35
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Akai M, Usuba M, Sekiguchi H, Hong B, Iwashita K, Shirasaki Y. A computer-controlled contracture correction device with low-load and continuous torque: an animal experiment and prototype design for clinical use. Prosthet Orthot Int 2007; 31:121-32. [PMID: 17520489 DOI: 10.1080/03093640500495606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to clarify the relationship between mechanical stress and tissue response of the contracted knee joint in rats and to propose a new design of contracture correction device for clinical use. Wistar rats were operated on to immobilize their knee joints with a procedure causing periarticular bleeding and were kept in flexed position for 40 days. At day 40, the immobilizing wire was removed, and after day 43, the contracted knee joint had been treated with tunable corrective devices secured by an external fixation method to the rear limb. These devices consisted of four types of motor-driving system which provided several different low-load and continuous stretch torques. Measuring the angle of maximum knee extension, its effectiveness was assessed comparing with a lower load and control group of natural recovery course. The device also had a cyclic joint movement within the acquired range of motion and an oval cam mechanism producing a small distraction force to the joint along its long axis. The results showed that an appropriate range of low-load continuous torque was more effective to correct joint contracture. On the basis of the animal experiment, a new computer-controlled, gas-driven contracture correction device was developed for clinical trial. It was concluded that mechanical application in a condition with low and continuous torque is a useful treatment for fixed joint contracture.
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Affiliation(s)
- M Akai
- Department of Rehabilitation for Movement Functions, Research Institute, National Rehabilitation Center, Tokorozawa, Japan.
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36
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Chen CH, Liu X, Yeh ML, Huang MH, Zhai Q, Lowe WR, Lintner DM, Luo ZP. Pathological changes of human ligament after complete mechanical unloading. Am J Phys Med Rehabil 2007; 86:282-9. [PMID: 17303960 DOI: 10.1097/phm.0b013e31803215dc] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the pathologic changes with a time sequence among patients with injured ligaments after complete mechanical unloading, based on a human anterior cruciate ligament (ACL) model. DESIGN Pathologic examinations were done on remnants of completely ruptured ACLs at various times up to 14 wks after injury on 31 patients and on normal ACLs from five cadaver donors. Testing variables included fibroblast density, crimp amplitude, and crimp nuclear shape. RESULTS Sequential changes were observed: Fibroblast density significantly increased within 5-6 wks of unloading. By 7-8 wks, crimp amplitude significantly decreased, accompanied by formation of irregular fiber patterns and fragments. This was followed by crimp wavelength and nuclear shape change within 9-14 wks. CONCLUSIONS These pathologic findings suggest that the ACL undergoes significantly deleterious changes from 5 to 6 wks after mechanical unloading. This study may emphasize the important concept of early implementation of mechanical force in rehabilitation programs for patients with injured ligaments.
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Affiliation(s)
- Chia-Hsin Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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37
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Laneuville O, Zhou J, Uhthoff HK, Trudel G. Genetic influences on joint contractures secondary to immobilization. Clin Orthop Relat Res 2007; 456:36-41. [PMID: 17195817 DOI: 10.1097/blo.0b013e3180312bc1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The primary research question of this study queries whether, beyond environmental conditions, genetic factors affect the development of joint contractures. We hypothesized that intrinsic genetic factors influence the severity of joint contractures developing secondary to joint immobilization. Forty rats from four inbred rat strains had one leg immobilized in knee flexion for 4 weeks. The contracture was measured mechanically as the lack of range of motion to a standardized torque. Using the contralateral leg as a control, the average severity of the contracture could be calculated and compared between strains. All immobilized legs presented knee contractures after 4 weeks of immobilization. Two strains (Dark Agouti and Fisher 344) showed a larger mean knee contracture than those of the two other rat strains (Augustus Copenhagen Irish and Brown Norway). Environmental factors, such as immobility, are usually identified as a cause of a joint contracture. These results demonstrate that, in addition to mechanical factors in the environment of a joint, intrinsic genetic factors participate in the process leading to joint contracture. This demonstration has important consequences for directing future research and may lead to interventions to help patients at risk of developing joint contractures.
