The Basic Science of Continuous Passive Motion in Promoting Knee Health: a Systematic Review of Studies in a Rabbit Model

Overview

Journal Arthroscopy

Specialty Orthopedics

Date 2013 Jul 30

PMID 23890952

Citations 19

Authors

Derrick M Knapik

Joshua D Harris

Garett Pangrazzi

Michael J Griesser

Robert A Siston

Sudha Agarwal

David C Flanigan

Affiliations

Soon will be listed here.

Abstract

Purpose: To determine whether the basic science evidence supports the use of continuous passive motion (CPM) after articular cartilage injury in the knee.

Methods: A systematic review was performed identifying and evaluating studies in animal models that focused on the basic science of CPM of the knee. Databases included in this review were PubMed, Biosis Previews, SPORTDiscus, PEDro, and EMBASE. All functional, gross anatomic, histologic, and histochemical outcomes were extracted and analyzed.

Results: Primary outcomes of CPM analyzed in rabbit animal models (19 studies) included histologic changes in articular cartilage (13 studies), biomechanical changes and nutrition of intra-articular tissue (3 studies), and anti-inflammatory biochemical changes (3 studies). Nine studies specifically examined osteochondral defects, 6 of which used autogenous periosteal grafts. Other pathologies included were antigen-induced arthritis, septic arthritis, medial collateral ligament reconstruction, hemarthrosis, and chymopapain-induced proteoglycan destruction. In comparison to immobilized knees, CPM therapy led to decreased joint stiffness and complications related to adhesions while promoting improved neochondrogenesis with formation and preservation of normal articular cartilage. CPM was also shown to create a strong anti-inflammatory environment by effectively clearing harmful, inflammatory particles from within the knee.

Conclusions: Current basic science evidence from rabbit studies has shown that CPM for the knee significantly improves motion and biological properties of articular cartilage. This may be translated to potentially improved outcomes in the management of articular cartilage pathology of the knee.

Clinical Relevance: If the rabbit model is relevant to humans, CPM may contribute to improved knee health by preventing joint stiffness, preserving normal articular tissue with better histologic and biologic properties, and improving range of motion as compared with joint immobilization and intermittent active motion.

Citing Articles

Mechanical stimulation promotes fibrochondrocyte proliferation by activating the TRPV4 signaling pathway during tendon-bone insertion healing: CCN2 plays an important regulatory role.

Bian X, Liu X, Zhou M, Tang H, Wang R, Ma L Burns Trauma. 2024; 12:tkae028.

PMID: 39429645 PMC: 11491146. DOI: 10.1093/burnst/tkae028.

Hot spots and frontiers in bone-tendon interface research: a bibliometric analysis and visualization from 2000 to 2023.

Xiao H, Wen B, Yan D, Li Q, Yang Y, Yin X Front Surg. 2024; 10:1326564.

PMID: 38327873 PMC: 10847327. DOI: 10.3389/fsurg.2023.1326564.

Efficacy and safety of continuous passive motion and physical therapy in recovery from knee arthroplasty: a systematic review and meta-analysis.

Jia Z, Zhang Y, Zhang W, Xu C, Liu W J Orthop Surg Res. 2024; 19(1):68.

PMID: 38218933 PMC: 10787984. DOI: 10.1186/s13018-024-04536-y.

Effect of hip CPM on gross motor function and development of the hip joint: a single-center randomized controlled study on spastic cerebral palsy children with hip dysplasia.

Wang L, Zhang N, Fang L, Cui Z, Niu H, Lv F Front Pediatr. 2023; 11:1090919.

PMID: 37228431 PMC: 10203473. DOI: 10.3389/fped.2023.1090919.

Physiotherapeutic Strategies and Their Current Evidence for Canine Osteoarthritis.

Mille M, McClement J, Lauer S Vet Sci. 2023; 10(1).

PMID: 36669003 PMC: 9863568. DOI: 10.3390/vetsci10010002.

