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Acta Orthopaedica Et Traumatologica... May 2022The aim of the study was to assess the relationship between the expression of elastin, collagen type I, II,III and the degenera- tion of the facet joint capsule and the...
OBJECTIVE
The aim of the study was to assess the relationship between the expression of elastin, collagen type I, II,III and the degenera- tion of the facet joint capsule and the ligamentum flavum.
METHODS
10 patients (4 male, 6 female) (mean age 61 ± 14,9) undergoing surgery for degenerative lumbar spine syndrome and 5 cadav- ers (3 male, 2 female) (age of death 87 ± 8,6 years) were included in this study. One set of tissue samples was taken from each patient in the patient group intraoperatively and two sets of samples were taken from each cadaver in the cadaver group posthumosly from the ligamentum flavum (medial and lateral) and from the facet joint capsules (superior and inferior articular process) at the L4/5 segment. Western blot analysis was performed for collagen types I, II, III and for elastin. Disc degeneration was scored according to the Pfirmann Classification, facet joint arthrosis was scored according to the Fujiwara Classification and their relationship with protein expression was investigated.
RESULTS
There was a strong expression of Collagen type I in the patient group (PG) compared to the body donor group (BDG) in the facet joint capsule (FJC) and in the lateral samples of the ligamentum flavum. Samples of the FJC showed lower expression of elastin in the PG compared with the BDG, but without statistical significance. An increased expression of collagen type I compared to elastin in the PG could be shown. In contrast, elastin predominated in the samples of the BDG group compared to collagen type I (collagen type I/ elastin PG: PAsup 2,78; PAinf 2,61; LFmed 2,23; 225 LFlat 1,83; BDG: PAsup 0,15; PAinf 0,2; LFmed 0,2; LFlat 0,27). Rank correlation coefficient according to Spearman showed low to moderate correlations for collagen type I, III and elastin for the degree of disc degeneration accord- ing to Pfirrmann and the degree of facet joint osteoarthritis according to Fujiwara, all of them without statistical significance.
CONCLUSION
This study has shown us that in the context of degenerative changes of the lumbar spine, there is an increased expression of collagen type I and a dominance over elastin.
LEVEL OF EVIDENCE
Level III, Diagnostic Study.
Topics: Aged, 80 and over; Cadaver; Collagen; Collagen Type I; Elastin; Female; Humans; Intervertebral Disc Degeneration; Joint Capsule; Ligamentum Flavum; Lumbar Vertebrae; Male; Middle Aged; Zygapophyseal Joint
PubMed: 35703510
DOI: 10.5152/j.aott.2022.21314 -
The Orthopedic Clinics of North America Jan 2018Massive, irreparable rotator cuff disease is a challenging problem to treat, especially in the younger active patient. This condition allows the deltoid to generate... (Review)
Review
Massive, irreparable rotator cuff disease is a challenging problem to treat, especially in the younger active patient. This condition allows the deltoid to generate anterosuperior translation and shoulder dysfunction. Ideally, this dysfunction may be improved with rotator cuff repair. However, in the setting of irreparable rotator cuff disease, normal function is challenging to restore. Superior capsule reconstruction theoretically improves function by recentering the humeral head and improving glenohumeral kinematics. This restoration of stability results in a stable fulcrum, and may allow the deltoid and remaining cuff can function more effectively.
Topics: Arthroplasty; Humans; Joint Capsule; Rotator Cuff Injuries; Shoulder Joint
PubMed: 29145990
DOI: 10.1016/j.ocl.2017.08.015 -
Zhongguo Gu Shang = China Journal of... Aug 2020To explore the tensile mechanics and anatomical characteristics of the posterior hip capsule, and provide biomechanical and anatomical evidence for capsule repair in...
OBJECTIVE
To explore the tensile mechanics and anatomical characteristics of the posterior hip capsule, and provide biomechanical and anatomical evidence for capsule repair in total hip replacement.
METHODS
Six bone-capsule-bone specimens were obtained from posterior hip joint of fresh frozen cadavers. The maximum strain, load, elastic modulus and load strain curves of the capsule ligament complex specimens were recorded by Instron Universal Material Testing Machine. Twelve cadaveric hip specimens were dissected to the capsule. The tensile strain of normal capsule and conventionally reconstructed capsule at 90 degrees of hip flexion were documented. The suture area of the posterior capsule was divided into nine sections, and the thicknessof different sections was measured and compared. Posterior capsule of the cadavers was repaired in conventionally way and anatomical way separately and simulated rehabilitation was conducted. The effect of rehabilitation on the repaired capsule was observed.
