1
|
Lee J, Yoon JP, Woo Y, Oh KS, Chung SW. Types and doses of anti-adhesive agents injected into subacromial space do not have an effect on the clinical and anatomical outcomes after arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2023; 31:5238-5247. [PMID: 37594502 DOI: 10.1007/s00167-023-07519-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 07/24/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE Joint stiffness after arthroscopic rotator cuff repair is a major concern for orthopaedic surgeons. Various antiadhesive agents are commonly administered after rotator cuff repair for its prevention. This study aimed to compare the outcomes among patients injected with different types and amounts of anti-adhesive agents after rotator cuff repair. It was hypothesized that the outcomes might differ depending on the use of the anti-adhesive agent and its type and dose. METHODS A total of 267 patients who underwent arthroscopic rotator cuff repair with or without subacromial injection of anti-adhesive agents were enrolled. The first group (group A; 51 patients) were injected with 3 mL of poloxamer/sodium alginate-based anti-adhesive agent. The second group (group B; 93 patients) were injected with 3 mL of sodium hyaluronate-based anti-adhesive agent. The third group (group C; 82 patients) were injected with 1.5 mL of sodium hyaluronate-based anti-adhesive agent. Finally, the last group (group D; 41 patients) who did not use anti-adhesive agents served as the control. The range of motion (ROM) and pain VAS scores were measured preoperatively and at 5 weeks, 3 months, 6 months, and 1 year postoperatively. Functional outcomes were evaluated using American Shoulder and Elbow Surgeons and Constant scores, whereas cuff integrity was assessed via MRI or ultrasonography at least 6 months postoperatively. RESULTS All ROM measurements, pain VAS scores, and functional scores were significantly improved regardless of the use, type, and dose of the anti-adhesive agents. In addition shoulder ROM and rotator cuff healing did not significantly differ among the groups (all n.s.). CONCLUSIONS No significant differences were found in the clinical and anatomical outcomes according to the type and dose of the anti-adhesive agents subacromially injected after rotator cuff repair. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Jongwon Lee
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, Konkuk University School of Medicine, 120-1 Neungdong-Ro (Hwayang-Dong), Gwangjin-Gu, Seoul, 143-729, Korea
| | - Jong Pil Yoon
- Department of Orthopaedic Surgery, Kyungpook National University, School of Medicine, Daegu, South Korea
| | - Youngje Woo
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, Konkuk University School of Medicine, 120-1 Neungdong-Ro (Hwayang-Dong), Gwangjin-Gu, Seoul, 143-729, Korea
| | - Kyung-Soo Oh
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, Konkuk University School of Medicine, 120-1 Neungdong-Ro (Hwayang-Dong), Gwangjin-Gu, Seoul, 143-729, Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, Konkuk University School of Medicine, 120-1 Neungdong-Ro (Hwayang-Dong), Gwangjin-Gu, Seoul, 143-729, Korea.
| |
Collapse
|
2
|
Zhang Z, Zhu L, Hu W, Dai J, Ren P, Shao X, Xiong B, Zhang T, Ji Z. Polypropylene mesh combined with electrospun poly (L-lactic acid) membrane in situ releasing sirolimus and its anti-adhesion efficiency in rat hernia repair. Colloids Surf B Biointerfaces 2022; 218:112772. [PMID: 35985128 DOI: 10.1016/j.colsurfb.2022.112772] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/23/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022]
Abstract
This study developed, a novel polypropylene (PP) mesh combined with poly (L-lactic acid) (PLA) electrospun nanofibers loaded sirolimus (SRL). The PP mesh was combined with PLA/SRL (1/0, 1/0.01, 1/0.02; mass ratios) composed electrospun membrane characterized by FTIR spectroscopy, XPS and SEM, and evaluated for cytocompatibility in vitro. In an in vivo study, a total of 84 Sprague-Dawley rats were employed to evaluate the efficacy of the novel composite PP mesh anti-adhesion, mechanical properties and inflammation. As a results, the PLA/SRL membrane could compound with PP mesh stably and load SRL. Although tensile testing showed that the mechanical properties of composite mesh decreased in vivo, the integration strength between the tissue and mesh was still able to counteract intra-abdominal pressure. Compared with the native PP mesh group, the novel PP mesh group showed a lower score for abdominal adhesion and inflammation. More importantly, the novel PP mesh completely integrated with the abdominal wall and had sufficient mechanical strength to repair abdominal wall defects.
