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Scientific Reports Nov 2021Recently, pathological changes in the fat pad on the anterior inferior iliac spine (AIIS), between the proximal rectus femoris and joint capsule, have been highlighted...
Recently, pathological changes in the fat pad on the anterior inferior iliac spine (AIIS), between the proximal rectus femoris and joint capsule, have been highlighted as a cause of anterior hip pain. However, precise fat pad features, such as the spatial distribution distal to the AIIS, histological features, and in vivo tissue elasticity, remain unclear. This study aimed to investigate the morphological characteristics of the fat pad on the AIIS. Four hips from four cadaveric donors were both macroscopically and histologically investigated, and eight hips from four volunteers were assessed using ultrasonography. The fat pad on the AIIS was also surrounded by the iliopsoas and gluteus minimus, extending distally to the superficial portion of the vastus lateralis, and the anterior portion of the gluteus maximus tendon. Histological analysis revealed that the fat pad was composed of loose connective tissue. Based on the ultrasonography, the shear wave velocity in the fat pad was significantly lower than that in the joint capsule. Conclusively, the pathological adhesion between the joint capsule and pericapsular muscles, if caused by fat pad fibrosis, may occur following the abovementioned fat pad spatial distribution.
Topics: Adipose Tissue; Adult; Aged; Anatomic Landmarks; Cadaver; Elasticity Imaging Techniques; Female; Hip Joint; Humans; Joint Capsule; Male; Predictive Value of Tests
PubMed: 34819610
DOI: 10.1038/s41598-021-02381-1 -
Journal of Orthopaedic Science :... Jan 2014Primary frozen shoulder (FS) is a painful contracture of the glenohumeral joint that arises spontaneously without an obvious preceding event. Investigation of the... (Review)
Review
BACKGROUND
Primary frozen shoulder (FS) is a painful contracture of the glenohumeral joint that arises spontaneously without an obvious preceding event. Investigation of the intra-articular and periarticular pathology would contribute to the treatment of primary FS.
REVIEW OF LITERATURE
Many studies indicate that the main pathology is an inflammatory contracture of the shoulder joint capsule. This is associated with an increased amount of collagen, fibrotic growth factors such as transforming growth factor-beta, and inflammatory cytokines such as tumor necrosis factor-alpha and interleukins. Immune system cells such as B-lymphocytes, T-lymphocytes and macrophages are also noted. Active fibroblastic proliferation similar to that of Dupuytren's contracture is documented. Presence of inflammation in the FS synovium is supported by the synovial enhancement with dynamic magnetic resonance study in the clinical setting.
CONCLUSION
Primary FS shows fibrosis of the joint capsule, associated with preceding synovitis. The initiator of synovitis, however, still remains unclear. Future studies should be directed to give light to the pathogenesis of inflammation to better treat or prevent primary FS.
Topics: Arthroscopy; Bursitis; Humans; Joint Capsule; Magnetic Resonance Imaging; Shoulder Joint
PubMed: 24306579
DOI: 10.1007/s00776-013-0495-x -
Aging Feb 2021Joint capsule fibrosis caused by excessive inflammation leading to post-traumatic joint contracture (PTJC). Fibroblasts trigger inflammation under the challenge of...
OBJECTIVES
Joint capsule fibrosis caused by excessive inflammation leading to post-traumatic joint contracture (PTJC). Fibroblasts trigger inflammation under the challenge of various proinflammatory cytokines. Macrophage migration inhibitory factor (MIF) is a prominent proinflammatory cytokine involved in inflammation- and fibrosis-associated pathophysiology, we investigated the role of MIF in PTJC.
METHODS
Using rat PTJC model and fibroblast inflammation model, we detected MIF expression in posterior joint capsule. Primary joint capsule fibroblasts (JFs) were used to investigate the effects of MIF on cell proliferation, migration and proinflammatory cytokines production. The mechanism of JF-mediated events was evaluated by qRT-PCR, western blot and immunoprecipitation. We screened the mRNA expression profile to identify gene candidates that mediate the effect of MIF on JFs.
RESULTS
MIF increased in posterior joint capsule following PTJC and co-localized with fibroblasts. Injection of MIF inhibitor significantly suppressed joint capsule inflammation and fibrosis. , MIF promoted JF proliferation, migration, and inflammation by regulating mitogen-activated protein kinase/nuclear factor-κB pathway through coupling with CD74. Transcriptome analysis revealed that lipid metabolism-related factors Pla2g2a, Angptl4, and Sgpp2, downstream of MIF/CD74, were potentially implicated in JF inflammation.
