Anti-fibrotic effects of the antihistamine ketotifen in a rabbit model of arthrofibrosis

M. E. Tibbo, A. K. Limberg, C. G. Salib, T. W. Turner, A. R. McLaury, A. G. Jay, J. W. Bettencourt, J. M. Carter, D. J. Berry, M. E. Morrey, J. Sanchez-Sotelo, M. P. Abdel, B. Bolon, A. J. van Wijnen

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1 Scopus citations


Aims Arthrofibrosis is a relatively common complication after joint injuries and surgery, particularly in the knee. The present study used a previously described and validated rabbit model to assess the biomechanical, histopathological, and molecular effects of the mast cell stabilizer ketotifen on surgically induced knee joint contractures in female rabbits. Methods A group of 12 skeletally mature rabbits were randomly divided into two groups. One group received subcutaneous (SQ) saline, and a second group received SQ ketotifen injections. Biomechanical data were collected at eight, ten, 16, and 24 weeks. At the time of necropsy, posterior capsule tissue was collected for histopathological and gene expression analyses (messenger RNA (mRNA) and protein). Results At the 24-week timepoint, there was a statistically significant increase in passive extension among rabbits treated with ketotifen compared to those treated with saline (p = 0.03). However, no difference in capsular stiffness was detected. Histopathological data failed to demonstrate a decrease in the density of fibrous tissue or a decrease in α-smooth muscle actin (α-SMA) staining with ketotifen treatment. In contrast, tryptase and α-SMA protein expression in the ketotifen group were decreased when compared to saline controls (p = 0.007 and p = 0.01, respectively). Furthermore, there was a significant decrease in α-SMA (ACTA2) gene expression in the ketotifen group compared to the control group (p < 0.001). Conclusion Collectively, these data suggest that ketotifen mitigates the severity of contracture formation in a rabbit model of arthrofibrosis.

Original languageEnglish (US)
Pages (from-to)302-310
Number of pages9
JournalBone and Joint Research
Issue number6
StatePublished - Jun 2020


  • Acquired idiopathic stiffness
  • Arthrofibrosis
  • Joint fibrosis
  • Ketotifen
  • Myofibroblast
  • Total knee arthroplasty

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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