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Katagiri H, Saito R, Shioda M, Jinno T, Watanabe T. Effect of posterior capsular release on intraoperative joint gap mismatch in the mid-flexion range during posterior-stabilized total knee arthroplasty. J Orthop Sci 2024; 29:200-206. [PMID: 36522245 DOI: 10.1016/j.jos.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/20/2022] [Accepted: 11/23/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Intraoperative mismatch between extension and mid-flexion joint gaps remains a critical issue in posterior-stabilized total knee arthroplasty (PS-TKA). Posterior capsular release has been found to increase the extension joint gap. However, there is still a lack of robust evidence for the effect of posterior capsular release on the mid-flexion joint gap. The purpose of the present study was to quantify the effect of posterior capsular release on the intraoperative joint gap from extension through 45° mid-flexion to flexion and to clarify how this procedure might affect the improvement of gap mismatch in the mid-flexion 45° range. MATERIALS AND METHODS In total, 38 consecutive cases of primary PS-TKA were reviewed. The center, medial, and lateral component gaps from extension to flexion were measured with a tensor device before and after posterior capsular release. The minimal detectable change for joint gap measurement was calculated using two methods, error variance and intra-observer intraclass correlation coefficients. Pre- and post-release joint gap differences were assessed using the paired t-test. RESULTS Minimal detectable change was found to be 0.59 mm. At 0° and 10° of flexion, the post-release center, medial, and lateral component gaps were significantly greater than at pre-release. At 45° and 90° and maximum flexion, there were no joint gap differences exceeding the minimal detectable change. The joint gap mismatches between 0° and 10°, and 45°, 90° and maximum flexion were significantly smaller at post-release than those at pre-release with the change values exceeding the minimal detectable change (P < 0.05). CONCLUSION Posterior capsular release significantly decreased both joint gap mismatch between extension and 45° mid-flexion, and extension and flexion, showing clinical usefulness in PS-TKA.
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Affiliation(s)
- Hiroki Katagiri
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Japan; Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Japan
| | - Ryusuke Saito
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Japan.
| | - Mikio Shioda
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Japan
| | - Tetsuya Jinno
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Japan
| | - Toshifumi Watanabe
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Japan
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Ramos MS, Pasqualini I, Surace PA, Molloy RM, Deren ME, Piuzzi NS. Arthrofibrosis After Total Knee Arthroplasty: A Critical Analysis Review. JBJS Rev 2023; 11:01874474-202312000-00001. [PMID: 38079496 DOI: 10.2106/jbjs.rvw.23.00140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
» Arthrofibrosis after total knee arthroplasty (TKA) is the new formation of excessive scar tissue that results in limited ROM, pain, and functional deficits.» The diagnosis of arthrofibrosis is based on the patient's history, clinical examination, absence of alternative diagnoses from diagnostic testing, and operative findings. Imaging is helpful in ruling out specific causes of stiffness after TKA. A biopsy is not indicated, and no biomarkers of arthrofibrosis exist.» Arthrofibrosis pathophysiology is multifactorial and related to aberrant activation and proliferation of myofibroblasts that primarily deposit type I collagen in response to a proinflammatory environment. Transforming growth factor-beta signaling is the best established pathway involved in arthrofibrosis after TKA.» Management includes both nonoperative and operative modalities. Physical therapy is most used while revision arthroplasty is typically reserved as a last resort. Additional investigation into specific pathophysiologic mechanisms can better inform targeted therapeutics.
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Affiliation(s)
- Michael S Ramos
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
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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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Zhang Y, Wang Z, Zong C, Gu X, Fan S, Xu L, Cai B, Lu S. Platelet-rich plasma attenuates the severity of joint capsule fibrosis following post-traumatic joint contracture in rats. Front Bioeng Biotechnol 2023; 10:1078527. [PMID: 36686225 PMCID: PMC9845589 DOI: 10.3389/fbioe.2022.1078527] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/28/2022] [Indexed: 01/06/2023] Open
Abstract
Background: Post-traumatic joint contracture (PTJC) mainly manifests as excessive inflammation leading to joint capsule fibrosis. Transforming growth factor (TGF)-β1, a key regulator of inflammation and fibrosis, can promote fibroblast activation, proliferation, migration, and differentiation into myofibroblasts. Platelet-rich plasma (PRP) is considered to have strong potential for improving tissue healing and regeneration, the ability to treat joint capsule fibrosis remains largely unknown. Methods: In this study, we aimed to determine the antifibrotic potential of PRP in vivo or in vitro and its possible molecular mechanisms. The TGF-β1-induced primary joint capsule fibroblast model and rat PTJC model were used to observe several fibrotic markers (TGF-β1, α-SMA, COL-Ⅰ, MMP-9) and signaling transduction pathway (Smad2/3) using histological staining, qRT-PCR and western blot. Results: Fibroblasts transformed to myofibroblasts after TGF-β1 stimulation with an increase of TGF-β1, α-SMA, COL-Ⅰ, MMP-9 and the activation of Smad2/3 in vitro. However, TGF-β1-induced upregulation or activation of these fibrotic markers or signaling could be effectively suppressed by the introduction of PRP. Fibrotic markers' similar changes were observed in the rat PTJC model and PRP effectively reduced inflammatory cell infiltration and collagen fiber deposition in the posterior joint capsule. Interestingly, HE staining showed that articular cartilage was degraded after rat PTJC, and PRP injection also have the potential to protect articular cartilage. Conclusion: PRP can attenuate pathological changes of joint capsule fibrosis during PTJC, which may be implemented by inhibiting TGF-β1/Smad2/3 signaling and downstream fibrotic marker expression in joint capsule fibroblasts.
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Affiliation(s)
- Yuxin Zhang
- Department of Rehabilitation Medicine, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Department of Oral Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China,Department of Rehabilitation Medicine, Huangpu Branch, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zengguang Wang
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenyu Zong
- Department of Orthopedics, Affiliated Hospital of Nantong University, Nantong, China
| | - Xiaoding Gu
- Department of Rehabilitation Medicine, Huangpu Branch, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuai Fan
- Department of Rehabilitation Medicine, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lili Xu
- Department of Rehabilitation Medicine, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Cai
- Department of Rehabilitation Medicine, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,*Correspondence: Bin Cai, ; Shenji Lu,
| | - Shenji Lu
- Department of Rehabilitation Medicine, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Department of Rehabilitation Medicine, Huangpu Branch, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,*Correspondence: Bin Cai, ; Shenji Lu,
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Zhang Y, Wu Z, Lu S, Lin M, Yue X, Wang Z, Cai B. Time-Series Expression Profile Analysis of Post-Traumatic Joint Contracture in Rats at the Early Stages of the Healing Process. J Inflamm Res 2023; 16:1169-1181. [PMID: 36945316 PMCID: PMC10024884 DOI: 10.2147/jir.s400557] [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: 12/07/2022] [Accepted: 03/09/2023] [Indexed: 03/17/2023] Open
Abstract
Objective This study aimed to characterize the gene expression profile at the early stages of the healing process of post-traumatic joint contracture (PTJC). Methods Twelve rats were used for PTJC model establishment and were divided into four groups according to the sampling time: S0d, S3d, S7d and S2w. Transcriptome sequencing was performed on fibrotic joint capsule samples in four groups followed by bioinformatics analyses including differentially expressed genes (DEGs) screening, Short Time-series Expression Miner (STEM) analysis, network construction, and pathway analysis. Five important genes were validated by qRT-PCR. Results A total of 1171, 1052 and 793 DEGs were screened in S3d vs S0d, S7d vs S0d, and S2w vs S0d comparison groups, respectively. A total of 383 overlapping genes were screened out, which were significantly enriched in some inflammatory functions and pathways. Through STEM analysis, three clusters were identified, including 105, 57 and 57 DEGs, respectively. Then, based on the cluster genes, 10 genes, such as Il6, Timp1, Cxcl1, Cxcr4 and Mmp3, were further selected after PPI and pathway analyses. The expression levels of Il6, Timp1, Cxcl1, Cxcr4 and Mmp3 were validated by qRT-PCR. Conclusion The present study screened out several genes with significant changes in expression levels at the early stages of the healing process in PTJC, such as Il6, Timp1, Cxcl1, Cxcr4 and Mmp3. Our study offers a valuable contribution to the understanding pathomechanism of PTJC.