References

Richmond J, Gladstone J, MacGillivray J . Continuous passive motion after arthroscopically assisted anterior cruciate ligament reconstruction: comparison of short- versus long-term use. Arthroscopy. 1991; 7(1):39-44. DOI: 10.1016/0749-8063(91)90076-a. View

Salter R, Simmonds D, Malcolm B, Rumble E, MacMichael D, Clements N . The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage. An experimental investigation in the rabbit. J Bone Joint Surg Am. 1980; 62(8):1232-51. View

Pope R, Corcoran S, McCaul K, Howie D . Continuous passive motion after primary total knee arthroplasty. Does it offer any benefits?. J Bone Joint Surg Br. 1997; 79(6):914-7. DOI: 10.1302/0301-620x.79b6.7516. View

ODriscoll S, Keeley F, Salter R . Durability of regenerated articular cartilage produced by free autogenous periosteal grafts in major full-thickness defects in joint surfaces under the influence of continuous passive motion. A follow-up report at one year. J Bone Joint Surg Am. 1988; 70(4):595-606. View

Wright R, Preston E, Fleming B, Amendola A, Andrish J, Bergfeld J . 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(3):217-24. PMC: 3692363. DOI: 10.1055/s-0030-1247822. View

Kurz B, Jin M, Patwari P, Cheng D, Lark M, Grodzinsky A . Biosynthetic response and mechanical properties of articular cartilage after injurious compression. J Orthop Res. 2002; 19(6):1140-6. DOI: 10.1016/S0736-0266(01)00033-X. View

Dorr L . Continuous passive motion offers no benefit to the patient. Orthopedics. 1999; 22(4):393. DOI: 10.3928/0147-7447-19990401-07. View

Johnson D, Eastwood D . Beneficial effects of continuous passive motion after total condylar knee arthroplasty. Ann R Coll Surg Engl. 1992; 74(6):412-6. PMC: 2497687. View

ODriscoll S, Kumar A, Salter R . The effect of the volume of effusion, joint position and continuous passive motion on intraarticular pressure in the rabbit knee. J Rheumatol. 1983; 10(3):360-3. View

10.

Dossumbekova A, Anghelina M, Madhavan S, He L, Quan N, Knobloch T . Biomechanical signals inhibit IKK activity to attenuate NF-kappaB transcription activity in inflamed chondrocytes. Arthritis Rheum. 2007; 56(10):3284-96. PMC: 4950916. DOI: 10.1002/art.22933. View

11.

Synder M, Kozlowski P, Drobniewski M, Grzegorzewski A, Glowacka A . The use of Continuous Passive Motion (CPM) in the rehabilitation of patients after total knee arthroplasty. Ortop Traumatol Rehabil. 2007; 6(3):336-41. View

12.

Goodfellow J, OConnor J . Clinical results of the Oxford knee. Surface arthroplasty of the tibiofemoral joint with a meniscal bearing prosthesis. Clin Orthop Relat Res. 1986; (205):21-42. View

13.

Curl W, Krome J, Gordon E, Rushing J, Smith B, Poehling G . Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy. 1997; 13(4):456-60. DOI: 10.1016/s0749-8063(97)90124-9. View

14.

Ferretti M, Srinivasan A, Deschner J, Gassner R, Baliko F, Piesco N . Anti-inflammatory effects of continuous passive motion on meniscal fibrocartilage. J Orthop Res. 2005; 23(5):1165-71. PMC: 4947460. DOI: 10.1016/j.orthres.2005.01.025. View

15.

Williams J, Moran M, Thonar E, Salter R . Continuous passive motion stimulates repair of rabbit knee articular cartilage after matrix proteoglycan loss. Clin Orthop Relat Res. 1994; (304):252-62. View

16.

Ververeli P, Sutton D, Hearn S, Booth Jr R, Hozack W, Rothman R . Continuous passive motion after total knee arthroplasty. Analysis of cost and benefits. Clin Orthop Relat Res. 1995; (321):208-15. View

17.

Chiarello C, Gundersen L, OHalloran T . The effect of continuous passive motion duration and increment on range of motion in total knee arthroplasty patients. J Orthop Sports Phys Ther. 1997; 25(2):119-27. DOI: 10.2519/jospt.1997.25.2.119. View

18.

Bennett L, Brearley S, Hart J, Bailey M . A comparison of 2 continuous passive motion protocols after total knee arthroplasty: a controlled and randomized study. J Arthroplasty. 2005; 20(2):225-33. DOI: 10.1016/j.arth.2004.08.009. View

19.

ODriscoll S, Salter R . The repair of major osteochondral defects in joint surfaces by neochondrogenesis with autogenous osteoperiosteal grafts stimulated by continuous passive motion. An experimental investigation in the rabbit. Clin Orthop Relat Res. 1986; (208):131-40. View

20.

THOMAS H . The classic. Diseases of the hip, knee and ankle joint with their deformities treated by a new and efficient method. Clin Orthop Relat Res. 1974; (102):4-9. DOI: 10.1097/00003086-197407000-00002. View