Acetabular labral reconstruction using autografts reduces osteoarthritis development compared with labral resection in a porcine model

Acetabular labral tears are common in patients presenting with hip or groin pain. When the labrum is irreparable, labral reconstruction procedures are warranted. A circumferentially intact labrum is essential for joint health, whereas labral deficiency may predispose hip joints to osteoarthritis (OA). We aimed to determine whether labral reconstruction provides a benefit in terms of reduced OA development compared with labral resection. We performed labral reconstructions, labral resections, and sham operations in a porcine model. We assessed subsequent OA development by macroscopic observation, scanning electron microscopy, nanoindentation, histology, magnetic resonance imaging of cartilage in the acetabulum and femoral head, and enzyme-linked immunosorbent assays for inflammatory cytokines in the synovial fluid. We subjected the postoperative implants to biomechanical, histological, and mRNA expression analyses. At 24 weeks after surgery, the resected joints displayed apparent degenerative changes, in which the labral defects were filled with tiny amounts of loose, fibrous scar tissue. Compared with the resected joints, the reconstructed joints showed smooth and homogeneous geomorphology of cartilage surfaces; increased cartilage extracellular matrix (type II collagen and proteoglycans) content, elastic modulus, and hardness; and decreased type X collagen content, macroscopic and histological pathology scores, and inflammatory cytokines in the synovial fluid. The postoperative implants had compression, tensile, and histological features similar to those of the native labrum, which may have helped to attenuate OA development following labral reconstruction. Labral reconstruction using autografts greatly reduced OA progression compared with labral resection. The autologous implants used for reconstruction effectively restored the biomechanical and histological features of the labrum, contributing to hip joint homeostasis.

Anatomical single bundle anterior cruciate ligament reconstruction with rounded rectangle tibial tunnel and oval femoral tunnel: a prospective comparative study versus conventional surgery

Conventional anatomical single bundle anterior cruciate ligament (ACL) reconstruction technique with round tunnels could not simulate morphology of native insertion, while studies about ACL reconstruction technique with modified tunnels based on morphology of anatomical insertion are rare. The purpose of this study was to demonstrate an ACL reconstruction technique with rounded rectangle tibial tunnel and oval femoral tunnel and compare clinical outcomes with conventional technique. A prospective comparative study was performed in 80 consecutive subjects who underwent ACL reconstruction with the conventional round tunnels (RT-Group, n=40) or modified tunnels (MT-Group, n=40). For the modified surgery, the tunnel was modified with a bone file based on the anatomical direction and area of the remnant insertion fibers. Graft maturity were evaluated by MR images at 12 months postoperatively and patients were examined for functional scores, physical examinations at 2-year follow-up. The primary variable was the pivot-shift test. No serious complications were experienced in either group. Seventy patients (87.5%) were examined at 2-year follow-up, significant improvements were seen in both groups compared with the preoperative values in terms of all clinical assessments. Tegner scores, pivot-shift test results and SNQ value in the MT-Group were significantly better than RT-Group (P=0.04, P=0.03 and P=0.001, respectively). There were no significant differences in Lysholm scores, IKDC scores, KT-2000 measurements and Lachman tests. We successfully developed the ACL reconstruction technique with rounded rectangle tibial tunnel and oval femoral tunnel, which was superior to conventional technique in terms of postoperative Tegner scores, pivot-shift tests and early graft maturity.

Advances in Porous Scaffold Design for Bone and Cartilage Tissue Engineering and Regeneration

IMPACT STATEMENT

Challenges in musculoskeletal tissue regeneration affect millions of patients globally. Scaffolds for tissue engineering bone and cartilage provide promising solutions that increase healing and decrease need for complicated surgical procedures. Porous scaffolds have emerged as an attractive alternative to traditional scaffolds. However, the success of advanced materials, use of biological factors, and manufacturing techniques can vary depending on use case. This review provides perspective on porous scaffold manufacturing, characterization and application, and can be used to inform future scaffold design.

