An Evaluation of Prophylactic Treatments to Prevent Post Traumatic Joint Stiffness

Arthrofibrosis is a major obstacle to restoring joint function after trauma. The objective of this study was to evaluate montelukast, forskolin, and triamcinolone as possible means of prophylaxis against the formation of arthrofibrosis. Forty-eight rats underwent surgical knee trauma with post-operative immobilization in full flexion. The treatment groups were: control (CTL), oral montelukast (3.75mg/kg/day) (MLK), intra-articular forskolin injections (0.6mg/kg) (FSK), and intra-articular triamcinolone injections (0.68mg/kg) (STR). Rats were sacrificed after 14 days and femorotibial contracture angles were measured with the posterior capsule intact and with the posterior capsule cut. A 0.015Nm extension moment was applied to the knee. All treatment groups had significant reductions in contracture angle compared to the control. Mean contractures with the posterior capsule intact were 32 degrees(CTL), 20 degrees (MLK), 22 degrees (FSK), and 7 degrees (STR). Contractures with the posterior capsule cut were 28 degrees (CTL), 19 degrees (MLK), 20 degrees (FSK), and 5 degrees (STR). The STR group was significantly better than FSK and MLK. Triamcinolone injections provided dramatic reductions in stiffness. Both forskolin and montelukast provided significant, though lesser, reductions in stiffness. While the triamcinolone contracture angles were significantly better, the novel treatments of forskolin and montelukast provided encouraging results and should be studied further. (c) 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:1520-1524, 2014.