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Alteration in Articular Structure of Knee Joints in the Progression of Contractures after Spinal Cord Injury, pp. 397-426 $100.00
Authors:  Hideki Moriyama and Yoshiko Tobimatsu
Abstract:
Joint contractures after spinal cord injuries (SCI) remain a prevalent and significant
complication. Contractures after SCI have been suggested to have developmental factors
associated with muscle tone. On the other hand, in patients with SCI, joints in the lower
extremity are unloaded and restricted in movement. Therefore, the alterations of the
periarticular connective tissue and the articular cartilage have been described in relation
to the results obtained on animal models with the suppression of mechanical forces
produced experimentally. The objective of this study was to clarify the relationship
between the muscular and articular factors leading to contractures after SCI and to
identify the changes in the periarticular connective tissue and the articular cartilage
during contracture formation. Fifty-two female Wistar rats that underwent a spinal cord
transection were assessed at 3, 5, 7, 14, 21, 56, 70, 84, 112 or 168 days postinjury. Knee
joint motion was measured for flexion and extension. Myotomy of the transarticular
muscles was then performed and range of motion was measured again. These procedures
allowed isolation of the muscular and articular factors of contractures. The periarticular
connective tissue and the articular cartilage of the knee joint were assessed with
histological, histomorphometric, and immunohistochemical analyses. Knee flexion
contractures progressed for 14 days after SCI, regardless of changes in muscle tone. The
restriction in motion progressed during the first 84 days and plateaued thereafter. Both
the muscles and the intra-articular tissues contributed to the progression of the contracture. In particular, the muscular factors were greater than the articular factors in
extension angular displacement in which the range of motion was restricted. Histological
results showed a disarranged posterior capsule in the SCI knees with the flexion
contracture. Cartilage thickness of SCI knees decreased at apposed regions and increased
at unapposed regions. SCI decreased the number of chondrocytes, especially at
unapposed regions. Matrix staining decreased at apposed regions. This study defined the
time course that contracture progression was more rapid in the early stage after SCI and
stabilized in the later stage of injury. Based on our findings of contractures in SCI, in
addition to the changes of the intra-articular tissues, more attention should be directed to
the changes of the muscles. A disarranged capsule may lead to joint stiffness. The
alteration of the periarticular connective tissue and the articular cartilage after SCI would
not be explained only by either a suppression of mechanical forces or an influence
through nerve tissues. 


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Alteration in Articular Structure of Knee Joints in the Progression of Contractures after Spinal Cord Injury, pp. 397-426