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PubMed1990

Osteolysis in alloarthroplasty of the hip. The role of bone cement fragmentation.

Movement at the interface between bone and cement and fractures of the cement can cause fragmentation of the polymethylmethacrylate (PMMA) bone cement implant. In order to obtain further information about the effect of PMMA fragments on the surrounding tissue and the role of such particles in the development of bone resorption, the authors investigated 17 patients with cemented total hip endoprostheses showing osteolysis and implant loosening in the femoral shaft with (Group B) and without (Group A) involvement of the acetabulum. The roentgenographic follow-up examinations revealed an initially slow and later more rapid extension of the endosteal bone erosions, with a predilection for the tip of the stem, the lesser trochanter, and laterally for the middle of the stem. At revision surgery, tissue samples were taken from the joint capsule and the bone-cement interface, in particular from the osteolysis in the femoral shaft and the acetabulum. The tissue samples were processed for histology, microscopically examined, and semiquantitatively evaluated. The retrieved devices were also carefully inspected. Large foreign-body granulomas were found at the bone-cement interface and in the joint capsule. Histiocytes and foreign-body giant cells stored particles of PMMA and polyethylene, of which fragmented bone cement predominated. Granulomatous tissue invaded bone canals and marrow spaces and induced resorption of the surrounding bone. In four cases in Group A, tissue from the osteolysis contained only fragmented bone cement, demonstrating that PMMA particles alone may be responsible for triggering focal bone resorption. Osteolysis seems to begin at the site where disintegration of bone cement begins. In cases in which polyethylene particles were found in the tissue in addition to fragmented bone cement, wear from the ultrahigh molecular weight polyethylene socket has been increased by entrapment of PMMA particles between the joint surfaces. Thus, fragmentation of bone cement and abrasion of polyethylene enhance each other. Bone cement particles promote polyethylene wear, which in turn promotes granuloma formation, bone resorption, and subsequent bone cement disintegration.

Acetabulum↗

PubMed2006

MR arthrography of traumatic anterior shoulder lesions showed modest reproducibility and accuracy when evaluated under clinical circumstances.

INTRODUCTION: We examined the reproducibility and accuracy of high-field MRA in traumatic anterior shoulder instability under conditions resembling clinical practice and assessed the influence of observer experience. MATERIALS AND METHODS: Two radiologists with different experience levels evaluated 61 MRAs. Assessment was independent, blinded and non-sequential. For 40 MRAs, surgical reports were available to assess diagnosis accuracy and influence of observer experience. The assessed lesions were cuff lesions, Hill-Sachs lesions, bony and classic Bankart lesions, greater humeral tuberosity fractures, SLAP lesions and joint capsule lesions. Reproducibility was quantified using kappa coefficients. Accuracy was evaluated with sensitivity and specificity rates, positive and negative predictive values. Differences in the percentage of correctly diagnosed MRAs between the radiologists were tested using McNemar's test for paired proportions. RESULTS: Inter-observer k-values ranged from 0.03 for joint capsule lesions to 0.45 for humeral head lesions. The overall kappa was 0.21 (95% CI; 0.12-0.30). We also observed markedly lower sensitivity and specificity rates than those reported in the literature for most lesions. The more experienced radiologist correctly diagnosed 78.9% of all lesions compared to 65.4% for the less experienced radiologist (P < 0.001; McNemar's test). CONCLUSION: MRA-interpretations of traumatic anterior shoulder instability should be regarded with caution in clinical practice. The experience level of radiologists can affect reproducibility and accuracy.

Adolescent↗

PubMed1980

Histochemical and histophysical detection of wear products resulting from prostheses.

The authors determined the wear products in tissues following hip prostheses implantations in 40 cases. The interval between prostheses implantation and histochemical examinations varied from 3 weeks to 15 years. The authors found that on the inner layer of the neighbouring joint capsule immediate to the implant a metal-protein layer developed and cobalt, chrom, nickel particles were demonstrated later in the connective and scar tissues as well. In the connective and fat tissues around the hip prostheses (from 4 cm) cobalt and chrom, in the regional lymph nodes cobalt, chrom nickel and in some cases manganese particles were found. Bone cement and plastic materials were found in the joint capsule, in the bone marrow of the distal part of the femur, but they were not present in the lymph nodes.