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Affiliation(s)
- Yuxin Zhang
- Department of Rehabilitation Medicine, Hainan Western Central Hospital, Danzhou, Hainan, People’s Republic of China
- Department of Rehabilitation Medicine, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Department of Oral Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai, People’s Republic of China
- Correspondence: Yuxin Zhang; Bin Cai, Department of Rehabilitation Medicine, Hainan Western Central Hospital, No. 2, Fubo East Road, Nada Town, Danzhou, Hainan, 571700, People’s Republic of China, Tel +86-21-53315248, Email ;
| | - Zhigang Wu
- Department of Rehabilitation Medicine, Hainan Western Central Hospital, Danzhou, Hainan, People’s Republic of China
| | - Shenji Lu
- Department of Rehabilitation Medicine, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Minghui Lin
- Department of Rehabilitation Medicine, Hainan Western Central Hospital, Danzhou, Hainan, People’s Republic of China
| | - Xiaokun Yue
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Zengguang Wang
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Bin Cai
- Department of Rehabilitation Medicine, Hainan Western Central Hospital, Danzhou, Hainan, People’s Republic of China
- Department of Rehabilitation Medicine, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
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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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Chen YC, Lin KC, Yeh SH, Wang CH, Pan AW, Chen HL, Chen CJ. Associations among quality of life, activities, and participation in elderly residents with joint contractures in long-term care facilities: a cross-sectional study. BMC Geriatr 2022; 22:197. [PMID: 35279091 PMCID: PMC8917858 DOI: 10.1186/s12877-022-02870-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 02/25/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Joint contractures and degenerative osteoarthritis are the most common joint diseases in the elderly population, can lead to limited mobility in elderly individuals, can exacerbate symptoms such as pain, stiffness, and disability, and can interfere with social participation and quality of life, thus affecting mental health. However, relevant studies on this topic are very limited. This study describes the associations of joint contracture categories and sites in elderly residents in long-term care facilities with their quality of life, activities, and participation.
Methods
Elderly individuals with joint contractures who were residents in long-term care facilities were recruited. The World Health Organization (WHO) Quality of Life and the WHO Disability Assessment Schedule 2.0 were used to survey the participants. Correlations, multiple linear regressions, and multiple analyses of variance, with joint contractures as the response variable, were used in the statistical analysis.
Results
The final statistical analysis included 232 participants. The explanatory power of contracture sites on activities and participation had a moderate strength of association (η2 = .113). Compared with elderly residents with joint contractures and osteoarthritis isolated to the upper limbs, those with joint contractures and osteoarthritis in both the upper and lower limbs had significantly worse activity and participation limitations. No significant differences in activity and participation were found between elderly residents with joint contractures affecting only the upper limbs and those with joint contractures affecting only the lower limbs (F1,226 = 2.604 and F1,226 = 0.674, nonsignificant). Osteoarthritis had the greatest impact on activity limitations and participation restrictions among elderly residents with joint contractures affecting both the upper and lower limbs (F1,226 = 6.251, p = .014).
Conclusions
Elderly residents in long-term care facilities belonging to minority groups, with a history of stroke, and with osteoarthritis are at a high risk of developing activity limitations and participation restrictions. Moreover, compared with other contraction sites, regardless of osteoarthritis, joint contractures affecting both the upper and lower limbs were associated with the greatest activity limitations and participation restrictions.
Trial registration
This study has been registered in the Chinese Clinical Trial Registry, registration number and date:ChiCTR2000039889 (13/11/2020).
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Hodgeson S, O’Brien S, Simkin J, Plakotaris E, McCarthy C, Dasa V, Marrero L. Differences in synovial fibrosis relative to range of motion in knee osteoarthritis patients. J Orthop Res 2022; 40:584-594. [PMID: 33913554 PMCID: PMC8553814 DOI: 10.1002/jor.25061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 04/12/2021] [Accepted: 04/19/2021] [Indexed: 02/04/2023]
Abstract
This study tests if differences exist in the severity of synovial fibrosis between patients undergoing total knee arthroplasty (TKA) for osteoarthritis (OA) to help explain disparate deficits in pre- and postoperative range of motion (ROM) between patient groups. 117 knee OA patients were grouped by women (n = 74) and men (n = 43) or those who self-reported as Black (n = 48) or White (n = 69). ROM was measured pre- and post-TKA. Condyles and synovium collected during TKA were scored histologically for OA severity and synovitis. Fibrosis was measured from picrosirius-stained sections of the synovium. Data were analyzed using Mann-Whitney, parametric, and Spearman's rho tests with alpha at 0.05. We found no significant differences between patient age, BMI, radiographic scores, or deformity type when grouped by sex or race, or between metrics or OA severity when grouped by sex. Notably, higher synovitis was measured in women (p = .039) than men. White patients had greater ROM before (p = 0.46) and after surgery (p = .021) relative to Black patients. Fibrosis, but not OA severity and synovitis scores, for the total patient sample negatively correlated with preoperative (r s = -0.330; p = .0003) but not postoperative (rs = -0.032; p = .7627) ROM. Black patients manifested more fibrosis than White patients (p = <.0001), without significant differences between sexes. Statement of Clinical Significance: Coupled with histological scoring, measuring perioperative differences in synovial fibrosis against ROM may refine OA classification and justify the in-depth preoperative assessment of the knee as a whole. Such individualized analyses could guide personalized strategies to relieve symptomatic OA when TKA is not readily accessible and promote equitable TKA outcomes.
