- •Joint contracture develops after anterior cruciate ligament reconstruction surgery.
- •Effects of immobilization duration on contractures after surgery are unknown
- •Two weeks of immobilization facilitated formation of joint contracture
- •Four weeks of immobilization further developed joint contractures
- •Periods of immobilization after surgery should be minimized to reduce contracture
Both myogenic and arthrogenic factors contribute to contracture formation after anterior cruciate ligament reconstruction surgery. However, effects of immobilization duration on myogenic and arthrogenic contractures after surgery are unknown. We examined the effects of immobilization duration on contracture formation.
Rats were divided into groups according to treatment received: untreated control, knee immobilization, anterior cruciate ligament reconstruction, and anterior cruciate ligament reconstruction plus immobilization. Extension range of motion before and after myotomy as well as histomorphological knee changes were assessed two or four weeks after experiment commencement. Range of motion before myotomy mainly represents contractures due to myogenic factors. Range of motion after myotomy represents arthrogenic factors.
Range of motion before and after myotomy was decreased in the immobilization, reconstruction, and reconstruction plus immobilization groups at both timepoints. In the reconstruction plus immobilization group, range of motion before and after myotomy was significantly smaller than in the immobilization and reconstruction groups. Shortening and thickening of the posterior joint capsule was induced in the immobilization and reconstruction groups. In the reconstruction plus immobilization group, capsule shortening was facilitated via adhesion formation, as compared to the immobilization and reconstruction groups.
Our results indicate that immobilization after anterior cruciate ligament reconstruction surgery facilitates contracture formation via exacerbation of both myogenic and arthrogenic contractures within two weeks. Capsule shortening would be one of the main mechanisms for severe arthrogenic contracture observed in the reconstruction plus immobilization group. Periods of joint immobilization after surgery should be minimized to reduce contracture.
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- Distribution of type A and B synoviocytes in the adhesive and shortened synovial membrane during immobilization of the knee joint in rats.Tohoku J. Exp. Med. 2010; 221: 161-168
- Remobilization does not restore immobilization-induced adhesion of capsule and restricted joint motion in rat knee joints.Tohoku J. Exp. Med. 2012; 227: 13-22
- Emerging trends in anterior cruciate ligament reconstruction.J. Knee Surg. 2017; 30: 63-69
- The effects of early aggressive rehabilitation on outcomes after anterior cruciate ligament reconstruction using autologous hamstring tendon: a randomized clinical trial.J. Sport Rehabil. 2013; 22: 191-201
- Arthrogenic muscle inhibition and return to sport after arthrofibrosis complicating anterior cruciate ligament surgery.Eur. J. Sport Sci. 2022; 22: 627-635
- Rehabilitation of patients following autogenic bone-patellar tendon-bone ACL reconstruction: a 20-year perspective.N. Am. J. Sports Phys. Ther. 2006; 1: 108-123
- The effect of early motion on tibial tunnel widening after anterior cruciate ligament replacement using hamstring tendon grafts.Arthroscopy. 2004; 20: 572-580
- Range of motion training in brace vs. plaster immobilization after anterior cruciate ligament reconstruction: a prospective randomized comparison with a 2-year follow-up.Scand. J. Med. Sci. Sports. 2002; 12: 73-80
- Knee immobilization for pain control after a hamstring tendon anterior cruciate ligament reconstruction: a randomized clinical trial.Am. J. Sports Med. 2009; 37: 56-64
- Loss of motion following knee ligament reconstruction.Sports Med. 1995; 19: 150-159
- Development of arthrogenic joint contracture as a result of pathological changes in remobilized rat knees.J. Orthopaed. Res. Off. Publ. Orthopaed. Res. Soc. 2017; 35: 1414-1423
- Low-level laser therapy prevents treadmill exercise-induced progression of arthrogenic joint contracture via attenuation of inflammation and fibrosis in remobilized rat knees.Inflammation. 2019; 42: 857-873
