Experimental model of knee contracture in extension: its prevention using a sheet made from hyaluronic acid and carboxymethylcellulose

Abstract

Treatment once extension contracture of the knee has completed is difficult and costly. The most effective treatment might be the prevention of contracture, especially after joint injury. In order to establish an effective method for contracture prevention we first made an extension contracture in rabbit knees, then studied the effect of a sheet made from hyaluronic acid and carboxymethyl cellulose (HA/CMC) for the prevention of knee contracture. One hundred and twenty two mature male Japanese white rabbits were divided into three groups: (1) group B (n=42), where bony holes were made at the medial and lateral epicondyles, (2) group H (n=40), where HA/CMC sheets were placed on the bony holes, and (3) group S (n=40),where only arthrotomy was performed. All surgical procedures were performed on the right knees. All right knees were fixed at 45 degrees using external fixators; this is the maximum extension angle the rabbit is able to tolerate and still walk. At 1, 3, and 6 weeks after surgery, we measured the moment necessary to flex the knee using a special device. We defined the moment as flexion moment (FM). Forty four left knees were also tested as group N, not operated on and serving as the healthy side. In all groups, FM was increased parallel to the increment of flexion angle from 45 degrees to 115 degrees . At many flexion angles, the FM in group B was higher than those of group S at 3 and 6 weeks. The FM in group H was significantly lower than those of group B at 85 degrees and 95 degrees of flexion at 6 weeks after the operation. By macroscopic observation, the area and degree of adhesion were greater in group B than those of group S. In group H, adhesions around the bony hole were less evident than in group B at 6 weeks after the operation. By histological examination, dense granulation tissue was found adjacent to the bony hole in group B at 3 and 6 weeks after the operation. In contrast, in group H the amount of granulation tissue was smaller at 3 and 6 weeks after the operation than those of group B. The usage of HA/CMC sheet should be effective for prevention of contracture occurring after trauma such as treatment for intra-articular fracture.

A Comparative Study of the Preventive Effects of Mitomycin C and Chitosan on Intraarticular Adhesion after Knee Surgery in Rabbits

“…Some patients suffer from limited joint motion, even rigidity, and debility, due to postoperative intraarticular adhesion formation. This condition causes cartilaginous degeneration of the knee joint, arthralgia, rigidity, etc., and thus leads to the failure of the operation and adversely affects the longterm postoperative therapeutic effect [1][2][3].…”

Reduction of Intra-Articular Adhesion by Topical Application of Daidzein Following Knee Surgery in Rabbits

“…Exact mechanism of formation of adhesion is not understood. Injury result in increase in stimulation and migration of fibroblast and cytokines at the same site and thus start the production of extracellular matrix and collagen, which forms adhesion and scar (Hayashi et al, 2004;Hildebrand et al, 2008;Monument et al, 2012). It is observed that intra articular adhesion alters the functions of knee by cartilage degeneration, stiffness, and arthralgia, all these event results in the surgery failure (Li et al, 2013).…”

Effect of carbodiimide‐derivatized hyaluronic acid gelatin on preventing postsurgical intra‐abdominal adhesion formation and promoting healing in a rat model

“…In addition, HA can bind to receptors in cells and initiate signal transduction pathways leading to angiogenesis. [6][7][8] It was found that HA could reduce adhesions in abdominal or pelvic surgery, [9][10][11] knee, 12,13 rotator cuff, 14 and temporomandibular joint. 15 Films or fluids containing HA have been used for anti-adhesion.…”