Superoxide dismutase 3 facilitates the chondrogenesis of bone marrow-derived mesenchymal stem cells

Articular cartilage defects are considered a major clinical problem because they cannot heal by themselves. To date, bone marrow-derived mesenchymal stem cells (BMSCs)-based therapy has been widely applied for cartilage repair. However, fibrocartilage was often generated after BMSC therapy; therefore, there is an urgent need to stimulate and maintain BMSCs chondrogenic differentiation. The specific role of superoxide dismutase 3 (SOD3) in chondrogenesis is unknown; therefore, the present study aimed to clarify whether SOD3 could facilitate the chondrogenic differentiation of BMSCs. We first evaluated SOD3 protein levels during chondrogenesis of BMSCs using plate cultures. We then tested whether SOD3 could facilitate chondrogenesis of BMSCs using knockdown or overexpression experiments. Increased SOD3 protein levels were observed during BMSCs chondrogenesis. SOD3 knockdown inhibited collagen type II alpha 1 chain (COL2A1), aggrecan (ACAN), and SRY-box 9 (SOX9) expression. Overexpression of SOD3 increased the levels of chondrogenesis markers (COL2A1, ACAN, and SOX9). Elevated superoxide anions were observed when SOD3 was knocked down. We concluded that SOD3 could facilitate chondrogenesis of BMSCs to improve cartilage regeneration.

Clinical study of anatomical ACL reconstruction with adjustable oval shaped bone tunnels: a CT evaluation

The purpose of this article was to demonstrate an adjustable oval bone tunnel ACLR technique. Aim of this technique was to fit the direction and shape of the footprint and tendon-bone healing passage (TBHP) which was defined as the passage of the normal ACL insertion embedded in the bone as closely as possible. 30 fresh-frozen human cadaveric knees were used to do the ACL anatomical insertions research. 20 patients underwent adjustable oval bone tunnel surgery and 20 patients were in round tunnel group. The tunnel of the presented technique was first drilled with a small diameter round drill bit. Then according to the direction and area of the remnant insersion fibers, the major axes of oval tunnels were expanded to theoretical value with a bone file. Major and minor axes, positions of bone apertures, and areas were evaluated on CT scans. These results were compared with cadaveric and theoretical values. The distance of major axis of oval femoral and tibial tunnel apertures were 10.42 ± 0.55 mm and 12.63 ± 0.5 mm respectively. There're no statistical significance compared with theoretical distance (femoral: P = 0.068, tibial: P = 0.058). The distance of minor axis of oval femoral and tibial tunnel apertures were 6.79 ± 0.28 mm and 6.02 ± 0.29 mm respectively. Both of them were longer than theoretical values (P < 0.001). Compared with the round femoral tunnel, the major/minor axis ratio of oval tunnel (1.53) was more close to the cadaveric results (1.83, P < 0.001). The areas of femoral and tibial apertures were 53.12 ± 1.87 mm² and 54.22 ± 3.21 mm² respectively. Both of them were smaller than the round tunnel area and lager than theoretical areas (P < 0.001). We successfully developed the adjustable single oval bone tunnel ACLR technique, which mimic the direction and shape of the tibial and femoral footprints together with the BTHP better than single round tunnel.

Three dimensional knee kinematics and kinetics in ACL-deficient patients with and without medial meniscus posterior horn tear during level walking

BACKGROUND

The location of the meniscus tear has been reported to influence kinematics in anterior cruciate ligament deficient (ACLD) knees. Medial meniscus posterior horn tear (MMPHT) often occurred after ACL rupture. Whether MMPHT influences the kinematics and kinetics in ACLD knees has not been reported yet.

RESEARCH QUESTION

The purpose of this study was to investigate three-dimensional (3D) kinematics and kinetics in ACLD knees with and without MMPHT (ACLD + MMPHT, ACLDs) during level walking.

