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Inflammation Jun 2019We investigated whether the combination of exercise and anti-inflammatory/anti-fibrotic treatment using low-level laser therapy (LLLT) promotes recovery from joint...
Low-Level Laser Therapy Prevents Treadmill Exercise-Induced Progression of Arthrogenic Joint Contracture Via Attenuation of Inflammation and Fibrosis in Remobilized Rat Knees.
We investigated whether the combination of exercise and anti-inflammatory/anti-fibrotic treatment using low-level laser therapy (LLLT) promotes recovery from joint contracture without arthrogenic contracture progression. Rat knees were immobilized for 3 weeks in a flexed position. After fixator removal, rats were divided into no intervention (RM), daily treadmill walking (WALK), and daily treadmill walking and LLLT (W + L) groups. Total and arthrogenic contractures were assessed by restrictions of passive range of motion (ROM) before (m-ROM) and after myotomy (a-ROM), respectively. After 7 days of remobilization, m-ROM restriction decreased equally in all groups. Conversely, a-ROM restriction further increased after remobilization in the RM and WALK groups. Furthermore, this restriction was significantly larger in the WALK group compared with the RM group. In the W + L group, however, progression of a-ROM restriction during remobilization was prevented. After 1 or 7 days of remobilization, inflammatory and fibrotic reactions in the joint capsule were induced in the RM group and were more pronounced in the WALK group, but these reactions were milder in the W + L group than in the WALK group. m-ROM restriction representing total contracture initially established by immobilization was partially improved by remobilization. Additional LLLT and exercise intervention did not further reduce total contracture, but LLLT suppressed the progression of arthrogenic contracture caused by ambulation and treadmill exercise. Therefore, exercise with LLLT in the early phase of remobilization would be one possible adjunct therapy to prevent further progression of arthrogenic contracture.
Topics: Animals; Contracture; Disease Progression; Fibrosis; Inflammation; Knee Joint; Low-Level Light Therapy; Muscle Strength; Myotomy; Physical Conditioning, Animal; Range of Motion, Articular; Rats
PubMed: 30506108
DOI: 10.1007/s10753-018-0941-1 -
Annals of Plastic Surgery Jul 2024Axillary cicatricial contracture is a debilitating condition that can greatly impair shoulder joint function. Therefore, timely correction of this condition is...
BACKGROUND
Axillary cicatricial contracture is a debilitating condition that can greatly impair shoulder joint function. Therefore, timely correction of this condition is imperative. In light of Ogawa's prior classification of axillary cicatricial contracture deformities, we have proposed a novel classification system and reconstruction principles based on a decade of treatment experience. Our proposed system offers a more comprehensive approach to correcting axillary cicatricial contracture deformities and aims to improve patient outcomes.
METHODS
Our study included 196 patients with a total of 223 axillary cicatricial contracture deformities. The range of shoulder abduction varied between 10 and 120 degrees. Our treatment approach included various methods such as the lateral thoracic flap, transverse scapular artery flap, cervical superficial artery flap, medial upper arm flap, latissimus dorsi flap, Z-shape modification, and the use of local flaps combined with skin grafting. After 2 weeks, the sutures were removed, and patients were instructed to start functional exercises. To categorize the deformities, we divided them into 2 types: axillary-adjacent region cicatricial contracture (type I) and extended area contracture (type II).
RESULTS
For each subtype, a specific treatment method was chosen based on a designed algorithm decision tree. Out of the total cases, 133 patients underwent treatment with various types of local flaps, including Z-plasty, whereas 63 patients received treatment involving skin grafting and different types of local flaps. At the time of discharge, the abduction angle of the shoulder joint ranged from 80 to 120 degrees. Among the 131 patients who were followed up, 108 of them adhered to a regimen of horizontal bar exercises. After a 1-year follow-up period, the abduction angle of the shoulder joint had significantly improved to a range of 110-180 degrees.
CONCLUSIONS
We have proposed a novel classification method for the correction of axillary cicatricial contracture deformity. This approach involves utilizing distinct correction strategies, in conjunction with postoperative functional exercise, to ensure the effectiveness of axillary reconstruction.
