Can Early Rehabilitation Prevent Posttraumatic Osteoarthritis in the Patellofemoral Joint after Anterior Cruciate Ligament Rupture? Understanding the Pathological Features

Abstract

Knee instability resulting from anterior cruciate ligament (ACL) rupture is a high-risk factor for posttraumatic osteoarthritis (PTOA) in the patellofemoral joint (PFJ). However, whether non-weight-bearing and weight-bearing treatments have chondroprotective effects remains unclear. Twenty-four adult New Zealand White male rabbits were employed in this study. All animals received ACL transection in the right knee and sham surgery in the left knee. The rabbits were randomly assigned to the following groups: (I) In the sedentary (SED) group, the rabbits (n = 6) were simply kept in their cage; (II) In the continuous passive motion (CPM) group, the rabbits (n = 6) performed CPM exercise for 7 days, starting from the first postoperative day; (III) In the active treadmill exercise (TRE) group, the rabbits (n = 6) performed TRE for 2 weeks; (IV) In the CPM + TRE group, the rabbits (n = 6) executed CPM exercise, followed by TRE. Two joint surfaces (the retropatella and femoral trochlear groove) were assessed at 4 weeks after operation. Although the gross appearance in each group was comparable, histological examination revealed significant differences in the articular cartilage status. The CPM group exhibited a greater thickness of articular cartilage, maintenance of tidemark continuity, abundant glycosaminoglycan (GAG), and significantly lower inflammatory cytokine 9, e.g., tumor necrosis factor-alpha (TNF-α) 0 levels, with modest cell apoptosis (i.e., caspase-3). By contrast, the TRE group displayed the worst pathological features: an irregular cartilage surface and chondrocyte disorganization, reduced cartilage thickness, breakdown of the tidemark, depletion of collagen fibers, loss of GAG, and the highest levels of TNF-α and caspase-3 expression. Furthermore, the CPM + TRE group had more favorable outcomes than the SED group, indicating that suitable exercise is needed. The sham treatment displayed no variance in the changes in the two joint surfaces among groups. These data indicate that the application of early CPM rehabilitation is suggested for subjects in order to decrease the risk of PTOA without ACL reconstruction in the PFJ compartment in rabbits. The early TRE program, however, had harmful outcomes. Additionally, inactivity was discovered to initiate the development of PTOA.

Continuous Passive Motion Promotes and Maintains Chondrogenesis in Autologous Endothelial Progenitor Cell-Loaded Porous PLGA Scaffolds during Osteochondral Defect Repair in a Rabbit Model

“…Early CPM rehabilitation was investigated over active treadmill exercise due to its potential to decrease the risk of posttraumatic osteoarthritis and to avoid cruciate ligament reconstruction [42]. Also, the evidence indicated that proper rehabilitation exercises benefit the knee joint restoration and improve collagen formation, GAG expression, and bone remodeling [43,44,45].…”

Induction of osteoarthritis by injecting monosodium iodoacetate into the patellofemoral joint of an experimental rat model

“…Clark et al used felines to inspect the histopathological changes in the articular cartilage of the PF joint after ACLT, and showed some erosion at 4 months and loss of proteoglycan staining at 5 years [ 31 ]. Chang et al investigated the histopathological changes after ACLT in rabbits, and reported that OA changes were detected in the superficial and middle zones of the articular cartilage at 4 weeks postoperatively [ 32 ]. Moreover, Tsai et al investigated the histological changes in the PF joint cartilage that resulted in subchondral marrow edema at 16 weeks and matrix degeneration with irregular surfaces at 32 weeks after ACLT in rats [ 33 ].…”

A Novel Rat Model of Patellofemoral Osteoarthritis Due to Patella Baja, or Low-Lying Patella

“…There have been previously described animal models of PFJOA. The most thoroughly characterized animal models involving PFJOA is the anterior cruciate ligament transection model in cats [12,14], rabbits [13], and rats [23]. Other surgical models involve changes to muscle strength [24,25] and realignment of the patella [26].…”