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Range of Extension Correlates with Posterior Capsule Length after Knee Remobilization


Medicine & Science in Sports & Exercise: December 2018 - Volume 50 - Issue 12 - p 2401–2408
doi: 10.1249/MSS.0000000000001741

Introduction Knee injuries are common in sports, and postinjury immobilization is often required to protect healing tissues and alleviate pain, but both the injury and the immobilization can lead to a knee contracture. Knee flexion contractures limit performance. Previous research has identified posterior knee capsule fibrosis as a contributor to immobility-induced knee flexion contractures. This study aims to measure posterior knee capsule length at various durations of remobilization after knee immobilization and to correlate with the recovery of knee range of motion.

Methods Two hundred fifty-nine male Sprague-Dawley rats had one knee extra-articularly immobilized in flexion with a Delrin® plate at a 45° angle for one of six durations: 1, 2, 4, 8, 16, or 32 wk, followed by spontaneous remobilization after plate removal, which lasted zero, one, two, and four times the duration of immobilization. The contralateral knees served as controls. The posterior knee capsule length was measured by histomorphometry. These measures were correlated with previously published range of motion data from the same cohort of specimens.

Results Knees immobilized for 1 and 2 wk partially recovered posterior capsule length (P > 0.05). Knees immobilized beyond 2 wk failed to recover posterior capsule length, irrespective of the duration of remobilization (P < 0.05). The residual posterior capsule shortening correlated with the lack of knee extension (P < 0.003).

Conclusions For knee injuries requiring more than 2 wk of immobilization, unassisted remobilization will not restore posterior knee capsule shortening and the reduction in knee extension. These results support the role of the posterior capsule in knee joint contracture and the need to minimize the duration of immobility and to assist the recovery of the range of knee extension after a sport injury.

1Bone and Joint Research Laboratory, Faculty of Medicine, University of Ottawa, Ottawa, ON, CANADA;

2Department of Biology, Faculty of Science, University of Ottawa, Ottawa, ON, CANADA; and

3Division of Physical Medicine and Rehabilitation, Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, CANADA

Address for correspondence: Odette Laneuville, Ph.D., Department of Biology, 30 Marie Curie Private, Ottawa, ON, Canada K1N6N5; E-mail:

Submitted for publication June 2018.

Accepted for publication July 2018.

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© 2018 American College of Sports Medicine