RESULTS
The load-strain curve of capsule ligament complex conforms to rheological and viscoelastic characteristics. The maximum tensile strain of the complex was (39.21±5.23)%, the maximum load was (142.06± 34.15) N, the tensile strength was (1.65±0.38) MPa, and the elastic modulus is (14.23±5.62) MPa. At 90 ° hip flexion, the tensile strain of repaired capsule was higher than that of normal capsule, and the difference was statistically significant (< 0.05). Tensile strain of conventionally reconstructed capsule is:upper part (37.0±4.9)%, middle part ( 53.3±1.1)%, lower part (68.3±6.2)%, tensile strain of normal capsule is:upper part (17.0±2.6)%, middle part (24.1±1.4)%, lower part (26.0± 4.3)% . The thickness of the posterior joint capsulein different sections is statistically significant (<0.05), and capsule at 0.5cm proximal to the femoral insertion is suitable for suture. There the average thickness of capsule is:upper part (3.48 ± 0.11) mm, middle part (2.36 ± 0.09) mm, lower part (1. 59±0.24) mm. The posterior inferior joint capsule is thinnest at (1.42± 0.02) cm proximal to the femoral insertion, and sutures should be avoided here. After simulating rehabilitation, avulsion occurred in the lower part of the posterior capsule repaired conventionally (10/12), and the anatomically repaired capsule remained intact.
CONCLUSION
The lower part of conventionally repaired capsule is overstretched and tends to fail. Anatomically repaired capsule conforms to tensile mechanics and is helpful to reduce the failure rate of repair.
Topics: Arthroplasty, Replacement, Hip; Biomechanical Phenomena; Femur; Hip Joint; Humans; Joint Capsule; Tensile Strength
PubMed: 32875769
DOI: 10.12200/j.issn.1003-0034.2020.08.015 -
Journal of Orthopaedic Research :... Mar 2020Joint stiffness due to fibrosis/capsule contracture is a seriously disabling complication of articular injury that surgical interventions often fail to completely...
Joint stiffness due to fibrosis/capsule contracture is a seriously disabling complication of articular injury that surgical interventions often fail to completely resolve. Fibrosis/contracture is associated with the abnormal persistence of myofibroblasts, which over-produce and contract collagen matrices. We hypothesized that intra-articular therapy with drugs targeting myofibroblast survival (sulfasalazine), or collagen production (β-aminopropionitrile and cis-hydroxyproline), would reduce joint stiffness in a rabbit model of fibrosis/contracture. Drugs were encapsulated in poly[lactic-co-glycolic] acid pellets and implanted in joints after fibrosis/contracture induction. Capsule α-smooth muscle actin (α-SMA) expression and intimal thickness were evaluated by immunohistochemistry and histomorphometry, respectively. Joint stiffness was quantified by flexion-extension testing. Drawer tests were employed to determine if the drugs induced cruciate ligament laxity. Joint capsule fibroblasts were tested in vitro for contractile activity and α-SMA expression. Stiffness in immobilized joints treated with blank pellets (control) was significantly higher than in non-immobilized, untreated joints (normal) (p = 0.0008), and higher than in immobilized joints treated with sulfasalazine (p = 0.0065). None of the drugs caused significant cruciate ligament laxity. Intimal thickness was significantly lower than control in the normal and sulfasalazine-treated groups (p = 0.010 and 0.025, respectively). Contractile activity in the cells from controls was significantly increased versus normal (p = 0.001). Sulfasalazine and β-aminopropionitrile significantly inhibited this effect (p = 0.005 and 0.0006, respectively). α-SMA expression was significantly higher in control versus normal (p = 0.0021) and versus sulfasalazine (p = 0.0007). These findings support the conclusion that sulfasalazine reduced stiffness by clearing myofibroblasts from fibrotic joints. Statement of clinical significance: The results provide proof-of-concept that established joint stiffness can be resolved non-surgically. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:629-638, 2020.
