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Palacios-Díaz L, González-Garcia ÁA, Sánchez Urgellés P, Antuña S, Barco R. Biomechanical outcomes of pharmacological therapies for post-traumatic arthrofibrosis in preclinical animal models: a systematic review and meta-analysis. Connect Tissue Res 2024; 65:265-278. [PMID: 38814178 DOI: 10.1080/03008207.2024.2358351] [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: 02/23/2024] [Revised: 05/02/2024] [Accepted: 05/17/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE/AIM OF THE STUDY There is still no evidence of which drug has the greatest therapeutic potential for post-traumatic arthrofibrosis. The aim of this study is to systematically review the literature for quality evidence and perform a meta-analysis about the pharmacological therapies of post-traumatic arthrofibrosis in preclinical models. MATERIALS AND METHODS A comprehensive and systematic search strategy was performed in three databases (MEDLINE, EMBASE and Web of Science) retrieving studies on the effectiveness of pharmacological therapies in the management of post-traumatic arthrofibrosis using preclinical models in terms of biomechanical outcomes. Risk of bias assessment was performed using the SYRCLE's risk of bias tool. A meta-analysis using a random-effects model was conducted if a minimum of three studies reported homogeneous outcomes for drugs with the same action mechanism. RESULTS Forty-six studies were included in the systematic review and evaluated for risk of bias. Drugs from 6 different action mechanisms of 21 studies were included in the meta-analysis. Overall, the methodological quality of the studies was poor. Statistically significant overall effect in favor of reducing contracture was present for anti-histamines (Chi2 p = 0.75, I2 = 0%; SMD (Standardized Mean Difference) = -1.30, 95%CI: -1.64 to -0.95, p < 0.00001) and NSAIDs (Chi2 p = 0.01, I2 = 63%; SMD= -0.93, 95%CI: -1.58 to -0.28, p = 0.005). CONCLUSIONS Anti-histamines, particularly ketotifen, have the strongest evidence of efficacy for prevention of post-traumatic arthrofibrosis. Some studies suggest a potential role for NSAIDs, particularly celecoxib, although heterogeneity among the included studies is significant.
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Affiliation(s)
- Luis Palacios-Díaz
- Upper Limb Surgery Unit, Orthopaedics and Traumatology Department, La Paz University Hospital, Madrid, Spain
| | | | - Pablo Sánchez Urgellés
- Upper Limb Surgery Unit, Orthopaedics and Traumatology Department, La Paz University Hospital, Madrid, Spain
| | - Samuel Antuña
- Upper Limb Surgery Unit, Orthopaedics and Traumatology Department, La Paz University Hospital, Madrid, Spain
| | - Raúl Barco
- Upper Limb Surgery Unit, Orthopaedics and Traumatology Department, La Paz University Hospital, Madrid, Spain
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Fan Y, Yuh J, Lekkala S, Asik MD, Thomson A, McCanne M, Randolph MA, Chen AF, Oral E. The efficacy of vitamin E in preventing arthrofibrosis after joint replacement. Animal Model Exp Med 2024; 7:145-155. [PMID: 38525803 PMCID: PMC11079150 DOI: 10.1002/ame2.12388] [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] [Received: 08/16/2023] [Accepted: 01/10/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Arthrofibrosis is a joint disorder characterized by excessive scar formation in the joint tissues. Vitamin E is an antioxidant with potential anti-fibroblastic effect. The aim of this study was to establish an arthrofibrosis rat model after joint replacement and assess the effects of vitamin E supplementation on joint fibrosis. METHODS We simulated knee replacement in 16 male Sprague-Dawley rats. We immobilized the surgical leg with a suture in full flexion. The control groups were killed at 2 and 12 weeks (n = 5 per group), and the test group was supplemented daily with vitamin E (0.2 mg/mL) in their drinking water for 12 weeks (n = 6). We performed histological staining to investigate the presence and severity of arthrofibrosis. Immunofluorescent staining and α2-macroglobulin (α2M) enzyme-linked immunosorbent assay (ELISA) were used to assess local and systemic inflammation. Static weight bearing (total internal reflection) and range of motion (ROM) were collected for functional assessment. RESULTS The ROM and weight-bearing symmetry decreased after the procedure and recovered slowly with still significant deficit at the end of the study for both groups. Histological analysis confirmed fibrosis in both lateral and posterior periarticular tissue. Vitamin E supplementation showed a moderate anti-inflammatory effect on the local and systemic levels. The vitamin E group exhibited significant improvement in ROM and weight-bearing symmetry at day 84 compared to the control group. CONCLUSIONS This model is viable for simulating arthrofibrosis after joint replacement. Vitamin E may benefit postsurgical arthrofibrosis, and further studies are needed for dosing requirements.
