Arthrofibrosis of the Knee after Tibial Spine Fracture in Children: A Report of Two Complicated Cases

Gholve, Purushottam; Voellmicke, Kurt V.; Güven, Melih; Potter, Hollis G.; Rodeo, Scott A.; Widmann, Roger F.

doi:10.1007/s11420-007-9059-y

Cited by 12 publications

(10 citation statements)

References 21 publications

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“…It can occur in most joints and frequently onsets following injury, surgery, diabetes or immobilization; however, the precise etiology remains unclear. 1–4 A particularly common example is adhesive capsulitis of the shoulder, also known as frozen shoulder syndrome. It is characterized by a painful fibrotic expansion of the synovium and joint capsule, which gradually results in the loss of active and passive motion of the joint.…”

mentioning

confidence: 99%

Gene delivery of TGF-β1 induces arthrofibrosis and chondrometaplasia of synovium in vivo

Watson

Gouze

Levings

et al. 2010

Laboratory Investigation

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To understand the cellular and molecular events contributing to arthrofibrosis, we used an adenovirus to deliver and overexpress transforming growth factor-beta 1 (TGF-β1) cDNA (Ad.TGF-β1) in the knee joints of immunocompromised rats. Following delivery, animals were killed periodically, and joint tissues were examined macroscopically and histologically. PCR-array was used to assay alterations in expression patterns of extracellular matrix (ECM)-associated genes. By days 5 and 10, TGF-β1 induced an increase in knee diameter and complete encasement of joints in dense scar-like tissue, locking joints at 90° of flexion. Histologically, massive proliferation of synovial fibroblasts was seen, followed by their differentiation into myofibroblasts. The fibrotic tissue displaced the normal architecture of the joint capsule and fused with articular cartilage. RNA expression profiles showed high levels of transcription of numerous MMPs, matricellular and ECM proteins. By day 30, the phenotype of the fibrotic tissue had undergone chondrometaplasia, indicated by cellular morphology, matrix composition and >100-fold increases in expression of collagen type II and cartilage link protein. Pre-labeling of articular cells by injection with recombinant lentivirus containing eGFP cDNA showed fibrotic/cartilaginous tissues appeared to arise almost entirely from local proliferation and differentiation of resident fibroblasts. Altogether, these results indicate that TGF-β1 is a potent inducer of arthrofibrosis, and illustrate the proliferative potential and plasticity of articular fibroblasts. They suggest the mechanisms causing arthrofibrosis share many aspects with tumorigenesis.

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mentioning

confidence: 99%

Gene delivery of TGF-β1 induces arthrofibrosis and chondrometaplasia of synovium in vivo

Watson

Gouze

Levings

et al. 2010

Laboratory Investigation

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“…15 Although excellent results have been reported with these techniques, arthrofibrosis continues to be one of the major complications following treatment of these fractures. 3,[16][17][18] Although the classification of tibial spine fractures by Meyers and McKeever 13 is widely used, the conclusion of their study that "full motion is the rule" and "no elaborate fixation is needed" does not hold true. The rate of arthrofibrosis after treatment of tibial spine fractures has been reported to be as high as 60%.…”

Section: Discussionmentioning

confidence: 99%

“…8 Also, the treatment of established arthrofibrosis in children and adolescents is associated with significant morbidity, including growth disturbances, distal femoral fractures, and the inability to regain full motion. 3,4 Thus, prevention rather than treatment of permanent arthrofibrosis is of the utmost importance. 20 The current authors agree with Noyes et al 20 that the initial phase of arthrofibrosis is transient and an early rehabilitation and intervention approach can prevent permanent arthrofibrosis.…”

Section: Discussionmentioning

confidence: 99%

“…Similar to screw fixation, suture fixation has also been associated with arthrofibrosis. [2][3][4]17,30 The current authors reserve the use of suture fixation for small or comminuted tibial spine fracture fragments (type IV, as described by Zaricznyj 31 ), which were not part of their study. The authors do not have experience with other reported methods of fixation, including retrograde screws, 32 headless screws, 33 epiphyseal suture fixation, 34 or bioabsorbable fixation.…”

Section: A B E62mentioning

confidence: 99%

“…A rthrofibrosis after tibial spine fracture is a major complication associated with poor clinical outcomes. [1][2][3][4] The definition of arthrofibrosis of the knee varies in the literature. 5 In simpler terms, any symptomatic loss of knee motion constitutes arthrofibrosis.…”

mentioning

confidence: 99%

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Prevention of Arthrofibrosis After Arthroscopic Screw Fixation of Tibial Spine Fracture in Children and Adolescents

Parikh¹,

Myer²,

Eismann³

2014

Orthopedics

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Arthrofibrosis is a major complication of tibial spine fracture treatment in children, potentially resulting in knee pain, quadriceps weakness, altered gait, decreased function, inability to return to sports, and long-term osteoarthritis. Thus, prevention rather than treatment of arthrofibrosis is desirable. The purpose of this study was to evaluate an aggressive postoperative rehabilitation and early intervention approach to prevent permanent arthrofibrosis after tibial spine fracture treatment and to compare epiphyseal and transphyseal screws for fixation. A consecutive series of 24 patients younger than age 18 with displaced type II and III tibial spine fractures who underwent arthroscopic reduction and screw fixation between 2006 and 2011 were retrospectively reviewed. Final range of motion was compared between patients with epiphyseal (n=12) and transphyseal (n=9) screws. One-third (4 of 12) of patients with epiphyseal screws underwent arthroscopic debridement and screw removal approximately 3 months postoperatively; 3 patients lacked 5° to 15° of extension, 1 experienced pain with extension, and 1 had radiographic evidence of screw pullout, loss of reduction, and resultant malunion. In the transphyseal screw group, 3 patients had 10° loss of extension, and all corrected after arthroscopic debridement and screw removal. The two groups did not significantly differ in time to hardware removal or return to sports or final range of motion. No growth disturbances were identified in patients after transphyseal screw removal. An aggressive approach of postoperative rehabilitation and early intervention after arthroscopic reduction and screw fixation of tibial spine fractures in children was successful in preventing permanent arthrofibrosis.

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Tibial Spine Fractures

Yen¹,

Kocher²

2012

Insall &Amp;amp;amp Scott Surgery of the Knee

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Arthrofibrosis of the Knee after Tibial Spine Fracture in Children: A Report of Two Complicated Cases

Cited by 12 publications

References 21 publications

Gene delivery of TGF-β1 induces arthrofibrosis and chondrometaplasia of synovium in vivo

Gene delivery of TGF-β1 induces arthrofibrosis and chondrometaplasia of synovium in vivo

Prevention of Arthrofibrosis After Arthroscopic Screw Fixation of Tibial Spine Fracture in Children and Adolescents

Tibial Spine Fractures

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