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PloS One 2020The hip joint capsule contributes to the stability of the hip joint and lower extremity, yet this structure is incised and often removed during total hip arthroplasty...
Innervation of the hip joint capsular complex: A systematic review of histological and immunohistochemical studies and their clinical implications for contemporary treatment strategies in total hip arthroplasty.
The hip joint capsule contributes to the stability of the hip joint and lower extremity, yet this structure is incised and often removed during total hip arthroplasty (THA). Increasing incidence of osteoarthritis is accompanied by a dramatic rise in THAs over the last few decades. Consequently, to improve this treatment, THA with capsular repair has evolved. This partial restoration of physiological hip stability has resulted in a substantial reduction in post-operative dislocation rates compared to conventional THA without capsular repair. A further reason for the success of this procedure is thought to be the preservation of the innervation of the capsule. A systematic review of studies investigating the innervation of the hip joint capsular complex and pseudocapsule with histological techniques was performed, as this is not well established. The literature was sought from databases Amed, Embase and Medline via OVID, PubMed, ScienceDirect, Scopus and Web of Science; excluding articles without a histological component and those involving animals. A total of 21 articles on the topic were identified. The literature indicates two primary outcomes and potential clinical implications of the innervation of the capsule. Firstly, a role in the mechanics of the hip joint, as mechanoreceptors may be present in the capsule. However, the nomenclature used to describe the distribution of the innervation is inconsistent. Furthermore, the current literature is unable to reliably confirm the proprioceptive role of the capsule, as no immunohistochemical study to date has reported type I-III mechanoreceptors in the capsule. Secondly, the capsule may play a role in pain perception, as the density of innervation appears to be altered in painful individuals. Also, increasing age may indicate requirements for different strategies to surgically manage the hip capsule. However, this requires further study, as well as the role of innervation according to sex, specific pathology and other morphometric variables. Increased understanding may highlight the requirement for capsular repair following THA, how this technique may be developed and the contribution of the capsule to joint function and stability.
Topics: Arthroplasty, Replacement, Hip; Hip Joint; Humans; Joint Capsule; Joint Instability; Postoperative Complications
PubMed: 32101545
DOI: 10.1371/journal.pone.0229128 -
Okajimas Folia Anatomica Japonica May 2002Using 26 osteoligamentous lumbar vertebral columns (260 facets), we morphometrically investigated the cartilagenous joint surface, inner capsular surface and capsular...
Using 26 osteoligamentous lumbar vertebral columns (260 facets), we morphometrically investigated the cartilagenous joint surface, inner capsular surface and capsular thickness. We also examined whether the subcapsular pocket was present and, if present, how far it extended along the joint margin. The proportion of the inner capsular area in the total joint surface area in a facet (the capsular-joint surface ratio) was hypothesized to correspond to the potential looseness (or tightness) of the facet. The absolute data themselves seemed to be useful for better understanding of the joint morphology. However, further evaluations of the differences between segments, left/right differences, individual segmental fluctuation patterns and correlations between parameters provided a novel classification of specimens according to the hypothetical progress of joint degeneration. Criteria for the classification existed in 1) the laterality in parameters defined as more than 100% larger or smaller than the contralateral facet and 2) the drastic segmental difference in parameters over 50% larger or smaller than the adjacent segment. Consequently, three types were identified: 1) outside of the criteria in both area and thickness (-/- type, 9 of 26); 2) the criteria did not fit the area parameters but did fit the thickness parameters (-/+ type, 8); the criteria were filled in both categories of parameters (+/+ type, 9). Notably, in the +/+ types, the capsular thickness and capsular-joint surface ratio correlated significantly (p < 0.01), i.e., the hypothetical loose joint had a thick capsule. We speculated that early joint degeneration starts from the -/- type and advances via the -/+ type to the +/+ type. Considerating these results, we recommended using MR imaging for detailed identification of laterality in the capsular thickness for low-back pain patients to discriminate candidates for future severe degenerative changes of the articular cartilage in the lumbar spine.
Topics: Aged; Aged, 80 and over; Cadaver; Female; Functional Laterality; Humans; Joint Capsule; Lumbar Vertebrae; Male; Middle Aged; Zygapophyseal Joint
PubMed: 12199537
DOI: 10.2535/ofaj.79.43 -
Annals of Biomedical Engineering Mar 2005There is a high incidence of low back pain (LBP) associated with occupations requiring sustained and/or repetitive lumbar flexion (SLF and RLF, respectively), which...
