Remobilization Does Not Fully Restore Immobilization Induced Articular Cartilage Atrophy

Haapala, Jussi; Arokoski, Jari; Hyttinen, Marko; Lammi, Mikko J.; Tammi, Markku; Kovanen, Vuokko; Helminen, Heikki J.; Kiviranta, Ilkka

doi:10.1097/00003086-199905000-00031

Cited by 119 publications

(147 citation statements)

References 24 publications

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“…Joint immobility may be caused by cast immobilization (CI), external fixation, or after neurological paralysis. Variable and somewhat controversial morphological alterations in the knee joint components resulting from immobilization have been described, and the changes include, increased thickness and decreased area of elastic fibers of the joint capsule 1) , increased surface irregularity [2][3][4] , increased or decreased or unchanged thickness of cartilage [5][6][7][8] , decreased synovial intima length 9) , augmentation of levels of type I c o l l a g e n i n t h e s y n o v i a l i n t i m a 1 0 ) , s y n o v i o c y t e proliferation 11,12) and decreased cross-sectional areas of myocytes 13) .…”

Section: Introductionmentioning

confidence: 99%

Histopathological Changes in Knee Joint Components after Spinal Cord Injury in Rats

et al. 2012

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Abstract.[Purpose] The purpose of this study was to examine the histopathological changes in knee joint components after spinal cord injury (SCI) in rats. [Subjects and Methods] Eighteen adult, nine-week-old female Wistar rats were used in this study. Nine experimental rats underwent a spinal cord transection at the level of Th8-9 and the other nine control rats were raised normally. The animals were assessed at 1, 2 and 4 weeks after surgery. Formalin fixed sections from knee joints were morphologically examined after hematoxylin and eosin staining. Alterations of knee joint components were evaluated at four regions: the synovial membrane within the posterior articular capsule region, the cartilage apposite the femur, the cartilage apposite the tibia, and the fat pad under the patellar ligament region.[Results] Dilatation and congestion of the microvasculature and lymphoid infiltration were observed in the synovial membrane in the SCI group. These findings are similar to those found in early osteoarthritis. The surface layer of the articular cartilage in the SCI group showed fibrous proliferation. [Conclusion] The histopathological changes appear not to be progressive and may be related to spasticity of the hindlimb or a disorder in the autonomic function.

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Section: Introductionmentioning

confidence: 99%

Histopathological Changes in Knee Joint Components after Spinal Cord Injury in Rats

et al. 2012

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“…Jurvelin et al (2), for example, observed a 9% decrease in cartilage thickness in the canine knee after 11 weeks of rigid immobilization. Haapala et al (3) reported a large decrease (ϳ20%) in cartilage of the medial femur, but no changes in cartilage of the lateral tibia and lateral femur (4), of canine knee joints. In contrast, Leroux et al (5) found that a shorter period of nonrigid immobilization (4 weeks) did not change the knee cartilage thickness of the dogs in their study.…”

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confidence: 99%

Longitudinal analysis of cartilage atrophy in the knees of patients with spinal cord injury