METHODS

Fifteen patients with isolated unilateral ACLD, ten with unilateral ACLD + MMPHT, and twenty-two healthy controls underwent gait testing between January 2014 and December 2016. Participant characteristics, as well as gait parameters, were compared among control, ACLDs and ACLD + MMPHT knees.

RESULTS

Compared to the healthy controls, the ACLD knees with and without MMPHT showed significant extension deficiency at maximum extension (flexion: ACLDs: 7.83 ± 4.3°, ACLD + MMPHT: 11.09 ± 7.8°, control: 3.12 ± 4.6°, p = 0.005) and lower extension moments during terminal stance phase of gait. Compared with the healthy controls, significantly increased external tibial rotation during pre-swing phase and lower rotation moments at terminal stance phase were observed in the ACLD + MMPHT knees, but not in the ACLDs knees. No significant differences in gait parameters were observed between ACLDs and ACLD + MMPHT knees during stance phase of walking.

SIGNIFICANCE

The ACLD knees with medial meniscus posterior horn tear exhibited extension deficiency, increased external tibial rotation, lower extension and internal rotation moments during the terminal stance phase compared to healthy control knees, presenting a combination of "stiffening gait" and "pivot shift gait" pattern. The ACLDs knees only presented extension deficiency and lower extension moments compared with healthy control knees, presenting a "stiffening gait". Medial meniscus posterior horn tear did not significantly affect gait patterns during stance of walking in ACLD knees.

Diagnostic utility of fluorogenic peptide-conjugated Au nanoparticle probe corroborated by rabbit model of mild cartilage injury and panel of osteoarthritic patients

Using a rabbit model of early-stage osteoarthritis (OA) and a sampling patients with OA, we evaluated the diagnostic utility of a fluorogenic peptide-conjugated gold nanoparticle (AuNP) probe in detecting mild cartilage injury, based on the a disintegrin and metalloproteinase with thrombospondin motifs 4 (ADAMTS-4) enzyme. Synthesis of this fluorescent turn-on probe (or AU-probe) required conjugation of AuNPs with a fluorescein isothiocyanate (FITC)-modified ADAMTS-4-specific peptide (DVQEFRGVTAVIR). Synovial fluid samples were then collected from 48 adult rabbits and 100 patients for comparative testing (ADAMTS-4 ELISA and AU-probe). Rabbit and patient MRI images were also evaluated and scored. Receiver operating characteristic (ROC) curve analysis was applied to various diagnostic methods (MRI, ELISA, AU-probe, and arthroscopy), performing comparisons via logistic regression. In rabbits, the AU-probe proved nonsuperior to MRI T2 mapping and ELISA (fluorescence cutpoint > 864.965 au). In patient groups, logistic regression analysis indicated that combined AU-probe/MRI testing outperformed MRI alone, thus offsetting low MRI sensitivity and low AU-probe specificity for improved detection of mild cartilage injury (sensitivity, 82.5%; specificity, 80.0%). We have consequently confirmed the efficacy of this AU-probe, using ADAMTS-4 activity in synovial fluid to diagnose mild cartilage injury. Combining the AU-probe with conventional MRI assessment proved optimal in this setting.

Effect of dual task on gait asymmetry in patients after anterior cruciate ligament reconstruction

Individuals who received anterior cruciate ligament (ACL) reconstruction surgeries demonstrated lower extremity movement asymmetries. The purpose of this study was to determine if psychological impairment was a contributor to lower extremity movement asymmetries in walking for individuals who received ACL reconstruction surgeries. Three-dimensional videographic and force plate data were collected for 25 males after unilateral ACL reconstruction performing walking without (single-task condition) and with the concurrent cognitive task (dual-task condition). Both uninjured and injured legs had significantly smaller peak knee flexion angle and peak knee extension moment during loading response and mid-stance phases in dual-task condition compared to single task condition (P ≤ 0.012). Walking condition and leg had significant interaction effects on peak hip adduction angle during mid-stance phase (P = 0.042) and peak hip abduction moment during loading response phase (P = 0.048). The inter-leg difference of peak hip adduction angle during mid-stance (P = 0.038) and terminal stance (P = 0.036) phases, and peak hip abduction moment during loading response phase (P = 0.024) were significantly decreased in dual-task condition compared to single-task condition. Psychological factors have significant effects on post-operative movements of both injured and uninjured knees of individuals who received ACL reconstruction surgery. Although physical factors may be primary contributors to the post-operative lower extremity movement asymmetries, psychological factors also contribute to the post-operative hip movement asymmetries.