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Affiliation(s)
- Yingfang Fan
- Harris Orthopaedic Laboratory, Department of Orthopaedic SurgeryMassachusetts General HospitalBostonMassachusettsUSA
- Department of Orthopaedic SurgeryHarvard Medical SchoolBostonMassachusettsUSA
| | - Jean Yuh
- Harris Orthopaedic Laboratory, Department of Orthopaedic SurgeryMassachusetts General HospitalBostonMassachusettsUSA
| | - Sashank Lekkala
- Harris Orthopaedic Laboratory, Department of Orthopaedic SurgeryMassachusetts General HospitalBostonMassachusettsUSA
| | - Mehmet D. Asik
- Harris Orthopaedic Laboratory, Department of Orthopaedic SurgeryMassachusetts General HospitalBostonMassachusettsUSA
- Department of Orthopaedic SurgeryHarvard Medical SchoolBostonMassachusettsUSA
| | - Andrew Thomson
- Harris Orthopaedic Laboratory, Department of Orthopaedic SurgeryMassachusetts General HospitalBostonMassachusettsUSA
| | - Madeline McCanne
- Harris Orthopaedic Laboratory, Department of Orthopaedic SurgeryMassachusetts General HospitalBostonMassachusettsUSA
| | - Mark A. Randolph
- Department of Orthopaedic SurgeryHarvard Medical SchoolBostonMassachusettsUSA
- Department of SurgeryHarvard Medical SchoolBostonMassachusettsUSA
| | - Antonia F. Chen
- Department of Orthopaedic SurgeryBrigham and Women's HospitalBostonMassachusettsUSA
| | - Ebru Oral
- Harris Orthopaedic Laboratory, Department of Orthopaedic SurgeryMassachusetts General HospitalBostonMassachusettsUSA
- Department of Orthopaedic SurgeryHarvard Medical SchoolBostonMassachusettsUSA
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Chen X, Li C, Wang Z, Zhou Y, Chu M. Computational screening of biomarkers and potential drugs for arthrofibrosis based on combination of sequencing and large nature language model. J Orthop Translat 2024; 44:102-113. [PMID: 38304615 PMCID: PMC10831815 DOI: 10.1016/j.jot.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 02/03/2024] Open
Abstract
Background Arthrofibrosis (AF) is a fibrotic joint disease resulting from excessive collagen production and fibrous scar formation after total knee arthroplasty (TKA). This devastating complication may cause consistent pain and dramatically reduction of functionality. Unfortunately, the conservative treatments to prevent the AF in the early stage are largely unknown due to the lack of specific biomarkers and reliable therapeutic targets. Methods In this study, we extracted1782 fibrosis related genes (FRGs) from 373,461published literature based on the large natural language processing models (ChatGPT) and intersected with the 2750 differential expressed genes (DEGs) from mRNA microarray (GSE135854). A total of 311 potential AF biomarker genes (PABGs) were obtained and functional analysis were performed including gene ontology (GO) annotation and the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses. Subsequently, we accomplished validation in AF animal models with immobilization of the unilateral knee joints of 16 rabbits for 1-week, 2-weeks, 3-weeks and 4-weeks. Finally, we tested the biomarkers in a retrospective cohort enrolled 35 AF patients and 35 control group patients. Results We identified G-protein-coupled receptor 17 (GPR17) as a reliable therapeutic biomarker for AF diagnosis with higher AUC (0.819) in the ROC curve. A total of 21 potential drugs targeted to GPR17 were screened. Among them, pranlukast and montelukast have achieved therapeutic effect in animal models. In addition, we established an online AF database for data integration (https://chenxi2023.shinyapps.io/afdbv1). Conclusions These results unveiling therapeutic biomarkers for AF diagnosis, and provide potential drugs for clinical treatment. The translational potential of this article Our study demonstrated that GPR17 holds significant promise as a potential biomarker and therapeutic target for arthrofibrosis. Moreover, pranlukast and montelukast targeted to GPR17 that could be instrumental in the treatment of AF.