Collapse
Affiliation(s)
- Zhigang Zhang
- Department of General Surgery, Affiliated ZhongDa Hospital, Southeast University, Dingjiaqiao 87, Nanjing 210009, China; Medical School of Southeast University, Dingjiaqiao 87, Nanjing 210009, China
| | - Long Zhu
- Medical School of Southeast University, Dingjiaqiao 87, Nanjing 210009, China
| | - Wanjun Hu
- State Key Lab of Bioelectronics, National Demonstration Center for Experimental Biomedical Engineering Education, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China; Department of light industry and materials science, Chengdu Textile College, Chengdu 611731, China.
| | - Jidong Dai
- State Key Lab of Bioelectronics, National Demonstration Center for Experimental Biomedical Engineering Education, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China
| | - Pengfei Ren
- State Key Lab of Bioelectronics, National Demonstration Center for Experimental Biomedical Engineering Education, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China
| | - Xiangyu Shao
- Department of General Surgery, Affiliated ZhongDa Hospital, Southeast University, Dingjiaqiao 87, Nanjing 210009, China
| | - Bo Xiong
- Department of General Surgery, Affiliated Zhong Da Hospital (Li Shui branch), Southeast University, China
| | - Tianzhu Zhang
- State Key Lab of Bioelectronics, National Demonstration Center for Experimental Biomedical Engineering Education, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China.
| | - Zhenling Ji
- Department of General Surgery, Affiliated ZhongDa Hospital, Southeast University, Dingjiaqiao 87, Nanjing 210009, China; Department of General Surgery, Affiliated Zhong Da Hospital (Li Shui branch), Southeast University, China.
| |
Collapse
|
3
|
Mitchell S, Lee A, Stenquist R, Yatsonsky II D, Mooney ML, Shendge VB. Extensive adhesion formation in a total knee replacement in the setting of a gastrointestinal stromal tumor: A case report. World J Orthop 2022; 13:538-543. [PMID: 35633745 PMCID: PMC9124998 DOI: 10.5312/wjo.v13.i5.538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/04/2022] [Accepted: 04/24/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) are rare primary neoplasms of the gastrointestinal tract, accounting for 1% to 2% of all gastrointestinal neoplasms worldwide. GISTs are frequently discovered incidentally during workup for other diagnosis or intestinal obstruction, as they can present with few or no symptoms. Simultaneously, GISTs confer a high degree of malignant transformation, with a progression in about 10% to 30% of cases.
CASE SUMMARY A 63-year-old healthy female presented to our institution with complaints of right knee pain and limited passive and active motion in the setting of a previous right total knee arthroplasty (TKA). One year after TKA, the patient was incidentally diagnosed with a GIST, which was successfully removed. After removal, the patient continued to have limited range of motion of the right knee and subsequently underwent revision TKA. Intraoperatively significant fibrotic adhesions were found encapsulating the femoral and tibial components. The patient’s pain improved postoperatively, however, she continued to have decreased range of motion with difficulty ambulating.
CONCLUSION We propose that this case may demonstrate a proinflammatory milieu arising from a GIST, which had a direct influence on the outcome of recent total knee arthroplasty. This proposed mechanism between neoplastic cytokinetic activity and adhesion formation could have implications on preoperative and postoperative orthopedic management of total knee arthroplasty.