A co-culture system of rat synovial stem cells and meniscus cells promotes cell proliferation and differentiation as compared to mono-culture

A meniscus tear often happens during active sports. It needs to be repaired or replaced surgically to avoid further damage to the articular cartilage. To address the shortage of autologous meniscal cells, we designed a co-culture system of synovial stem cells (SMSCs) and meniscal cells (MCs) to produce a large cell number and to maintain characteristics of MCs. Different ratios of SMSCs and MCs at 3:1, 1:1, and 1:3 were tested. Mono-culture of SMSCs or MCs served as control groups. Proliferation and differentiation abilities were compared. The expression of extracellular matrix (ECM) genes in MCs was assessed using an ECM array to reveal the mechanism at the gene level. The co-culture system of SMSCs/MCs at the ratio of 1:3 showed better results than the control groups or those at other ratios. This co-culture system may be a promising strategy for meniscus repair with tissue engineering.

Effect of tibia marker placement on knee joint kinematic analysis

Variability of kinematic measures determined by different marker sets among sites participating in a collaborative study is necessary for determining the reliability of a multi-site gait analysis research. We compared knee kinematics based on different marker sets on the tibia, calculating by segmental optimization (SO) and multi-body optimization (MBO) methods respectively, in order to assess the effect of marker locations on the methods. 11 healthy subjects participated in the study with 33 markers attached to the lower extremity segments, and 4 groups were identified according to markers on the tibia. Knee joint kinematics during level walking were measured and then compared among the 4 groups using statistical parametric mapping. For SO method, the results showed that there were no significant differences in the knee joint angles when used different marker sets on the tibia. However, significant differences were found in the transverse plane kinematics for MBO method. It was concluded that MBO method was more likely to be influenced by different marker sets. More attention should be paid to marker sets, specifically for MBO method, when three-dimensional gait analysis data are shared and interpreted among sites for clinical decision-making.

Synthesis and characterization of polyphosphazene microspheres incorporating demineralized bone matrix scaffolds controlled release of growth factor for chondrogenesis applications

As a promising strategy for the successful regeneration of articular cartilage, tissue engineering has received increasing recognition of control release. Two kinds of functional poly (alanine ethyl ester-co-glycine ethyl ester) phosphazene microspheres with different ratios of side-substituent groups were synthesized by emulsion technique. The rate of degradation/hydrolysis of the polymers was carefully tuned to suit the desired application for control release. For controlled delivery of growth factors, the microspheres overcame most of severe side effects linked to demineralized bone matrix (DBM) scaffolds, which had been previously optimized for cartilage regeneration. The application of scaffolds in chondrogenic differentiation was investigated by subcutaneous implantation in nude mice. In the present study, we have provided a novel microsphere-incorporating demineralized bone matrix (MS/DBM) scaffolds to release transforming growth factor-β1 or insulin-like growth factors-1. Laser confocal fluorescence staining showed that the surface of microspheres was a suitable environment for cell attachment. Histological and immunohistochemical evaluations have shown that significantly more cartilaginous extracellular matrix was detected in MS/DBM group when compared with DBM alone group (P<0.05). In addition, the biomechanical test showed that this composite scaffold exhibited favorable mechanical strength as a delivery platform. In conclusion, we demonstrated that MS/DBM scaffolds was sufficient to support stem bone marrow-derived mesenchymal stem cells chondrogenesis and neo-cartilage formation.