- Morphological and biomechanical adaptations of skeletal muscle in the recovery phase after immobilization in a rat.Clin. Biomechan. (Bristol, Avon). 2020; 75104992
- Nitric oxide synthase inhibitor L-NG-nitroarginine methyl ester (L-NAME) attenuates remobilization-induced joint inflammation.Nitric Oxide. 2020; 96: 13-19
- Intra-articular injection of mitomycin C prevents progression of immobilization-induced arthrogenic contracture in the remobilized rat knee.Physiol. Res. 2020; 69: 145-156
- Formation process of joint contracture after anterior cruciate ligament reconstruction in rats.J. Orthopaed. Res. Off. Publ. Orthopaed. Res. Soc. 2021; 39: 1082-1092
- A rat model of arthrofibrosis developed after anterior cruciate ligament reconstruction without rigid joint immobilization.Connect. Tissue Res. 2021; 62: 263-276
- Effects of each phase of anterior cruciate ligament reconstruction surgery on joint contracture in rats.J. Investig. Surg. 2022; 35: 984-995
- Low-level laser therapy attenuates arthrogenic contracture induced by anterior cruciate ligament reconstruction surgery in rats.Physiol. Res. 2022; 71: 389-399
- Conflicting time-dependent effects of treadmill exercise on joint contracture after anterior cruciate ligament reconstruction in rats.Tissue Cell. 2022; 77101861
- Reducing intra-articular hemarthrosis after arthroscopic anterior cruciate ligament reconstruction by the administration of intravenous tranexamic acid: a prospective, randomized controlled trial.Am. J. Sports Med. 2015; 43: 2720-2726
- Knee stability and movement coordination impairments: knee ligament sprain revision 2017.J. Orthop. Sports Phys. Ther. 2017; 47: A1-A47
- Arthrofibrosis following ACL reconstruction--reasons and outcome.Arch. Orthop. Trauma Surg. 2004; 124: 518-522
- Current standards of early rehabilitation after anterior cruciate ligament reconstruction in German speaking countries-differentiation based on tendon graft and concomitant injuries.Int. J. Environ. Res. Public Health. 2022; 19
- Motion loss after ligament injuries to the knee. Part I: causes.Am. J. Sports Med. 2001; 29: 664-675
- Comparison of muscular and articular factors in the progression of contractures after spinal cord injury in rats.Spinal Cord. 2006; 44: 174-181
- Effects of hypertonia on contracture development in rat spinal cord injury.Spinal Cord. 2019; 57: 850-857
- Operative treatment of primary anterior cruciate ligament rupture in adults.J. Bone Joint Surg. Am. 2014; 96: 685-694
- Contributions of biarticular myogenic components to the limitation of the range of motion after immobilization of rat knee joint.BMC Musculoskelet. Disord. 2014; 15: 224
- Joint haemorrhage partly accelerated immobilization-induced synovial adhesions and capsular shortening in rats.Knee Surg. Sports Traumatol. Arthrosc. 2014; 22: 2874-2883
- Early accelerated versus delayed conservative rehabilitation protocol after anterior cruciate ligament reconstruction: a prospective randomized trial.Rev. Bras. Ortop. (Sao Paulo). 2022; 57: 429-436
- Return to play following ACL reconstruction: survey among experienced arthroscopic surgeons (AGA instructors).Arch. Orthop. Trauma Surg. 2013; 133: 969-977
- Contractures secondary to immobility: is the restriction articular or muscular? An experimental longitudinal study in the rat knee.Arch. Phys. Med. Rehabil. 2000; 81: 6-13
- Synovial adhesions are more important than pannus proliferation in the pathogenesis of knee joint contracture after immobilization: an experimental investigation in the rat.J. Rheumatol. 2000; 27: 351-357
- Four weeks of mobility after 8 weeks of immobility fails to restore normal motion: a preliminary study.Clin. Orthop. Relat. Res. 2008; 466: 1239-1244
- Quantitative and temporal differential recovery of articular and muscular limitations of knee joint contractures; results in a rat model.J. Appl. Physiol. (Bethesda, Md. : 1985). 2014; 117: 730-737
- Anterior cruciate ligament reconstruction rehabilitation: MOON guidelines.Sports Health. 2015; 7: 239-243
Published online: February 24, 2023
Accepted: February 21, 2023
Received: November 2, 2022
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