Topics: Aminopropionitrile; Animals; Collagen; Contracture; Disease Models, Animal; Fibrosis; Hydroxyproline; Joint Capsule; Joint Diseases; Male; Muscle Contraction; Myofibroblasts; Rabbits; Stress, Mechanical; Sulfasalazine
PubMed: 31692083
DOI: 10.1002/jor.24499 -
Journal of Shoulder and Elbow Surgery Apr 2021Sensory receptors in the joint capsule are critical for maintaining joint stability. However, the distribution of sensory receptors in the glenohumeral joint of the...
BACKGROUND AND HYPOTHESES
Sensory receptors in the joint capsule are critical for maintaining joint stability. However, the distribution of sensory receptors in the glenohumeral joint of the shoulder, including mechanoreceptors and free nerve endings, has not been described yet. This study aimed to describe the distributions of different sensory receptor subtypes in the glenohumeral joint capsule. Our hypotheses were as follows: (1) Sensory receptor subtypes would differ in density but follow a similar distribution pattern, and (2) the anterior capsule would have the highest density of sensory receptors.
METHODS
Six glenohumeral joint capsules were harvested from the glenoid to the humeral attachment. The capsule was divided into 4 regions of interest (anterior, posterior, superior, and inferior) and analyzed using modified gold chloride stain. Sensory receptors as well as free nerve endings were identified and counted under a light microscope from sections of each region of interest. The density of each sensory receptor subtype was calculated relative to capsule volume.
RESULTS
Sensory receptors were distributed in the glenohumeral joint capsule with free nerve endings. The anterior capsule exhibited the highest median density of all 4 sensory receptors examined, followed by the superior, inferior, and posterior capsules. The median densities of these sensory receptor subtypes also significantly differed (P = .007), with type I (Ruffini corpuscles) receptors having the highest density (2.97 U/cm), followed by type IV (free nerve endings, 2.25 U/cm), type II (Pacinian corpuscles, 1.40 U/cm), and type III (Golgi corpuscles, 0.24 U/cm) receptors.
CONCLUSION
Sensory receptor subtypes are differentially expressed in the glenohumeral joint capsule, primarily type I and IV sensory receptors. The expression of sensory receptors was dominant in the anterior capsule, stressing the important role of proprioception feedback for joint stability. The surgical procedure for shoulder instability should consider the topography of sensory receptors to preserve or restore the proprioception of the shoulder joint.
Topics: Aged; Cadaver; Female; Humans; Joint Capsule; Joint Instability; Male; Mechanoreceptors; Middle Aged; Nerve Endings; Proprioception; Sensory Receptor Cells; Shoulder Joint
PubMed: 32707328
DOI: 10.1016/j.jse.2020.07.006 -
Anatomical Record (Hoboken, N.J. : 2007) Dec 2019This observational study was conducted to evaluate the anatomic relationship between the proximocaudal femoral joint capsule insertion and the femoral caudolateral...
This observational study was conducted to evaluate the anatomic relationship between the proximocaudal femoral joint capsule insertion and the femoral caudolateral curvilinear osteophyte (CCO), across ancient and modern domestic and non-domestic canids. Museum specimens of proximal femora were screened for presence of remnant enthesophytes of the caudal joint capsule insertion (first inclusion criterion) and then for the CCO (second inclusion criterion). The initially screened population included 267 dry bone specimens: Six Canis species, hybrid coyote × domestic dog, and five vulpines (three Vulpes species, one Urocyon, and one Nyctereutes). Proximocaudal joint capsule insertion remnant enthesophytes were limiting at n = 19 specimens: Seven ancient domestic dogs, four modern coyotes, two ancient coyotes, two modern hybrid coyote × dog, two modern red foxes, and two modern raccoon dogs. The joint capsule enthesophytes are associated with inflammation, but are observed far less frequently than the CCO. The CCO is seen radiographically but is visible more frequently by direct inspection. The primary inclusion criterion necessarily was a visible caudal joint capsule insertion; spatial relationships of the CCO can be assigned with confidence only when a capsule insertion line can be recognized clearly. We demonstrate that the anatomic CCO associates with the joint capsule insertion being nonspecific and species-independent. A joint capsule insertion-CCO spatial relationship across species is an important new observation, strongly indicating that both are pathological features. Our data indicate need for new research to characterize the canid coxofemoral joint and its overt and incipient pathology in a phylogenetic context. Anat Rec, 302:2164-2170, 2019. © 2019 American Association for Anatomy.