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Affiliation(s)
- Xi Chen
- Department of Adult Joint Reconstructive Surgery, Beijing Jishuitan Hospital, Capital Medical University, 31 East Xinjiekou Street, Beijing, 100035, China
- Department of Immunology, School of Basic Medical Sciences, Peking University, Beijing, 100191, China
- NHC Key Laboratory of Medical Immunology (Peking University), Beijing, 100191, China
| | - Cheng Li
- Department of Adult Joint Reconstructive Surgery, Beijing Jishuitan Hospital, Capital Medical University, 31 East Xinjiekou Street, Beijing, 100035, China
| | - Ziyuan Wang
- Department of Immunology, School of Basic Medical Sciences, Peking University, Beijing, 100191, China
- NHC Key Laboratory of Medical Immunology (Peking University), Beijing, 100191, China
| | - Yixin Zhou
- Department of Adult Joint Reconstructive Surgery, Beijing Jishuitan Hospital, Capital Medical University, 31 East Xinjiekou Street, Beijing, 100035, China
| | - Ming Chu
- Department of Immunology, School of Basic Medical Sciences, Peking University, Beijing, 100191, China
- NHC Key Laboratory of Medical Immunology (Peking University), Beijing, 100191, China
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Chen X, Gong L, Li C, Wang S, Wang Z, Chu M, Zhou Y. Single-cell and bulk tissue sequencing unravels the heterogeneity of synovial microenvironment in arthrofibrosis. iScience 2023; 26:107379. [PMID: 37705954 PMCID: PMC10495645 DOI: 10.1016/j.isci.2023.107379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/06/2023] [Accepted: 07/07/2023] [Indexed: 09/15/2023] Open
Abstract
Arthrofibrosis (AF) is a debilitating complication that occurs after trauma or surgery, leading to functional impairment and surgical failures worldwide. This study aimed to uncover the underlying mechanism of AF. A total of 141 patients were enrolled, and synovial samples were collected from both patients and animal models at different time points. Single-cell RNA-sequencing (scRNA-seq) and bulk tissue RNA sequencing (bulk-seq) were employed to profile the distinct synovial microenvironment. This study revealed changes in cell proportions during AF pathogenesis and identified Engrailed-1 (EN1) as a key transcription factor strongly associated with disease severity and clinical prognosis. Additionally, the researchers discovered a specific type of synovial fibroblast called DKK3-SLF, which played a critical role in driving AF development. These findings shed light on the composition and heterogeneity of the synovial microenvironment in AF, offering potential avenues for identifying therapeutic targets and developing clinical treatments for AF and other fibrotic diseases.
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Affiliation(s)
- Xi Chen
- Department of Adult Joint Reconstructive Surgery, Beijing Jishuitan Hospital, Capital Medical University, 31 East Xinjiekou Street, Beijing 100035, China
- Department of Immunology, School of Basic Medical Sciences, Peking University, NHC Key Laboratory of Medical Immunology (Peking University), Beijing, China
| | - Lihua Gong
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Cheng Li
- Department of Adult Joint Reconstructive Surgery, Beijing Jishuitan Hospital, Capital Medical University, 31 East Xinjiekou Street, Beijing 100035, China
| | - Siyuan Wang
- Department of Adult Joint Reconstructive Surgery, Beijing Jishuitan Hospital, Capital Medical University, 31 East Xinjiekou Street, Beijing 100035, China
| | - Ziyuan Wang
- Department of Adult Joint Reconstructive Surgery, Beijing Jishuitan Hospital, Capital Medical University, 31 East Xinjiekou Street, Beijing 100035, China
| | - Ming Chu
- Department of Immunology, School of Basic Medical Sciences, Peking University, NHC Key Laboratory of Medical Immunology (Peking University), Beijing, China
| | - Yixin Zhou
- Department of Adult Joint Reconstructive Surgery, Beijing Jishuitan Hospital, Capital Medical University, 31 East Xinjiekou Street, Beijing 100035, China
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Abstract
Fibrosis is a common and debilitating pathological process that affects many organ systems and contributes to connective tissue disorders in orthopaedics. Tendons heal after acute and chronic injury through a process of fibrovascular scar tissue formation, and soft tissue joint capsules can be affected after traumatic joint injury, leading to arthrofibrosis. Although the precise underlying mechanisms are still being elucidated, fibrosis is thought to be a consequence of dysregulated immune and cytokine signaling that leads to myofibroblast activation and proliferation and subsequent excessive collagen deposition. Current treatments for connective tissue fibrosis include physical therapy and surgery, but there are no therapies that directly target the underlying cellular and molecular mechanisms of fibrosis. Many pharmacological agents have been used to successfully target fibrosis in other tissues and organ systems and thus are a promising treatment option to fill this gap. However, limited evidence is available to guide the use of these agents in musculoskeletal connective tissues. This article provides an overview of pharmacological therapies that have potential to treat connective tissue fibrosis in patients with musculoskeletal conditions, along with the current supporting evidence and future uses of each therapy.
