INJEKSI DEKSAMETASON INTRA-ARTIKULAR UNTUK MENCEGAH PROGRESIVITAS KONTRAKTUR FLEKSI ARTROGENIK PADA LUTUT TIKUS SELAMA FASE REMOBILISASI:

Nico Sutanto; Otman Siregar; Iman Dwi Winanto; Stephan Udjung

doi:10.30743/ibnusina.v25i2.1119

Nico Sutanto Departemen Orthopaedi dan Traumatologi, Rumah Sakit Umum Pusat H. Adam Malik, Fakultas Kedokteran, Universitas Sumatera Utara
Otman Siregar Departemen Orthopaedi dan Traumatologi, Rumah Sakit Umum Pusat H. Adam Malik, Fakultas Kedokteran, Universitas Sumatera Utara
Iman Dwi Winanto Departemen Orthopaedi dan Traumatologi, Rumah Sakit Umum Pusat H. Adam Malik, Fakultas Kedokteran, Universitas Sumatera Utara
Stephan Udjung Departemen Patologi Anatomi, Rumah Sakit Umum Pusat H. Adam Malik, Fakultas Kedokteran, Universitas Sumatera Utara

DOI: https://doi.org/10.30743/ibnusina.v25i2.1119

Keywords: Kontraktur Sendi, Deksametason, Artrofibrosis

Abstract

Imobilisasi sendi berkepanjangan memicu kontraktur artrogenik akibat fibrosis kapsular. Studi ini mengevaluasi efikasi injeksi deksametason intra-artikular dosis tunggal dalam mencegah kontraktur tersebut pada model lutut tikus selama fase remobilisasi. Studi ini menggunakan desain experimental pretest-posttest control group dengan 24 tikus Wistar jantan. Semua tikus menjalani 28 hari imobilisasi lutut menggunakan K-wire. Pada hari ke-28, K-wire dilepas, dan tikus dibagi menjadi tiga kelompok: kelompok deksametason (injeksi tunggal deksametason natrium fosfat 0,5 mg/kg intra-artikular, 30 µL), kelompok saline (injeksi NaCl 0,9% 30 µL), dan kelompok kontrol (tanpa injeksi). PROM diukur pada baseline, setelah imobilisasi, serta setelah injeksi dan miotomi. Evaluasi histopatologis kapsul sendi posterior mencakup pengukuran ketebalan, panjang, dan jumlah sel radang. Kelompok deksametason menunjukkan rerata PROM yang signifikan lebih tinggi (130,13 ± 4,94°) dibandingkan kelompok saline dan kontrol (p < 0,001). Analisis histopatologis mengonfirmasi penurunan ketebalan kapsul dan infiltrasi sel radang, serta peningkatan panjang kapsul yang signifikan, mengindikasikan berkurangnya artofibrosis. Injeksi deksametason intra-artikular dosis tunggal efektif meningkatkan PROM dan memitigasi artofibrosis. Hal ini menunjukkan potensi deksametason lokal sebagai strategi profilaksis kontraktur artrogenik.

References

Wong K, Trudel G, Laneuville O. Noninflammatory Joint Contractures Arising from Immobility : Animal Models to Future Treatments. BioMed Research International. 2015;2015. doi:10.1155/2015/848290

Syed MA, Azim SR, Baig M. Frequency of Orthopedic Problems Among Patients Attending an Orthopedic Outpatient Department: A Retrospective Analysis of 23495 Cases. Ann Saudi Med. 2019;39(3):172-177. doi:10.5144/0256-4947.2019.172

Clavet H, Hébert PC, Fergusson D, Doucette S. Joint Contracture Following Prolonged Stay in The Intensive Care Unit. Canadian Medical Association Journal. 2008;178(6):1-7.

Trudel G, Uhthoff HK, G AT, Hk U. Contractures Secondary to Immobility : Is the Restriction Articular or Muscular ? An Experimental Longitudinal Study in the Rat Knee. Arch Phys Med Rehabil. 2000;81(January):6-13.

Braithwaite I, Healy B, Cameron L, Weatherall M, Beasley R. Lower Limb Immobilisation and Venous Thromboembolism Risk : Combined Case – Control Studies. Postgrad Med J. 2017;93:354-359. doi:10.1136/postgradmedj-2016-134365

Halloran T, Bassa B, Nemeth B, et al. The (T) Thrombosis (I) in Patients with (L) Lower (L) Limb (I) Injuries (R) Requiring (I) Immobilisation (TILLIRI) Study. J Thromb Haemost. 2025;23(3):947-956. doi:10.1016/j.jtha.2024.11.010

Tibbo ME, Limberg AK, Salib CG, et al. Acquired Idiopathic Stiffness After Total Knee Arthroplasty. THE JOURNAL OF BONE AND JOINT SURGERY. 2019;101(14):1320-1330. doi:10.2106/JBJS.18.01217

