title: The effect of local corticosteroid or ketorolac exposure on histologic and biomechanical properties of rabbit tendon and cartilage.
abstract: Tendonitis, tenosynovitis, and the arthritides are clinical problems commonly encountered in daily orthopaedic practice. Systemic anti-inflammatories, physical therapy, and local corticosteroid injections all are used as nonoperative treatments of these conditions. Systemic anti-inflammatory agents and local corticosteroid agents, however, can be associated with adverse effects that render them intolerable to some patients. As a preliminary study assessing the feasibility of local injection of nonsteroidal anti-inflammatory medication, the histological and biomechanical effects of local exposure of rabbit cartilage and tendon to injectable steroidal (corticosteroid) and injectable nonsteroidal anti-inflammatory agents (ketorolac tromethamine, KT) were determined. Thirty rabbits underwent bilateral knee joint, patellar tendon, and Achilles tendon injections with either normal saline, corticosteroid, or KT. Mechanical and histologic evaluation of the tissues was performed at 6 and 15 weeks after injection. Gross tendon adhesions were observed in more corticosteroid-treated specimens than those exposed to normal saline or KT. Microscopic evaluation of tendons revealed no significant differences among the three groups. Mild cartilage degenerative changes were noted across all groups. Evidence of cartilage necrosis was noted for the corticosteroid-treated group only. Tendons exposed to corticosteroid or KT demonstrated increased load and energy to failure, but exhibited no difference in material stiffness or strain. The use of an injectable nonsteroidal anti-inflammatory agent may be safe and even pose less threat to local tissues after intra-articular and peri-tendinous administration.
authors.affiliation: Department of Orthopaedic Surgery, William Beaumont Hospital, 3535 West Thirteen Mile Road, Suite 744, Royal Oak, MI, 48073, USA.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Shapiro
authors.forename: Rachel S
authors.initials: RS
authors.lastname: Rohde
authors.forename: Mark I
authors.initials: MI
authors.lastname: Froimson
authors.forename: Richard H
authors.initials: RH
authors.lastname: Lash
authors.forename: Paul
authors.initials: P
authors.lastname: Postak
authors.forename: A Seth
authors.initials: AS
authors.lastname: Greenwald
references.citation: J Bone Joint Surg Br. 1972 Nov;54(4):729-34
references.pmid: 4639447
references.citation: Can J Physiol Pharmacol. 2004 Jul;82(7):502-5
references.pmid: 15389297
references.citation: J Hand Surg Am. 2005 May;30(3):479-82
references.pmid: 15925155
references.citation: Clin Orthop Relat Res. 1975 May;(108):264-74
references.pmid: 49235
references.citation: Ann Emerg Med. 1991 Jul;20(7):807-9
references.pmid: 1676570
references.citation: Clin Rheumatol. 1983 Jun;2(2):159-61
references.pmid: 6678689
references.citation: Arthritis Rheum. 1980 Sep;23(9):1010-20
references.pmid: 7417350
references.citation: Am J Med. 1995 Oct;99(4):370-3
references.pmid: 7573091
references.citation: Can Med Assoc J. 1967 Aug 19;97(8):374-7
references.pmid: 6037390
references.citation: Br Med J. 1961 Jun 10;1(5240):1658
references.pmid: 13696093
references.citation: Dermatologica. 1975;151(5):274-80
references.pmid: 1225665
references.citation: J Bone Joint Surg Am. 2006 Jun;88(6):1331-8
references.pmid: 16757768
references.citation: J Bone Joint Surg Am. 1975 Jan;57(1):70-6
references.pmid: 1123374
references.citation: Clin Orthop Relat Res. 1976 Mar-Apr;(115):286-90
references.pmid: 1253492
references.citation: Clin Orthop Relat Res. 1975 Jan-Feb;(106):350-6
references.pmid: 1126088
references.citation: Clin Orthop Relat Res. 1977 Mar-Apr;(123):197-209
references.pmid: 404109
references.citation: Cardiovasc Hematol Disord Drug Targets. 2006 Jun;6(2):85-100
references.pmid: 16787194
references.citation: South Med J. 2006 Dec;99(12):1393-4
references.pmid: 17233199
references.citation: Br J Anaesth. 1998 Jun;80(6):837-9
references.pmid: 9771318
references.citation: Clin Orthop Relat Res. 1972 Sep;87:254-6
references.pmid: 4263298
references.citation: J Bone Joint Surg Am. 1954 Jun;36-A(3):588-601
references.pmid: 13163091
references.citation: Clin Orthop Relat Res. 1969 May-Jun;64:21-32
references.pmid: 4183768
references.citation: Br J Gen Pract. 1999 Jun;49(443):465-6
references.pmid: 10562748
references.citation: J Orthop Res. 2003 Mar;21(2):265-71
references.pmid: 12568958
references.citation: Hepatogastroenterology. 1992 Feb;39 Suppl 1:31-6
references.pmid: 1577394
references.citation: Ann Rheum Dis. 1970 Sep;29(5):494-5
references.pmid: 5476677
references.citation: Clin Orthop Relat Res. 1982 Mar;(163):170-9
references.pmid: 7067249
references.citation: J Pharm Pharmacol. 2003 May;55(5):661-8
references.pmid: 12831509
references.citation: J Bone Joint Surg Br. 1969 Aug;51(3):503-5
references.pmid: 5820795
references.citation: J Anat. 1978 Oct;127(Pt 2):393-402
references.pmid: 721699
references.citation: Arthritis Rheum. 1965 Oct;8(5):960-9
references.pmid: 5863110
references.citation: J Hand Surg Am. 2006 Jul-Aug;31(6):979-81
references.pmid: 16843159
references.citation: Clin Orthop Relat Res. 1974 May;(100):345-8
references.pmid: 4838418
references.citation: Arch Pathol. 1966 Dec;82(6):569-82
references.pmid: 5922672
references.citation: Clin Rheumatol. 2003 Dec;22(6):386-90
references.pmid: 14677011
references.citation: J Hand Surg Br. 1991 Feb;16(1):72-4
references.pmid: 2007820
references.citation: Foot Ankle. 1992 Feb;13(2):70-9
references.pmid: 1349292
references.citation: Med Sci Sports. 1974 Fall;6(3):198-202
references.pmid: 4437349
references.citation: J Bone Joint Surg Am. 2004 Apr;86(4):794-801
references.pmid: 15069146
references.citation: J Am Acad Orthop Surg. 1994 May;2(3):133-140
references.pmid: 10709001
references.citation: Z Rheumatol. 1985 Jul-Aug;44(4):167-71
references.pmid: 4050149
references.citation: Ann Rheum Dis. 1985 Aug;44(8):561-3
references.pmid: 4026419
references.citation: Clin Orthop Relat Res. 1972 May;84:193-6
references.pmid: 4555850
references.citation: J Bone Joint Surg Am. 1966 Oct;48(7):1383-8
references.pmid: 5921793
references.citation: Am J Sports Med. 2006 Dec;34(12):1992-7
references.pmid: 16902230
references.citation: Dermatol Clin. 1995 Oct;13(4):925-39
references.pmid: 8785896
references.citation: Postgrad Med. 1980 Jul;68(1):169-74
references.pmid: 6156443
references.citation: Clin Orthop Relat Res. 1986 Dec;(213):84-91
references.pmid: 3780106