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Affiliation(s)
- Sydney Hodgeson
- Louisiana State University Health Sciences Center, School of Medicine, New Orleans, LA, United States
| | - Sarah O’Brien
- Louisiana State University Health Sciences Center, Morphology and Imaging Core, New Orleans, LA, United States
| | - Jennifer Simkin
- Louisiana State University Health Sciences Center, Department of Orthopaedics, New Orleans, LA, United States
| | - Elena Plakotaris
- Louisiana State University Health Sciences Center, Morphology and Imaging Core, New Orleans, LA, United States
| | - Christina McCarthy
- Louisiana State University Health Sciences Center, Department of Orthopaedics, New Orleans, LA, United States
| | - Vinod Dasa
- Louisiana State University Health Sciences Center, Department of Orthopaedics, New Orleans, LA, United States
| | - Luis Marrero
- Louisiana State University Health Sciences Center, Department of Orthopaedics, New Orleans, LA, United States,Louisiana State University Health Sciences Center, Morphology and Imaging Core, New Orleans, LA, United States,Address correspondence to Dr. Luis Marrero, Louisiana State University Health Sciences Center, 533 Bolivar St., Clinical Sciences Research Bldg., Room 608, New Orleans, LA 70112, . Ph: +1-504-568-2538
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Campbell TM, McGonagle D. Flexion contracture is a risk factor for knee osteoarthritis incidence, progression and earlier arthroplasty: Data from the Osteoarthritis Initiative. Ann Phys Rehabil Med 2021; 64:101439. [PMID: 33065299 DOI: 10.1016/j.rehab.2020.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 07/05/2020] [Accepted: 09/22/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Knee joint osteoarthritis (OA) is often accompanied by flexion contracture (FC), but the impact of FC on important outcomes across the spectrum of OA, such as the incidence, progression and need for total knee arthroplasty (TKA), is not well established. OBJECTIVE We evaluated whether the presence and/or severity of knee FC were risk factors for worse OA clinical outcomes, radiographic incidence and progression as well as time to TKA. METHODS We evaluated longitudinal 9-year data from the Osteoarthritis Initiative (OAI) database for 3 sub-cohorts: at-risk of knee OA (n=3284), radiographically established knee OA (n=1390), and low-risk controls (n=122). We classified knee FC as none, mild, moderate or severe based on knee extension at enrolment. Knee OA outcomes were extracted from the database. RESULTS FC was present in 32.4% of knees. Participants with FC had increased knee OA incidence with joint space narrowing in the definition (corrected odds ratio 1.31 [95% confidence interval (CI) 1.04-1.64]). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores for pain, stiffness and function were worse with than without FC at nearly all times (p<0.001). Effect estimates were significant for all 3 WOMAC sub-scales comparing FC to no FC (pain: 0.15 [95% CI 0.02-0.28], stiffness: 0.11 [0.05-0.18], function: 0.49 [0.05-0.93]). Individuals with knee FC had higher Kellgren and Lawrence grade (effect size 0.31 [95% CI 0.25-0.37]) and were more likely to undergo TKA (corrected odds ratio 1.37 [95% CI 1.10-1.71]) than those without FC. All outcomes were worse with increasing FC severity. CONCLUSION The presence of knee FC at enrolment was a risk factor for radiographic OA incidence including joint space narrowing, worse clinical outcomes, radiographic progression and the need for early TKA. Treatment of knee FC may represent an option across the OA spectrum. Further research is needed to evaluate the pathophysiology, joint structure alterations and longitudinal impact of treating FC in individuals with knee OA.
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Affiliation(s)
- T Mark Campbell
- Department of Physical Medicine and Rehabilitation, Elisabeth Bruyère Hospital-Ottawa, 43 Bruyère St, K1N 5C8 Ontario, ON, Canada.
| | - Dennis McGonagle
- University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK.
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Zhang Y, Lu S, Fan S, Xu L, Jiang X, Wang K, Cai B. Macrophage migration inhibitory factor activates the inflammatory response in joint capsule fibroblasts following post-traumatic joint contracture. Aging (Albany NY) 2021; 13:5804-5823. [PMID: 33601337 PMCID: PMC7950233 DOI: 10.18632/aging.202505] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/23/2020] [Indexed: 12/11/2022]
Abstract
Objectives: Joint capsule fibrosis caused by excessive inflammation leading to post-traumatic joint contracture (PTJC). Fibroblasts trigger inflammation under the challenge of various proinflammatory cytokines. Macrophage migration inhibitory factor (MIF) is a prominent proinflammatory cytokine involved in inflammation- and fibrosis-associated pathophysiology, we investigated the role of MIF in PTJC. Methods: Using rat PTJC model and fibroblast inflammation model, we detected MIF expression in posterior joint capsule. Primary joint capsule fibroblasts (JFs) were used to investigate the effects of MIF on cell proliferation, migration and proinflammatory cytokines production. The mechanism of JF-mediated events was evaluated by qRT-PCR, western blot and immunoprecipitation. We screened the mRNA expression profile to identify gene candidates that mediate the effect of MIF on JFs. Results: MIF increased in posterior joint capsule following PTJC and co-localized with fibroblasts. Injection of MIF inhibitor significantly suppressed joint capsule inflammation and fibrosis. In vitro, MIF promoted JF proliferation, migration, and inflammation by regulating mitogen-activated protein kinase/nuclear factor-κB pathway through coupling with CD74. Transcriptome analysis revealed that lipid metabolism-related factors Pla2g2a, Angptl4, and Sgpp2, downstream of MIF/CD74, were potentially implicated in JF inflammation. Conclusion: MIF/CD74 axis elicited JF inflammation and may provide new therapeutic targets for joint capsule fibrosis in PTJC.
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Affiliation(s)
- Yuxin Zhang
- Department of Rehabilitation Medicine, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.,Shanghai Key Laboratory of Orthopedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Shenji Lu
- Department of Rehabilitation Medicine, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Shuai Fan
- Department of Rehabilitation Medicine, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Lili Xu
- Department of Rehabilitation Medicine, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Xin Jiang
- Department of Rehabilitation Medicine, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Kexin Wang
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Bin Cai
- Department of Rehabilitation Medicine, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
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Campbell TM, Ramsay T, Trudel G. Knee Flexion Contractures Are Associated with Worse Pain, Stiffness, and Function in Patients with Knee Osteoarthritis: Data from the Osteoarthritis Initiative. PM R 2020; 13:954-961. [DOI: 10.1002/pmrj.12497] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 08/25/2020] [Accepted: 09/11/2020] [Indexed: 12/22/2022]
Affiliation(s)
- T Mark Campbell
- Department of Physical Medicine and Rehabilitation Elisabeth Bruyère Hospital Ottawa ON Canada
| | - Tim Ramsay
- Ottawa Hospital Research Institute Ottawa ON Canada
| | - Guy Trudel
- Department of Medicine, Division of Physical and Rehabilitation Medicine The Ottawa Hospital Ottawa ON Canada
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Xiao D, Liang T, Zhuang Z, He R, Ren J, Jiang S, Zhu L, Wang K, Shi D. Lumican promotes joint fibrosis through TGF-β signaling. FEBS Open Bio 2020; 10:2478-2488. [PMID: 32910552 PMCID: PMC7609791 DOI: 10.1002/2211-5463.12974] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/26/2020] [Accepted: 09/03/2020] [Indexed: 01/06/2023] Open
Abstract
Joint contracture (also known as arthrofibrosis) is a fibrotic joint disorder characterized by excessive collagen production to form fibrotic scar tissue and adhesions within joint capsules. This can severely affect day‐to‐day activities and quality of life because of a restricted range of motion in affected joints. The precise pathogenic mechanism underlying joint contractures is not fully understood. Lumican belongs to the class II small leucine‐rich repeat proteoglycan superfamily, which makes up collagen fibrils in the extracellular matrix. Lumican is ubiquitously expressed in the skin, liver, heart, uterus and articular cartilage and has reported roles in cell migration, proliferation, angiogenesis and Toll‐like receptor 4 signaling. Previous research has suggested that lumican is involved in the pathogenesis of several fibrotic diseases. Because joint contracture resembles a fibrotic disease, we aimed to investigate the role of lumican in the development of joint contracture in vitro. Here, we showed that protein levels were up‐regulated in the fibrotic joint capsule versus control. We observed that lumican significantly enhanced the proliferation, migration and fibroblast–myofibroblast transition of synovial fibroblasts. Moreover, lumican led to increased transcription of alpha‐smooth muscle actin, matrix metallopeptidase 9, Collagen I, plasminogen activator inhibitor 1 and transforming growth factor‐β in vitro. Lumican treatment promoted collagen lattice contraction in a dose‐dependent manner as early as 24 h after treatment. Thus, our studies reveal that lumican could promote fibroblast–myofibroblast transition and joint contracture.