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Affiliation(s)
- Nathaniel P Disser
- Hospital for Special Surgery, New York, New York, USA
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jonathan S Yu
- Hospital for Special Surgery, New York, New York, USA
- Weill Cornell Medicine, New York, New York, USA
| | - Vincent J H Yao
- Hospital for Special Surgery, New York, New York, USA
- Sophie Davis Biomedical Education Program at CUNY School of Medicine, New York, New York, USA
| | - Scott A Rodeo
- Hospital for Special Surgery, New York, New York, USA
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Jeffs AD, Boyd M, Larabee L, Shelton M, Bassil A, Taylor R, Berkoff D. The role of leukotriene inhibition using a 5-lipoxygenase (5-LO) inhibitor in a joint contracture model. J Exp Orthop 2023; 10:64. [PMID: 37341811 DOI: 10.1186/s40634-023-00616-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 05/05/2023] [Indexed: 06/22/2023] Open
Abstract
PURPOSE Arthrofibrosis is a common inflammatory complication of joint trauma and surgery. 5lipoxygenase (5-LO) is a key enzyme involved in inflammation. Inhibition of 5-LO has been shown to reduce inflammation in heart and lung models but has not been examined in a joint contracture model. METHODS Twenty-six rats underwent joint contracture. Six rats served as non-surgical controls. A 5-LO inhibitor, caffeic acid (CA), suspended in 10% ethanol was orally administered to 14 rats and ethanol without CA to the remaining 12 rats daily for 21 days. Leukotriene B4 (LTB4) levels were measured, both systemically and locally. 5-LO levels in the posterior capsule were quantified by measuring the ratio of the length of the posterior capsule demonstrating 5-LO immunostaining to the total length of the capsule. RESULTS Joint contracture was successfully achieved in all rats who underwent manipulation. Levels of 5- LO measured in the posterior capsule were significantly increased in the animals who underwent surgery (56%/44-64) compared to the non-surgical control animals (7%/4-9). LTB4 levels were found to be significantly lower in the non-surgical control animals (107.79 ± 34.08 pg/ml) compared to all surgical animals (157.6 ± 55.3 pg/ml). CONCLUSION Surgical intervention resulted in increased 5-LO activity of the synovial surface of the posterior capsule and increased LTB4 levels in the patellar tendon-fat pad. Oral administration of the 5LO inhibitor, CA, was ineffective at reducing systemic and local LTB4 levels and preventing knee joint contracture. Inhibiting 5-LO activity may still be effective in preventing arthrofibrosis and warrants further investigation.
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Affiliation(s)
- Alexander D Jeffs
- Department of Orthopaedics, The University of North Carolina, Chapel Hill, NC, USA.
| | - Michael Boyd
- Department of Orthopaedics, The University of North Carolina, Chapel Hill, NC, USA
- Department of Family Medicine, The University of North Carolina, Chapel Hill, NC, USA
| | - Landon Larabee
- The University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Matthew Shelton
- The University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - Ross Taylor
- Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - David Berkoff
- Department of Orthopaedics, The University of North Carolina, Chapel Hill, NC, USA
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Wegner E, Slotina E, Mickan T, Truffel S, Arand C, Wagner D, Ritz U, Rommens PM, Gercek E, Drees P, Baranowski A. Pleiotropic Long-Term Effects of Atorvastatin on Posttraumatic Joint Contracture in a Rat Model. Pharmaceutics 2022; 14:pharmaceutics14030523. [PMID: 35335899 PMCID: PMC8950153 DOI: 10.3390/pharmaceutics14030523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 11/19/2022] Open
Abstract
The antifibrotic effect of atorvastatin has already been demonstrated in several organ systems. In the present study, a rat model was used to investigate the effect of atorvastatin on posttraumatic joint contracture. Forty-eight Sprague Dawley rats were equally randomized into an atorvastatin group and a control group. After initial joint trauma, knee joints were immobilized for intervals of 2 weeks (n = 16) or 4 weeks (n = 16) or immobilized for 4 weeks with subsequent remobilization for another 4 weeks (n = 16). Starting from the day of surgery, animals received either atorvastatin or placebo daily. After euthanasia at week 2, 4 or 8, joint contracture was determined, histological examinations were performed, and gene expression was assessed. The results suggest that the joint contracture was primarily arthrogenic. Atorvastatin failed to significantly affect contracture formation and showed a reduction in myofibroblast numbers to 98 ± 58 (control: 319 ± 113, p < 0.01) and a reduction in joint capsule collagen to 60 ± 8% (control: 73 ± 9%, p < 0.05) at week 2. Gene expression of α-smooth muscle actin (α-SMA), collagen type I, transforming growth factor β1 (TGF-β1) and interleukin-6 (IL-6) was not significantly affected by atorvastatin. Atorvastatin decreases myofibroblast number and collagen deposition but does not result in an improvement in joint mobility.