Collapse
Affiliation(s)
- Steven Mitchell
- Department ofOrthopaedic Surgery, The University of Toledo Medical Center, Toledo, OH 43614, United States
| | - Anderson Lee
- Department ofOrthopaedic Surgery, The University of Toledo Medical Center, Toledo, OH 43614, United States
| | - Ryan Stenquist
- Department ofOrthopaedic Surgery, The University of Toledo Medical Center, Toledo, OH 43614, United States
| | - David Yatsonsky II
- Department ofOrthopaedic Surgery, The University of Toledo Medical Center, Toledo, OH 43614, United States
| | - Megan L Mooney
- Department ofOrthopaedic Surgery, The University of Toledo Medical Center, Toledo, OH 43614, United States
| | - Vithal B Shendge
- Department ofOrthopaedic Surgery, The University of Toledo Medical Center, Toledo, OH 43614, United States
| |
Collapse
|
4
|
Takada S, Setoyama K, Norimatsu K, Otsuka S, Nakanishi K, Tani A, Nakakogawa T, Matsuzaki R, Matsuoka T, Sakakima H, Tancharoen S, Maruyama I, Tanaka E, Kikuchi K, Uchikado H. E8002 Reduces Adhesion Formation and Improves Joint Mobility in a Rat Model of Knee Arthrofibrosis. Int J Mol Sci 2022; 23:ijms23031239. [PMID: 35163163 PMCID: PMC8835358 DOI: 10.3390/ijms23031239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 11/26/2022] Open
Abstract
Knee arthrofibrosis is a common complication of knee surgery, caused by excessive scar tissue, which results in functional disability. However, no curative treatment has been established. E8002 is an anti-adhesion material that contains L-ascorbic acid, an antioxidant. We aimed to evaluate the efficacy of E8002 for the prevention of knee arthrofibrosis in a rat model, comprising injury to the surface of the femur and quadriceps muscle 1 cm proximal to the patella. Sixteen male, 8-week-old Sprague Dawley rats were studied: in the Adhesion group, haemorrhagic injury was induced to the quadriceps and bone, and in the E8002 group, an adhesion-preventing film was implanted between the quadriceps and femur after injury. Six weeks following injury, the restriction of knee flexion owing to fibrotic scarring had not worsened in the E8002 group but had worsened in the Adhesion group. The area of fibrotic scarring was smaller in the E8002 group than in the Adhesion group (p < 0.05). In addition, the numbers of fibroblasts (p < 0.05) and myofibroblasts (p < 0.01) in the fibrotic scar were lower in the E8002 group. Thus, E8002 reduces myofibroblast proliferation and fibrotic scar formation and improves the range of motion of the joint in a model of knee injury.
Collapse
Affiliation(s)
- Seiya Takada
- Department of Systems Biology in Thromboregulation, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan; (S.T.); (S.O.); (I.M.)
| | - Kentaro Setoyama
- Division of Laboratory Animal Science, Natural Science Center for Research and Education, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan;
| | - Kosuke Norimatsu
- Course of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan; (K.N.); (K.N.); (A.T.); (T.N.); (R.M.); (T.M.); (H.S.)
| | - Shotaro Otsuka
- Department of Systems Biology in Thromboregulation, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan; (S.T.); (S.O.); (I.M.)
| | - Kazuki Nakanishi
- Course of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan; (K.N.); (K.N.); (A.T.); (T.N.); (R.M.); (T.M.); (H.S.)
| | - Akira Tani
- Course of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan; (K.N.); (K.N.); (A.T.); (T.N.); (R.M.); (T.M.); (H.S.)
| | - Tomomi Nakakogawa
- Course of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan; (K.N.); (K.N.); (A.T.); (T.N.); (R.M.); (T.M.); (H.S.)
| | - Ryoma Matsuzaki
- Course of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan; (K.N.); (K.N.); (A.T.); (T.N.); (R.M.); (T.M.); (H.S.)