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Affiliation(s)
- Dahai Xiao
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tangzhao Liang
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ze Zhuang
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ronghan He
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jianhua Ren
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shihai Jiang
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lei Zhu
- Department of Plastic Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kun Wang
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dehai Shi
- Department of Joint and Trauma Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Bayram B, Limberg AK, Salib CG, Bettencourt JW, Trousdale WH, Lewallen EA, Reina N, Paradise CR, Thaler R, Morrey ME, Sanchez-Sotelo J, Berry DJ, van Wijnen AJ, Abdel MP. Molecular pathology of human knee arthrofibrosis defined by RNA sequencing. Genomics 2020; 112:2703-2712. [PMID: 32145378 PMCID: PMC7217749 DOI: 10.1016/j.ygeno.2020.03.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/21/2020] [Accepted: 03/03/2020] [Indexed: 12/11/2022]
Abstract
Arthrofibrosis is an abnormal histopathologic response, is debilitating for patients, and poses a substantial unsolved clinical challenge. This study characterizes molecular biomarkers and regulatory pathways associated with arthrofibrosis by comparing fibrotic and non-fibrotic human knee tissue. The fibrotic group encompasses 4 patients undergoing a revision total knee arthroplasty (TKA) for arthrofibrosis (RTKA-A) while the non-fibrotic group includes 4 patients undergoing primary TKA for osteoarthritis (PTKA) and 4 patients undergoing revision TKA for non-arthrofibrotic and non-infectious etiologies (RTKA-NA). RNA-sequencing of posterior capsule specimens revealed differences in gene expression between each patient group by hierarchical clustering, principal component analysis, and correlation analyses. Multiple differentially expressed genes (DEGs) were defined in RTKA-A versus PTKA patients (i.e., 2059 up-regulated and 1795 down-regulated genes) and RTKA-A versus RTKA-NA patients (i.e., 3255 up-regulated and 3683 down-regulated genes). Our findings define molecular and pathological markers of arthrofibrosis, as well as novel potential targets for risk profiling, early diagnosis and pharmacological treatment of patients.
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Affiliation(s)
- Banu Bayram
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
| | - Afton K Limberg
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
| | | | - Jacob W Bettencourt
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
| | - William H Trousdale
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
| | - Eric A Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
| | - Nicolas Reina
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
| | | | - Roman Thaler
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
| | - Mark E Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
| | | | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
| | - Andre J van Wijnen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States; Department of Biochemistry & Molecular Biology, Mayo Clinic, Rochester, MN, United States
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
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Knee Flexion Contracture Associated With a Contracture and Worse Function of the Contralateral Knee: Data From the Osteoarthritis Initiative. Arch Phys Med Rehabil 2020; 101:624-632. [DOI: 10.1016/j.apmr.2019.11.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/14/2019] [Accepted: 11/29/2019] [Indexed: 12/21/2022]
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15
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Campbell TM, Ghaedi BB, Ghogomu ET, Westby M, Welch VA. Effectiveness of stretching and bracing for the treatment of osteoarthritis-associated joint contractures prior to joint replacement: a systematic review protocol. BMJ Open 2019; 9:e028177. [PMID: 31366647 PMCID: PMC6678023 DOI: 10.1136/bmjopen-2018-028177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Many patients with osteoarthritis (OA) develop restrictions in passive range of motion (ROM) of their affected joints (called contractures), leading to increased pain and reduced function. Effective treatment to reverse OA-associated contractures is lacking. Our aim is to evaluate the effectiveness of stretching and bracing on native (non-operated) joint contractures in people with radiographically diagnosed OA. METHODS AND ANALYSIS We will search the following databases without time restriction: Cochrane Library (CENTRAL, Database of Abstracts of Reviews of Effects, Health Technology Assessment Database), MEDLINE, Embase, CINAHL, SCI-EXPANDED (ISI Web of Knowledge) and PEDro. Other sources will include WHO International Clinical Trials Registry Platform, reference lists of included studies, relevant systematic reviews and textbooks. We will include randomised controlled trials (RCTs), controlled clinical trials, controlled before-and-after studies, cohort studies and case-control studies that include participants ≥18 years of age with radiographic evidence of OA. Participants with inflammatory arthropathies or those that have undergone joint arthroplasty will be excluded. Interventions will include therapist-administered or patient-administered stretching, use of an orthosis (static or dynamic), use of serial casting and/or adjunctive modalities. Outcomes will include joint ROM (active and passive), pain (rest and/or activity related), stiffness, activity limitations, participation restrictions, quality of life and adverse events. Studies will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study inclusion, data extraction and quality assessment will be performed independently by two reviewers. Risk of bias will be assessed using appropriate tools for each study design. Data synthesis will be performed using Cochrane Review Manager software. If sufficient data are available, meta-analysis will be conducted. We will summarise the quality of evidence using Grading of Recommendations Assessment, and the effect size of interventions for RCT and non-RCT studies. ETHICS AND DISSEMINATION Ethics approval not required because individual patient data are not included. Findings will be disseminated in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42019127244.
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Affiliation(s)
- T Mark Campbell
- Physical Medicine and Rehabilitation, Elisabeth-Bruyère Hospital, Ottawa, Ontario, Canada
| | - Bahareh Bahram Ghaedi
- Physical Medicine and Rehabilitation, Bruyère Research Institute, Ottawa, Ontario, Canada
| | | | - Marie Westby
- Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada
| | - Vivian A Welch
- Methods Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
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Charlier E, Deroyer C, Ciregia F, Malaise O, Neuville S, Plener Z, Malaise M, de Seny D. Chondrocyte dedifferentiation and osteoarthritis (OA). Biochem Pharmacol 2019; 165:49-65. [DOI: 10.1016/j.bcp.2019.02.036] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/28/2019] [Indexed: 02/08/2023]
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Rai MF, Tycksen ED, Cai L, Yu J, Wright RW, Brophy RH. Distinct degenerative phenotype of articular cartilage from knees with meniscus tear compared to knees with osteoarthritis. Osteoarthritis Cartilage 2019; 27:945-955. [PMID: 30797944 PMCID: PMC6536326 DOI: 10.1016/j.joca.2019.02.792] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 01/29/2019] [Accepted: 02/07/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the transcriptome of articular cartilage from knees with meniscus tears to knees with end-stage osteoarthritis (OA). DESIGN Articular cartilage was collected from the non-weight bearing medial intercondylar notch of knees undergoing arthroscopic partial meniscectomy (APM; N = 10, 49.7 ± 10.8 years, 50% females) for isolated medial meniscus tears and knees undergoing total knee arthroplasty (TKA; N = 10, 66.0 ± 7.6 years, 70% females) due to end-stage OA. Ribonucleic acid (RNA) preparation was subjected to SurePrint G3 human 8 × 60K RNA microarrays to probe differentially expressed transcripts followed by computational exploration of underlying biological processes. Real-time polymerase chain reaction amplification was performed on selected transcripts to validate microarray data. RESULTS We observed that 81 transcripts were significantly differentially expressed (45 elevated, 36 repressed) between APM and TKA samples (≥ 2 fold) at a false discovery rate of ≤ 0.05. Among these, CFD, CSN1S1, TSPAN11, CSF1R and CD14 were elevated in the TKA group, while CHI3L2, HILPDA, COL3A1, COL27A1 and FGF2 were highly expressed in APM group. A few long intergenic non-coding RNAs (lincRNAs), small nuclear RNAs (snoRNAs) and antisense RNAs were also differentially expressed between the two groups. Transcripts up-regulated in TKA cartilage were enriched for protein localization and activation, chemical stimulus, immune response, and toll-like receptor signaling pathway. Transcripts up-regulated in APM cartilage were enriched for mesenchymal cell apoptosis, epithelial morphogenesis, canonical glycolysis, extracellular matrix organization, cartilage development, and glucose catabolic process. CONCLUSIONS This study suggests that APM and TKA cartilage express distinct sets of OA transcripts. The gene profile in cartilage from TKA knees represents an end-stage OA whereas in APM knees it is clearly earlier in the degenerative process.