Risk of total/subtotal meniscectomy for respective medial and lateral meniscus injury: correlation with tear type, duration of complaint, age, gender and ACL rupture in 6034 Asian patients

Background

To evaluate the risk factor associated with total or subtotal meniscectomy for respective medial and lateral meniscus injury.

Methods

The data of all the meniscus injured patients undergoing arthroscopy in our institute between January 15th, 2000 and December 31st, 2008 was collected and 6034 patients with 7241 injured menisci met the inclusion criteria. The mean patient age was 33.6 ± 14.9 years and there were 4785 males and 2456 females with 3568 medial and 3673 lateral menisci. The decision tree approach was applied to investigate the correlation of the tear type, the duration of complaint, age, gender, ACL rupture and total/subtotal meniscectomy for respective medial and lateral meniscus.

Results

The tear type was associated with both medial (χ2 = 70.901, P < 0.001) and lateral (χ2 = 268.019, P < 0.001) total/subtotal meniscectomy. The strongest risk of total/subtotal meniscectomy of both medial and lateral meniscus tear was shown for the complex tear followed by the longitudinal, oblique, horizontal and radial tear of the medial meniscus and followed by horizontal, longitudinal, radial and oblique tear of the lateral meniscus. The risk of total/subtotal medial meniscectomy was significantly elevated for the patients with complex tear and the age of ≤40 years old (χ2 = 21.028, P < 0.001) and those with the oblique, horizontal or radial tear accompanied by ACL rupture (χ2 = 6.631, P = 0.01). Besides, the duration of complaint was also associated with total/subtotal meniscectomy of the medial longitudinal tear with ACL rupture (χ2 = 17.155, P < 0.001). On the other side, the risk of total/subtotal lateral meniscectomy was significantly elevated for the complex tear of the female patients (χ2 = 5.877, P = 0.015) with no ACL rupture (χ2 = 50.501, P < 0.001). The ACL rupture was associated with a decreased risk of total/subtotal meniscectomy for all the types of the lateral meniscus (complex: χ2 = 50.501, P < 0.001; horizontal: χ2 = 20.897, P < 0.001; oblique: χ2 = 27.413, P < 0.001; longitudinal and radial: χ2 = 110.85, P < 0.001).

Conclusion

Analyzing data from a big sample available in an Asian patient database, we found different risk factors associated with total/subtotal meniscectomy for respective medial and lateral meniscus. Identifying patients at high risk for total/subtotal meniscectomy may allow for interventions after meniscus injury.

Time-dependent effect of electrical stimulation on osteogenic differentiation of bone mesenchymal stromal cells cultured on conductive nanofibers

Bone tissue engineering using bone mesenchymal stromal cells (BMSCs) is a multidisciplinary strategy that requires biodegradable scaffold, cell, various promoting cues to work simultaneously. Electrical stimulation (ES) is known able to promote osteogenic differentiation of BMSCs, but it is interesting to know how can it play the strongest promotion effect. To strengthen local ES on BMSCs, parallel-aligned conductive nanofibers were electrospun from the mixtures of poly(L-lactide) (PLLA) and multi-walled carbon nanotubes (MWCNTs), and used for cell culture. Osteogenic differentiation of BMSCs was conducted by applying ES (direct current, 1.5 V, 1.5 h/day) perpendicular to the fiber direction during the day 1-7, day 8-14, or day 15-21 period of the osteoinductive culture. In comparison with ES-free groups, bone-related markers and genes were found significantly up-regulated when ES was applied on BMSCs growing on nanofibers having higher conductivity. When the ES was applied at the earlier stage of osteoinductive culture, the promotion effect on osteogenic differentiation would be stronger. In the presence of a BMP blocker, the down-regulated expressions of bone-related genes were able to be slightly recovered by ES, especially when the ES was applied at the beginning of osteoinductive culture (i.e. day 1-7). The promotion effect generated by ES in the early stage was found sustainable to later stages of differentiation, while those ES applied at later stages of differentiation should have missed the optimal point. In other words, later ES was not so necessary in inducing the osteogenic differentiation of BMSCs. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 3369-3383, 2017.

