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Healing Characteristics of a Type I Collagenous Structure Treated with Corticosteroids

Department of Orthopaedics, Brown University School of Medicine, Rhode Island Hospital

Paul D. Fadale, MD

Department of Orthopaedics, Brown University School of Medicine, Rhode Island Hospital

Hans Barrach, MD

Department of Orthopaedics, Brown University School of Medicine, Rhode Island Hospital

Michael G. Ehrlich, MD

Department of Orthopaedics, Brown University School of Medicine, Rhode Island Hospital

William R. Walsh, PhD

Department of Orthopaedics, Brown University School of Medicine, Rhode Island Hospital, Division of Engineering, Brown University, Providence, Rhode Island

One hundred twenty-eight skeletally mature New Zea land White rabbits were used to study the effect of a single corticosteroid injection on the biomechanical, biochemical, and histologic aspects of ligamentous healing. Two steroid dosages were used. The amount of the low-dose steroid was calculated by determining the corticosteroid concentration at which fibroblastic synthesis of collagen was inhibited in vitro. A human equivalent dose of betamethasone was used as the high-dose steroid injection. These two steroid doses and a saline control were injected around a transected medial collateral-ligament. At 10 days all groups showed significantly inferior biomechanical properties relative to noninjected controls. By 3 weeks the human equivalent steroid dose group continued to demonstrate signifi cantly inferior properties. Histologic and biochemical analyses confirmed the biomechanical results. The clinical relevance of the study was that the delivery of a human equivalent steroid dose into an acutely injured ligament significantly impairs the healing process rela tive to a noninjected ligament at 10 days and at 3 weeks after injury. This implies that a corticosteroid-treated in jured ligament may not be able to withstand the me chanical loads of early vigorous rehabilitation.

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