Topics: Humans; Contracture; Cicatrix; Female; Adult; Male; Axilla; Middle Aged; Surgical Flaps; Adolescent; Young Adult; Plastic Surgery Procedures; Range of Motion, Articular; Shoulder Joint; Child; Treatment Outcome; Aged
PubMed: 38864418
DOI: 10.1097/SAP.0000000000004014 -
The Journal of Arthroplasty Oct 2021Despite the expanding indications for unicompartmental knee arthroplasty (UKA), the classic indication that limits flexion contracture to <5° in fixed bearing UKA...
BACKGROUND
Despite the expanding indications for unicompartmental knee arthroplasty (UKA), the classic indication that limits flexion contracture to <5° in fixed bearing UKA excludes most patients with arthritic knees and has not been challenged in modern literature. This study compared the clinical outcomes between patients with severe flexion contracture and controls undergoing UKA.
METHODS
Eighty seven medial fixed bearing UKAs performed in patients with severe (≥15°) flexion contracture were matched 1:1 with 87 controls without flexion or recurvatum deformity (-5°
RESULTS
Preoperative knee extension in the control and contracture groups was 0.9° ± 1.9° and 18.0° ± 3.5° (P < .001), respectively, whereas flexion was 122.8° ± 27.9° and 120.6° ± 13.6° (P = .502). The contracture group had poorer Knee Society functional (P = .023) and SF-36 physical score (P = .010) at 6 months. However, there was no difference in PROMs at 2 years. A similar proportion achieved the minimal clinically important difference for each PROM and was satisfied with surgery. Range of motion remained poorer in the contracture group and a higher percentage had residual contractures (P < .001). Ten-year survivorship was 94% and 97% in the control and contracture groups, respectively (P = .145).
CONCLUSION
Although patients with severe flexion contractures had a poorer range of motion and postoperatively, these patients attained comparable PROMs, satisfaction rates, and mid-term survivorship after UKA.
LEVEL OF EVIDENCE
III, therapeutic study.
Topics: Arthroplasty, Replacement, Knee; Contracture; Humans; Knee Joint; Knee Prosthesis; Osteoarthritis, Knee; Range of Motion, Articular; Survivorship; Treatment Outcome
PubMed: 34090691
DOI: 10.1016/j.arth.2021.05.019 -
Annals of Plastic Surgery Feb 2021Severe postburn contractures can lead to partial or total loss of function of the limbs, with devastating socioeconomic and psychosocial impact on the individual,...
INTRODUCTION
Severe postburn contractures can lead to partial or total loss of function of the limbs, with devastating socioeconomic and psychosocial impact on the individual, especially in low- and middle-income countries. We present a surgical technique for the treatment of severe burn contractures with the purpose of limiting recurrence of the contracture after surgery, which was developed based on the observation that in most burn contractures, one side of a contracture has unburnt, soft, and pliable healthy skin. By advancing this skin as a flap over the joint crease, a bridge of healthy tissue is interposed. We postulate that the pliable skin, together with the fact that secondary wound contracture progresses away from the joint in the skin-grafted areas adjacent to the flap and not over a mobile joint, promote healing, prevent skin graft breakdown, and limit recurrence of the contracture in the long term.
METHODS
We retrospectively analyzed data of all patients who have undergone surgery for severe burn contractures of elbow and axilla by means of our technique on the MV Africa Mercy between January 2013 and February 2014.
RESULTS
In 27 patients (19 female, 8 male) with a mean age of 16.4 years, shoulder range of motion improved significantly from preoperative 111.0° to postoperative 149.4° of abduction-adduction. The elbow range of motion improved from preoperative 76.6° to postoperative 108.6° of flexion-extension, with a significant reduction in the residual elbow contracture from 60.5° preoperatively to 18.5° postoperatively. The average follow-up was 3 months (range, 1.5-7 months).
CONCLUSIONS
We conclude that this relatively simple and safe technique limits the risk for early postoperative healing complications and recurrence of the contractures in the long term.
