Temporary Presence of Myofibroblasts in Human Elbow Capsule After Trauma

Doornberg, Job N.; Bosse, Tjalling; Cohen, Mark S.; Jupiter, Jesse B.; Ring, David; Kloen, Peter

doi:10.2106/jbjs.m.00388

Cited by 34 publications

(18 citation statements)

References 48 publications

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“…4). In addition, human data also exhibits limited neovascularization and synovial proliferation, similar to our observations 3 . Surprisingly, similar histological results were observed for all three injury groups (Sham, Injury I and Injury II), which was unexpected since Injury I and Injury II involve direct disruption of the anterior capsule during surgery.…”

Section: Discussionsupporting

confidence: 90%

Persistent motion loss after free joint mobilization in a rat model of post-traumatic elbow contracture

Dunham

Castile

Havlioglu

et al. 2017

Journal of Shoulder and Elbow Surgery

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Background Post-traumatic joint contracture (PTJC) in the elbow is a challenging clinical problem due to the anatomical and biomechanical complexity of the elbow joint. Methods Previously, we established an animal model to study elbow PTJC, wherein surgically induced soft tissue damage followed by six-weeks of unilateral immobilization in Long-Evans rats led to stiffened and contracted joints that exhibited features similar to the human condition. In this study following the six-weeks of immobilization, we remobilized the animal (i.e. external bandage removed and free cage activity) for an additional six-weeks; after which the limbs were evaluated mechanically and histologically. Hypothesis The objective of this study was to evaluate whether this decreased joint motion would persist following six-weeks of free mobilization. Results After free mobilization (FM), flexion-extension demonstrated decreased total range of motion (ROM) and neutral zone length, and increased ROM midpoint for injured limbs compared to control and contralateral limbs. Specifically, following FM total ROM demonstrated a significant decrease of approximately 22% and 26% compared to control and contralateral limbs for Injury I (anterior capsulotomy) and Injury II (anterior capsulotomy with lateral collateral ligament transection), respectively. Histological evaluation showed increased adhesion, fibrosis and thickness of the capsule tissue in the injured limbs after FM compared to control and contralateral limbs, which is consistent with patterns previously reported in human tissue. Conclusion Therefore, even with free mobilization, injured limbs in this model demonstrate persistent joint motion loss and histological results similar to the human condition. Future work will use this animal model to investigate the mechanisms responsible for PTJC and responses to therapeutic intervention.

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Section: Discussionsupporting

confidence: 90%

Persistent motion loss after free joint mobilization in a rat model of post-traumatic elbow contracture

Dunham

Castile

Havlioglu

et al. 2017

Journal of Shoulder and Elbow Surgery

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“…Histologically, the protocol developed in this study induced changes in the capsule tissue similar to what has been reported for biopsies taken from human patients with contracted joints. Specifically, previous studies of human tissue have reported thickened capsular tissue, disorganized dense/fibrous collagen, and increased fibroblast‐like cell proliferation, which are consistent with our findings (Table ; Fig. ).…”

Section: Disscusionsupporting

confidence: 93%

“…On blinded sections from each elbow joint, anterior capsule tissue was evaluated by a musculoskeletal pathologist using semi‐quantitative scores for several biological characteristics of interest. Analysis focused on capsule tissue because of the role of the capsule in PTJS and because we sought to compare results from this animal model to previous histological data of capsule tissue from human patients with contracted elbows . Evaluated criteria included adhesion, cellularity, inflammation, synovial proliferation and vascularity, which were scored as summarized in Table .…”

Section: Methodsmentioning

confidence: 99%

“…While the etiology of PTJS is likely to be multifactorial, the capsule clearly plays a role . Analyses of capsule biopsies from patients with contracted joints have revealed significant biological changes including capsular thickening, increased turnover of extracellular matrix, presence of disorganized/fibrotic collagen, and hypercellularity . While clinical biopsies are insightful, biological variation of human tissue makes identification of causative factors difficult.…”

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confidence: 99%

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Development and use of an animal model to study post‐traumatic stiffness and contracture of the elbow

Lake

Castile

Borinsky

et al. 2015

Journal Orthopaedic Research

111

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Post-traumatic joint stiffness (PTJS) of the elbow is a debilitating condition that poses unique treatment challenges. While previous research has implicated capsular tissue in PTJS, much regarding the development and progression of this condition remains unknown. The objective of this study was to develop an animal model of post-traumatic elbow contracture and evaluate its potential for studying the etiology of PTJS. The Long-Evans rat was identified as the most appropriate species/breed for development due to anatomical and functional similarities to the human elbow joint. Two surgical protocols of varying severity were utilized to replicate soft tissue damage seen in elbow subluxation/dislocation injuries, including anterior capsulotomy and lateral collateral ligament transection, followed by 6 weeks of unilateral joint immobilization. Following sacrifice, flexion-extension mechanical joint testing demonstrated decreased range-of-motion and increased stiffness for injured-immobilized limbs compared to control and sham animals, where functional impact correlated with severity of injury. Histological evaluation showed increased cellularity, adhesion, and thickness of capsule tissue in injured limbs, consistent with clinical evidence. To our knowledge, this is the first animal model capable of examining challenges unique to the anatomically and biomechanically complex elbow joint. Future studies will use this animal model to investigate mechanisms responsible for PTJS. ß

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“…Etiopathogenesis remains largely unknown [3,6,7]. According to Morrey and colleagues, most of the activities of daily living can be accomplished with 100°of elbow flexion (30-130) and 100°of forearm rotation (50-50).…”

Section: Introductionmentioning

confidence: 99%

Static progressive versus dynamic splinting for posttraumatic elbow stiffness: a systematic review of 232 patients

Veltman

Doornberg

Eygendaal

et al. 2015

Arch Orthop Trauma Surg

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Temporary Presence of Myofibroblasts in Human Elbow Capsule After Trauma

Cited by 34 publications

References 48 publications

Persistent motion loss after free joint mobilization in a rat model of post-traumatic elbow contracture

Persistent motion loss after free joint mobilization in a rat model of post-traumatic elbow contracture

Development and use of an animal model to study post‐traumatic stiffness and contracture of the elbow

Static progressive versus dynamic splinting for posttraumatic elbow stiffness: a systematic review of 232 patients

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