There is a high incidence of low back pain (LBP) associated with occupations requiring sustained and/or repetitive lumbar flexion (SLF and RLF, respectively), which cause creep of the viscoelastic tissues. The purpose of this study was to determine the effect of creep on lumbar biomechanics and facet joint capsule (FJC) strain. Specimens were flexed for 10 cycles, to a maximum 10 Nm moment at L5-S1, before, immediately after, and 20 min after a 20-min sustained flexion at the same moment magnitude. The creep rates of SLF and RLF were also measured during each phase and compared to the creep rate predicted by the moment relaxation rate function of the lumbar spine. Both SLF and RLF resulted in significantly increased intervertebral motion, as well as significantly increased FJC strains at the L3-4 to L5-S1 joint levels. These parameters remained increased after the 20-min recovery. Creep during SLF occurred significantly faster than creep during RLF. The moment relaxation rate function was able to accurately predict the creep rate of the lumbar spine at the single moment tested. The data suggest that SLF and RLF result in immediate and residual laxity of the joint and stretch of the FJC, which could increase the potential for LBP.
Topics: Aged; Biomechanical Phenomena; Cadaver; Computer Simulation; Elasticity; Female; Humans; In Vitro Techniques; Joint Capsule; Lumbar Vertebrae; Male; Models, Biological; Stress, Mechanical; Tensile Strength; Viscosity; Zygapophyseal Joint
PubMed: 15868730
DOI: 10.1007/s10439-005-1742-x -
Scientific Reports Apr 2022Although the flexion abduction external rotation (FABER) test is a useful hip provocation test, hip soft tissue characteristics in the FABER position remain unclear....
Although the flexion abduction external rotation (FABER) test is a useful hip provocation test, hip soft tissue characteristics in the FABER position remain unclear. This study investigated the in-vivo joint capsule characteristics, including its articular cavity area and relation to the fat pad surrounded by the joint capsule and pericapsular muscles, in the FABER position using magnetic resonance imaging. Thirteen hips from 13 healthy volunteers were analyzed. The images were obtained, with the participant hips at 15°-extension, 45°-flexion, and in the FABER position, to analyze the articular cavity size and fat pad and calculate these ratios to size of the femoral neck. The articular cavity area and its ratio to the femoral neck were significantly greatest in the FABER position, followed by those in the hip flexion and extension. Additionally, the area of the fat pad in the inter-pericapsular muscle space and its ratio to the femoral neck in the FABER position were significantly larger than those in the hip flexion and, as a tendency, larger than those in hip extension. To the best of our knowledge, this is the first in-vivo study to show the interrelationship among the joint capsule, pericapsular muscles, and fat pad in the FABER position.
Topics: Hip; Hip Joint; Humans; Joint Capsule; Magnetic Resonance Imaging; Range of Motion, Articular
PubMed: 35459931
DOI: 10.1038/s41598-022-10718-7 -
Physiological Research Feb 2020This study tested whether cell cycle inhibitor mitomycin C (MMC) prevents arthrogenic contracture progression during remobilization by inhibiting fibroblast...
This study tested whether cell cycle inhibitor mitomycin C (MMC) prevents arthrogenic contracture progression during remobilization by inhibiting fibroblast proliferation and fibrosis in the joint capsule. Rat knees were immobilized in a flexed position to generate flexion contracture. After three weeks, the fixation device was removed and rat knees were allowed to freely move for one week. Immediately after and three days after fixator removal, rats received intra-articular injections of MMC or saline. The passive extension range of motion (ROM) was measured before and after myotomy of the knee flexors to distinguish myogenic and arthrogenic contractures. In addition, both cellularity and fibrosis in the posterior joint capsule were assessed histologically. Joint immobilization significantly decreased ROMs both before and after myotomy compared with untreated controls. In saline-injected knees, remobilization increased ROM before myotomy, but further decreased that after myotomy compared with that of knees immediately after three weeks of immobilization. Histological analysis revealed that hypercellularity, mainly due to fibroblast proliferation, and fibrosis characterized by increases in collagen density and joint capsule thickness occurred after remobilization in saline-injected knees. Conversely, MMC injections were able to prevent the remobilization-enhanced reduction of ROM after myotomy by inhibiting both hypercellularity and joint capsule fibrosis. Our results suggest that joint capsule fibrosis accompanied by fibroblast proliferation is a potential cause of arthrogenic contracture progression during remobilization, and that inhibiting fibroblast proliferation may constitute an effective remedy.