Aged↗

PubMed1995

A topographical and ultrastructural study of sensory trigeminal nerve endings in the rat temporomandibular joint as demonstrated by anterograde transport of wheat germ agglutinin-horseradish peroxidase (WGA-HRP).

To extend our previous light microscopic observations concerning the distribution of trigeminal sensory nerves in the synovium of the rat temporomandibular joint, we investigated the detailed distribution and fine structure of sensory nerve endings at the light and electron microscopic level by the anterograde transport method using wheat germ agglutinin-horseradish peroxidase (WGA-HRP) injected into the trigeminal ganglion. At the light microscopic level, HRP-labeled nerve fibers were observed in the joint capsule and peripheral portion of the disc. The anterior portion of the disc was more densely innervated than the posterior portion, while no nerves were found in the central portion. At the electron microscopic level, HRP reaction products were observed intra-axonally in the thinly myelinated (A delta) and unmyelinated (C) axons in the anterior portion of the joint capsule, and were also localized in the extracellular space surrounding the unmyelinated fibers and terminals. In the subsynovial layer of the synovial membrane, the majority of labeled axons located near blood vessels or among the collagenous fibrils were covered by Schwann cell sheaths, although some naked axon terminals without sheaths were also found. These unsheathed terminals contained mitochondria, small clear vesicles, and large granular vesicles, and were close to the synovial A and/or B cells near the joint cavity. The minimum distance between the terminals and synovial cells was 75 nm. This is the first demonstration of trigeminal sensory nerve terminals close to synovial lining cells or joint cavity and suggests that neuropeptides such as substance P may be released close to the synovial lining cells or joint cavity.

Animals↗

PubMedDate not supplied

Anatomical variation of the tibial plafond: the anteromedial tibial notch.

An investigation of 77 intact foot and ankle specimens (21 fresh frozen and 62 preserved) was conducted to determine normal anatomical variation of the anteromedial region of the tibial plafond. Lower extremity specimens were obtained and carefully disarticulated at the ankle joint. Care was taken to observe anterior joint capsule attachments along with plafond surface anatomy. Specimens that exhibited signs of previous trauma or significant degenerative arthritic changes were not included in the study. All of the specimens were photographed with a millimeter scale, and the photographs were later evaluated to quantify anatomical variations of the anterior medial tibial plafond. The results of this investigation demonstrated a normal variant of articular notching of the anteromedial tibial plafond. The notching appears to function as a joint capsule anchor. In the more well developed notches, a fold, apparently of synovial tissue, was found. The notching increases the surface area for capsular attachment, is variable in size, and may assist in synovial fluid movement across the joint during ambulation. This articular notching, although often encountered arthroscopically, should be considered a normal anatomical variant unless localized degenerative processes are identified.

Aged↗

PubMed1988

Meniscal and ganglion cysts of the knee: MR evaluation.

Meniscal and ganglion cysts frequently present as palpable masses of the knee but occur at different locations than do popliteal cysts. Meniscal cysts also may be discovered incidentally on studies performed for suspected internal derangement. Sixteen cystic lesions of the knee were evaluated with MR, including 11 meniscal cysts and five ganglion cysts. Scans were performed at 1.5 T by using a transmit/receive extremity coil or a receive-only surface coil. Standard spin-echo imaging, including at least one long-TR/asymmetric-TE sequence, was performed in all cases. In six patients, gradient-echo, reduced flip-angle sequences also were done. All meniscal cysts (but none of the ganglion cysts) were associated with horizontal meniscal tears. Cysts were visualized best on the long-TR/TE images; meniscal tears were seen best on the short-TR/TE and long-TR/short-TE images. Meniscal tears and cysts were also seen well on the fast-scanning sequences. Septations were noted in four meniscal cysts and in four ganglion cysts on the long-TR/TE images. Long-TR/TE images were also useful in showing the relationship between the cyst and joint capsule in three of the ganglion cysts. MR imaging is an effective, noninvasive method for evaluating cystic lesions of the knee. Meniscal cysts are always associated with underlying horizontal meniscal tears, which can be detected with MR. Ganglion cysts are not associated with meniscal tears, but may have connections to the joint capsule, which can be detected with MR.

Humans↗

PubMed2000

Sonography of the temporomandibular joint from 60 examinations and comparison with MRI and axiography.