Vanwanseele¹,

Eckstein²,

Knecht³

et al. 2003

Arthritis & Rheumatism

137

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Objective. A previous cross-sectional study indicated that the morphology of patellar and tibial cartilage is subject to change after spinal cord injury (SCI). The aim of this study was to perform a longitudinal analysis of cartilage atrophy in all knee compartments, including the femoral condyles, in SCI patients over 12 months.Methods. The right knees of 9 patients with complete, traumatic SCI were examined shortly after the injury (mean ؎ SD 9 ؎ 4 weeks) and at 6 and 12 months postinjury. Three-dimensional morphology of the patellar, tibial, and femoral cartilage (mean and maximum thickness, volume, and surface area) was determined from coronal and transversal magnetic resonance images (fat-suppressed gradient-echo sequences) using validated postprocessing techniques.Results. The mean thickness of knee joint cartilage decreased significantly during the first 6 months after injury (range 5-7%; P < 0.05). The mean change at 12 months was 9% in the patella, 11% in the medial tibia, 11% in the medial femoral condyle, 13% in the lateral tibia, and 10% in the lateral femoral condyle (P < 0.05 for all compartments).Conclusion. This is the first report of a longitudinal analysis of cartilage atrophy in patients with SCI. These data show that human cartilage atrophies in the absence of normal joint loading and movement after SCI, with a rate of change that is higher than that observed in osteoarthritis (OA). A potential clinical implication is that cartilage thinning after SCI may affect the stress distribution in the joint and render it vulnerable to OA. Future studies should focus on whether specific exercise protocols and rehabilitation programs can prevent cartilage thinning.Integrity of the morphologic and mechanical properties of articular cartilage is a prerequisite for appropriate function of diarthrodial joints. As suggested by various animal studies, a certain amount of mechanical loading and movement of the joint is required in order to maintain normal cartilage morphology, biochemical composition, and biomechanical properties (1). However, the results of these animal studies have been highly variable and inconsistent. Jurvelin et al (2), for example, observed a 9% decrease in cartilage thickness in the canine knee after 11 weeks of rigid immobilization. Haapala et al (3) reported a large decrease (ϳ20%) in cartilage of the medial femur, but no changes in cartilage of the lateral tibia and lateral femur (4), of canine knee joints. In contrast, Leroux et al (5) found that a shorter period of nonrigid immobilization (4 weeks) did not change the knee cartilage thickness of the dogs in their study.Spinal cord injury (SCI) causes unloading and restricted movement of the lower limb joints for substantial periods of time. As a consequence, patients with SCI encounter secondary complications, such as decreases in muscle mass, cardiovascular fitness, and bone density (6,7). Radiographic evidence of narrowing of the hip joint space by more than 50% in 25 of 200 patients with flaccid paralysis was identified in one st...

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“…[4][5][6][7][8][13][14][15] Animal studies have revealed that the mechanical, biochemical and morphological properties of the cartilage were altered after immobilization and did not always recover upon remobilization. 4,5 In humans, changes in cartilage have been demonstrated in different types of immobilization.…”

Section: Discussionmentioning

confidence: 99%

The effect of knee joint loading and immobilization on the femoral cartilage thickness in paraplegics

et al. 2015

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Background: Femoral cartilage thickness has been used as an indicator for immobilization and unloading in patients with spinal cord injury (SCI). However, conflicting results have been reported on this subject. Objectives: (i) To determine femoral cartilage thickness alterations after prolonged immobilization, (ii) to demonstrate the effect of the daily standing or ambulation time on the cartilage and (iii) to analyze the predictors of the femoral cartilage in patients with SCI. Methods: A total of 50 patients with SCI and 50 healthy age and sex-matched volunteers were enrolled in the study. A physician scanned both knees of all participants and measurements were taken at three locations: trochlear notch, midpoints of the medial and lateral condyle. Results: The trochlear notch, medial and lateral condyle femoral cartilage thickness of both sides were significantly thicker in the control group (Po0.05). Patients with o1 h daily standing/walking time had higher thickness measurements in all sub parameters than patients with 41 h daily standing/walking time (Po0.05). Daily standing/walking time and the Walking index for SCI score were statistically significant predictors for cartilage thickness. Conclusion: SCI patients had thinner knee cartilage compared with healthy individuals in ultrasonographic assessment. More than 1 h daily standing/walking time may have a negative effect on the femoral cartilage thickness. Thus, ultrasonographic evaluation of the femoral cartilage should be considered in clinical practice to detect early cartilage thinning in patients with SCI.

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Remobilization Does Not Fully Restore Immobilization Induced Articular Cartilage Atrophy

Cited by 119 publications

References 24 publications

Histopathological Changes in Knee Joint Components after Spinal Cord Injury in Rats

Histopathological Changes in Knee Joint Components after Spinal Cord Injury in Rats

Longitudinal analysis of cartilage atrophy in the knees of patients with spinal cord injury

The effect of knee joint loading and immobilization on the femoral cartilage thickness in paraplegics

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