Topics: Animals; Coyotes; Dogs; Femur; Foxes; Hip Joint; Joint Capsule
PubMed: 31433562
DOI: 10.1002/ar.24231 -
Arthroscopy : the Journal of... Dec 2015To analyze outcomes of surgical and conservative treatment options for multidirectional instability (MDI). (Review)
Review
PURPOSE
To analyze outcomes of surgical and conservative treatment options for multidirectional instability (MDI).
METHODS
A systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. A comprehensive search of the PubMed, MEDLINE, CINAHL, Cochrane, EMBASE, and Google Scholar databases using various combinations of the keywords "shoulder," "multidirectional instability," "dislocation," "inferior instability," "capsulorrhaphy," "capsular plication," "capsular shift," "glenoid," "humeral head," "surgery," and "glenohumeral," over the years 1966 to 2014 was performed.
RESULTS
Twenty-four articles describing patients with open capsular shift, arthroscopic treatment, and conservative or combined management in the setting of atraumatic MDI of the shoulder were included. A total of 861 shoulders in 790 patients was included. The median age was 24.3 years, ranging from 9 to 56 years. The dominant side was involved in 269 (58%) of 468 shoulders, whereas the nondominant side was involved in 199 (42%) shoulders. Patients were assessed at a median follow-up period of 4.2 years (ranging from 9 months to 16 years). Fifty-two of 253 (21%) patients undergoing physiotherapy required surgical intervention for MDI management, whereas the overall occurrence of redislocation was seen in 61 of 608 (10%) shoulders undergoing surgical procedures. The redislocation event occurred in 17 of 226 (7.5%) shoulders with open capsular shift management, in 21 of 268 (7.8%) shoulders with arthroscopic plication management, in 12 of 49 (24.5%) shoulders undergoing arthroscopic thermal shrinkage, and in 11 of 55 (22%) shoulders undergoing arthroscopic laser-assisted capsulorrhaphy.
CONCLUSIONS
Arthroscopic capsular plication and open capsular shift are the best surgical procedures for treatment of MDI after failure of rehabilitative management. Arthroscopic capsular plication shows results comparable to open capsular shift.
LEVEL OF EVIDENCE
Level IV, systematic review of Level I to IV studies.
Topics: Arthroscopy; Humans; Joint Capsule; Joint Instability; Shoulder Dislocation; Shoulder Joint
PubMed: 26208802
DOI: 10.1016/j.arthro.2015.06.006 -
Journal of Orthopaedic Research :... May 2021Knee joint contracture is often induced by anterior cruciate ligament reconstruction (ACLR). However, the temporal and spatial arthrofibrotic changes following...
Knee joint contracture is often induced by anterior cruciate ligament reconstruction (ACLR). However, the temporal and spatial arthrofibrotic changes following inflammatory events, which occur in parallel with the formation of joint contractures after ACLR, are unknown. This study aimed to reveal: (a) time-dependent changes in myogenic and arthrogenic contractures; and (b) the process of arthrofibrosis development after ACLR. ACLR was performed on knees of rats unilaterally. Passive ranges of motions (ROMs) before and after myotomy, as well as inflammatory and fibrotic reactions, were examined before and after the surgery at various periods up to 56 days. Both ROMs before and after myotomy exhibited their lowest value on day 7 and increased thereafter in a time-dependent manner; nevertheless, significant restrictions remained by day 56. Myotomy partially increased ROMs at all time points, indicating contribution of the myogenic component to ACLR-induced contracture. Inflammatory and fibrotic reactions peaked on day 7. Arthrofibrosis, characterized by the thickening of the joint capsule and the shortening of the synovial length, was established by day 7 and was not completely resolved by day 56. Our results indicate that: (a) both myogenic and arthrogenic contractures generated through ACLR develop maximally by day 7 after surgery and subside thereafter, but persist at least until day 56; and (b) arthrofibrosis is established by day 7 after surgery and is not completely resolved by day 56. These findings suggest that treatment and intervention for preventing joint contracture after ACLR should be performed within the first 7 days after surgery.
Topics: Animals; Anterior Cruciate Ligament Reconstruction; Contracture; Cytokines; Fibrosis; Joint Capsule; Knee Joint; Male; Range of Motion, Articular; Rats; Rats, Wistar; Time Factors
PubMed: 32667709
DOI: 10.1002/jor.24800 -
Acta Bio-medica : Atenei Parmensis May 2020In the last decade, arthroscopic treatment of hip diseases has significantly spread and evolved and currently it represents the gold standard for the treatment of...
