Novel Use of Botulinum Toxin to Ameliorate Arthrofibrosis: An Experimental Study in Rabbits

Abstract

This study aimed to investigate the effects of intra-articular botulinum toxin in preventing arthrofibrosis. Arthrofibrosis was induced in both stifle joints of 20 rabbits by transecting the anterior cruciate ligament under intramuscular anesthesia with ketamine and xylazine. Intra-articular toxin at a dose of 0.6 ml (50 unit) and physiologic saline solution (0.6 ml) were injected into the right and left stifle joints, respectively, 3 times with a 1-week interval between each injection. The rabbits were euthanized in the 12th week via high dose anesthesia to remove the stifle joint. The severity of adhesions was assessed, applying a universal scoring system. Also the stifle joints were histologically evaluated for fibrosis. With regards to severity of adhesion a significant reduction in the adhesion score was observed in the toxin-treated group in comparison to untreated controls with mean ± SE values of 0.2 ± 0.1 and 2.4 ± 0.2, respectively ( p < 0.01). The histological evaluation showed no significant fibroblast in the toxin-treated group versus dense fibers with mature fibroblasts in the control group. Our results suggest that botulinum toxin demonstrated efficacy in preventing adhesion after knee surgery and all the parameters monitored showed consistent statistically significant improvement.

The use of botulinum toxin as primary or adjunctive treatment for post acne and traumatic scarring

“…[13] Intra-articular botulinum toxin has been demonstrated to be useful in preventing arthrofibrosis in rabbits after transection of the anterior cruciate ligament. [14]…”

Reduction of adhesion formation after knee surgery in a rat model by botulinum toxin A

“…These results suggest that the role of BTX-A may be associated with fibrosis and inflammation. A previous study demonstrated that an intra-articular injection of BTX-A into the rabbit knee prevented adhesion formation and reduced arthrofibrosis of the knee after knee surgery [21], but the precise mechanism remains unclear.…”

Management of arthrofibrosis in haemophilic arthropathy

“…A short course of oral steroids is more attractive than intra-articular steroids, but may not be adequate to reverse the fibroplastic process. Namazi and co-investigators have studied arthrofibrosis of the knee in New Zealand White Rabbits by dividing the anterior cruciate ligament [22]. They were able to prevent the development of intraarticular scar by injecting botulinum toxin (Botox).…”