Intra-articular celecoxib improves knee extension regardless of surgical release in a rabbit model of arthrofibrosis

Aims Outcomes of current operative treatments for arthrofibrosis after total knee arthroplasty (TKA) are not consistently positive or predictable. Pharmacological in vivo studies have focused mostly on prevention of arthrofibrosis. This study used a rabbit model to evaluate intra-articular (IA) effects of celecoxib in treating contracted knees alone, or in combination with capsular release. Methods A total of 24 rabbits underwent contracture-forming surgery with knee immobilization followed by remobilization surgery at eight weeks. At remobilization, one cohort underwent capsular release (n = 12), while the other cohort did not (n = 12). Both groups were divided into two subcohorts (n = 6 each) - one receiving IA injections of celecoxib, and the other receiving injections of vehicle solution (injections every day for two weeks after remobilization). Passive extension angle (PEA) was assessed in live rabbits at 10, 16, and 24 weeks, and disarticulated limbs were analyzed for capsular stiffness at 24 weeks. Results IA celecoxib resulted in greater mean PEA at ten weeks (69.6 degrees (SD 4.6) vs 45.2 degrees (SD 9.6), p = 0.004), 16 weeks (109.8 degrees (SD 24.2) vs 60.9 degrees (SD10.9), p = 0.004), and 24 weeks (101.0 degrees (SD 8.0) vs 66.3 degrees (SD 5.8), p = 0.004). Capsular stiffness was significantly reduced with IA celecoxib (2.72 Newton per cm (N center dot cm)/* (SD 1.04), p = 0.008), capsular release (2.41 N.cm/degrees (SD 0.80), p = 0.008), and capsular release combined with IA celecoxib (3.56 N.cm/degrees (SD 0.99), p = 0.018) relative to IA vehicle (6.09 N.cm/degrees (SD 1.64)). Conclusion IA injections of a celecoxib led to significant improvements in passive extension angles, with reduced capsular stiffness, when administered to rabbit knees with established experimental contracture. Celecoxib was superior to surgical release, and the combination of celecoxib and a surgical release did not provide any additional value.