BACKGROUND AND AIM OF THE WORK
In the last decade, arthroscopic treatment of hip diseases has significantly spread and evolved and currently it represents the gold standard for the treatment of femoral- acetabular impingement. In the recent years, the function of the joint capsule (and therefore the results of an arthroscopic capsulotomy) has been hugely developed, opening a heated debate. The Literature is still torn about the need for a capsular suture, but more recent studies are more oriented in its execution at the end of the surgical procedure. According to these recent studies, the joint capsule performs an essential function of primary stability, and its closure is therefore necessary to restore the native anatomy and physiology. Nevertheless, capsular management remains a controversial topic. This is a retrospective study with the aim of assessing the influence of capsular suture on the patient's functional outcome in a cohort of patients with femoral-acetabular impingement arthroscopically treated.
HYPOTHESIS
Our hypothesis is that an adequate capsular suture positively influences the patient's functional outcome.
METHODS AND RESULTS
50 patients treated with hip arthroscopy for femoral-acetabular impingement have been retrospectively enrolled at the Orthopaedic Clinic of Academic Hospital of Udine during a period of two-years (2017-2018); collected data have been analysed and compared with a retrospective model. Patients have been divided into two equivalent groups, 25 treated with capsular suture, 25 without performing the suture. Patient's post-operative functional outcome has been analysed using the modified Harris Hip Score (mHHS), the Non-Arthritic Hip Score (NAHS) and the Hip Outcome Score-Sport Scale (HOS-SS). The functional outcome in patients where capsular sutures were performed was better than in non-sutured patients, in all three analysed scales.
CONCLUSIONS
Capsular suture with a single side-to-side stitch at the end of the procedure can positively influence the patient's functional outcome.
Topics: Adolescent; Adult; Arthroscopy; Female; Femoracetabular Impingement; Hip Joint; Humans; Joint Capsule; Male; Retrospective Studies; Young Adult
PubMed: 32555082
DOI: 10.23750/abm.v91i4-S.9664 -
Journal of Shoulder and Elbow Surgery Jul 2020During anatomic total shoulder arthroplasty (TSA) for primary glenohumeral osteoarthritis (GHOA), the anterior shoulder joint capsule (ASJC) is characterized grossly by...
BACKGROUND
During anatomic total shoulder arthroplasty (TSA) for primary glenohumeral osteoarthritis (GHOA), the anterior shoulder joint capsule (ASJC) is characterized grossly by contracture, synovitis, and fibrosis. In tissues that develop fibrosis, there is substantial cross-talk between macrophages, fibroblasts, and myofibroblasts, modulated by calcium signaling and transient receptor potential (TRP) channel signaling. The purpose of this study was to compare and characterize the degree of synovitis, inflammatory infiltrate, and TRP channel expression in ASJC harvested from shoulders with and without primary GHOA.
METHODS
The ASJC was resected from patients undergoing TSA for primary GHOA or other diagnoses and compared with ASJC from cadaveric donors with no history of shoulder pathology. ASJC was evaluated by immunohistochemistry to characterize synovial lining and capsular inflammatory cell infiltrate and fibrosis, and to evaluate for expression of TRPA1, TRPV1, and TRPV4, known to be involved in fibrosis in other tissues. Blinded sections were evaluated by 3 graders using a semiquantitative scale; then results were compared between diagnosis groups using nonparametric methods.
RESULTS
Compared with normal control, the ASJC in primary GHOA had significantly increased synovitis, fibrosis, mixed inflammatory cell infiltrate including multiple macrophages subsets, and upregulation of TRP channel expression.
CONCLUSION
These data support the clinical findings of ASJC and synovial fibrosis in primary GHOA, identify a mixed inflammatory response, and identify dysregulation of TRP channels in the synovium and joint capsule. Further studies will identify the role of synovial and capsular fibrosis early in the development of GHOA.
Topics: Adult; Arthroplasty, Replacement, Shoulder; Contracture; Female; Fibrosis; Humans; Immunohistochemistry; Joint Capsule; Male; Middle Aged; Osteoarthritis; Shoulder Joint; Synovial Membrane; Transient Receptor Potential Channels; Up-Regulation
PubMed: 32113865
DOI: 10.1016/j.jse.2019.11.013