| | - Teruki Matsuoka
- Course of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan; (K.N.); (K.N.); (A.T.); (T.N.); (R.M.); (T.M.); (H.S.)
| | - Harutoshi Sakakima
- Course of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan; (K.N.); (K.N.); (A.T.); (T.N.); (R.M.); (T.M.); (H.S.)
| | - Salunya Tancharoen
- Department of Pharmacology, Faculty of Dentistry, Mahidol University, Bangkok 10400, Thailand;
| | - Ikuro Maruyama
- Department of Systems Biology in Thromboregulation, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan; (S.T.); (S.O.); (I.M.)
| | - Eiichiro Tanaka
- Division of Brain Science, Department of Physiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan;
| | - Kiyoshi Kikuchi
- Department of Systems Biology in Thromboregulation, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan; (S.T.); (S.O.); (I.M.)
- Division of Brain Science, Department of Physiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan;
- Department of Neurosurgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
- Correspondence: (K.K.); (H.U.); Tel.: +81-942-31-7542 (K.K.); +81-92-477-2355 (H.U.); Fax: +81-942-31-7695 (K.K.); +81-92-477-2325 (H.U.)
| | - Hisaaki Uchikado
- Department of Neurosurgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
- Uchikado Neuro-Spine Clinic, 1-2-3 Naka, Hakata-ku, Fukuoka 812-0893, Japan
- Correspondence: (K.K.); (H.U.); Tel.: +81-942-31-7542 (K.K.); +81-92-477-2355 (H.U.); Fax: +81-942-31-7695 (K.K.); +81-92-477-2325 (H.U.)
| |
Collapse
|
5
|
Sun Y, Dai J, Jiao R, Jiang Q, Wang J. Homoharringtonine inhibits fibroblasts proliferation, extracellular matrix production and reduces surgery-induced knee arthrofibrosis via PI3K/AKT/mTOR pathway-mediated apoptosis. J Orthop Surg Res 2021; 16:9. [PMID: 33407698 PMCID: PMC7789651 DOI: 10.1186/s13018-020-02150-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 12/07/2020] [Indexed: 12/30/2022] Open
Abstract
Background The prevention of surgery-induced intraarticular fibrosis remains a challenge following orthopedic surgery. Homoharringtonine (HHT) has been reported to have positive effects in preventing various kinds of fibrosis. However, little is known regarding its effect as well as the potential mechanism of HHT in preventing surgery-induced intraarticular fibrosis. Methods Various concentrations of HHTs were locally applied in vivo to reduce knee intraarticular fibrosis in rabbits. Histological macroscopic assessments such as hematoxylin and eosin (HE) staining, Masson’s trichrome staining, and Picric-sirius red polarized light were used to evaluate the effect of HHT in reducing intraarticular fibrosis. CCK-8, cell cycle assay, and EdU incorporation assay were used in vitro to detect HHT’s effect on inhibiting fibroblast viability and proliferation. The effect of HHT on fibroblast differentiation, extracellular matrix production, and apoptosis were evaluated by western blot, flow cytometry, immunofluorescent staining, and TUNEL analysis. Moreover, the expressions of PI3K/AKT/mTOR signaling pathway were detected. Results The results demonstrated that HHT could reduce the formation of intraarticular fibrosis. HHT was also found to induce fibroblast apoptotic cell death in a dose- and time-dependent manner in vitro. Moreover, HHT could effectively inhibit the production of the extracellular matrix secreted by fibroblasts and inhibited the expression of p-PI3K, p-AKT, and p-mTOR in a dose-dependent manner. After treating with insulin-like growth factor-1 (IGF-1), an activator of the PI3K/AKT axis, the expressions of pro-apoptosis-related proteins were decreased, and the fibroblast apoptosis rate was also inhibited. Conclusions In conclusion, this study demonstrated that HHT could reduce the formation of intraarticular fibrosis through the inhibition of fibroblast proliferation, extracellular matrix production, and the induction of fibroblast apoptotic cell death. Furthermore, its potential mechanism may be through the suppression of the PI3K/AKT/mTOR signaling pathway.