BACKGROUND AND OBJECTIVE: Establishing a diagnosis of temporomandibular joint disorder is mainly based on clinical assessment, functional examination, nuclear magnetic resonance imaging (MRI) and axiography. Sonographic examination was compared with MRI and axiography in assessing temporomandibular joint (TMJ) function in 55 patients. PATIENTS AND METHODS: Fifty-five patients with different TMJ problems were examined clinically, by means of axiography, sonography and some also by MRI. The range of motion was measured by sonography and axiography and the results compared using Student's t-test. Anatomical details diagnostic for disc-displacement were tested by sonography and MRI. RESULTS: The average time required for sonography was 2 min and for axiography 20 min. The mean measurement differences for condylar movement in maximal mouth opening was 1.7 mm, for protrusion 1.6 mm and for mediotrusion 2.5 mm. The range of condylar movement as measured by sonography and axiography coincided for opening and for protrusion (statistically significant). No significance was found for lateral excursions. The concordance in diagnosis of disc dislocation, hypermobility and impaired range of motion when comparing ultrasound with MRI was 83%. All sonographic examinations were performed by one person only. Sixty repeat examinations in patients produced no complaints and showed an absolute range of difference of 0.6 mm, with a relative range of 7%. Student's t-test was significant (p<0.05) (two repetitive measurements). CONCLUSION: Sonography proved to be a fast and reliable method for evaluating the range of movement of the TMJ. The lateral joint capsule, lateral disc, and upper condyle could be demonstrated. Pathological processes such as anterior or lateral disc displacement, disc perforation, seroma following contusion, capsular fibrosis, crystalline structures in the synovia and fracture dislocation of the condyle could be diagnosed with considerable reliability when compared with MRI. However, the medial aspect of the joint, medial disc dislocation and the angulation of the condylar slope could not be seen.

Adult↗

PubMed2002

Electrophysiologic evidence for an intersegmental reflex pathway between lumbar paraspinal tissues.

STUDY DESIGN: Electrophysiologic recordings were obtained from a lumbar paraspinal nerve or muscle in the anesthetized cat while electrically stimulating a paraspinal nerve or facet capsule in an adjacent lumbar segment. A variety of approaches were used to demonstrate the reflex nature of both the nerve and the muscle response. OBJECTIVE: The primary purpose of this study was to seek electrophysiologic evidence for the presence of intersegmental reflexes between adjacent lumbar vertebral segments. A second purpose of this study was to confirm a previous procedure used to evoke paraspinal reflexes. This previous work had shown that electrical stimulation of the L1-L2 facet joint capsule elicits electromyographic activity from multifidus muscle one to two vertebral segments caudal to the stimulated facet in a porcine preparation. SUMMARY OF BACKGROUND DATA: Biomechanical approaches have stressed the need for spinal stability to avoid conditions that could give rise to low back dysfunction. It seems reasonable to believe that reflex interactions between vertebral segments contribute to the sensorimotor integration of lumbar paraspinal tissues. It also seems reasonable to believe that alterations or abnormal elicitation of these reflexes could contribute to biomechanical changes associated with low back pain and paraspinal muscle spasm. METHODS: Experiments were performed on 23 alpha-chloralose anesthetized adult cats. In eight cats the L3, L4, and L5 medial branch from each dorsal ramus was exposed and placed on a bipolar hook electrode. In six cats the L4 medial branch was stimulated and a compound action potential was recorded from the L3 medial branch. In three of the six cats the L5 medial branch was stimulated and a compound action potential was recorded from the L3 medial branch. In one cat the L4 medial branch was stimulated and a compound action potential was recorded from the L5 medial branch. In one cat the L3 medial branch was stimulated and a compound action potential was recorded from the L5 medial branch. At the end of each protocol the medial branch was cut just proximal to the stimulating electrode to confirm that the compound action potential was reflexive in nature and not initiated by volume conduction. In 15 cats three approaches were used to confirm that multifidus electromyographic activity evoked by electrical stimulation of a lumbar facet capsule was reflexive in nature: 1) by anesthetizing the site of the sensory endings, i.e., the facet capsule, 2) by injecting lidocaine intrathecally to block neural conduction centrally, i.e., within the spinal canal, or 3) by cutting the afferent pathway, i.e., the medial branch of the dorsal ramus. RESULTS: Electrical stimulation of the medial branch of the dorsal ramus innervating the medial-most lumbar paraspinal tissues evoked a compound action potential in the medial branch innervating the medial-most paraspinal tissues one and two segments away. Stimulating voltages between 2 and 70 V were necessary to evoke the compound action potential. Each compound action potential was reflexive in nature because cutting the lumbar medial branch proximal to its contact with the stimulating electrode abolished each compound action potential. The conduction velocity of the reflex ranged from 3.5 to 6.1 m/sec. Electrical stimulation of a lumbar facet capsule evoked lumbar multifidus muscle electromyographic activity. However, injecting lidocaine intrathecally or transecting the medial branch of the dorsal ramus had no effect on electromyographic activity. Injecting lidocaine into the facet or into the multifidus muscle around the facet joint (near the stimulating electrode) significantly decreased the magnitude of the multifidus electromyography. CONCLUSION: These results indicate that afferent impulses conveyed by the medial branch of the dorsal ramus reflexly altered efferent activity to an adjacent lumbar segment. This intersegmental paraspinal reflex may span at least one or two vertebral segments. The data suggest that electrical stimulation of the facet joint capsule may not have reflexly elicited multifidus activity because neither chemical interruption (intrathecal lidocaine) nor physical interruption (nerve transection) of the presumed reflex pathway diminished or abolished the electromyographic response. Volume conduction of the stimulating currents likely elicited multifidus activity during electrical stimulation of the facet capsule. When using electrical stimulation of neural paraspinal tissues to evoke reflex muscle activity, appropriate control experiments must be performed to clearly demonstrate the reflexive nature of the response.