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Affiliation(s)
- Odette Laneuville
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
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38
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Moriyama H, Yoshimura O, Kawamata S, Takemoto H, Saka Y, Tobimatsu Y. Alteration of knee joint connective tissues during contracture formation in spastic rats after an experimentally induced spinal cord injury. Connect Tissue Res 2007; 48:180-7. [PMID: 17653974 DOI: 10.1080/03008200701413512] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study was made to elucidate the changes in the periarticular connective tissue that can underlie the contracture after spasticity development. Sixteen Wistar rats underwent a spinal cord injury and 16 rats were either sham- or nonoperated. The periarticular connective tissue of the knee joint was assessed with histological, histomorphometric, immunohistochemical, and biochemical analyses. Histological results showed a smaller synovial intima, a dense subintimal and posterior joint capsule without fibrosis, and a disarranged posterior capsule in the spinal cord-injured knees with the flexion contracture. The synovial intima length was shortened only at the posterior capsule. Neither the distribution nor expression of type I and III collagen was affected. Contractures after spinal cord injuries are characterized by synovial intima adhesions. A dense and disarranged capsule may lead to joint stiffness. The alteration of periarticular connective tissues exhibits properties characteristic of the contracture after spasticity development.
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Affiliation(s)
- Hideki Moriyama
- School of Health and Social Services, Saitama Prefectural University, Saitama, Japan.
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39
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Israel HA, Langevin CJ, Singer MD, Behrman DA. The Relationship Between Temporomandibular Joint Synovitis and Adhesions: Pathogenic Mechanisms and Clinical Implications for Surgical Management. J Oral Maxillofac Surg 2006; 64:1066-74. [PMID: 16781339 DOI: 10.1016/j.joms.2006.03.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2005] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this investigation was to determine the relationship between arthroscopically diagnosed synovitis and adhesions in a population of patients with significant limitation of mandibular opening and temporomandibular joint pain. PATIENTS AND METHODS Temporomandibular joint arthroscopy was performed on 126 joints in 80 patients (female:male = 5.7:1; mean age = 35.5 years; mean duration of symptoms = 50 months). All patients were diagnosed with severe temporomandibular joint disease recalcitrant to conservative therapy. Each joint was evaluated arthroscopically for the presence of synovitis and adhesions. Chi-squared analysis was performed to determine if there was a significant relationship between the presence of synovitis and adhesions. RESULTS Diagnostic arthroscopic examination showed the following: no synovitis and no adhesions in 18/126 joints (14%), no synovitis with adhesions present in 33/126 joints (26%), synovitis with no adhesions in 13/126 joints (10%), and synovitis and adhesions present in 62/126 joints (49%). Statistical analysis showed a significant relationship between arthroscopically diagnosed synovitis and adhesions. CONCLUSION Synovitis and adhesions are commonly present in the temporomandibular joints of patients requiring arthroscopic surgery due to painful limitation of mandibular movement. Excessive mechanical stress on the temporomandibular joint leads to maladaptive responses in the articular and synovial tissues, ultimately leading to synovitis, osteoarthritis and the formation of adhesions. An understanding of the pathogenic mechanisms that lead to synovitis, osteoarthritis and adhesions has important clinical implications for the nonsurgical as well as surgical management of patients suffering from these disorders.
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Affiliation(s)
- Howard A Israel
- Department of Surgery, Cornell University, New York, NY, USA.
