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The Journal of Bone and Joint Surgery, Vol 62, Issue 8 1232-1251, Copyright © 1980 by Journal of Bone and Joint Surgery, Inc
The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage. An experimental investigation in the rabbit
RB Salter, DF Simmonds, BW Malcolm, EJ Rumble, D MacMichael and ND Clements
A new concept, continuous passive motion of a synovial joint in vivo, was
investigated to determine its biological effect on the healing of
full-thickness articular cartilage defects that penetrate the subchondral
bone of knee joints of adolescent and adult rabbits. The effect of
continuous passive motion was compared with the effects of immobilization
and of intermittent active motion. This investigation included assessment
of 480 defects in the knees of 120 adolescent rabbits and assessment of 108
defects in the knees of twenty-seven adult rabbits. The continuous passive
motion was well tolerated by these animals, whose general well-being was
undisturbed. The healing of the defects at weekly intervals up to four
weeks was assessed by gross examination and by an analysis of two indices
of healing determined by light microscopy: (1) the nature of the reparative
tissue, and (2) the degree of metachromasia of the matrix as demonstrated
by toluidine-blue staining. At three weeks this assessment revealed that in
the adolescent rabbits, healing of the defects by hyaline articular
cartilage was present in 8 per cent of forty defects in ten animals whose
knees were immobilized, in 9 per cent of forty defects in ten animals whose
knees were permitted intermittent active motion, and in 52 per cent of
forty defects in ten animals whose knees were managed immediately after
operation by continuous passive motion. At three weeks, in the adult
animals, healing of the defects by hyaline articular cartilage was present
in 3 per cent of thirty-six defects in nine animals whose knees were
immobilized, in 5 per cent of thirty-six defects in nine animals whose
knees were permitted intermittent active motion, and in 44 per cent of
thirty-six defects in nine animals whose knees were managed immediately
after operation by continuous passive motion. Thus, the metaplasia of the
healing tissue within the defects from undifferentiated mesenchymal tissue
to hyaline articular cartilage was not only much more rapid but also much
more complete with continuous passive motion than with either
immobilization or intermittent active motion.
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