Action Potentials↗

PubMed1993

A randomized double-blind trial of dextrose-glycerine-phenol injections for chronic, low back pain.

This randomized clinical trial evaluated the efficacy of injections of a dextrose-glycerine-phenol connective tissue proliferant into the posterior ligaments, fascia, and joint capsules to treat chronic low back pain. Seventy-nine patients with chronic low back pain that had failed to respond to previous conservative care were randomly assigned to receive a double-blind series of six injections at weekly intervals of either Xylocaine/saline solution or Xylocaine/proliferant into the posterior sacroiliac and interspinous ligaments, fascia, and joint capsules of the low back from L4 to the sacrum. Patients were observed with a visual analog, disability, and pain grid scores, and with objective computerized triaxial tests of lumbar function for 6 months following conclusion of injections. Pretreatment imaging tests with either magnetic resonance imaging (MRI) or computed tomography (CT) scans were performed in all patients. Thirty of the 39 patients randomly assigned to the proliferant group achieved a 50% or greater diminution in pain or disability scores at 6 months compared to 21 of 40 in the group receiving lidocaine (p = 0.042). Subjective parameters measured at 6 months posttreatment improved (p < 0.001) overall in both the treatment and control group compared to baseline. Improvements in visual analog (p = 0.056), disability (p = 0.068), and pain grid scores (p = 0.025) were greater in the proliferant group. Objective testing of range of motion, isometric strength, and velocity of movement showed significant improvements in both groups following treatment but did not favor either group. The MRI and CT scans showed significant abnormalities in both groups, but these did not correlate with subjective complaints and were not predictive of response to treatment.

Adult↗

PubMed2005

MR images mimic disc after discectomy.

MRI of a 30-year-old woman 1 year after discectomy showed a residual disc-like tissue. The observation was initially confusing, but a close comparison of pre- and post-operative images suggested that the inferior wall of the anterior joint capsule had migrated superiorly after the removal of the disc and mimicked a residual disc on the follow-up MR images.

Adult↗

PubMed1992

[Investigation of panipenem/betamipron levels in sera and various tissues in patients of orthopedic surgery].

Panipenem/betamipron (PAPM/BP), a new parenteral carbapenem antibiotic, was investigated with regard to their levels in sera and various tissues collected from patients under orthopedic surgery. The subjects were 17 patients, complaining low back pain and hospitalized for surgical operations. PAPM/BP was administered by intravenous drip infusion for 30 minutes of a dose of 500 mg/500 mg. Serum and cerebrospinal fluid (CSF) specimens were taken from 8 patients at 15-70 minutes after administration and assayed for PAPM and BP levels. Serum, bone, and joint capsule samples where taken from the other 9 cases at 25-127 minutes after administration and assayed. PAPM levels in CSF were considerably lower than those in serum. They were 23.74-1.11 micrograms/ml in sera, 0.31-0.05 micrograms/ml in CSF's during 15 to 70 minutes after administration. PAPM levels were 27.85-2.97 micrograms/ml in sera, 2.54-0.20 micrograms/g in bones, 5.63 and 1.67 micrograms/g in joint capsules during 25 to 127 minutes after administration. BP levels in sera and various tissues were low compared to those of PAPM. These results showed that PAPM was detected at higher levels than 0.2 microgram/g in various tissues, except CSF during 20 to 120 minutes after drip infusion of PAPM/BP 500 mg/500 mg for 30 minutes.

