-
Cureus Sep 2022Idiopathic capital femoral chondrolysis is a rare condition most commonly seen in African-American pre-adolescent females. The primary symptoms are hip stiffness and...
Idiopathic capital femoral chondrolysis is a rare condition most commonly seen in African-American pre-adolescent females. The primary symptoms are hip stiffness and pain, which are accompanied by limping. Physical examinations typically reveal an external rotation contracture, flexion contracture, and abduction contracture. There is also immobility at the hip secondary to muscle spasms. Here, we present and discuss the follow-up case of a 10-year-old female patient who was diagnosed with idiopathic chondrolysis of capital femoral epiphysis, right side, and underwent right hip arthroscopic evaluation and lavage. At follow-up two months after the right hip arthroscopic evaluation, she presented with painless limping on the right side. The patient underwent soft tissue release right hip under general anaesthesia and was discharged in stable condition.
PubMed: 36225422
DOI: 10.7759/cureus.28789 -
Journal of Orthopaedic Research :... Sep 2021Posttraumatic joint contracture (PTJC) is a debilitating condition characterized by loss of joint motion following injury. Previous work in a rat model of elbow PTJC...
Posttraumatic joint contracture (PTJC) is a debilitating condition characterized by loss of joint motion following injury. Previous work in a rat model of elbow PTJC investigated disease etiology, progression, and recovery in only male animals; this study explored sex-based differences. Rat elbows were subjected to a unilateral anterior capsulotomy and lateral collateral ligament transection followed by 42 days of immobilization and 42 days of free mobilization. Grip strength and gait were collected throughout the free mobilization period while joint mechanical testing, microcomputed tomography and histological analysis were performed postmortem. Overall, few differences were seen between sexes in functional, mechanical, and morphological outcomes with PTJC being similarly debilitating in male and female animals. Functional measures of grip strength and gait showed that, while some baseline differences existed between sexes, traumatic injury produced similar deficits that remained significantly different long-term when compared to control animals. Similarly, male and female animals both had significant reductions in joint range of motion due to injury. Ectopic calcification (EC), which had not been previously evaluated in this injury model, was present in all limbs on the lateral side. Injury caused increased EC volume but did not alter mineral density regardless of sex. Furthermore, histological analysis of the anterior capsule showed minor differences between sexes for inflammation and thickness but not for other histological parameters. A quantitative understanding of sex-based differences associated with this injury model will help inform future therapeutics aimed at reducing or preventing elbow PTJC.
Topics: Animals; Contracture; Elbow; Female; Joint Dislocations; Male; Range of Motion, Articular; Rats; X-Ray Microtomography; Elbow Injuries
PubMed: 33222267
DOI: 10.1002/jor.24918 -
Journal of ISAKOS : Joint Disorders &... Feb 2024Treatment of the stiff elbow can be a challenging task. A thorough understanding of normal elbow anatomy and the potential causes of elbow contracture are essential for... (Review)
Review
Treatment of the stiff elbow can be a challenging task. A thorough understanding of normal elbow anatomy and the potential causes of elbow contracture are essential for the development of effective treatment strategies. This chapter provides a review of key points for the treating surgeon including normal elbow anatomy, etiological factors that commonly contribute to elbow stiffness, physical examination and imaging of the stiff elbow, and treatment options for contracture correction.
Topics: Humans; Elbow; Elbow Joint; Joint Dislocations; Treatment Outcome; Contracture
PubMed: 37866511
DOI: 10.1016/j.jisako.2023.10.006 -
Journal of ISAKOS : Joint Disorders &... Feb 2024In elbow stiffness, pre-operative assessments should identify the articular and peri-articular tissues involved and, more specifically, they should determine how...