Topics: Animals; Antibiotics, Antineoplastic; Cell Proliferation; Contracture; Drug Evaluation, Preclinical; Fibroblasts; Immobilization; Injections, Intra-Articular; Joint Capsule; Male; Mitomycin; Range of Motion, Articular; Rats, Wistar
PubMed: 31852201
DOI: 10.33549/physiolres.934149 -
Journal of Orthopaedic Surgery (Hong... Apr 2007
Topics: Bursitis; Fibrosis; Humans; Joint Capsule; Range of Motion, Articular; Shoulder Joint; Shoulder Pain
PubMed: 17429107
DOI: 10.1177/230949900701500101 -
Journal of Orthopaedic Surgery and... Dec 2018Wound closure is one of the crucial aspects of total knee arthroplasty (TKA) for patients who perform high-flexion activities of daily living, because the joint capsule... (Comparative Study)
Comparative Study
BACKGROUND
Wound closure is one of the crucial aspects of total knee arthroplasty (TKA) for patients who perform high-flexion activities of daily living, because the joint capsule is highly stretched and integrity of the arthrotomy closure must be maintained. Watertightness of the knee joint is a different aspect of the repair integrity of arthrotomy closure and is being noticed with increasing usage of the drain clamp method for blood management after TKA. Recently, the barbed knotless suture has been growing in popularity as a strong, secure closure appropriate for high-tension areas, such as the fascia and joint capsule. The purpose of this study was to compare the barbed knotless suture with simple interrupted suture in cadaveric knees.
METHODS
Nine fresh-frozen cadaveric lower extremities were used. After placing a parapatellar incision and setting a closed suction drain, arthrotomies were closed randomly using three suture materials: simple interrupted absorbable suture (No. 0 PDS, group C); or a single running knotless barbed suture Stratafix with 8N (group BS-8N) or 15N (group BS-15N) of tension. After arthrotomy closure, saline was injected in a retrograde manner into the joint through a drain until saline started to leak from the joint. Peak values for intra-articular pressure and infusion volume in each group were recorded and compared.
RESULTS
Mean infusion volumes were 13.0 ± 7.2 ml, 38.6 ± 10.7 ml, and 5.1 ± 2.5 ml in groups BS-8N, BS-15N, and C, respectively. Mean intra-articular pressures were 0.67 ± 0.47 kPa, 9.44 ± 4.55 kPa, and 0.56 ± 0.44 kPa in groups BS-8N, BS-15N, and C, respectively. Infusion volume and joint internal pressure were significantly higher in group BS-15N than in groups BS-8N (p = 0.008) or C (p = 0.04).
CONCLUSIONS
Barbed suture with 15N appears appropriate for maintaining maximal watertightness after knee joint capsule closure, offering successful drain clamping, higher resistance to early mobilization protocols, and subsequent achievement of early deep knee flexion after TKA.
Topics: Arthroplasty, Replacement, Knee; Cadaver; Humans; Joint Capsule; Knee Joint; Postoperative Complications; Random Allocation; Range of Motion, Articular; Saline Solution; Suture Techniques; Sutures
PubMed: 30572958
DOI: 10.1186/s13018-018-1035-3 -
Capsule function following anterior dislocation: implications for diagnosis of shoulder instability.Journal of Orthopaedic Research :... Jun 2013During shoulder dislocation, the glenohumeral capsule undergoes non-recoverable strain, leading to joint instability. Clinicians use physical exams to diagnose injury...
