Technical Note| Volume 50, ISSUE 3, P633-638, March 2019

Prevention of arthrofibrosis during knee repair by extracorporeal shock wave therapy: Preliminary study in rabbits

Published:February 02, 2019DOI:



      Surgery or trauma may induce extensive arthrofibrosis around joints and tendon for the restrictive range of motion. Although some approaches were proposed, this problem is not solved satisfactorily. Extracorporeal shock wave therapy (ESWT) has been used for orthopedic, musculoskeletal, and fibrotic disorders. Whether it could prevent the formation of arthrofibrosis during the joint repair is unknown.


      Intra-articular adhesions were created in the right knee of the rabbit by cortical bone shaving and subsequent cast immobilization. Arthrofibrosis in the control and ESWT group was evaluated and compared at week 4.


      Macroscopic score of arthrofibrosis and contracture angle of the control group are significantly higher. Histologically, the apparent gap between patella and tibia, loose connective tissue, and much less density of the blood vessel are found in the ESWT group.


      ESWT could noninvasively, effectively, and safely prevent the formation of arthrofibrosis during the knee repair.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Morrey B.F.
        Posttraumatic stiffness: distraction arthroplasty.
        Orthopedics. 1992; 15: 863-869
        • Eakin C.L.
        Knee arthrofibrosis: prevention and management of a potentially devastating condition.
        Phys Sportsmed. 2001; 29: 31-42
        • Magit D.
        • Wolff A.
        • Sutton K.
        • Medvecky M.J.
        Arthrofibrosis of the knee.
        JAAOS-J Am Acad Orthop Surg. 2007; 15: 682-694
        • Vander Have K.L.
        • Ganley T.J.
        • Kocher M.S.
        • Price C.T.
        • Herrera-Soto J.A.
        Arthrofibrosis after surgical fixation of tibial eminence fractures in children and adolescents.
        Am J Sports Med. 2010; 38: 298-301
        • Utsugi K.
        • Sakai H.
        • Hiraoka H.
        • Yashiki M.
        • Mogi H.
        Intra-articular fibrous tissue formation following ankle fracture: the significance of arthroscopic debridement of fibrous tissue.
        Arthrosc: J Arthrosc Relat Surg. 2007; 23: 89-93
        • Ries M.D.
        • Badalamente M.
        Arthrofibrosis after total knee arthroplasty.
        Clin Orthop. 2000; 380: 177-183
        • Haklar U.
        • Ayhan E.
        • Ulku T.K.
        • Karaoğlu S.
        Arthrofibrosis of the knee. Sports injuries.
        Springer, 2015: 915-931
        • Harner C.D.
        • Irrgang J.J.
        • Paul J.
        • Dearwater S.
        • Fu F.H.
        Loss of motion after anterior cruciate ligament reconstruction.
        Am J Sports Med. 1992; 20: 499-506
        • Fukui N.
        • Tashiro T.
        • Hiraoka H.
        • Oda H.
        • Nakamura K.
        Adhesion formation can be reduced by the suppression of transforming growth factor‐β1 activity.
        J Orthop Res. 2000; 18: 212-219
        • Huisstede B.M.
        • Gebremariam L.
        • van der Sande R.
        • Hay E.M.
        • Koes B.W.
        Evidence for effectiveness of Extracorporal Shock-Wave Therapy (ESWT) to treat calcific and non-calcific rotator cuff tendinosis–a systematic review.
        Manual Ther. 2011; 16: 419-433
        • Ogden J.A.
        • Alvarez R.G.
        • Levitt R.
        • Marlow M.
        Shock wave therapy (Orthotripsy (R)) in musculoskeletal disorders.
        Clin Orthop. 2001; 387: 22-40
        • Romeo P.
        • Lavanga V.
        • Pagani D.
        • Sansone V.
        Extracorporeal shock wave therapy in musculoskeletal disorders: a review.
        Med Princ Pract. 2014; 23: 7-13
        • Speed C.
        • Nichols D.
        • Wies J.
        • Humphreys H.
        • Richards C.
        • Burnet S.
        • et al.
        Extracorporeal shock wave therapy for plantar fasciitis. A double blind randomised controlled trial.
        J Orthop Res. 2003; 21: 937-940
        • Hsu J.E.
        • Anakwenze O.A.
        • Warrender W.J.
        • Abboud J.A.