In elbow stiffness, pre-operative assessments should identify the articular and peri-articular tissues involved and, more specifically, they should determine how preserved the articular surfaces and osteo-articular congruity are. We will focus on the most important conditions and tissue reactions after trauma in order to understand the causes of joint stiffness. A logical surgical planning is based upon a deep knowledge of the anatomical obstacles and of the associated lesions that the trauma provoked with. The peri-articular soft tissue contractures. The osteo-articular incongruity.
Topics: Humans; Elbow; Elbow Joint; Elbow Injuries; Treatment Outcome; Joint Dislocations; Arthritis; Ossification, Heterotopic
PubMed: 37879605
DOI: 10.1016/j.jisako.2023.10.009 -
OTA International : the Open Access... Mar 2022Using a rabbit in vivo joint injury model, the primary objective of the study was to determine if a relationship exists between earlier time to initiation of ketotifen...
An in vivo rabbit joint injury model to measure trauma-induced coagulopathy and the effect of timing of administration of ketotifen fumarate on posttraumatic joint contracture.
OBJECTIVES
Using a rabbit in vivo joint injury model, the primary objective of the study was to determine if a relationship exists between earlier time to initiation of ketotifen fumarate (KF) treatment and posttraumatic joint contracture (PTJC) reduction. The secondary objective was to determine if a coagulation response could be detected with serial thrombelastography (TEG) analysis following acute trauma in this model.
METHODS
PTJC of the knee were created in 25 skeletally mature, New Zealand White rabbits. Five groups of 5 animals were studied: a control group that received twice daily subcutaneous injections of normal saline and 4 treatment groups that received twice daily subcutaneous injections of KF (0.5 mg/kg) starting immediately, 1-, 2-, and 4-weeks post-injury. After 8 weeks of immobilization, flexion contractures were measured biomechanically. Serial TEG analysis was performed on the control group animals pre-injury and weekly post-injury.
RESULTS
The average joint contracture in the Control Group (43.1° ± 16.2°) was higher than all KF treatment groups; however, the differences were not statistically significant. The average joint contracture was lowest in the 2-week post-injury treatment group (29.4° ± 12.1°), although not statistically significant compared to the other treatment groups. Serial TEG analysis demonstrated significantly higher mean maximal amplitude (maximal amplitude = 68.9 ± 1.7 mm; < .001), alpha-angle (81.9° ± 0.9°; < .001), and coagulation index (4.5 ± 0.3; < .001) 1-week post-injury, which normalized to pre-injury values by 5-weeks post-injury.
CONCLUSIONS
The use of the mast cell stabilizer KF within 2 weeks of injury demonstrated a nonsignificant trend towards reducing joint contracture in a rabbit in vivo model of PTJC. TEG and the in vivo rabbit joint injury model may be valuable in future preclinical studies of venous thromboembolism prevention and furthering our understanding of the pathophysiology of posttraumatic hypercoagulability.
PubMed: 35282394
DOI: 10.1097/OI9.0000000000000177 -
Archives of Rehabilitation Research and... Mar 2021To investigate whether nonsurgical treatment can reduce muscle contractures in individuals with neurologic disorders. The primary outcome measure was muscle contractures... (Review)
Review
OBJECTIVE
To investigate whether nonsurgical treatment can reduce muscle contractures in individuals with neurologic disorders. The primary outcome measure was muscle contractures measured as joint mobility or passive stiffness.
DATA SOURCES
Embase, MEDLINE, Cumulative Index to Nursing and Allied Health, and Physiotherapy Evidence Database in June-July 2019 and again in July 2020.
STUDY SELECTION
The search resulted in 8020 records, which were screened by 2 authors based on our patient, intervention, comparison, outcome criteria. We included controlled trials of nonsurgical interventions administered to treat muscle contractures in individuals with neurologic disorders.
DATA EXTRACTION
Authors, participant characteristics, intervention details, and joint mobility/passive stiffness before and after intervention were extracted. We assessed trials for risk of bias using the Downs and Black checklist. We conducted meta-analyses investigating the short-term effect on joint mobility using a random-effects model with the pooled effect from randomized controlled trials (RCTs) as the primary outcome. The minimal clinically important effect was set at 5°.