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Owen AR, Dagneaux L, Limberg AK, Bettencourt JW, Bayram B, Bolon B, Berry DJ, Morrey ME, Sanchez-Sotelo J, van Wijnen AJ, Abdel MP. Biomechanical, histological, and molecular characterization of a new posttraumatic model of arthrofibrosis in rats. J Orthop Res 2022; 40:323-337. [PMID: 33871082 PMCID: PMC8523596 DOI: 10.1002/jor.25054] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/18/2021] [Accepted: 04/12/2021] [Indexed: 02/04/2023]
Abstract
Experimental analyses of posttraumatic knee arthrofibrosis utilize a rabbit model as a gold standard. However, a rodent model of arthrofibrosis offers many advantages including reduced cost and comparison with other models of organ fibrosis. This study aimed to characterize the biomechanical, histological, and molecular features of a novel posttraumatic model of arthrofibrosis in rats. Forty eight rats were divided into two equal groups. An immobilization procedure was performed on the right hind limbs of experimental rats. One group was immobilized for 4 weeks and the other for 8 weeks. Both groups were remobilized for 4 weeks. Limbs were studied biomechanically via assessment of torque versus degree of extension, histologically via whole knee specimen, and molecularly via gene expression of posterior capsular tissues. Significant differences were observed between experimental and control limbs at 4 N-cm of torque in the 4-week (knee extension: 115° ± 8° vs. 169° ± 17°, respectively; p = 0.007) and 8-week immobilization groups (knee extension: 99° ± 12° vs. 174° ± 9°, respectively; p = 0.008). Histologically, in each group experimental limbs demonstrated increased posterior capsular thickness and total area of tissue when compared to control limbs (p < 0.05). Gene expression values evaluated in each group were comparable. This study presents a novel rat model of arthrofibrosis with severe and persistent knee contractures demonstrated biomechanically and histologically. Statement of clinical significance: Arthrofibrosis is a common complication following contemporary total knee arthroplasties. The proposed model is reproducible, cost-effective, and can be employed for translational investigations studying the pathogenesis of arthrofibrosis and efficacy of neoadjuvant pharmacologic agents.
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Affiliation(s)
- Aaron R. Owen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Louis Dagneaux
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | | | | | - Banu Bayram
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | | | - Daniel J. Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Mark E. Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | | | - Andre J. van Wijnen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN,Department of Biochemistry & Molecular Biology, Mayo Clinic, Rochester, MN
| | - Matthew P. Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN,Corresponding author and requests for reprints author (Matthew P. Abdel, M.D.),
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Kallianos SA, Singh V, Henry DS, Berkoff DJ, Arendale CR, Weinhold PS. Interleukin-1 receptor antagonist inhibits arthrofibrosis in a post-traumatic knee immobilization model. Knee 2021; 33:210-215. [PMID: 34715560 DOI: 10.1016/j.knee.2021.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Therapies for arthrofibrosis after knee surgery are needed to prevent loss of joint function. Interleukin-1 receptor antagonists (IL-1RA) have shown promise in treating established arthrofibrosis in pilot clinical studies. The objective of this study was to evaluate the ability of intra-articular injection of IL-1RA to prevent knee joint contracture in a post-traumatic knee immobilization model. METHODS 20 male Sprague Dawley rats were block randomized into two groups: control and IL-1RA. Rats underwent intra-articular surgical trauma of the right knee with placement of an immobilization suture, securing the knees in 150° flexion. On post-operative days 1 and 8, each group received a 0.1 ml intra-articular injection of either saline (control) or anakinra (IL-1RA:single dosage; 2.63 mg/kg). Rats were euthanized fourteen days after surgery and the immobilization femorotibial angles were measured on the operative limbs with the suture and musculature intact. Subsequently, musculature was removed and femorotibial angles were measured in the operative and non-operative limbs with a defined extension moment applied with the posterior capsule intact or cut. A contracture angle was calculated as the angular difference between the operative and non-operative limb. RESULTS The immobilization knee flexion angle did not differ (P = 0.761) between groups (control: 152 ± 9; IL-1RA: 150 ± 11). The joint contracture angles (smaller angle = improved outcome) were reduced by 12 degrees on average in the IL-1RA group compared to the control for both the capsule intact (P = 0.024) and cut (P = 0.019) states. CONCLUSIONS Intra-articular IL-1RA injection was found to diminish knee extension deficits associated with arthrofibrosis in a post-traumatic joint immobilization model.