Adolescent↗

PubMed1993

Intraarticular capacity and compliance of stiff and normal elbows.

The capacity, compliance, and position of minimum intraarticular pressure were measured in eight stiff and 10 normal elbows of 11 patients before corrective surgery for posttraumatic elbow joint contracture. Capsular compliance was determined from the slope of the pressure/volume relationships. The capacity of the normal elbow joint capsule was 14 +/- 2, whereas that of the stiff elbow was 6 +/- 3 ml. The capsular compliance of the stiff elbow was only 15% of normal, confirming that the capsule is structurally altered and not just contracted. Adequate capsular distension of the stiff elbow might therefore not be possible, increasing the potential for neurovascular injury with use of the anterior portals in elbow arthroscopy. The position of minimum intraarticular pressure and maximum compliance ("resting position"), of the normal elbow was 70 degrees. If the elbow is left immobilized in this position for an extended period of time, the risk of posttraumatic elbow joint capsule contracture might increase. This agrees with our finding that the stiff elbows had a preoperative arc of motion of 70-120 degrees and a significantly diminished capsular capacity relative to normal.

Adolescent↗

PubMed1989

Measurement of human lumbar spine ligaments during loaded and unloaded motion.

Length changes in the ligaments of human lumbar spine motion segments were investigated in order to find conditions under which unusual stress or stress reduction is found in the longitudinal ligaments and facet joint capsules. Flexibility measurements were performed under load. Increasing load and height reduction in the motion segment increases the flexibility. The anterior and posterior longitudinal ligament normally operate in the elastic part of their stress-strain curve. Destruction of the intervertebral disc leads to a dislocation of the centers of rotation in the motion segment. Two types of facet joint capsules were observed. Height reduction in the motion segment leads to abnormal strains in one type sooner than in the other, which can be normalized by slight flexion. Injection of a silicone compound into the disc normalizes many of the changes in the motion segment due to height reduction.

Humans↗

PubMedDate not supplied

The hypomobile temporomandibular joint.

The hypomobile (restricted) temporomandibular joint (TMJ) is usually caused by a restricted joint capsule or by an anteriorly displaced disk. Here, painful unilateral hypomobility (19 mm jaw opening), with normal disk position, caused by voluntary immobilization after a dental procedure, was the presenting symptom. Management included inflammation control, TMJ manipulation (mobilization), and lateral pterygoid muscle relaxation. Inflammation and pain were alleviated by nonsteroidal anti-inflammatory drugs (NSAIDs) and local TMJ ice massage. TMJ mobilization was performed at every visit, to tear joint capsule adhesions and to realign collagen fibers. Exercise consisted mainly of resistive opening (the patient resists an upward force applied to the chin), with the jaw maintained at full opening. This produced lateral pterygoid muscle relaxation at full length, aiding in the restoration of a pain-free 44 mm opening.

Aged↗

PubMed2001

[MRI in dislocation and instability of the shoulder joint].

The value of magnetic resonance imaging (MRI) in shoulder instability depends on its ability to demonstrate pathologic lesions within the joint. Traumatic dislocation in particular often results in capsulo-labral-avulsion, stretching of the joint capsule and impression fracture at the humeral head. Various MR weightings, including spin echo and gradient echo, are useful at the shoulder. A surface coil should be used. Image planes are oriented at the scapula. A capsulo-labral-avulsion can not be reliably demonstrated on non-contrast imaging in the absence of intra-articular effusion. With indirect arthrography, gadolinium is intravenously injected and enhances the articular space. With direct arthrography, gadolinium or saline are injected into the joint, optimising the demonstration of labral lesions. In grade I lesions, fluid enters the lesion without deformation or detachment of the labrum. In grade II lesions, the labrum is of abnormal size or shape, but still attached to the glenoid. In grade III lesions, the labrum is completely detached. Sensitivity of magnetic resonance arthrography for labral lesions is 90% and specificity is 95%. Impression fractures at the humeral head are well demonstrated but avulsion fractures at the glenoid are not. Lesions at the joint capsule cannot be seen. Decisions relating to shoulder instability are primarily based on patient history and physical examination. MRI adds valuable information, particular in unclear clinical settings.