Topics: Adolescent; Africa; Burns; Contracture; Female; Humans; Male; Range of Motion, Articular; Retrospective Studies; Surgical Flaps
PubMed: 32756246
DOI: 10.1097/SAP.0000000000002519 -
Journal of Pediatric Orthopedics Jul 2020Shoulder imbalance secondary to residual brachial plexus birth palsy requires release of internal rotation contracture and tendon transfer. Subscapularis is considered...
BACKGROUND
Shoulder imbalance secondary to residual brachial plexus birth palsy requires release of internal rotation contracture and tendon transfer. Subscapularis is considered as the prime element of internal rotation contracture and various methods have been described for subscapularis lengthening. It includes open subscapularis slide or lengthening and arthroscopic release. We hypothesized that subscapularis can be released through minimally invasive approach from the medial border of scapula and thus avoiding formal open procedures and risk of weakening the internal rotation strength.
METHODS
Safety zones to avoid injury to important neurovascular structures while performing minimally invasive subscapularis release (MISR) were determined through cadaveric dissection. Between 2014 and 2016, 45 patients underwent MISR. A concomitant conjoined Latissimus Dorsi and Teres Major transfer was performed. Twenty patients with minimum 2-year follow-up were included in this study. Average age of patients was 6.4 years. A 5-point modified Mallet Score, degrees of active and passive rotations and abduction were used as outcome measures. Axial MRI imaging were available to classify the gleno-humeral deformity.
RESULTS
Mean improvement in passive external rotation was 80 degrees and in active external rotation was 43 degrees (P <0.001) at 3 months, which was maintained at final follow-up. Average shoulder abduction improved from preoperative-101 degrees to postoperative-142 degrees. Aggregate 5-point Mallet Score improved from 12.8 points (range, 11 to 16) preoperatively to 18.5 points (range, 16 to 21) postoperatively. None of the patients developed external rotation contracture. The results were comparable with other existing techniques of subscapularis release with conjoint tendon transfer.
CONCLUSIONS
MISR with conjoined tendon transfer is an effective way of treating internal rotation contracture in children with congruent glenohumeral joints. This procedure has shown beneficial outcomes even in patients with noncongruous glenohumeral joints, when performed in children younger than 4 years. Advantages of MISR include less risk to neurovascular structures, minimal soft tissue trauma, directly addressing the medial tight subscapularis fibers, significantly less surgical time and minimum learning curve.
LEVELS OF EVIDENCE
Level III-retrospective comparative study.
Topics: Adolescent; Birth Injuries; Brachial Plexus Neuropathies; Cadaver; Child; Child, Preschool; Contracture; Female; Humans; Infant; Magnetic Resonance Imaging; Male; Minimally Invasive Surgical Procedures; Muscle, Skeletal; Retrospective Studies; Rotator Cuff; Scapula; Shoulder Joint; Tendon Transfer; Treatment Outcome
PubMed: 32501917
DOI: 10.1097/BPO.0000000000001458 -
American Journal of Physical Medicine &... May 2018The aim of this study was to investigate the therapeutic effect of stretching combined with ultrashort wave on joint contracture and explore its possible mechanism.
OBJECTIVE
The aim of this study was to investigate the therapeutic effect of stretching combined with ultrashort wave on joint contracture and explore its possible mechanism.
DESIGN
Thirty-two rabbits underwent unilateral immobilization of a knee joint at full extension to cause joint contracture. At 6 wks after immobilization, the rabbits were randomly divided into the following four groups: natural recovery group, stretching treatment group, ultrashort wave treatment group, and combined treatment group. For comparison, eight control group animals of corresponding age were also examined. The effect of stretching and ultrashort wave treatment on joint contracture was assessed by measuring the joint range of motion, evaluating the collagen deposition of joint capsule and assessing the mRNA and protein levels for transforming growth factor β1 in the joint capsule.
RESULTS
The combined treatment group led to the best recovery of joint function. The combined treatment with stretching and ultrashort wave was more effective than stretching or ultrashort wave treatment alone against the synovial thickening of suprapatellar joint capsule, the collagen deposition of anterior joint capsule, and the elevated expression of transforming growth factor β1 in the joint capsule.