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Affiliation(s)
- Stephen A Kallianos
- Dept. of Orthopaedics, University of North Carolina, Chapel Hill, NC, United States
| | - Vishavpreet Singh
- Dept. of Orthopaedics, University of North Carolina, Chapel Hill, NC, United States
| | - David S Henry
- School of Osteopathic Medicine, Campbell University, Lillington, NC, United States
| | - David J Berkoff
- Dept. of Orthopaedics, University of North Carolina, Chapel Hill, NC, United States
| | - C Richard Arendale
- Dept. of Orthopaedics, University of North Carolina, Chapel Hill, NC, United States
| | - Paul S Weinhold
- Dept. of Orthopaedics, University of North Carolina, Chapel Hill, NC, United States.
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Harmer JR, Wyles CC, Mara KC, Warner NS, Trousdale RT. Impact of Perioperative Pain Control on Knee Range of Motion and Development of Arthrofibrosis Following Primary Total Knee Arthroplasty. J Arthroplasty 2021; 36:532-536. [PMID: 32933800 DOI: 10.1016/j.arth.2020.08.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/13/2020] [Accepted: 08/18/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Inadequate pain control following total knee arthroplasty (TKA) has been postulated to negatively impact knee range of motion (ROM). We sought to determine the association between perioperative pain levels and knee ROM at 3-month follow-up or need for manipulation under anesthesia (MUA). METHODS We retrospectively reviewed 2243 primary TKAs performed from 2002 to 2019 at a single academic center using an institutional total joint registry. Mean age was 68, mean body mass index was 32.8, and 59% were female. Knee ROM was measured preoperatively and 3 months postoperatively. Change in knee ROM, rates of soft tissue contracture, and MUA were assessed in relation to in-hospital 10-point pain visual analog scale (VAS) measurements. RESULTS Overall, 44% had improved ROM at 3-month follow-up, 29% had no change in ROM, and 27% had worsened ROM. There was no significant difference in mean VAS scores of patients with improved, unchanged, or worsened ROM postoperatively (3.0 vs 2.8 vs 3.0; P = .068). There was no significant difference in mean VAS scores of patients who developed a soft tissue contracture or required MUA vs those who did not develop these complications (2.7 vs 2.9; P = .24). Similarly, no significant relationship with these outcomes was identified when maximum and discharge VAS scores were analyzed. CONCLUSION Comparable ROM and rates of MUA based on in-hospital pain levels were observed in this large series of primary TKA patients. While significant early pain may limit participation in ROM exercises initially, this does not appear to have a marked impact on ROM-related complications for most patients. LEVEL OF EVIDENCE III, Therapeutic.