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Affiliation(s)
- Muhammad Farooq Rai
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, Washington University School of Medicine, St. Louis, MO 63110, United States of America,Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO 63110, United States of America
| | - Eric D. Tycksen
- Genome Technology Access Center, Washington University School of Medicine, St. Louis, MO 63110, United States of America
| | - Lei Cai
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, Washington University School of Medicine, St. Louis, MO 63110, United States of America
| | - Jinsheng Yu
- Genome Technology Access Center, Washington University School of Medicine, St. Louis, MO 63110, United States of America
| | - Rick W. Wright
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, Washington University School of Medicine, St. Louis, MO 63110, United States of America
| | - Robert H. Brophy
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, Washington University School of Medicine, St. Louis, MO 63110, United States of America
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Ko JH, Kang YM, Yang JH, Kim JS, Lee WJ, Kim SH, Yang IH, Moon SH. Regulation of MMP and TIMP expression in synovial fibroblasts from knee osteoarthritis with flexion contracture using adenovirus-mediated relaxin gene therapy. Knee 2019; 26:317-329. [PMID: 30770167 DOI: 10.1016/j.knee.2019.01.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 12/07/2018] [Accepted: 01/17/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to investigate the effects of relaxin (RLN) expression on fibrosis inhibition in synovial fibroblasts. MATERIALS AND METHODS Tissue cells from patients with knee osteoarthritis and >30° flexion contractures were utilised. Synovial fibroblasts were activated by TGF-β1 (two nanograms per millilitre) and then exposed to Ad-RLN as a therapeutic gene, adenovirus-lacZ construct as a marker gene, and SB505124 as an inhibitor for TGF-β1 signal for 48 h. The mRNA expression levels of collagens and MMPs were analysed by reverse transcription-polymerase chain reaction. Also, fibronectin, phosphorylation of Smad2 and ERK1/2, alpha smooth muscle actin, TIMP-1, TIMP-2, MMP-1 and MMP-13 levels were estimated using western blotting, and the total collagen synthesis was assayed. RESULTS Ad-RLN-transduced synovial fibroblasts demonstrated 17%, 13%, and 48% reduction in collagen I, III and IV mRNA expression levels, respectively, and a 40% decrease in MMP-3, MMP-8, 20% decrease in MMP-9, MMP-13 mRNA expression, compared to non-Ad-RLN-transduced cells. In protein expression, Ad-RLN-transduced synovial fibroblasts demonstrated 46% increase in MMP-1, 5% decrease in MMP-2, 51% increase in MMP-9, and 22% increase in MMP-13, compared to non-Ad-RLN-transduced cells. Ad-RLN-transduced synovial fibroblasts showed a 25% decrease in TIMP-1 and 65% decrease in TIMP-2 protein expression at 48h, compared to non-Ad-RLN-transduced cells. Ad-RLN-transduced synovial fibroblasts demonstrated a 45% inhibition of fibronectin in protein expression level and 38% decrease in total collagen synthesis at 48h, compared to non-Ad-RLN-transduced cells. CONCLUSION Relaxin expression exerted anti-fibrogenic effects on synovial fibroblasts from patients with knee osteoarthritis and flexion contractures. Therefore, relaxin could be an alternative therapeutic agent during the initial stage of osteoarthritis with flexion contracture by exerting its anti-fibrogenic effects.
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Affiliation(s)
- Jae Han Ko
- Department of Orthopaedic Surgery, Yonsei Barun Orthopaedic Surgery Clinic, Seoul, Republic of Korea; Department of Orthopaedic Surgery, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Young Mi Kang
- Department of Orthopaedic Surgery, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Jae Ho Yang
- Department of Orthopaedic Surgery, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Ji Sup Kim
- Department of Orthopaedic Surgery, Yonsei University, College of Medicine, Seoul, Republic of Korea; Department of Orthopaedic Surgery, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
| | - Won Jai Lee
- Department of Plastic Surgery, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Sang Ho Kim
- Department of Orthopaedic Surgery, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Ick Hwan Yang
- Department of Orthopaedic Surgery, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Seong Hwan Moon
- Department of Orthopaedic Surgery, Yonsei University, College of Medicine, Seoul, Republic of Korea.
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Chughtai M, Newman JM, Sultan AA, Samuel LT, Rabin J, Khlopas A, Bhave A, Mont MA. Astym ® therapy: a systematic review. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:70. [PMID: 30963065 DOI: 10.21037/atm.2018.11.49] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Soft tissue dysfunction can result from the degeneration of tissues as in the case of degenerative tendinopathy or from the build-up of problematic scar tissue, which can be the result of several aggravating factors, including overuse injuries, acute or chronic trauma, or as a result of surgery. This dysfunction often results in impaired movement, pain, and swelling of the affected area, which can lead to patient dissatisfaction and a lower quality of life. These soft tissue dysfunctions also have a marked economic impact. Although a number of traditional treatments attempt to address these issues, no optimal treatment choice has emerged. Traditional treatments are not always successful, can be invasive, and can consume many medical resources. A relatively new treatment approach, Astym therapy, is a potentially useful, non-invasive, more cost-effective option. This therapy was developed to address soft-tissue dysfunctions by stimulating the regeneration of soft tissues and the resorption of inappropriate scar tissue/fibrosis. It has been reported to help with the resorption and remodeling of abnormal tissue, thereby leading to improved motion, function and pain relief. The purpose of this analysis was to review the published literature related to Astym therapy on various musculoskeletal disorders. Specifically, we evaluated the effectiveness of this therapeutic method on disorders related to the: (I) knee; (II) upper extremity; (III) hamstring muscles; and (IV) ankle and Achilles tendon injuries.
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Affiliation(s)
- Morad Chughtai
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Jared M Newman
- Department of Orthopedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Assem A Sultan
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Linsen T Samuel
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Jacob Rabin
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Anil Bhave
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY, USA
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Abstract
Large joint arthrofibrosis and scarring, involving the shoulder, elbow, hip, and knee, can result in the loss of function and immobility. The pathway of joint contracture formation is still being elucidated and is due to aberrations in collagen synthesis and misorientation of collagen fibrils. Novel antibodies are being developed to prevent arthrofibrosis, and current treatment methods for arthrofibrosis include medical, physical, and surgical treatments. This article describes the biology of joint contracture formation, along with current and future pharmacologic, biologic, and medical interventions.