CONCLUSION
MIF/CD74 axis elicited JF inflammation and may provide new therapeutic targets for joint capsule fibrosis in PTJC.
Topics: Animals; Contracture; Fibroblasts; Inflammation; Joint Capsule; Macrophage Migration-Inhibitory Factors; Rats
PubMed: 33601337
DOI: 10.18632/aging.202505 -
Acta Orthopaedica Feb 2008A recently developed animal model of posttraumatic contractures reflects the chronic stages of the human condition. To understand the initiation of the process, we...
BACKGROUND AND PURPOSE
A recently developed animal model of posttraumatic contractures reflects the chronic stages of the human condition. To understand the initiation of the process, we evaluated the cellular, matrix, and growth factor changes in the joint capsule in the early stages of the animal model, which would not be possible in humans.
METHODS
18 skeletally mature rabbits had intraarticular cortical windows removed from the medial and lateral femoral condyles, and the knee joint was immobilized. The contralateral unoperated limb served as a control. Equal numbers of rabbits were killed 2,4, and 6 weeks after surgery. Myofibroblast, mRNA, and protein determinations were done with immunohistochemistry, RT-PCR, and western blot, respectively.
RESULTS
Myofibroblast numbers were statistically significantly elevated in the joint capsules of the experimental knees as compared to control knees. The mRNA and protein levels for collagen types I and III, matrix metalloproteinases 1 and 13, and transforming growth factor beta1 were statistically significantly greater, and for tissue inhibitor of matrix metalloproteinases 1 significantly less, in the experimental capsules than in the control capsules.
INTERPRETATION
The experimental joint capsule changes in the acute stages of posttraumatic contractures are similar to those in the chronic stages of the process in this model. Thus, it appears that the mechanisms that attenuate the acute stages of the response to injury are circumvented, contributing to a prolonged modulation of myofibroblast numbers, matrix molecules and growth factors, and leading to joint contractures. Thus, in clinical practice, new approaches to prevention of posttraumatic contractures should be implemented as soon as possible.
Topics: Animals; Blotting, Western; Collagen; Contracture; Extracellular Matrix Proteins; Fibroblasts; Intercellular Signaling Peptides and Proteins; Joint Capsule; Knee Injuries; Knee Joint; Matrix Metalloproteinases; Models, Biological; RNA, Messenger; Rabbits; Time Factors
PubMed: 18283583
DOI: 10.1080/17453670710014860 -
Orthopaedics & Traumatology, Surgery &... Dec 2021The superior part of the glenohumeral joint capsule has an intimate relationship with the tendons of the rotator cuff and the tendon of the long head of the biceps. One...
INTRODUCTION
The superior part of the glenohumeral joint capsule has an intimate relationship with the tendons of the rotator cuff and the tendon of the long head of the biceps. One of the strategies currently proposed in the event of a massive cuff rupture is to reconstruct this superior capsule. The main objective of this anatomical study was to describe the superior joint capsule of the embryonic glenohumeral joint and its relationship to the tendons of the rotator cuff.
HYPOTHESIS
The hypothesis was that this structure was an anatomical entity, morphologically identifiable from the embryogenesis of the joint (more pronounced tissue boundaries in the fetus).
MATERIAL AND METHODS
In total, 101 continuous fetal anatomical sections (4 fetuses of 336mm), in the frontal plane, made it possible to identify and measure: diameters of the humeral head and glenoid, dimensions of the joint capsule insertion zone at the level of the greater tubercle, as well as the different thicknesses of this insertion zone. The ratios above the head of the biceps and against the superior labrum were also measured.
RESULTS
At the level of its distal insertion on the greater tuberosity, the thickness of the superior joint capsule varies on average between 0.8mm laterally and 1.2mm next to the tendons of the supraspinatus and infraspinatus; the thickness is 0.9mm next to the middle part of the supraspinatus tendon (the "rotator cable" zone). For its insertion at the level of the glenoid labrum, the superior capsule measures 0.6mm thick on average. The capsule around the tendon of the long head of the biceps is 1.5mm thick on average.