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Affiliation(s)
- Joshua R Harmer
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Cody C Wyles
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Kristin C Mara
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Nafisseh S Warner
- Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Rochester, MN
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Gholizadeh N, Sadrzadeh-Afshar MS, Sheykhbahaei N. Intralesional corticosteroid injection as an effective treatment method for oral lesions: a meta-analysis. BRAZ J PHARM SCI 2020. [DOI: 10.1590/s2175-97902019000418077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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12
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Baranowski A, Schlemmer L, Förster K, Slotina E, Mickan T, Truffel S, Klein A, Mattyasovszky SG, Hofmann A, Ritz U, Rommens PM. Effects of losartan and atorvastatin on the development of early posttraumatic joint stiffness in a rat model. Drug Des Devel Ther 2019; 13:2603-2618. [PMID: 31440039 PMCID: PMC6679684 DOI: 10.2147/dddt.s204135] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 06/27/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND After a trauma, exuberant tissue healing with fibrosis of the joint capsule can lead to posttraumatic joint stiffness (PTJS). Losartan and atorvastatin have both shown their antifibrotic effects in different organ systems. OBJECTIVE The purpose of this study was the evaluation of the influence of losartan and atorvastatin on the early development of joint contracture. In addition to joint angles, the change in myofibroblast numbers and the distribution of bone sialoprotein (BSP) were assessed. STUDY DESIGN AND METHODS In this randomized and blinded experimental study with 24 rats, losartan and atorvastatin were compared to a placebo. After an initial joint injury, rat knees were immobilized with a Kirschner wire. Rats received either losartan, atorvastatin or a placebo orally daily. After 14 days, joint angle measurements and histological assessments were performed. RESULTS Losartan increased the length of the inferior joint capsule. Joint angle and other capsule length measurements did not reveal significant differences between both drugs and the placebo. At cellular level both losartan and atorvastatin reduced the total number of myofibroblasts (losartan: 191±77, atorvastatin: 98±58, placebo: 319±113 per counting field, p<0.01) and the percentage area of myofibroblasts (losartan: 2.8±1.8% [p<0.05], atorvastatin: 2.5±1.7% [p<0.01], vs control [6.4±4%], respectively). BSP was detectable in equivalent amounts in the joint capsules of all groups with only a trend toward a reduction of the BSP-stained area by atorvastatin. CONCLUSION Both atorvastatin and losartan reduced the number of myofibroblasts in the posterior knee joint capsule of rat knees 2 weeks after trauma and losartan increased the length of the inferior joint capsule. However, these changes at the cellular level did not translate an increase in range of motion of the rats´ knee joints during early contracture development.
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Affiliation(s)
- Andreas Baranowski
- Department of Orthopaedics and Traumatology, Biomatics Group, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Ludwig Schlemmer
- Department of Orthopaedics and Traumatology, Biomatics Group, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Katharina Förster
- Department of Orthopaedics and Traumatology, Biomatics Group, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Ekaterina Slotina
- Department of Orthopaedics and Traumatology, Biomatics Group, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Tim Mickan
- Department of Orthopaedics and Traumatology, Biomatics Group, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Sebastian Truffel
- Department of Orthopaedics and Traumatology, Biomatics Group, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Anja Klein
- Department of Orthopaedics and Traumatology, Biomatics Group, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Stefan G Mattyasovszky
- Department of Orthopaedics and Traumatology, Biomatics Group, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Alexander Hofmann
- Department of Orthopaedics and Traumatology, Biomatics Group, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
- Department of Traumatology and Orthopaedics 1, Westpfalz-Medical Centre Kaiserslautern, Kaiserslautern, Germany
| | - Ulrike Ritz
- Department of Orthopaedics and Traumatology, Biomatics Group, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Pol M Rommens
- Department of Orthopaedics and Traumatology, Biomatics Group, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
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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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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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Baranowski A, Schlemmer L, Förster K, Mattyasovszky SG, Ritz U, Wagner D, Rommens PM, Hofmann A. A novel rat model of stable posttraumatic joint stiffness of the knee. J Orthop Surg Res 2018; 13:185. [PMID: 30045767 PMCID: PMC6060505 DOI: 10.1186/s13018-018-0894-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 07/17/2018] [Indexed: 11/25/2022] Open
Abstract
Background Animal models of posttraumatic joint stiffness (PTJS) are helpful in understanding underlying mechanisms, which is important for developing specific treatments and prophylactic therapies. Existing rat models of PTJS in the knee failed to show that the created contracture does not resolve through subsequent remobilization. Our objective was to establish a rat model of persisting PTJS of the knee and compare it to existing models. Methods Thirty skeletally immature male Sprague Dawley rats underwent surgical intervention with knee hyperextension, extracartilaginous femoral condyle defect, and Kirschner (K)-wire transfixation for 4 weeks with the knee joint in 146.7° ± 7.7° of flexion (n = 10 per group, groups I–III). After K-wire removal, group I underwent joint angle measurements and group II and group III were allowed for 4 or 8 weeks of free cage activity, respectively, before joint angles were measured. Eighteen rats (n = 6 per group, groups Ic–IIIc) served as untreated control. Results Arthrogenic contracture was largest in group I (55.2°). After 4 weeks of remobilization, the contracture decreased to 25.7° in group II (p < 0.05 vs. group I), whereas 8 weeks of remobilization did not reduce the contracture significantly (group III, 26.5°, p = 0.06 vs. group I). Between 4 and 8 weeks of remobilization, no increase in extension (26.5° in group III, p = 0.99 vs. group II) was observed. Interestingly, muscles did not contribute to the development of contracture. Conclusion In our new rat model of PTJS of the knee joint, we were able to create a significant joint contracture with an immobilization time of only 4 weeks after trauma. Remobilization of up to 8 weeks alone did not result in full recovery of the range of motion. This model represents a powerful tool for further investigations on prevention and treatment of PTJS. Future studies of our group will use this new model to analyze medical treatment options for PTJS.