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Affiliation(s)
- Antonia F Chen
- a Department of Orthopaedic Surgery , Brigham and Women's Hospital, Harvard Medical School , Boston , MA , USA
| | - Yong Seuk Lee
- b Department of Orthopedic Surgery , Seoul National University College of Medicine, Seoul National University Bundang Hospital , Seoul , Korea
| | - Adam J Seidl
- c Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedics , University of Colorado , Aurora , CO , USA
| | - Joseph A Abboud
- d Department of Orthopaedics , Rothman Institute at Thomas Jefferson University , Philadelphia , PA , USA
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Endoplasmic reticulum stress-dependent ROS production mediates synovial myofibroblastic differentiation in the immobilization-induced rat knee joint contracture model. Exp Cell Res 2018; 369:325-334. [PMID: 29856991 DOI: 10.1016/j.yexcr.2018.05.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 01/25/2023]
Abstract
Joint contracture is a common complication for people with joint immobility that involves fibrosis structural alteration in the joint capsule. Considering that endoplasmic reticulum (ER) stress plays a prominent role in the promotion of tissue fibrosis, we investigated whether the unfolded protein response (UPR) contributes to the fibrotic development in immobilization-induced knee joint contractures. Using a non-traumatic rat knee joint contracture model, twelve female Sprague-Dawley rats received knee joint immobilization for a period of 8 weeks. We found that fibrosis protein markers (type I collagen, α-SMA) and UPR (GRP78, ATF6α, XBP1s) markers were parallelly upregulated in rat primary cultured synovial myofibroblasts. In the same cell types, pre-treatment with an ER stress inhibitor, 4-phenylbutyric acid (4-PBA), not only abrogated cytokine TGFβ1 stimulation but also reduced the protein level of UPR. Additionally, high reactive oxygen species (ROS) generation was detected in synovial myofibroblasts through flow cytometry, as expected. Notably, TGFβ1-induced UPR was significantly reduced through the inhibition of ROS with antioxidants. These data suggest that ER stress act as a pro-fibrotic stimulus through the overexpression of ROS in synovial fibroblasts. Interestingly, immunohistochemical results showed an increase in the UPR protein levels both in human acquired joint contractures capsule tissue and in animal knee joint contracture tissue. Together, our findings suggest that ER stress contributes to synovial myofibroblastic differentiation in joint capsule fibrosis and may also serve as a potential therapeutic target in joint contractures.
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Brophy RH, Zhang B, Cai L, Wright RW, Sandell LJ, Rai MF. Transcriptome comparison of meniscus from patients with and without osteoarthritis. Osteoarthritis Cartilage 2018; 26:422-432. [PMID: 29258882 PMCID: PMC6007850 DOI: 10.1016/j.joca.2017.12.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 11/13/2017] [Accepted: 12/08/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To assess the impact of osteoarthritis (OA) on the meniscus by comparing transcripts and biological processes in the meniscus between patients with and without OA. DESIGN RNA microarrays were used to identify transcripts differentially expressed (DE) in meniscus obtained from 12 OA and 12 non-OA patients. The non-OA specimens were obtained at the time of arthroscopic partial meniscectomy. Real-time PCR was performed on selected transcripts. Biological processes and gene-networking was examined computationally. Transcriptome signatures were mapped with 37 OA-related transcripts to evaluate how meniscus gene expression relates to that of OA cartilage. RESULTS We identified 168 transcripts significantly DE between OA (75 elevated, 93 repressed) and non-OA samples (≥1.5-fold). Among these, CSN1S1, COL10A1, WIF1, and SPARCL1 were the most prominent transcripts elevated in OA meniscus, POSTN and VEGFA were most highly repressed in OA meniscus. Transcripts elevated in OA meniscus represented response to external stimuli, cell migration and cell localization while those repressed in OA meniscus represented histone deacetylase activity (related to epigenetics) and skeletal development. Numerous long non-coding RNAs (lncRNAs) were DE between the two groups. When segregated by OA-related transcripts, two distinct clustering patterns appeared: OA meniscus appeared to be more inflammatory while non-OA meniscus exhibited a "repair" phenotype. CONCLUSIONS Numerous transcripts with potential relevance to the pathogenesis of OA are DE in OA and non-OA meniscus. These data suggest an involvement of epigenetically regulated histone deacetylation in meniscus tears as well as expression of lncRNAs. Patient clustering based on transcripts related to OA in articular cartilage confirmed distinct phenotypes between injured (non-OA) and OA meniscus.
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Affiliation(s)
- R H Brophy
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, Washington University School of Medicine at Barnes-Jewish Hospital, 660 South Euclid Avenue, St. Louis, MO 63110, USA.
| | - B Zhang
- Department of Developmental Biology, Center of Regenerative Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, 660 South Euclid Avenue, St. Louis, MO 63110, USA.
| | - L Cai
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, Washington University School of Medicine at Barnes-Jewish Hospital, 660 South Euclid Avenue, St. Louis, MO 63110, USA.
| | - R W Wright
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, Washington University School of Medicine at Barnes-Jewish Hospital, 660 South Euclid Avenue, St. Louis, MO 63110, USA.
| | - L J Sandell
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, Washington University School of Medicine at Barnes-Jewish Hospital, 660 South Euclid Avenue, St. Louis, MO 63110, USA; Department of Cell Biology and Physiology, Washington University School of Medicine at Barnes-Jewish Hospital, 660 South Euclid Avenue, St. Louis, MO 63110, USA; Department of Biomedical Engineering, Washington University School of Engineering & Applied Science, 1 Brookings Drive, St. Louis, MO 63130, USA.
| | - M F Rai
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, Washington University School of Medicine at Barnes-Jewish Hospital, 660 South Euclid Avenue, St. Louis, MO 63110, USA; Department of Cell Biology and Physiology, Washington University School of Medicine at Barnes-Jewish Hospital, 660 South Euclid Avenue, St. Louis, MO 63110, USA.
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Chan DD, Li J, Luo W, Predescu DN, Cole BJ, Plaas A. Pirfenidone reduces subchondral bone loss and fibrosis after murine knee cartilage injury. J Orthop Res 2018; 36. [PMID: 28646530 PMCID: PMC5742076 DOI: 10.1002/jor.23635] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Pirfenidone is an anti-inflammatory and anti-fibrotic drug that has shown efficacy in lung and kidney fibrosis. Because inflammation and fibrosis have been linked to the progression of osteoarthritis, we investigated the effects of oral Pirfenidone in a mouse model of cartilage injury, which results in chronic inflammation and joint-wide fibrosis in mice that lack hyaluronan synthase 1 (Has1-/- ) in comparison to wild-type. Femoral cartilage was surgically injured in wild-type and Has1-/- mice, and Pirfenidone was administered in food starting after 3 days. At 4 weeks, Pirfenidone reduced the appearance, on micro-computed tomography, of pitting in subchondral bone at, and cortical bone surrounding, the site of cartilage injury. This corresponded with a reduction in fibrotic tissue deposits as observed with gross joint surface photography. Pirfenidone resulted in significant recovery of trabecular bone parameters affected by joint injury in Has1-/- mice, although the effect in wild-type was less pronounced. Pirfenidone also increased Safranin-O staining of growth plate cartilage after cartilage injury and sham operation in both genotypes. Taken together with the expression of selected extracellular matrix, inflammation, and fibrosis genes, these results indicate that Pirfenidone may confer chondrogenic and bone-protective effects, although the well-known anti-fibrotic effects of Pirfenidone may occur earlier in the wound-healing response than the time point examined in this study. Further investigations to identify the specific cell populations in the joint and signaling pathways that are responsive to Pirfenidone are warranted, as Pirfenidone and other anti-fibrotic drugs may encourage tissue repair and prevent progression of post-traumatic osteoarthritis. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:365-376, 2018.