CONCLUSIONS
Stretching combined with ultrashort wave treatment was effective in improving joint range of motion, reducing the biomechanical, histological, and molecular manifestations of joint capsule fibrosis in a rabbit model of extending joint contracture.
Topics: Animals; Contracture; Diathermy; Disease Models, Animal; Fibrosis; Joint Capsule; Knee Joint; Muscle Stretching Exercises; Rabbits; Range of Motion, Articular; Transforming Growth Factor beta1; Treatment Outcome
PubMed: 29210704
DOI: 10.1097/PHM.0000000000000873 -
Journal of Investigative Surgery : the... May 2022Although anterior cruciate ligament reconstruction surgery is known to cause joint contracture, the mechanisms of this process are unknown. We aimed to assess the...
BACKGROUND
Although anterior cruciate ligament reconstruction surgery is known to cause joint contracture, the mechanisms of this process are unknown. We aimed to assess the effects of transection of this ligament and each phase of reconstruction surgery on contracture formation.
MATERIALS AND METHODS
Rats were divided into groups according to treatment received: sham (arthrotomy), ligament transection, ligament transection plus bone drilling, and ligament reconstruction. Surgery was performed on the right knee. Untreated left knees in the sham group were used as controls.
RESULTS
At 7 and 28 d post-surgery, range of motion before myotomy, mainly representing myogenic contracture, was restricted in the sham and ligament transection groups, and more so in the bone drilling and reconstruction groups. Restricted range of motion after myotomy, representing arthrogenic contracture, was detected at both timepoints in the bone drilling and reconstruction groups, but not in the sham or ligament transection groups. At 3 d post-surgery, although a large blood clot was observed in all three treatment groups, only the bone drilling and reconstruction groups showed significant joint swelling. At 7 d post-surgery, inflammatory-cell infiltration into the joint capsule was most apparent in the bone drilling and reconstruction groups, and joint capsule fibrosis was also most apparent in these groups at 7 and 28 d post-surgery.
CONCLUSIONS
Our results suggest that (1) myogenic contracture after anterior cruciate ligament reconstruction is caused by arthrotomy and aggravated by bone drilling, and (2) arthrogenic contracture is mostly due to bone drilling, which triggers an inflammation-fibrosis cascade.
Topics: Animals; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Contracture; Fibrosis; Knee Joint; Range of Motion, Articular; Rats
PubMed: 34620030
DOI: 10.1080/08941939.2021.1985193 -
Medicine Mar 2021Contractures frequently occur in the finger joints after immobilization. This report describes the effect of acupotomy treatment in patients with joint contracture due...
INTRODUCTION
Contractures frequently occur in the finger joints after immobilization. This report describes the effect of acupotomy treatment in patients with joint contracture due to immobilization of the finger joints.
PATIENT CONCERNS AND CLINICAL FINDINGS
Case 1 was of a 39-year-old male patient who had flexion limitation of the left thumb and difficulty in grasping. Case 2 was of a 41-year-old female patient who had flexion limitation of the right index finger and difficulty in typing. Stiffness occurred after tendon repair surgery and cast immobilization in both cases. In Case 1, the patient had limited flexion movement of the first metacarpophalangeal and interphalangeal joints after 5 weeks of immobilization of the left thumb in a cast. In Case 2, the patient had limited flexion movement after 3 weeks of immobilization of the second proximal interphalangeal joint of the left hand in a cast.
DIAGNOSIS, INTERVENTIONS, AND OUTCOMES
We diagnosed both patients with finger joint contracture due to immobilization. Conservative treatment for approximately 4 weeks did not lead to improvement in either patient. Acupotomy is the key treatment for improving movement in Korean Medicine. Therefore, acupotomy was performed, and joint stiffness markedly improved without adverse events. Both patients reported that the daily use of the damaged fingers became comfortable.
CONCLUSION
We found that acupotomy may be effective for finger joint contracture due to improper immobilization. We suggest it as a simple and safe treatment for joint contracture.