Acute Disease↗

PubMedDate not supplied

The anatomy and histology of the inferior glenohumeral ligament complex of the shoulder.

The gross and histologic anatomy of the inferior glenohumeral ligament was studied in 11 fresh frozen cadaver shoulders. Arthroscopic observations of the joint capsule through the normal range of motion revealed that the inferior glenohumeral ligament is actually a complex of structures consisting of an anterior band, a posterior band, and an interposed axillary pouch. While these components of the inferior glenohumeral ligament complex were present in all 11 specimens, they were best demonstrated in some shoulders by placing the humeral head in internal or external rotation in varying degrees of abduction. Histologic examination of the joint capsule revealed that the anterior and posterior bands of the inferior glenohumeral ligament complex were readily identifiable as distinct structures comprised of thickened bands of well-organized collagen bundles. Although slight variations were noted in the attachment sites of the anterior and posterior bands to the glenoid, the inferior glenohumeral ligament complex was observed to attach to the humeral neck in one of two distinct configurations. A collar-like attachment, in which the entire inferior glenohumeral ligament complex attaches just inferior to the articular edge of the humeral head, was observed in six specimens. In the remaining five specimens, the attachment was in the shape of a "V," with the anterior and posterior bands attaching adjacent to the articular edge of the humeral head and the axillary pouch attaching at the apex of the "V" distal to the articular edge. The orientation and design of the inferior glenohumeral ligament complex supports the functional concept of this single structure as an important anterior and posterior stabilizer of the shoulder joint.

Arthroscopy↗

PubMed2002

[Developmental lumbar stenosis in eleven French Antilles patients].

PURPOSE OF THE STUDY: Developmental lumbar stenosis is a rare entity, exceptionally described in the literature. No study has been directly devoted to this condition. The purpose of the present study was to examine specific features, particularly clinical and anatomic expression, observed in a series of operated patients. MATERIAL AND METHODS: Eleven patients from the French Antilles were treated for developmental lumbar stenosis between 1996 and 2000. The Verbiest criteria were used to define canal narrowness. Signs of degeneration and presence of discal herniation were exclusion criteria. Epidemiological and clinical data were collected for the 11 patients. The degree of sagittal stenosis (fixed diameter at the bone level and mobile diameter at the discal level) was measured on computed tomography images. Transverse stenosis was determined by measuring the interpedicular and interapophyseal distances. Lateral stenosis was determined by measuring the depth of the recessus. RESULTS: These patients were young (mean age 42.4 years). Most of the clinical signs were monoradicular. Discal level stenosis predominated, generally at level L4-L5. It was generally central and lateral, sagittal and transverse. The interpedicular distance was the only diameter that remained within normal limits. Soft tissues (yellow ligaments and joint capsules) played an important role in the stenosis. DISCUSSION: The rare reports of developmental lumbar stenosis describe decompensated stenosis due to discal herniation in the adolescent. Developmental lumbar stenosis is considered to be a genetic disease and its particular high frequency in the French Antilles favors this hypothesis. The stenosis results from bony (short pedicles, hypertrophic lateral masses) and ligament (hypertrophy of the yellow ligament and joint capsules) structures. CONCLUSION: Developmental lumbar stenosis produces a global (sagittal, transverse, central, lateral) narrowing of the lumbar canal where soft tissue structures apparently play a greater role than usually thought. A prospective study examining the impact of ethnic origin is required to analyze the genetic hypothesis.

Adult↗

PubMed1987

[Plasma levels and tissue concentrations in rabbits following cutaneous administration of an indomethacin solution].

After cutaneous application to rabbits of a solution containing 1% of indomethacin (Elmetacin), concentration-time curves were determined in the skin-layers, in the subcutaneous tissue, in the superficial musculature, in the knee-joint capsule and in plasma. The quantitative assay used on-line fluorimetric detection after separation by HPLC and alkaline hydrolysis. Levels of indomethacin decreased with the depth of the tissue layers at the site of application. Indomethacin concentrations in the examined tissues exceeded plasma concentration at least twice for up to 8 h. Indomethacin was also detectable in the contralateral untreated tissue specimens and in the knee joint capsule.

Administration, Topical↗