Collapse
Affiliation(s)
- Yu Sun
- Department of Orthopedics, Clinical medical college of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, 225001, Jiangsu, China.,School of Medicine, Nanjing University, Nanjing, 210008, Jiangsu, China
| | - Jihang Dai
- Dalian medical university, Dalian, 116044, Liaoning, China
| | - Rui Jiao
- Department of Orthopedics, Clinical medical college of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, 225001, Jiangsu, China
| | - Qing Jiang
- School of Medicine, Nanjing University, Nanjing, 210008, Jiangsu, China.
| | - Jingcheng Wang
- Department of Orthopedics, Clinical medical college of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, 225001, Jiangsu, China.
| |
Collapse
|
6
|
Kim J, Kim Y, Jung W, Nam JH, Kim SH. Effects of a Thermosensitive Antiadhesive Agent on Single-Row Arthroscopic Rotator Cuff Repair. Am J Sports Med 2020; 48:2669-2676. [PMID: 32795189 DOI: 10.1177/0363546520946088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Postoperative stiffness after rotator cuff repair is a common complication that can lead to poor outcomes and patient discomfort. The application of an antiadhesive agent at the time of repair recently became an option for clinicians, but little information is available on its effects. PURPOSE To evaluate and compare retear rates, the incidence of postoperative stiffness, and the clinical outcomes of patients who underwent cuff repair with or without the application of an antiadhesive agent. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Among 296 patients who underwent arthroscopic rotator cuff repair surgery, we compared the outcomes of those injected with a thermosensitive gel antiadhesive agent into the subacromial space (112 cases) versus noninjected controls (184 cases). Retear rates in the 2 groups were determined by magnetic resonance imaging at 1 year after surgery. Shoulder joint range of motion and functional scores were evaluated serially. RESULTS The rate of retear was significantly lower in the injection group (20/112 cases; 17.9%) than the control group (53/184 cases; 28.8%) (P = .034). Postoperative stiffness was not significantly different between the 2 groups (P = .710). Among the data regarding range of motion, only forward flexion at 6 months after surgery showed superior results in the injection group. Functional scores showed conflicting results: The control group had better visual analog scale scores for pain (injection vs control: 2.17 vs 1.68 at 6 months; 1.82 vs 1.28 at 12 months), American Shoulder and Elbow Surgeons scores (79.89 vs 89.64 at 12 months), and simple shoulder test scores (8.70 vs 10.06 at 12 months), whereas the injection group had better Constant-Murley scores (injection vs control: 59.49 vs 55.60 at 3 months; 77.35 vs 71.98 at 6 months; 87.28 vs 81.56 at 12 months). CONCLUSION The tendon healing rate was significantly higher in the group receiving an antiadhesive agent than in the control group. No intergroup difference was seen in the occurrence of postoperative stiffness. However, the pain-related functional score showed inferior results in the injection group at 12 months. The biological action of antiadhesive agents in rotator cuff repair should be further evaluated.