DATA SYNTHESIS
A total of 70 trials (57 RCTs) were eligible for inclusion. Stretch had a pooled effect of 3° (95% CI, 1-4°; prediction interval (PI)=-2 to 7°; =66%; <.001), and robot-assisted rehabilitation had an effect of 1 (95% CI, 0-2; PI=-8 to 9; =73%; =.03). We found no effect of shockwave therapy (=.56), physical activity (=.27), electrical stimulation (=.11), or botulinum toxin (=.13). Although trials were generally of moderate to high quality according to the Downs and Black checklist, only 18 of the 70 trials used objective measures of muscle contractures. In 23 trials, nonobjective measures were used without use of assessor-blinding.
CONCLUSIONS
We did not find convincing evidence supporting the use of any nonsurgical treatment option. We recommend that controlled trials using objective measures of muscle contractures and a sufficiently large number of participants be performed.
PubMed: 33778477
DOI: 10.1016/j.arrct.2021.100104 -
The Knee Jun 2023To explore the effects and mechanism of millimeter-wave treatment on the development of joint stiffness in the immobilized knee rat model.
AIM
To explore the effects and mechanism of millimeter-wave treatment on the development of joint stiffness in the immobilized knee rat model.
METHODS
Twenty-four Sprague-Dawley (SD) rats were randomly divided into the control group (O, n = 8), the surgical control group (OC, n = 8), and the millimeter-wave treatment group (MO, n = 8). After immobilized knee modeling, the knee mobility and quadriceps diameter was measured at the 6th week. Hematoxylin and eosin and Masson staining were performed to detect the pathology and fibrous lesions of the knee joint. Furthermore, the expression of TGF-β1 and Collagen I was quantified by immunohistochemical assay in the knee capsule, and Western blotting was performed to quantify the protein expression of NF-κB and MuRF1 in skeletal muscle.
RESULTS
Compared with the O group, knee mobility, and quadriceps diameter was decreased (P < 0.01), and articular capsule fibrosis and quadriceps atrophy occurred in all rats with fixed knee joints. Compared with the OC group, millimeter-wave treatment significantly increased articular mobility and the quadriceps diameter; and improved the fibrotic lesions of the joint capsule and quadriceps atrophy. Moreover, levels of TGF-β1, Collagen I, and MuRF1 were upregulated (P < 0.01) by knee immobilization, and collagen fiber content in the articular capsule was also increased (P < 0.01). However, millimeter-wave treatment reversed it. The most noteworthy result was that NF-κB expression was not significantly different in all groups.
CONCLUSION
Millimeter-wave treatment reversed joint contracture and quadriceps atrophy caused by joint fixation, inhibited TGF-β1 and Collagen I protein expression of the joint capsule and reduced MuRF1 expression of the quadriceps muscle, thereby inhibiting the development of joint stiffness.
Topics: Animals; Rats; Atrophy; Collagen Type I; Contracture; Joint Capsule; Joint Diseases; Knee Joint; NF-kappa B; Range of Motion, Articular; Rats, Sprague-Dawley; Transforming Growth Factor beta1
PubMed: 37086540
DOI: 10.1016/j.knee.2023.03.019 -
Acta Orthopaedica Apr 2021Background and purpose - Joint contracture is a common problem among children with cerebral palsy (CP). To prevent severe contracture and its effects on adjacent joints,...