During shoulder dislocation, the glenohumeral capsule undergoes non-recoverable strain, leading to joint instability. Clinicians use physical exams to diagnose injury and direct repair procedures; however, they are subjective and do not provide quantitative information. Our objectives were to: (1) determine the relationship between capsule function following anterior dislocation and non-recoverable strain; and (2) identify joint positions at which physical exams can be used to detect non-recoverable strain in specific capsule regions. Physical exams were simulated at three joint positions including external rotation (ER) using robotic technology before and after anterior dislocation. The resulting joint kinematics, strain distribution in the capsule, and non-recoverable strain were determined. Following dislocation, anterior translation increased by as much as 48% (0° ER: p = 0.03; 30° ER: p = 0.03; 60° ER: p < 0.01). Capsule sub-regions with less non-recoverable strain required more ER to detect differences in the strain ratios between the intact and injured joint. Strain ratio changes on the humeral side of the posterior axillary pouch (0.31 ± 0.32) were significant at all joint positions (0° ER: p = 0.03; 30° ER: p = 0.048; 60° ER: p = 0.04), whereas strain ratio differences on the humeral side of the anterior axillary pouch (0.18 ± 0.21) were significant only at 60° of ER (p = 0.03). Therefore, standardizing physical exams for joint position could help surgeons identify specific locations of non-recoverable strain that may have been ignored.
Topics: Aged; Humans; Joint Capsule; Joint Instability; Physical Examination; Shoulder Dislocation; Shoulder Joint
PubMed: 23335098
DOI: 10.1002/jor.22300 -
British Journal of Sports Medicine May 2006The mechanism of the overhead action in throwing sports has been studied extensively. This motion is unnatural and highly dynamic, often exceeding the physiological... (Review)
Review
The mechanism of the overhead action in throwing sports has been studied extensively. This motion is unnatural and highly dynamic, often exceeding the physiological limits of the joint. Owing to overload of various anatomical structures, the shoulder is susceptible to injury. Optimal shoulder function requires good kinetic chain function, optimal stability, and coordination of the scapula in the overhead action. A well balanced action of the rotator cuff muscles and capsular structures is necessary to obtain a stable centre of rotation during the overhead action. This review concerns shoulder injuries, related to the overhead motion in tennis players, which can be explained by the same mechanism as thrower's shoulder.
Topics: Biomechanical Phenomena; Humans; Joint Capsule; Movement; Range of Motion, Articular; Rotator Cuff; Rotator Cuff Injuries; Shoulder; Shoulder Injuries; Tennis
PubMed: 16632575
DOI: 10.1136/bjsm.2005.023218 -
Molecular Pain Aug 2014Cyclic phosphatidic acid (cPA) is a naturally occurring phospholipid mediator with a unique cyclic phosphate ring at the sn-2 and sn-3 positions of its glycerol...
BACKGROUND
Cyclic phosphatidic acid (cPA) is a naturally occurring phospholipid mediator with a unique cyclic phosphate ring at the sn-2 and sn-3 positions of its glycerol backbone. Natural cPA and its chemically stabilized cPA derivative, 2-carba-cPA (2ccPA), inhibit chronic and acute inflammation, and 2ccPA attenuates neuropathic pain. Osteoarthritis (OA) is a degenerative disease frequently associated with symptoms such as inflammation and joint pain. Because 2ccPA has obvious antinociceptive activity, we hypothesized that 2ccPA might relieve the pain caused by OA. We aimed to characterize the effects of 2ccPA on the pathogenesis of OA induced by total meniscectomy in the rabbit knee joint.
RESULTS
Intra-articular injection of 2ccPA (twice a week for 42 days) significantly reduced pain and articular swelling. Histopathology showed that 2ccPA suppressed cartilage degeneration in OA. We also examined the effects of 2ccPA on the inflammatory and catabolic responses of human OA synoviocytes and chondrosarcoma SW1353 cells in vitro. 2ccPA stimulated synthesis of hyaluronic acid and suppressed production of the metalloproteinases MMP-1, -3, and -13. However, it had no effect on the production of interleukin (IL)-6, an inflammatory cytokine. The suppressive effect of 2ccPA on MMP-1 and -3 production in synoviocytes and on MMP-13 production in SW1353 cells was not mediated by the lysophosphatidic acid receptor, LPA1 receptor (LPA1R).
CONCLUSIONS
Our results suggest that 2ccPA significantly reduces the pain response to OA by inducing hyaluronic acid production and suppressing MMP-1, -3, and -13 production in synoviocytes and chondrocytes.
Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Cells, Cultured; Cytokines; Disease Models, Animal; Edema; Female; Follow-Up Studies; Humans; Isoxazoles; Joint Capsule; Male; Middle Aged; Osteoarthritis; Pain Measurement; Phosphatidic Acids; Propionates; RNA, Messenger; Rabbits; Synovial Membrane; Time Factors
PubMed: 25123228
DOI: 10.1186/1744-8069-10-52