Isokinetic angle-specific moments and ratios characterizing hamstring and quadriceps strength in anterior cruciate ligament deficient knees

This study is intended to find more effective and robust clinical diagnostic indices to characterize muscle strength and coordination alternation following anterior cruciate ligament (ACL) rupture. To evaluate angle-specific moments and hamstring (H)/quadriceps (Q) ratios, 46 male subjects with unilateral chronic ACL-rupture performed isokinetic concentric (c), eccentric (e) quadriceps and hamstring muscle tests respectively at 60°/s. Normalized moments and H/Q ratios were calculated for peak moment (PM) and 30°, 40°, 50°, 60°, 70°, 80° knee flexion angles. Furthermore, we introduced single-to-arithmetic-mean (SAM) and single-to-root-mean-square (SRMS) muscle co-contraction ratios, calculating them for specific angles and different contraction repetitions. Normalized PM and 40° specific concentric quadriceps, concentric hamstring strength in the ACL-deficient knee were reduced significantly (P ≤ 0.05). Concentric angle-specific moments together with Qe/Qc ratios at 40° (d = 0.766 vs. d = 0.654) identify more obvious differences than peak values in ACL ruptured limbs. Furthermore, we found SRMS-QeQc deficits at 40° showed stronger effect than Qe/Qc ratios (d = 0.918 vs. d = 0.766), albeit other ratio differences remained basically the same effect size as the original H/Q ratios. All the newly defined SAM and SRMS indices could decrease variance. Overall, 40° knee moments and SAM/SRMS ratios might be new potential diagnosis indices for ACL rupture detection.

Structurally and Functionally Optimized Silk-Fibroin-Gelatin Scaffold Using 3D Printing to Repair Cartilage Injury In Vitro and In Vivo

Articular cartilage repair remains a great challenge for clinicians and researchers. Recently, there emerges a promising way to achieve one-step cartilage repair in situ by combining endogenic bone marrow stem cells (BMSCs) with suitable biomaterials using a tissue engineering technique. To meet the increasing demand for cartilage tissue engineering, a structurally and functionally optimized scaffold is designed, by integrating silk fibroin with gelatin in combination with BMSC-specific-affinity peptide using 3D printing (3DP) technology. The combination ratio of silk fibroin and gelatin greatly balances the mechanical properties and degradation rate to match the newly formed cartilage. This dually optimized scaffold has shown superior performance for cartilage repair in a knee joint because it not only retains adequate BMSCs, due to efficient recruiting ability, and acts as a physical barrier for blood clots, but also provides a mechanical protection before neocartilage formation and a suitable 3D microenvironment for BMSC proliferation, differentiation, and extracellular matrix production. It appears to be a promising biomaterial for knee cartilage repair and is worthy of further investigation in large animal studies and preclinical applications. Beyond knee cartilage, this dually optimized scaffold may also serve as an ideal biomaterial for the regeneration of other joint cartilages.

Microfracture combined with functional pig peritoneum-derived acellular matrix for cartilage repair in rabbit models

Due to avascular and hypocellular nature of cartilage, repair of articular cartilage defects within synovial joints still poses a significant clinical challenge. To promote neocartilage properties, we established a functional scaffold named APM-E7 by conjugating a bone marrow-derived mesenchymal stem cell (BM-MSC) affinity peptide (E7) onto the acellular peritoneum matrix (APM). During in vitro culture, the APM-E7 scaffold can support better proliferation as well as better differentiation into chondrocytes of BM-MSCs. After implanting into cartilage defects in rabbits for 24weeks, compared with microfracture and APM groups, the APM-E7 scaffolds exhibited superior quality of neocartilage without transplant rejection, according to general observations, histological assessment, synovial fluid analysis, magnetic resonance imaging (MRI) and nanomechanical properties. This APM-E7 scaffold provided a scaffold for cell attachment, which was crucial for cartilage regeneration. Overall, the APM-E7 is a promising biomaterial with low immunogenicity for one-step cartilage repair by promoting autologous connective tissue progenitor (CTP) attachment.