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Affiliation(s)
- Deva D. Chan
- Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center; 1653 West Congress Parkway, Chicago, Illinois, USA 60612,Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York, USA,Corresponding author: Deva D. Chan, 110 Eighth St., BT 3141, Troy, NY 12180, Phone: (518) 276-4272
| | - Jun Li
- Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center; 1653 West Congress Parkway, Chicago, Illinois, USA 60612,Department of Biochemistry, Rush University Medical Center
| | - Wei Luo
- Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center; 1653 West Congress Parkway, Chicago, Illinois, USA 60612,Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | | | - Brian J. Cole
- Midwest Orthopaedics at Rush, Rush University Medical Center,Department of Anatomy and Cell Biology, Rush University Medical Center
| | - Anna Plaas
- Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center; 1653 West Congress Parkway, Chicago, Illinois, USA 60612,Department of Biochemistry, Rush University Medical Center
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Campbell TM, Reilly K, Laneuville O, Uhthoff H, Trudel G. Bone replaces articular cartilage in the rat knee joint after prolonged immobilization. Bone 2018; 106:42-51. [PMID: 28974461 DOI: 10.1016/j.bone.2017.09.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/23/2017] [Accepted: 09/26/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND Lost joint range of motion (ROM) is common in chronic osteoarthritis, alters regional weight-bearing across the articular surfaces, and contributes to loss of cartilage and bone alterations. Limited data exist on the regional effects on joints subjected to chronic losses of ROM. OBJECTIVE To characterize the regional replacement by bone as part of articular cartilage degeneration after prolonged immobilization. METHODS Eleven rat knees were rigidly-immobilized in flexion for 32weeks with contralateral and sham-operated (n=6) knees as controls. Sagittal medial tibial epiphysis histological sections assessed the anterior (non-weight-bearing), middle and posterior (both weight-bearing) regions. We quantified the distribution of collagen I, collagen II, cartilage thickness, glycosaminoglycan (GAG) staining, Mankin scoring, and subchondral bone plate cross-sectional area. Using immunohistochemistry (IHC), we visualized blood vessels, osteoblasts, and mesenchymal stem cells (MSCs). RESULTS Immobilized cartilage had increased collagen I content in the anterior tibial region with picrosirius red staining (immobilized=61±20%; contralateral=43±12%, p=0.033; sham=20±10%, p=0.028) and collagen I IHC (immobilized=40±10%; contralateral=11±4%, p=0.003; sham=5±3%, p=0.043). Articular cartilage was thinner anteriorly (18±30μm) in immobilized knees versus contralateral (124±40μm, p<0.001) and sham (125±43μm, p=0.043). GAG staining covered 2±4% of the anterior articular area in immobilized knees versus 28±12% contralaterally (p=0.003) and 26±7% in sham (p=0.043). Mankin scores in immobilized knees were 4.7±1.7 versus 0.2±0.4 and 0±0 for contralateral and sham (p=0.003, p=0.042), respectively. The trabecular bone plate area of anterior and posterior regions showed relative loss of cross-sectional area in immobilized knees compared to controls (immobilized/contralateral area ratios of 0.67 and 0.46 respectively, both p=0.003), while the area in the middle region was preserved. Movat's pentachrome stain and CD31 staining showed chondral vascular ingrowth from subchondral bone. Osteocalcin and CD90 MSC staining were decreased in immobilized knees versus contralateral (p=0.003, p=0.036 respectively). CONCLUSIONS Bony replacement characterizes articular cartilage degeneration of knees immobilized for 32weeks in the anterior, non-weight bearing region of the tibia. Replacement of cartilage by bone may have been mediated by chondral vascularization, suggesting irreversible changes. These findings stress the importance of weight-bearing and joint motion to maintain cartilage structure.
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Affiliation(s)
- T M Campbell
- Elizabeth Bruyère Hospital, Ottawa, Ontario, Canada.
| | - K Reilly
- Department of Medicine, University of Ottawa, Ontario, Canada.
| | - O Laneuville
- Department of Biology, University of Ottawa, Ontario, Canada.
| | - H Uhthoff
- Department of Medicine, University of Ottawa, Ontario, Canada.
| | - G Trudel
- Department of Medicine, University of Ottawa, Ontario, Canada; The Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario, Canada.
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Wong K, Trudel G, Laneuville O. Intra-articular collagenase injection increases range of motion in a rat knee flexion contracture model. DRUG DESIGN DEVELOPMENT AND THERAPY 2017; 12:15-24. [PMID: 29317799 PMCID: PMC5743116 DOI: 10.2147/dddt.s144602] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objectives A knee joint contracture, a loss in passive range of motion (ROM), can be caused by prolonged immobility. In a rat knee immobilization flexion contracture model, the posterior capsule was shown to contribute to an irreversible limitation in ROM, and collagen pathways were identified as differentially expressed over the development of a contracture. Collagenases purified from Clostridium histolyticum are currently prescribed to treat Dupuytren’s and Peyronie’s contractures due to their ability to degrade collagen. The potential application of collagenases to target collagen in the posterior capsule was tested in this model. Materials and methods Rats had one hind leg immobilized, developing a knee flexion contracture. After 4 weeks, the immobilization device was removed, and the rats received one 50 µL intra-articular injection of 0.6 mg/mL purified collagenase. Control rats were injected with only the buffer. After 2 weeks of spontaneous remobilization following the injections, ROM was measured with a rat knee arthrometer, and histological sections were immunostained with antibodies against rat collagen types I and III. Results/conclusion Compared with buffer-injected control knees, collagenase-treated knees showed increased ROM in extension by 8.0°±3.8° (p-value <0.05). Immunohistochemical analysis revealed an increase in collagen type III staining (p<0.01) in the posterior capsule of collagenase-treated knees indicating an effect on the extracellular matrix due to the collagenase. Collagen I staining was unchanged (p>0.05). The current study provides experimental evidence for the pharmacological treatment of knee flexion contractures with intra-articular collagenase injection, improving the knee ROM.
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Affiliation(s)
- Kayleigh Wong
- Bone and Joint Research Laboratory, The Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario
| | - Guy Trudel
- Department of Medicine, Bone and Joint Research Laboratory, The Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario
| | - Odette Laneuville
- Department of Biology, Faculty of Science, University of Ottawa, Ottawa, Ontario, Canada
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Arthrofibrosis Associated With Total Knee Arthroplasty. J Arthroplasty 2017; 32:2604-2611. [PMID: 28285897 DOI: 10.1016/j.arth.2017.02.005] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 01/03/2017] [Accepted: 02/05/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Arthrofibrosis is a debilitating postoperative complication of total knee arthroplasty (TKA). It is one of the leading causes of hospital readmission and a predominant reason for TKA failure. The prevalence of arthrofibrosis will increase as the annual incidence of TKA in the United States rises into the millions. METHODS In a narrative review of the literature, the etiology, economic burden, treatment strategies, and future research directions of arthrofibrosis after TKA are examined. RESULTS Characterized by excessive proliferation of scar tissue during an impaired wound healing response, arthrofibrotic stiffness causes functional deficits in activities of daily living. Postoperative, supervised physiotherapy remains the first line of defense against the development of arthrofibrosis. Also, adjuncts to traditional physiotherapy such as splinting and augmented soft tissue mobilization can be beneficial. The effectiveness of rehabilitation on functional outcomes depends on the appropriate timing, intensity, and progression of the program, accounting for the patient's ability and level of pain. Invasive treatments such as manipulation under anesthesia, debridement, and revision arthroplasty improve range of motion, but can be traumatic and costly. Future studies investigating novel treatments, early diagnosis, and potential preoperative screening for risk of arthrofibrosis will help target those patients who will need additional attention and tailored rehabilitation to improve TKA outcomes. CONCLUSION Arthrofibrosis is a multi-faceted complication of TKA, and is difficult to treat without an early, tailored, comprehensive rehabilitation program. Understanding the risk factors for its development and the benefits and shortcomings of various interventions are essential to best restore mobility and function.
