The posttraumatic stiff elbow: an update

Mellema, Jos J.; Lindenhovius, Anneluuk L.C.; Jupiter, Jesse B.

doi:10.1007/s12178-016-9336-9

Cited by 59 publications

(63 citation statements)

References 113 publications

(126 reference statements)

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“…Joint stiffness is a disabling condition and occurs mostly after trauma or operation. 4,56 Excessive active exercises or stretching might even aggravate the fibrosis and subsequent motion restriction. [57][58][59] Although the surgical treatment of joint stiffness can improve joint motion, there is an urgent need for a non invasive prophylactic or first-line treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Synonyms for this disorder are joint contracture, stiff knee, stiff elbow or arthrofibrosis. 4,5 In our study, PTJS of the knee was defined as a limited passive extension of the knee joint after trauma, which was not caused by incongruency of the joint. Prolonged physiotherapeutic treatment or operative removal of the joint capsule (with certain associated risks) are often capable of improving the range of motion in PTJS.…”

Section: Introductionmentioning

confidence: 99%

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<p>Effects of losartan and atorvastatin on the development of early posttraumatic joint stiffness in a rat model</p>

Baranowski

Schlemmer

Förster

et al. 2019

DDDT

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

<p>Effects of losartan and atorvastatin on the development of early posttraumatic joint stiffness in a rat model</p>

Baranowski

Schlemmer

Förster

et al. 2019

DDDT

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“…1,2,3 In order to study the pathophysiology behind arthrofibrosis, animal models have been developed using the New Zealand White rabbit knee. 4,5 These models involve an intracapsular knee injury followed by Kirschner-wire (K-wire) immobilisation for eight weeks, and result in substantial contracture that resembles the human biomechanical, cellular, and molecular response to injury, with increased myofibroblasts and transforming growth factor beta (TGF-β) activity.…”

Section: Introductionmentioning

confidence: 99%

Intra-articular implantation of collagen scaffold carriers is safe in both native and arthrofibrotic rabbit knee joints

Walker

Ewald

Lewallen

et al. 2017

Bone & Joint Research

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ObjectivesSustained intra-articular delivery of pharmacological agents is an attractive modality but requires use of a safe carrier that would not induce cartilage damage or fibrosis. Collagen scaffolds are widely available and could be used intra-articularly, but no investigation has looked at the safety of collagen scaffolds within synovial joints. The aim of this study was to determine the safety of collagen scaffold implantation in a validated in vivo animal model of knee arthrofibrosis.Materials and MethodsA total of 96 rabbits were randomly and equally assigned to four different groups: arthrotomy alone; arthrotomy and collagen scaffold placement; contracture surgery; and contracture surgery and collagen scaffold placement. Animals were killed in equal numbers at 72 hours, two weeks, eight weeks, and 24 weeks. Joint contracture was measured, and cartilage and synovial samples underwent histological analysis.ResultsAnimals that underwent arthrotomy had equivalent joint contractures regardless of scaffold implantation (-13.9° versus -10.9°, equivalence limit 15°). Animals that underwent surgery to induce contracture did not demonstrate equivalent joint contractures with (41.8°) or without (53.9°) collagen scaffold implantation. Chondral damage occurred in similar rates with (11 of 48) and without (nine of 48) scaffold implantation. No significant difference in synovitis was noted between groups. Absorption of the collagen scaffold occurred within eight weeks in all animalsConclusionOur data suggest that intra-articular implantation of a collagen sponge does not induce synovitis or cartilage damage. Implantation in a native joint does not seem to induce contracture. Implantation of the collagen sponge in a rabbit knee model of contracture may decrease the severity of the contracture.Cite this article: J. A. Walker, T. J. Ewald, E. Lewallen, A. Van Wijnen, A. D. Hanssen, B. F. Morrey, M. E. Morrey, M. P. Abdel, J. Sanchez-Sotelo. Intra-articular implantation of collagen scaffold carriers is safe in both native and arthrofibrotic rabbit knee joints. Bone Joint Res 2016;6:162–171. DOI: 10.1302/2046-3758.63.BJR-2016-0193.

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“…Attributing to increasing development of industrialization and transportation, however, elbow stiffness is a common complaint after elbow trauma, with an incidence ranging from 3% to 20% [2]. Generally, arthrolysis is indicated when patients have no (further) prospect of effect by conservative therapy [3].…”

Section: Introductionmentioning

confidence: 99%

“…Open arthrolysis is still the commonest treatment method, which has been proven to be an effective choice with low incidence of complications [3,5].…”

Section: Introductionmentioning

confidence: 99%

Impact of Smoking on Clinical Outcomes of Open Arthrolysis for Post-Traumatic Elbow Stiffness

Sun¹,

Fan²,

Xiong³

2017

J Bone Res

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Background: Elbow stiffness is a common orthopedics problem after elbow trauma. Meanwhile, smoking is becoming a worldwide public health challenge, which has been considered as a predisposing factor for adverse functional outcomes after various orthopedic surgeries. This retrospective study seeks to identify whether smoking affects clinical outcomes of open arthrolysis for post-traumatic elbow stiffness in male patients.

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The posttraumatic stiff elbow: an update

Cited by 59 publications

References 113 publications

<p>Effects of losartan and atorvastatin on the development of early posttraumatic joint stiffness in a rat model</p>

<p>Effects of losartan and atorvastatin on the development of early posttraumatic joint stiffness in a rat model</p>

Intra-articular implantation of collagen scaffold carriers is safe in both native and arthrofibrotic rabbit knee joints

Impact of Smoking on Clinical Outcomes of Open Arthrolysis for Post-Traumatic Elbow Stiffness

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