STATEMENT OF SIGNIFICANCE

We report the one-step transplantation of functional acellular peritoneum matrix (APM-E7) with specific mesenchymal stem cell recruitment to repair rabbit cartilage injury. The experimental results illustrated that the APM-E7 scaffold was successfully fabricated, which could specifically recruit MSCs and fill the cartilage defects in the femoral trochlear of rabbits at 24weeks post-surgery. The repaired tissue was hyaline cartilage, which exhibited ideal mechanical stability. The APM-E7 biomaterial could provide scaffold for MSCs and improve cell homing, which are two key factors required for cartilage tissue engineering, thereby providing new insights into cartilage tissue engineering.

Emerging Roles of circRNA Related to the Mechanical Stress in Human Cartilage Degradation of Osteoarthritis

Circular RNAs (circRNAs) are involved in the development of various diseases; however, knowledge on circRNAs in osteoarthritis (OA) is limited. This study aims to identify circRNA expression in different regions affected by OA and to explore the function of mechanical stress-related circRNAs (circRNAs-MSR) in cartilage. Bioinformatics was employed to predict the interaction of circRNAs and mRNAs in the cartilage. Loss-of-function experiments for circRNAs-MSR were performed in vitro. A total of 104 circRNAs were differentially expressed in damaged versus intact cartilage. Of these circRNAs, 44 and 60 were upregulated and downregulated, respectively, in the damaged tissue. circRNA-MSR expression increased under mechanical stress in chondrocytes. circRNAs-MSR were silenced using small interfering RNA, and knockdown of circRNAs-MSR could suppress tumor necrosis factor alpha (TNF-α) expression and increase extracellular matrix (ECM) formation. Our results demonstrated that circRNAs-MSR regulated TNF-α expression and participated in the chondrocyte ECM degradation process. We propose that the inhibition of circRNAs-MSR could inhibit the degradation of chondrocyte ECM and knockdown of circRNAs-MSR could be a potential therapeutic target for OA.

The characteristics of EEG power spectra changes after ACL rupture

Background

Reestablishing knee stability is the core of the treatment of ACL (Anterior Cruciate Ligament) injury. Some patients still have a feeling of instability of the knee after ACL injury treatment. This unstable feeling may be caused by central nervous system changes after ACL rupture.

Methods

To identify the central changes after ACL rupture, EEG spectra were recorded to compare ACL patients and healthy controls when they were walking, jogging, and landing.

Results

There was a significant increase in delta, theta, alpha and beta band power during walking, jogging and landing in ACL patients. We also found an asymmetry phenomenon of EEG only in the ACL patients, mainly in the frontal area and central-parietal area. The asymmetry of beta band power extended to the frontal and the central area during jogging and landing task.

Conclusions

There were significant differences in EEG power spectra between the ACL patients and healthy people. ACL patients showed high EEG band power activities and an asymmetry phenomenon. EEG power changes were affected by movements, the asymmetry extended when performing more complicated movements.

Similarity of Center of Pressure Progression during Walking and Jogging of Anterior Cruciate Ligament Deficient Patients

OBJECTIVE

To evaluate the center of pressure (COP) progression similarity and its change during walking and jogging in Anterior Cruciate Ligament deficient (ACLD) patients.

METHODS

A study was performed in 64 unilateral ACLD subjects and 32 healthy volunteers who walked and jogged on footscan® system at a self-selected speed. COP trajectory during walking and jogging was calculated. The robustness and similarity scores of COP (SSCOP, similarity scores with respect to corresponding COP trajectories) were computed, and then the Analysis of Variance test was employed to compare among different conditions (left or right side, within a subject or between subjects, walking or jogging).