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Kaneguchi A, Ozawa J, Kawamata S, Yamaoka K. Development of arthrogenic joint contracture as a result of pathological changes in remobilized rat knees. J Orthop Res 2017; 35:1414-1423. [PMID: 27601089 DOI: 10.1002/jor.23419] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 08/31/2016] [Indexed: 02/04/2023]
Abstract
This study aimed to elucidate how rats recover from immobilization-induced knee joint contracture. Rats' right knees were immobilized by an external fixator at a flexion of 140° for 3 weeks. After removal of the fixator, the joints were allowed to move freely (remobilization) for 0, 1, 3, 7, or 14 days (n = 5 each). To distinguish myogenic and arthrogenic contractures, the passive extension range of motion was measured before and after myotomy of the knee flexors. Knee joints were histologically analyzed and the expression of genes encoding inflammatory or fibrosis-related mediators, interleukin-1β (1L-1β), fibrosis-related transforming growth factor-β1 (TGF-β1), and collagen type I (COL1A1) and III (COL3A1), were examined in the knee joint posterior capsules using real-time PCR. Both myogenic and arthrogenic contractures were established within 3 weeks of immobilization. During remobilization, the myogenic contracture decreased over time. In contrast, the arthrogenic contracture developed further during the remobilization period. On day 1 of remobilization, inflammatory changes characterized by edema, inflammatory cell infiltration, and upregulation of IL-1β gene started in the knee joint posterior capsule. In addition, collagen deposition accompanied by fibroblast proliferation, with upregulation of TGF-β1, COL1A1, and COL3A1 genes, appeared in the joint capsule between days 7 and 14. These results suggest the progression of arthrogenic contracture following remobilization, which is characterized by fibrosis development, is possibly triggered by inflammation in the joint capsule. It is therefore necessary to focus on developing new treatment strategies for immobilization-induced joint contracture. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1414-1423, 2017.
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Affiliation(s)
- Akinori Kaneguchi
- Major in Medical Engineering and Technology, Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan
| | - Junya Ozawa
- Faculty of Rehabilitation, Department of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima 739-2695, Japan
| | - Seiichi Kawamata
- Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima, Japan
| | - Kaoru Yamaoka
- Faculty of Rehabilitation, Department of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima 739-2695, Japan
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Human genome-wide expression analysis reorients the study of inflammatory mediators and biomechanics in osteoarthritis. Osteoarthritis Cartilage 2015; 23:1939-45. [PMID: 26521740 PMCID: PMC4630670 DOI: 10.1016/j.joca.2015.03.027] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 02/19/2015] [Accepted: 03/20/2015] [Indexed: 02/02/2023]
Abstract
A major objective of this article is to examine the research implications of recently available genome-wide expression profiles of cartilage from human osteoarthritis (OA) joints. We propose that, when viewed in the light of extensive earlier work, this novel data provides a unique opportunity to reorient the design of experimental systems toward clinical relevance. Specifically, in the area of cartilage explant biology, this will require a fresh evaluation of existing paradigms, so as to optimize the choices of tissue source, cytokine/growth factor/nutrient addition, and biomechanical environment for discovery. Within this context, we firstly discuss the literature on the nature and role of potential catabolic mediators in OA pathology, including data from human OA cartilage, animal models of OA, and ex vivo studies. Secondly, due to the number and breadth of studies on IL-1β in this area, a major focus of the article is a critical analysis of the design and interpretation of cartilage studies where IL-1β has been used as a model cytokine. Thirdly, the article provides a data-driven perspective (including genome-wide analysis of clinical samples, studies on mutant mice, and clinical trials), which concludes that IL-1β should be replaced by soluble mediators such as IL-17 or TGF-β1, which are much more likely to mimic the disease in OA model systems. We also discuss the evidence that changes in early OA can be attributed to the activity of such soluble mediators, whereas late-stage disease results more from a chronic biomechanical effect on the matrix and cells of the remaining cartilage and on other local mediator-secreting cells. Lastly, an updated protocol for in vitro studies with cartilage explants and chondrocytes (including the use of specific gene expression arrays) is provided to motivate more disease-relevant studies on the interplay of cytokines, growth factors, and biomechanics on cellular behavior.
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Chan DD, Xiao W, Li J, de la Motte CA, Sandy JD, Plaas A. Deficiency of hyaluronan synthase 1 (Has1) results in chronic joint inflammation and widespread intra-articular fibrosis in a murine model of knee joint cartilage damage. Osteoarthritis Cartilage 2015; 23:1879-89. [PMID: 26521733 PMCID: PMC4630789 DOI: 10.1016/j.joca.2015.06.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 06/25/2015] [Accepted: 06/28/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Articular cartilage defects commonly result from traumatic injury and predispose to degenerative joint diseases. To test the hypothesis that aberrant healing responses and chronic inflammation lead to osteoarthritis (OA), we examined spatiotemporal changes in joint tissues after cartilage injury in murine knees. Since intra-articular injection of hyaluronan (HA) can attenuate injury-induced osteoarthritis in wild-type (WT) mice, we investigated a role for HA in the response to cartilage injury in mice lacking HA synthase 1 (Has1(-/-)). DESIGN Femoral groove cartilage of WT and Has1(-/-) mice was debrided to generate a non-bleeding wound. Macroscopic imaging, histology, and gene expression were used to evaluate naïve, sham-operated, and injured joints. RESULTS Acute responses (1-2 weeks) in injured joints from WT mice included synovial hyperplasia with HA deposition and joint-wide increases in expression of genes associated with inflammation, fibrosis, and extracellular matrix (ECM) production. By 4 weeks, some resurfacing of damaged cartilage occurred, and early cell responses were normalized. Cartilage damage in Has1(-/-) mice also induced early responses; however, at 4 weeks, inflammation and fibrosis genes remained elevated with widespread cartilage degeneration and fibrotic scarring in the synovium and joint capsule. CONCLUSIONS We conclude that the ineffective repair of injured cartilage in Has1(-/-) joints can be at least partly explained by the markedly enhanced expression of particular genes in pathways linked to ECM turnover, IL-17/IL-6 cytokine signaling, and apoptosis. Notably, Has1 ablation does not alter gross HA content in the ECM, suggesting that HAS1 has a unique function in the metabolism of inflammatory HA matrices.
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Affiliation(s)
- Deva D. Chan
- Department of Internal Medicine, Division of Rheumatology, Rush University Medical Center; Chicago, Illinois, USA
| | - Wenfeng Xiao
- Department of Orthopedics, Xiangya Hospital, Central South University; Changsha, Hunan, China
| | - Jun Li
- Department of Internal Medicine, Division of Rheumatology, Rush University Medical Center; Chicago, Illinois, USA
| | | | - John D. Sandy
- Department of Biochemistry, Rush University Medical Center; Chicago, Illinois, USA,Department of Orthopedic Surgery, Rush University Medical Center; Chicago, Illinois, USA
| | - Anna Plaas
- Department of Internal Medicine, Division of Rheumatology, Rush University Medical Center; Chicago, Illinois, USA,Department of Biochemistry, Rush University Medical Center; Chicago, Illinois, USA,Corresponding author: Anna Plaas, Ph.D., 1653 West Congress Parkway, Jelke Building, Suite 1413, Chicago, IL 60612, Phone: +1-312-942-7194, Fax: +1-312-563-2267,
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30
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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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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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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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