Topics: Acupuncture Therapy; Adult; Casts, Surgical; Contracture; Female; Finger Injuries; Finger Joint; Humans; Joint Capsule; Male; Postoperative Complications; Range of Motion, Articular; Tendon Injuries; Treatment Outcome
PubMed: 33725871
DOI: 10.1097/MD.0000000000024988 -
The Journal of Hand Surgery May 2020The aims of this study were to verify proximal phalangeal head normalization after a stretching exercise in patients with infantile-type camptodactyly and to propose...
PURPOSE
The aims of this study were to verify proximal phalangeal head normalization after a stretching exercise in patients with infantile-type camptodactyly and to propose radiographic indices for quantifying bony deformities.
METHODS
Forty-eight fingers of 20 patients with camptodactyly were enrolled in this study. All patients and their parents received instruction on how to perform the stretching exercise. The qualitative assessments of proximal phalangeal head remodeling were conducted by consensus of 2 hand surgeons. Two radiographic parameters, head triangle ratio (HTR) and head angle (HA), were measured on finger lateral radiographs taken at the initial visit and at 12-month follow-up. The intra- and interobserver reliability of both parameters was assessed. Those parameters of the patients were compared with those of 177 fingers of 80 children without camptodactyly. The extent of proximal interphalangeal (PIP) joint flexion contracture was used to evaluate clinical outcomes resulting from nonsurgical treatment.
RESULTS
Qualitative assessments of proximal phalangeal head remodeling exhibited meaningful improvements. Both radiographic parameters showed significant change between their status before and after intervention and had excellent intra- and interobserver reliability. Average PIP joint flexion contracture significantly improved. In the noncamptodactyly group, neither parameter showed significant differences in accordance with finger types and age ranges.
CONCLUSIONS
Stretching improved movement within the proximal phalangeal joint and helped to restore proximal phalangeal head roundness and concentricity in patients with infantile-type camptodactyly. The HTR and HA would be useful indices for objectively assessing the degree of bony deformity in patients with camptodactyly.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic IV.
Topics: Child; Contracture; Finger Joint; Finger Phalanges; Humans; Joint Dislocations; Range of Motion, Articular; Reproducibility of Results
PubMed: 31005462
DOI: 10.1016/j.jhsa.2019.02.014 -
Plastic and Reconstructive Surgery Feb 2020Posttraumatic proximal interphalangeal (PIP) joint contractures of the digits are common and are associated with impaired hand function. However, relapse is common after...
BACKGROUND
Posttraumatic proximal interphalangeal (PIP) joint contractures of the digits are common and are associated with impaired hand function. However, relapse is common after surgical release of PIP joint contractures. This article presents a novel treatment strategy with a PIP joint adipofascial flap to resurface the joint after release, and compares patients with similar joint contracture release who did and did not undergo resurfacing with a PIP joint adipofascial flap.
METHODS
From January of 2010 to January of 2018, 10 patients received single-digit PIP joint flexion contracture release and PIP joint adipofascial flap resurfacing; 20 patients received a stepwise release as a control group. Thirty joints were compared, and the degree of extension lag improvement over time was measured during an average follow-up period of 292.4 days.
RESULTS
Greater extension lag improvement was observed in the PIP joint adipofascial flap group compared with the control group (37.0 ± 19.2 degrees versus 21.0 ± 19.5 degrees; p =0.055). The ratio of improvement was also significantly higher in the flap group (0.79 ± 0.26 versus 0.49 ± 0.46; p =0.049). Flap resurfacing appeared to have a beneficial effect on improvements in extension lag (p =0.042), whereas a higher number of secondary operations, associated fractures, and maximum visual analogue scale score 1 week postoperatively were negatively associated with extension lag in univariate analysis (p < 0.05). Generalized estimating modeling showed that flap resurfacing had a significantly positive effect on extensor lag improvement with time (β = 2.235; p =0.04).
CONCLUSIONS
PIP joint adipofascial flap resurfacing following PIP joint contracture release may improve and maintain extensor lag. Recovery of joint motion may also be quicker compared with conventional release alone.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, III.
Topics: Adipose Tissue; Adolescent; Adult; Aged; Child; Contracture; Exercise Therapy; Female; Finger Joint; Humans; Male; Middle Aged; Range of Motion, Articular; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 31985638
DOI: 10.1097/PRS.0000000000006472