Background and purpose - Joint contracture is a common problem among children with cerebral palsy (CP). To prevent severe contracture and its effects on adjacent joints, it is crucial to identify children with a reduced range of motion (ROM) early. We examined whether significant hip, knee, or foot contracture occurs earliest in children with CP.Patients and methods - This was a longitudinal study involving 27,230 measurements obtained for 2,693 children (59% boys, 41% girls) with CP born 1990 to 2018 and registered before 5 years of age in the Swedish surveillance program for CP. The analysis was based on 4,751 legs followed up for an average of 5.0 years. Separate Kaplan-Meier (KM) curves were drawn for each ROM to illustrate the proportions of contracture-free legs at a given time during the follow-up. Using a clustered bootstrap method and considering the child as the unit of clustering, 95% pointwise confidence intervals were generated for equally spaced time points every 2.5 years for each KM curve.Results - Contracture developed in 34% of all legs, and the median time to the first contracture was 10 years from the first examination. Contracture was most common in children with a higher Gross Motor Function Classification System (GMFCS) level. The first contracture was a flexion contracture preventing dorsiflexion in children with GMFCS level I or II and preventing knee extension in children with GMFCS level III to V.Interpretation - Early interventions to prevent knee and foot contractures in children with CP should be considered.
Topics: Adolescent; Cerebral Palsy; Child; Child, Preschool; Contracture; Female; Foot Joints; Hip Joint; Humans; Knee Joint; Longitudinal Studies; Male; Sweden; Time Factors
PubMed: 33228441
DOI: 10.1080/17453674.2020.1848154 -
Journal of ISAKOS : Joint Disorders &... Apr 2024Stiffness is a clinical disorder that affects the patient's function of the entire upper limb. Many classifications systems have been developed for elbow stiffness based...
Stiffness is a clinical disorder that affects the patient's function of the entire upper limb. Many classifications systems have been developed for elbow stiffness based on the plane of motion, severity, aetiology, prognosis or anatomical location. A new classification, the Stiffness types and Influencing Factors Classification System, is proposed as a treatment algorithm to guide the surgical treatment and the preferred operative approach (open or arthroscopic).
Topics: Humans; Contracture; Elbow; Elbow Joint; Joint Diseases; Prognosis
PubMed: 37923144
DOI: 10.1016/j.jisako.2023.10.011 -
Gait & Posture Sep 2023Toe-walking is one of the most common gait deviations (due to soleus and/or gastrocnemius muscle contractures), compromising the first (heel rocker) and second (ankle...
BACKGROUND
Toe-walking is one of the most common gait deviations (due to soleus and/or gastrocnemius muscle contractures), compromising the first (heel rocker) and second (ankle rocker) of the foot during walking. The aim of this study is to evaluate the effect of emulated artificially gastrocnemius and soleus contractures on the first and second rocker during walking.
METHOD
An exoskeleton was built to emulate contractures of the bilateral gastrocnemius and soleus muscles. Ten healthy participants were recruited to walk under the following conditions: without emulated contractures or with bilateral emulated contractures at 0°,10°, 20° and 30° of plantarflexion of the soleus or gastrocnemius in order to create an artificial restriction of dorsiflexion ankle movement. A linear regression from the ankle plantar-dorsiflexion angle pattern was performed on 0-5 % of the gait cycle (first rocker) and on 12-31 % of the gait cycle (second rocker) to compute the slope of the curve. The proportion of participants with the presence of the first and second rocker was then computed. A Statistical Parametric Mapping (SPM) analysis assessed the kinematic variations among different degrees of emulated contractures.
FINDINGS
The first and second rockers are completely absent from 10° of plantarflexion emulated contracture. The data indicate there was a non-linear shift of the gait pattern of the ankle kinematics and an important shift toward plantarflexion values with the loss of the rockers.
INTERPRETATION
This study suggests that toe-walking in the experimental simulation situation is not necessarily due to a high emulated contracture level and can occur with a small emulated contracture by an adaptation choice. This study may improve interpretation of clinical gait analysis and shows that the link between the level of gastrocnemius/soleus emulated contracture and progression of toe-walking (increased plantarflexion during gait) is not linear.
Topics: Humans; Gait; Muscle, Skeletal; Walking; Contracture; Ankle Joint; Movement Disorders; Toes; Biomechanical Phenomena
PubMed: 37523808
DOI: 10.1016/j.gaitpost.2023.07.285