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Affiliation(s)
- Andreas Baranowski
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg University, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Ludwig Schlemmer
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Katharina Förster
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Stefan G Mattyasovszky
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Ulrike Ritz
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Daniel Wagner
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Pol M Rommens
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Alexander Hofmann
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg University, Langenbeckstraße 1, 55131, Mainz, Germany.,Department of Traumatology and Orthopaedics 1, Westpfalz-Medical Centre Kaiserslautern, Hellmut-Hartert-Str 1, 67655, Kaiserslautern, Germany
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16
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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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17
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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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Barlow JD, Morrey ME, Hartzler RU, Arsoy D, Riester S, van Wijnen AJ, Morrey BF, Sanchez-Sotelo J, Abdel MP. Effectiveness of rosiglitazone in reducing flexion contracture in a rabbit model of arthrofibrosis with surgical capsular release: A biomechanical, histological, and genetic analysis. Bone Joint Res 2016; 5:11-7. [PMID: 26813567 PMCID: PMC5009236 DOI: 10.1302/2046-3758.51.2000593] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIMS Animal models have been developed that allow simulation of post-traumatic joint contracture. One such model involves contracture-forming surgery followed by surgical capsular release. This model allows testing of antifibrotic agents, such as rosiglitazone. METHODS A total of 20 rabbits underwent contracture-forming surgery. Eight weeks later, the animals underwent a surgical capsular release. Ten animals received rosiglitazone (intramuscular initially, then orally). The animals were sacrificed following 16 weeks of free cage mobilisation. The joints were tested biomechanically, and the posterior capsule was assessed histologically and via genetic microarray analysis. RESULTS There was no significant difference in post-traumatic contracture between the rosiglitazone and control groups (33° (standard deviation (sd) 11) vs 37° (sd14), respectively; p = 0.4). There was no difference in number or percentage of myofibroblasts. Importantly, there were ten genes and 17 pathways that were significantly modulated by rosiglitazone in the posterior capsule. DISCUSSION Rosiglitazone significantly altered the genetic expression of the posterior capsular tissue in a rabbit model, with ten genes and 17 pathways demonstrating significant modulation. However, there was no significant effect on biomechanical or histological properties.Cite this article: M. P. Abdel. Effectiveness of rosiglitazone in reducing flexion contracture in a rabbit model of arthrofibrosis with surgical capsular release: A biomechanical, histological, and genetic analysis. Bone Joint Res 2016;5:11-17. doi: 10.1302/2046-3758.51.2000593.
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Affiliation(s)
- J D Barlow
- Ohio State Orthopedic Surgery, 915 Olentangy River Rd, Suite 3200 Columbus, OH 43212, USA
| | - M E Morrey
- Mayo Clinic, 200 First Street SW, Rochester, MN 55901, USA
| | - R U Hartzler
- San Antonio Orthopaedic Group and Burkhart Research Institute for Orthopaedics, 150 E. Sonterra Blvd. Suite 300 San Antonio, Texas 78258, USA
| | - D Arsoy
- Stanford University School of Medicine, 450 Broadway St. MC: 6342, Redwood City, CA 94063, USA
| | - S Riester
- Mayo Clinic, 200 First Street SW, Rochester, MN 55901, USA
| | - A J van Wijnen
- Mayo Clinic, 200 First Street SW, Rochester, MN 55901, USA
| | - B F Morrey
- Mayo Clinic, 200 First Street SW, Rochester, MN 55901, USA
| | | | - M P Abdel
- Mayo Clinic, 200 First Street SW, Rochester, MN 55901, USA
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Hoyt BW, Pavey GJ, Pasquina PF, Potter BK. Rehabilitation of Lower Extremity Trauma: a Review of Principles and Military Perspective on Future Directions. CURRENT TRAUMA REPORTS 2015. [DOI: 10.1007/s40719-014-0004-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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