DISCUSSION
Here, we confirm the existence of this superior joint capsule, which can potentially be reconstructed. It is inserted on the greater tubercle covering 30 to 60% of its surface with variations in thickness. The joint capsule is fused to the supraspinatus tendon at the rotator cuff insertion area, preventing independent reinsertion of the tendon.
LEVEL OF EVIDENCE
IV; anatomical study.
Topics: Cadaver; Fetus; Humans; Humeral Head; Joint Capsule; Rotator Cuff; Rotator Cuff Injuries; Shoulder Joint
PubMed: 34562650
DOI: 10.1016/j.otsr.2021.103073 -
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 Journal of Bone and Joint Surgery.... Jul 2018The hip joint capsule passively restrains extreme range of motion, protecting the native hip against impingement, dislocation, and edge-loading. We hypothesized that...
BACKGROUND
The hip joint capsule passively restrains extreme range of motion, protecting the native hip against impingement, dislocation, and edge-loading. We hypothesized that following total hip arthroplasty (THA), the reduced femoral head size impairs this protective biomechanical function.
METHODS
In cadavers, THA was performed through the acetabular medial wall, preserving the entire capsule, and avoiding the targeting of a particular surgical approach. Eight hips were examined. Capsular function was measured by rotating the hip in 5 positions. Three head sizes (28, 32, and 36 mm) with 3 neck lengths (anatomical 0, +5, and +10 mm) were compared.
RESULTS
Internal and external rotation range of motion increased following THA, indicating late engagement of the capsule and reduced biomechanical function (p < 0.05). Internal rotation was affected more than external. Increasing neck length reduced this hypermobility, while too much lengthening caused nonphysiological restriction of external rotation. Larger head sizes only slightly reduced hypermobility.
CONCLUSIONS
Following THA, the capsular ligaments were unable to wrap around the reduced-diameter femoral head to restrain extreme range of motion. The posterior capsule was the most affected, indicating that native posterior capsule preservation is not advantageous, at least in the short term. Insufficient neck length could cause capsular dysfunction even if native ligament anatomy is preserved, while increased neck length could overtighten the anterior capsule.
CLINICAL RELEVANCE
Increased understanding of soft-tissue balancing following THA could help to prevent instability and improve early function. This study illustrates how head size and neck length influence the biomechanical function of the hip capsule in the early postoperative period.
Topics: Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip; Biomechanical Phenomena; Cadaver; Female; Humans; Joint Capsule; Ligaments, Articular; Male; Middle Aged; Range of Motion, Articular
PubMed: 30020129
DOI: 10.2106/JBJS.17.00251 -
Radiology Feb 1999To study the anatomic components of the anterior joint capsule of the normal hip and in children with transient synovitis.
PURPOSE
To study the anatomic components of the anterior joint capsule of the normal hip and in children with transient synovitis.
MATERIALS AND METHODS
Six cadaveric specimens were imaged with ultrasonography (US) with special attention to the anterior joint capsule. Subsequently, two specimens were analyzed histologically. These anatomic findings were correlated with the US findings in 58 healthy children and 105 children with unilateral transient synovitis.
RESULTS
The anterior joint capsule comprises an anterior and posterior layer, mainly composed of fibrous tissue, lined by only a minute synovial membrane. Both fibrous layers were identified separately at US in 98 of 116 (84%) hips of healthy subjects and in all hips with transient synovitis. Overall, the anterior layer was thicker than the posterior layer. In transient synovitis compared with normal hips, no significant thickening of both layers was present (P = .24 and .57 for the anterior and posterior layers, respectively). Normal variants include plicae, local thickening of the capsule, and pseudodiverticula.
CONCLUSION
Increased thickness of the anterior joint capsule in transient synovitis is caused entirely by effusion. There is no US evidence for additional capsule swelling or synovial hypertrophy.
Topics: Adult; Cadaver; Child; Female; Hip Joint; Humans; Joint Capsule; Male; Synovitis; Ultrasonography
PubMed: 10207436
DOI: 10.1148/radiology.210.2.r99fe52499 -
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 -
Annals of the Rheumatic Diseases May 1995
Review
Topics: Animals; Humans; Hyaluronic Acid; Rabbits; Synovial Fluid; Synovial Membrane
PubMed: 7794055
DOI: 10.1136/ard.54.5.429