Collapse
Affiliation(s)
- Jangwoo Kim
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Yuna Kim
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Whanik Jung
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Hoon Nam
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Sae Hoon Kim
- Seoul National University Hospital, Seoul, Republic of Korea
| |
Collapse
|
7
|
Kim TI, Jung W, Chung JY, Jeong H, Kim SH. Effect of a poloxamer-based thermosensitive gel on rotator cuff repair in a rabbit model: a controlled laboratory study. J Orthop Surg Res 2019; 14:190. [PMID: 31238965 PMCID: PMC6593526 DOI: 10.1186/s13018-019-1246-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 06/19/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND A common complication after rotator cuff repair is postoperative stiffness, which can be reduced by a simple application of an anti-adhesive agent. However, anti-adhesive agents may affect rotator cuff healing by preventing fibrosis. This experimental animal study evaluated the effect of the application of a poloxamer-based thermosensitive anti-adhesive gel and its influence on the healing of an acute rotator cuff repair in a rabbit model. METHODS Acute rotator cuff repair (supraspinatus tendon) was performed using a transosseous suturing method. One shoulder on a randomly selected side was treated with a local application of the anti-adhesive agent (applied side), and saline was applied to the contralateral side (control side). Biomechanical testing and histological analyses were performed at 4 and 8 weeks postoperatively. Eight rabbits were included for each testing and time point, for a total of 32 rabbits. RESULTS The failure load at 4 weeks was lower in the experimental group (95.2 ± 19.6 N vs. 110.0 ± 20.5 N; P = 0.017). Conversely, at 8 weeks, the failure load was higher in the experimental group (148.3 ± 16.2 N) than in the control group (122.4 ± 16.9 N; P = 0.002). Histological analyses revealed no statistically significant differences in the tendon maturing scores at 4 and 8 weeks between the two groups (all P > 0.05). The thickness of the fibrosis between the rotator cuff tendon and deltoid was thinner in the experimental group at both time points (0.50 ± 0.25 vs. 1.27 ± 0.47; P = 0.002 at 4 weeks, and 0.37 ± 0.35 vs. 1.39 ± 0.50; P = 0.003 at 8 weeks). CONCLUSIONS Application of an anti-adhesive agent in this rotator cuff model confirmed the agent's effectiveness at reducing fibrosis in the subacromial space. The healing of the tendon showed interesting results, as the experimental group had poorer biomechanical strength at 4 weeks but superior strength at 8 weeks.
Collapse
Affiliation(s)
- Tae In Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Whanik Jung
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jin-Young Chung
- Department of Veterinary Internal Medicine and Institute of Veterinary Science, College of Veterinary Medicine, Kangwon National University, Chuncheon-si, Gangwon-do, South Korea
| | - Hyunseok Jeong
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Sae Hoon Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea.
| |
Collapse
|
8
|
Li X, Chen S, Yan L, Wang J, Pei M. Prospective application of stem cells to prevent post-operative skeletal fibrosis. J Orthop Res 2019; 37:1236-1245. [PMID: 30835890 PMCID: PMC9202416 DOI: 10.1002/jor.24266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 02/17/2019] [Indexed: 02/04/2023]
Abstract
Post-operative skeletal fibrosis is considered one of the major complications causing dysfunction of the skeletal system and compromising the outcomes of clinical treatment. Limited success has been achieved using current therapies; more effective therapies to reduce post-operative skeletal fibrosis are needed. Stem cells possess the ability to repair and regenerate damaged tissue. Numerous studies show that stem cells serve as a promising therapeutic approach for fibrotic diseases in tissues other than the skeletal system by inhibiting the inflammatory response and secreting favorable cytokines through activating specific signaling pathways, acting as so-called medicinal signaling cells. In this review, current therapies are summarized for post-operative skeletal fibrosis. Given that stem cells are used as a promising therapeutic approach for fibrotic diseases, little effort has been undertaken to use stem cells to prevent post-operative skeletal fibrosis. This review aims at providing useful information for the potential application of stem cells in preventing post-operative skeletal fibrosis in the near future. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1236-1245, 2019.
