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• W4250223726 abstract "Introduction: Post-traumatic stiffness of the elbow is common. While this may be multifactorial, the capsule clearly plays a role. Release or excision of the elbow capsule is necessary when treating arthrofibrosis surgically and diminished compliance of the capsular tissue itself has been documented following trauma. This study evaluates the physiologic profile and morphological characteristics in the capsule of contracted elbows. Materials and Methods: Thirty seven anterior elbow capsules were collected at the time of joint release for post-traumatic contracture. Preoperatively, elbow extension averaged 35° (range 40-80°) and flexion averaged 94° (range 80 to 115°). Capsules from seven cadaveric elbows with no history of trauma or pathology were harvested as controls. The sections were evaluated with polarizing microscopy for birefringence and for comparison of collagen fiber orientation. Immunohistochemistry was performed on paraffin sections using immunoperoxidase to measure specimens for specific cytokines involved in connective tissue turnover. Sections were graded by a blinded examiner. Results: The mean thickness of the control capsules was 0.6 mm ± 0.2 mm, and for the contracture specimens, 4.0 mm ± 2.1 (p < 0.05). All control capsules revealed a well organized, parallel arrangement of collagen fibers with intervening fibroblasts. All contracture capsules revealed thickening of the tissue with extensive disorganization of the collagen fiber bundle arrangement. More fibroblasts, particularly in large groups, were found in these specimens and five displayed moderate to severe lymphocyte infiltration. No correlation was identified between these cases and those without lymphocytes in any clinical parameter. Cytokine MMP-1, MMP-2, and MMP-3 staining were significantly increased in the contracture group as compared to the controls (p<0.05). However, collagen type III content was markedly decreased in the contracture capsules compared to the controls. Discussion: Contracted elbow capsules were characterized by a marked thickening, on the average of approximately seven times (and up to 13 times) that of the normal capsule accompanied by collagen disorganization and fibroblast infiltration. In addition, we found the cytokines, MMP-1, MMP-2, MMP-3 and TIMP to be present in greater levels in contracture elbow capsules compared to control specimens. These abnormal cytokines may be involved in the remodeling or repair process following trauma. However, the mechanism of contracture tissue formation differs from that observed in wound healing due to the decreased collagen type III levels observed. This is the first study to characterize the histological profile in post-traumatic contracture of the elbow capsule and associate this to the presence of MMPs, their inhibitors and collagen typing. If noted, the author indicates something of value received. The codes are identified as follows: a, research or institutional support; b, miscellaneous funding; c, royalties; d, stock options; e, consultant or employee. *The Food and Drug Administration has not cleared the drug and/or medical device for the use described in this presentation (ie, the drug or medical device is being discussed for an “off-label” use). If noted, the author indicates something of value received. The codes are identified as follows: a, research or institutional support; b, miscellaneous funding; c, royalties; d, stock options; e, consultant or employee. *The Food and Drug Administration has not cleared the drug and/or medical device for the use described in this presentation (ie, the drug or medical device is being discussed for an “off-label” use)." @default.
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• W4250223726 date "2007-03-01" @default.
• W4250223726 modified "2023-09-28" @default.
• W4250223726 title "5" @default.
• W4250223726 doi "https://doi.org/10.1016/j.jse.2007.02.054" @default.
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