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Moriyama H, Yoshimura O, Sunahori H, Tobimatsu Y. Comparison of muscular and articular factors in the progression of contractures after spinal cord injury in rats. Spinal Cord 2006; 44:174-81. [PMID: 16130021 DOI: 10.1038/sj.sc.3101802] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Experimental, controlled trial. OBJECTIVES To identify the relationship between the muscular and articular factors in the progression of contractures after spinal cord injury (SCI). SETTING Hiroshima University, Hiroshima, Japan. METHODS In total, 48 female Wistar rats were used. The 24 experimental rats that underwent a spinal cord transection and the other 24 control rats that underwent a sham-operation were assessed at 2, 4, 8, 12, 16, or 24 weeks postsurgery. Knee joint motion was measured for flexion and extension. Myotomy of the transarticular muscles was then performed and range of motion was measured again. The degree of contractures was assessed by goniometry measuring the femorotibial angle before and after the myotomies. RESULTS The spinal cord-injured rats demonstrated flaccid paralysis during the first few days postsurgery and thereafter spastic paralysis. Intra- and inter-rater reliabilities for all measurements were >0.814. Knee flexion contractures developed in the all experimental rats, and progressed for the first 12 weeks and plateaued thereafter. Both the muscular (48+/-5%) and articular (52+/-5%) factors contributed almost equally to the overall progression of the contracture. CONCLUSION The present findings may shed light on the underlying pathophysiology of contractures and should help guide research towards finding the elucidation of contracture development after SCI.
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Affiliation(s)
- H Moriyama
- Graduate School of Health Science, Hiroshima University, Hiroshima, Japan
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Usuba M, Miyanaga Y, Miyakawa S, Maeshima T, Shirasaki Y. Effect of Heat in Increasing the Range of Knee Motion After the Development of a Joint Contracture: An Experiment With an Animal Model. Arch Phys Med Rehabil 2006; 87:247-53. [PMID: 16442980 DOI: 10.1016/j.apmr.2005.10.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2005] [Revised: 10/06/2005] [Accepted: 10/12/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare the effects of 2 different heat modalities, infrared and ultrasonic therapy, on a knee flexion contracture. DESIGN In vivo, experimental, controlled study involving a rat knee joint contracture model that was immobilized using a ligature in flexion for 40 days. SETTING Collegiate research laboratory. ANIMALS Ninety-three adult male Wistar rats. INTERVENTIONS After remobilization, rats were assigned to 3 treatment groups: stretching only (S), stretching with infrared therapy (S+IR), and stretching with ultrasonic therapy (S+US). Six treatment sessions were given in 2 weeks. MAIN OUTCOME MEASURES The angle of maximum knee extension, wet-weight of triceps surae muscles, phase lag, and dynamic stiffness as mechanical responses were measured, and histologic study was conducted. RESULTS Compared with the S group, both the S+IR and S+US groups exhibited a significant increase in range of motion (ROM) (P=.021, P=.008, respectively) and a tendency to decrease the phase lag, but there was no significant difference between the 2 heat-combined groups. There were no differences in the weights of the triceps surae muscles and in dynamic stiffness among the groups. CONCLUSIONS Six treatment sessions of stretching with infrared or ultrasound were more effective than stretching without heat at increasing the ROM and decreasing the phase lag of a moderately severe joint contracture. The clinical implementation of heat is advocated to regain a normal ROM and mechanical property when experiencing a joint contracture.
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Affiliation(s)
- Mariko Usuba
- Doctoral Program of Sports Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, Japan.
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Abstract
Spastic paresis follows chronic disruption of the central execution of volitional command. Motor function in patients with spastic paresis is subjected over time to three fundamental insults, of which the last two are avoidable: (1) the neural insult itself, which causes paresis, i.e., reduced voluntary motor unit recruitment; (2) the relative immobilization of the paretic body part, commonly imposed by the current care environment, which causes adaptive shortening of the muscles left in a shortened position and joint contracture; and (3) the chronic disuse of the paretic body part, which is typically self-imposed in most patients. Chronic disuse causes plastic rearrangements in the higher centers that further reduce the ability to voluntarily recruit motor units, i.e., that aggravate baseline paresis. Part I of this review focuses on the pathophysiology of the first two factors causing motor impairment in spastic paresis: the vicious cycle of paresis-disuse-paresis and the contracture in soft tissues.
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Affiliation(s)
- Jean-Michel Gracies
- Department of Neurology, Mount Sinai Medical Center, One Gustave L Levy Place, Annenberg 2/Box 1052, New York, New York 10029-6574, USA.
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