        Current review of adhesive capsulitis.
        J Shoulder Elbow Surg. 2011; 20: 502-514
        • Rassweiler J.
        • Rassweiler M.-C.
        • Kenngott H.
        • Frede T.
        • Michel M.-S.
        • Alken P.
        • et al.
        The past, present and future of minimally invasive therapy in urology: a review and speculative outlook.
        Minim Invasive Ther Allied Technol. 2013; 22: 200-209
        • Hussein A.Z.
        • Donatelli R.A.
        The efficacy of radial extracorporeal shockwave therapy in shoulder adhesive capsulitis: a prospective, randomised, double-blind, placebo-controlled, clinical study.
        Eur J Physiother. 2016; 18: 63-76
        • Chen C.-Y.
        • Hu C.-C.
        • Weng P.-W.
        • Huang Y.-M.
        • Chiang C.-J.
        • Chen C.-H.
        • et al.
        Extracorporeal shockwave therapy improves short-term functional outcomes of shoulder adhesive capsulitis.
        J Shoulder Elbow Surg. 2014; 23: 1843-1851
        • Lee S.
        • Lee S.
        • Jeong M.
        • Oh H.
        • Lee K.
        The effects of extracorporeal shock wave therapy on pain and range of motion in patients with adhesive capsulitis.
        J Phys Ther Sci. 2017; 29: 1907-1909
        • Louwerens J.K.
        • Veltman E.S.
        • van Noort A.
        • van den Bekerom M.P.
        The effectiveness of high-energy extracorporeal shockwave therapy versus ultrasound-guided needling versus arthroscopic surgery in the management of chronic calcific rotator cuff tendinopathy: a systematic review.
        Arthrosc: J Arthrosc Relat Surg. 2016; 32: 165-175
        • Rothkopf D.M.
        • Webb S.
        • Szabo R.M.
        • Gelberman R.H.
        • May J.W.
        An experimental model for the study of canine flexor tendon adhesions.
        J Hand Surg. 1991; 16: 694-700
        • Shelbourne K.D.
        • Patel D.V.
        • Martini D.J.
        Classification and management of arthrofibrosis of the knee after anterior cruciate ligament reconstruction.
        Am J Sports Med. 1996; 24: 857-862
        • Wright R.W.
        • Preston E.
        • Fleming B.C.
        • Amendola A.
        • Andrish J.T.
        • Bergfeld J.A.
        • et al.
        A systematic review of anterior cruciate ligament reconstruction rehabilitation: part I: continuous passive motion, early weight bearing, postoperative bracing, and home-based rehabilitation.
        J Knee Surg. 2008; 21: 217-224
        • Frairia R.
        • Berta L.
        Biological effects of extracorporeal shock waves on fibroblasts. A review.
        Muscl Ligam Tendons J. 2011; 1: 138
        • Knobloch K.
        • Vogt P.M.
        High-energy focussed extracorporeal shockwave therapy reduces pain in plantar fibromatosis (Ledderhose’s disease).
        BMC Res Notes. 2012; 5: 542
        • Chen P.C.
        • Kuo S.M.
        • Jao J.C.
        • Yang S.W.
        • Hsu C.W.
        • Wu Y.C.
        Noninvasive shock wave treatment for capsular contractures after breast augmentation: a rabbit study.
        Aesthetic Plast Surg. 2016; 40: 435-445
        • Costa M.
        • Shepstone L.
        • Donell S.
        • Thomas T.
        Shock wave therapy for chronic Achilles tendon pain: a randomized placebo-controlled trial.
        Clin Orthop Relat Res. 2005; 440: 199-204
        • LeBrun C.M.
        Low-dose extracorporeal shock wave therapy for previously untreated lateral epicondylitis.
        Clin J Sport Med. 2005; 15: 401-402
        • Mariotto S.
        • de Prati A.C.
        • Cavalieri E.
        • Amelio E.
        • Marlinghaus E.
        • Suzuki H.
        Extracorporeal shock wave therapy in inflammatory diseases: molecular mechanism that triggers anti-inflammatory action.
        Curr Med Chem. 2009; 16: 2366-2372
        • Chen Y.J.
        • Wang C.J.
        • Yang K.D.
        • Kuo Y.R.
        • Huang H.C.
        • Huang Y.T.
        • et al.
        Extracorporeal shock waves promote healing of collagenase‐induced Achilles tendinitis and increase TGF‐β1 and IGF‐I expression.
        J Orthop Res. 2004; 22: 854-861