Collapse
Affiliation(s)
- Xiaolei Li
- Department of Orthopaedics, Orthopaedics Institute, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu, 225001, China,Stem Cell and Tissue Engineering Laboratory, Department of Orthopaedics, West Virginia University, Morgantown, WV, 26506, USA
| | - Song Chen
- Department of Orthopaedics, Chengdu Military General Hospital, Chengdu, Sichuan, 610083, China
| | - Lianqi Yan
- Department of Orthopaedics, Orthopaedics Institute, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu, 225001, China
| | - Jingcheng Wang
- Department of Orthopaedics, Orthopaedics Institute, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu, 225001, China,Co-Corresponding author: Jingcheng Wang, MD, Department of Orthopaedics, Subei People’s Hospital, 98 West Nantong Road, Yangzhou 225001, China;
| | - Ming Pei
- Stem Cell and Tissue Engineering Laboratory, Department of Orthopaedics, West Virginia University, Morgantown, WV, 26506, USA,Exercise Physiology, West Virginia University, Morgantown, WV, 26506, USA,WVU Cancer Institute, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, WV, 26506, USA,Corresponding author: Ming Pei MD, PhD, Stem Cell and Tissue Engineering Laboratory, Department of Orthopaedics, West Virginia University, PO Box 9196, 64 Medical Center Drive, Morgantown, WV 26506-9196, USA, Telephone: 304-293-1072; Fax: 304-293-7070;
| |
Collapse
|
9
|
Namazi H, Emami MJ, Nazhvani FD, Dehghani Nazhvani A, Kargarshouroki Z. Effectiveness of Methylene Blue in the Prevention of Stifle Joint Arthrofibrosis in Rabbit Models. THE ARCHIVES OF BONE AND JOINT SURGERY 2019; 7:269-277. [PMID: 31312686 PMCID: PMC6578471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 04/04/2017] [Indexed: 06/10/2023]
Abstract
BACKGROUND One of the major challenges in orthopedic surgery is the prevention of arthrofibrosis, which can be successfully alleviated in its early stages. Many studies suggest the administration of methylene blue (MB) as an accessible and effective agent for the prevention of post-operation adhesions. The purpose of this study was to evaluate the efficacy of MB in the prevention of arthrofibrosis. METHODS This study was conducted on 18 New Zealand white female mature rabbits. The anterior cruciate ligament of the left stifle joint of each animal was cut during aseptic surgery. In the next step, the rabbits were divided into three groups based on their treatments. The rabbits in the first, second, and third groups were subjected to the injection of normal saline, 1% MB solution, and 2% MB solution into their synovial space, respectively. The postoperative stifle range of motion was measured every week. After 4 weeks, the animals were euthanized and all joints were dissected for histopathology. RESULTS The histopathological evaluation of tissues indicated the presence of fibrotic connective tissue as a sign of fibrosis in all groups. The fibrosis rate, inflammatory rate, tissue disarrangement, fibroblastic cellularity, and granulation tissue formation were at their highest levels in the 1% MB group. The integrity of articular cartilage in the 2% MB group was lower than the other groups. The level of bone degeneration was similar in both MB groups; however, it was more than the control saline group. The range of motion was reduced during the first week, then increased in the second and third weeks, and finally decreased in the fourth week. CONCLUSION The MB was not an effective method regarding the prevention or treatment of arthofibrosis and the subsequent osteoarthritis. In contrast with previous studies, fibrosis was lower in the high dose MB group, compared to the low dose MB group. The alterations in the range of motion were related to the reduced movement caused by the pain and stiffness of the operated joints. The current study can be considered as the first report addressing the adverse effect of MB on synovial components. LEVEL OF EVIDENCE I.
Collapse
Affiliation(s)
- Hamid Namazi
- Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
- Research performed at Comparative and Experimental Medicine Center of Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad J Emami
- Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
- Research performed at Comparative and Experimental Medicine Center of Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Dehghani Nazhvani
- Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
- Research performed at Comparative and Experimental Medicine Center of Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Dehghani Nazhvani
- Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
- Research performed at Comparative and Experimental Medicine Center of Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zeinab Kargarshouroki
- Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
- Research performed at Comparative and Experimental Medicine Center of Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
10
|
Haefeli PC, Schmaranzer F, Steppacher SD, Cullmann JL, Tannast M, Büchler L. Imaging appearance and distribution of intra-articular adhesions following open FAI surgery. Eur J Radiol 2018; 104:71-78. [DOI: 10.1016/j.ejrad.2018.04.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 03/21/2018] [Accepted: 04/24/2018] [Indexed: 11/24/2022]
|