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Quantitative analysis of the reversibility of knee flexion contractures with time: an experimental study using the rat model.

Trudel G, Uhthoff HK, Goudreau L, Laneuville O - BMC Musculoskelet Disord (2014)

Bottom Line: The etiology is not well defined.Extended periods of immobilization of joints lead to contractures difficult to completely reverse by rehabilitation treatments.No reversal occurred in the highest severity group (32 week; P>0.05).

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Faculty of Medicine, University of Ottawa, 451 Smyth Rd,, Ottawa, ON K1H 8M5, Canada. gtrudel@ottawahospital.on.ca.

ABSTRACT

Background: Knee flexion contractures prevent the full extension of the knee joint and cause disability. The etiology is not well defined. Extended periods of immobilization of joints lead to contractures difficult to completely reverse by rehabilitation treatments. Recovery of the complete range of motion without intervention has not been studied but is of importance to optimize clinical management. This study was designed to quantify the spontaneous reversibility of knee flexion contractures over time.

Methods: Knee flexion contractures of increasing severities were induced by internally fixing one knee of 250 adult male rats for 6 increasing durations. The contractures were followed for four different durations of spontaneous recovery up to 48 weeks (24 groups, target n=10 per group). The angle of knee of extension at a standardized torque was measured. Contralateral knees constituted controls.

Results: Full reversibility characterized by knee extension similar to controls was only measured in the lowest severity group where 4 weeks of spontaneous recovery reversed early-onset contractures. Spontaneous recovery of 2, 4 and 8 weeks caused partial gain of knee extension in longer-lasting contractures (P ≤ 0.05; all 4 comparisons). Extending the durations of spontaneous recovery failed to further improve knee extension (P>0.05, all 12 comparisons). No reversal occurred in the highest severity group (32 week; P>0.05).

Conclusions: Reversibility of knee flexion contractures was dependent on their severity. Full spontaneous recovery was limited to the least severe contractures. While contractures initially improved, a plateau was reached beyond which additional durations of spontaneous recovery led to no additional gain of knee extension. These results support our view that without treatment, permanent losses in knee mobility must be anticipated in immobility-induced contractures.

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Range of extension after spontaneous recovery of knee joint contractures of various severities. Knees were surgically fixed at approximately 45° of flexion. More severe flexion contractures obtained decreased range of knee extension, irreversibly, despite proportionately long recovery durations. Data shown correspond to the angles of extension reached after the longest spontaneous recovery durations. (e.g., “week 2/8” = 2 weeks of fixation and 8 weeks of recovery).
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Fig3: Range of extension after spontaneous recovery of knee joint contractures of various severities. Knees were surgically fixed at approximately 45° of flexion. More severe flexion contractures obtained decreased range of knee extension, irreversibly, despite proportionately long recovery durations. Data shown correspond to the angles of extension reached after the longest spontaneous recovery durations. (e.g., “week 2/8” = 2 weeks of fixation and 8 weeks of recovery).

Mentions: Prolonged immobility of healthy joints resulted in contractures in the rat model. We quantified the spontaneous reversibility of knee joint contractures of various severities in 24 situations over 80 weeks. The data constitute convincing evidence for dose–response relationships not only between severity of the knee contracture and duration of internal fixation but also between severity of the contractures and potential for reversibility with spontaneous recovery (Figure 3).Figure 3


Quantitative analysis of the reversibility of knee flexion contractures with time: an experimental study using the rat model.

Trudel G, Uhthoff HK, Goudreau L, Laneuville O - BMC Musculoskelet Disord (2014)

Range of extension after spontaneous recovery of knee joint contractures of various severities. Knees were surgically fixed at approximately 45° of flexion. More severe flexion contractures obtained decreased range of knee extension, irreversibly, despite proportionately long recovery durations. Data shown correspond to the angles of extension reached after the longest spontaneous recovery durations. (e.g., “week 2/8” = 2 weeks of fixation and 8 weeks of recovery).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4289348&req=5

Fig3: Range of extension after spontaneous recovery of knee joint contractures of various severities. Knees were surgically fixed at approximately 45° of flexion. More severe flexion contractures obtained decreased range of knee extension, irreversibly, despite proportionately long recovery durations. Data shown correspond to the angles of extension reached after the longest spontaneous recovery durations. (e.g., “week 2/8” = 2 weeks of fixation and 8 weeks of recovery).
Mentions: Prolonged immobility of healthy joints resulted in contractures in the rat model. We quantified the spontaneous reversibility of knee joint contractures of various severities in 24 situations over 80 weeks. The data constitute convincing evidence for dose–response relationships not only between severity of the knee contracture and duration of internal fixation but also between severity of the contractures and potential for reversibility with spontaneous recovery (Figure 3).Figure 3

Bottom Line: The etiology is not well defined.Extended periods of immobilization of joints lead to contractures difficult to completely reverse by rehabilitation treatments.No reversal occurred in the highest severity group (32 week; P>0.05).

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Faculty of Medicine, University of Ottawa, 451 Smyth Rd,, Ottawa, ON K1H 8M5, Canada. gtrudel@ottawahospital.on.ca.

ABSTRACT

Background: Knee flexion contractures prevent the full extension of the knee joint and cause disability. The etiology is not well defined. Extended periods of immobilization of joints lead to contractures difficult to completely reverse by rehabilitation treatments. Recovery of the complete range of motion without intervention has not been studied but is of importance to optimize clinical management. This study was designed to quantify the spontaneous reversibility of knee flexion contractures over time.

Methods: Knee flexion contractures of increasing severities were induced by internally fixing one knee of 250 adult male rats for 6 increasing durations. The contractures were followed for four different durations of spontaneous recovery up to 48 weeks (24 groups, target n=10 per group). The angle of knee of extension at a standardized torque was measured. Contralateral knees constituted controls.

Results: Full reversibility characterized by knee extension similar to controls was only measured in the lowest severity group where 4 weeks of spontaneous recovery reversed early-onset contractures. Spontaneous recovery of 2, 4 and 8 weeks caused partial gain of knee extension in longer-lasting contractures (P ≤ 0.05; all 4 comparisons). Extending the durations of spontaneous recovery failed to further improve knee extension (P>0.05, all 12 comparisons). No reversal occurred in the highest severity group (32 week; P>0.05).

Conclusions: Reversibility of knee flexion contractures was dependent on their severity. Full spontaneous recovery was limited to the least severe contractures. While contractures initially improved, a plateau was reached beyond which additional durations of spontaneous recovery led to no additional gain of knee extension. These results support our view that without treatment, permanent losses in knee mobility must be anticipated in immobility-induced contractures.

Show MeSH
Related in: MedlinePlus