Campbell TM, Trudel G. A Knee Flexion Contracture is Associated With a Contracture and Worse Function of the Contralateral Knee: Data From the Osteoarthritis Initiative. Archives Of Physical Medicine And Rehabilitation. 2020;101(4):624-632. doi:10.1016/j.apmr.2019.11.018

Attias M, Chevalley O, Bonnefoy-mazure A, De G, Cheze L. Effects of Contracture on Gait Kinematics: A Systematic Review. Clin Biomech (Bristol). 2016;33:103-110. doi:10.1016/j.clinbiomech.2016.02.017

Kaneguchi A, Ozawa J, Kawamata S, Yamaoka K. Development of Arthrogenic Joint Contracture as a Result of Pathological Changes Inremobilized Rat Knees. J Orthop Res. 2017;35(7):1414-1423. doi:10.1002/jor.23419

Malinowski K, Góralczyk A, Hermanowicz K, Laprade RF, Więcek R, Domzalski M. Arthroscopic Complete Posterior Capsulotomy for Knee Flexion Contracture. Arthrosc Tech. 2018;7(11):1135-1139. doi:10.1016/j.eats.2018.07.008

Severino C, Brizzi P, Solinas A, Secchi G, Maioli M, Tonolo G. Low-dose Dexamethasone in The Rat: A Model to Study Insulin Resistance. Am J Physiol Endocrinol Metab. 2002;283(2):367-374. doi:10.1152/ajpendo.00185.2001

Kaneguchi A, Ozawa J, Yamaoka K. Anti-inflammatory Drug Dexamethasone Treatment During the Remobilization Period Improves Range of Motion in a Rat Knee Model of Joint Contracture. Inflammation. 2018;41(4):1409-1423. doi:10.1007/s10753-018-0788-5

Heard BJ, Barton KI, Chung M, et al. Single intra‐articular dexamethasone injection immediately post‐surgery in a rabbit model mitigates early inflammatory responses and post‐traumatic osteoarthritis‐like alterations. Journal Orthopaedic Research. 2015;33(12):1826-1834. doi:10.1002/jor.22972

Aytekin K, Uysal M, Şahiner GG, et al. Evaluation of different intraarticular injection volumes to assess optimum efficient amount; an experimental study in rat knee joints. Journal of Pharmacological and Toxicological Methods. 2020;101:106658. doi:10.1016/j.vascn.2019.106658

Trudel G, Uhthoff HK. Contractures secondary to immobility: Is the restriction articular or muscular? An experimental longitudinal study in the rat knee. Archives of Physical Medicine and Rehabilitation. 2000;81(1):6-13. doi:10.1016/S0003-9993(00)90213-2

Millett P, Steadman J. The Role of Capsular Distention in the Arthroscopic Management of Arthrofibrosis of the Knee : A Technical Consideration. Arthoscopy. 2001;17(7):7-8. doi:10.1053/jars.2001.25240

Hall R, Verhey J, Deckey D. Which Medications Are Effective in Reducing the Risk of Arthrofibrosis After Total Knee Arthroplasty? J Arthroplasty. Published online 2025.

Kaneguchi A, Ozawa J. Inflammation and Fibrosis Induced by Joint Remobilization , and Relevance to Progression of Arthrogenic Joint Contracture : A Narrative Review. Physiol Res. 2022;71(4):447-455. doi:10.33549/physiolres.934876

Kaneguchi A, Ozawa J, Yamaoka K. The Effects of Immobilization Duration on Joint Contracture Formation After Anterior Cruciate Ligament Reconstruction in Rats. Clin Biomech (Bristol). 2023;103:105926. doi:10.1016/j.clinbiomech.2023.105926

Dietrich ZF, Alim A, Beckman LB, Eliasson P. Dexamethasone treatment influences tendon healing through altered resolution and a direct effect on tendon cells. Scientific Reports. 2024;14(1):15304. doi:10.1038/s41598-024-66038-5

Johnson D, Lopez M, Kelley B. Dexamethasone. StatPearls. Treasure Island (FL): StarPearls Publishing. 2025. https://www.ncbi.nlm.nih.gov/books/NBK482130/

INJEKSI DEKSAMETASON INTRA-ARTIKULAR UNTUK MENCEGAH PROGRESIVITAS KONTRAKTUR FLEKSI ARTROGENIK PADA LUTUT TIKUS SELAMA FASE REMOBILISASI

INTRA-ARTICULAR DEXAMETHASONE INJECTION FOR THE PREVENTION OF ARTHROGENIC KNEE FLEXION CONTRACTURE PROGRESSION IN RATS DURING THE REMOBILIZATION PHASE

Abstract

References