RESULTS

(1) During the same motion status (walking or jogging), SSCOP were higher than 0.885. However, SSCOP between walking and jogging were lower than 0.25 in both the healthy and ACLD group. SSCOP between the intrasubjects were statistically higher than those between the intersubjects (p<0.01). (2) SSCOP in the ACLD group were statistically significantly reduced to 0.885±0.074 compared to 0.912±0.057 in healthy volunteers during walking, and 0.903±0.066 in the ACLD group compared to 0.919±0.050 in the healthy group during jogging (p<0.01).

CONCLUSIONS

SSCOP can distinguish walking from jogging, and SSCOP of ACLD patients would be different from that of healthy controls. The study protocol was approved by the Institutional Research Board of Peking University Third Hospital (IRB00006761-2012010).

Characterization and comparison of flower bud microRNAs from yellow-horn species

An increasing number of microRNAs (miRNAs) are known to play crucial regulatory roles in floral organ differentiation and development. Yellow-horn (Xanthoceras sorbifolia Bunge) is an oil-rich seed shrub that has great potential for biodiesel production. To evaluate the roles of miRNAs in the regulation of flower development, we used high-throughput sequencing to characterize them from flower buds of double-flower yellow-horn mutant and wild-type plants. Approximately 33 million raw reads were obtained through Solexa sequencing of two small RNA libraries, and the conserved and novel miRNA locations were annotated. Nineteen conserved miRNAs (belonging to nine families) and eight novel miRNAs were identified from the two libraries. Twelve conserved and eight novel miRNA-star sequences were also discovered, providing additional evidence for the existence of miRNAs in this species. Thirteen miRNAs were differentially expressed between wild-type and mutant plants. Real-time reverse transcription-polymerase chain reaction analysis revealed the expression patterns of eight microRNAs, which were confirmed by sequencing. The assessed targets of these miRNAs are involved in transcriptional regulation, disease resistance, antioxidative metabolism, nucleobase regulation, and nucleic acid metabolism. This study opens up new avenues for understanding the roles of miRNAs in X. sorbifolia.

Inhibition of transforming growth factor β-activated kinase 1 prevents inflammation-related cartilage degradation in osteoarthritis

Osteoarthritis (OA) is a common debilitating joint disorder, there’s still no available disease-modifying drug for OA currently. This study aims to explore the role of TAK1 in OA pathogenesis and therapeutic efficiency of TAK1 inhibition for OA. The contribution of TAK1 to OA pathogenesis was investigated by intra-articular injection of TAK1-encoding adenovirus in rats. TAK1 inhibitor 5Z-7-induced expression changes of extracellular matrix (ECM)-related genes were detected by real-time PCR. The protective effect of 5Z-7 against OA progression was evaluated in a post-traumatic OA rat model. Our results showed that intra-articular injection of Ad-Tak1 induced cartilage destruction and OA-related cytokine secretion in rat joints. TAK1 inhibition by 5Z-7 efficiently blocked NF-κB, JNK and p38 pathways activation in OA chondrocytes and synoviocytes, Meanwhile, 5Z-7 significantly decreased the expression of matrix-degrading enzymes and pro-inflammatory cytokine, while increased ECM protein expression, which are all crucial components in OA. 5Z-7 also ameliorated ECM loss in OA cartilage explants. More importantly, 5Z-7 significantly protected against cartilage destruction in a rat model of OA. In conclusion, our findings provide the first in vivo evidence that TAK1 contributes to OA by disrupting cartilage homeostasis, thus represents an ideal target for OA treatment, with 5Z-7 as a candidate therapeutic.

Comparison Between Single- and Double-Bundle Anterior Cruciate Ligament Reconstruction With 6- to 8-Stranded Hamstring Autograft: A Prospective, Randomized Clinical Trial

BACKGROUND

Whether double-bundle (DB) anterior cruciate ligament (ACL) reconstruction with 6- to 8-stranded hamstring autograft (HG) is better than single-bundle (SB) ACL reconstruction remains debatable, as long-term follow-up data are lacking.

PURPOSE

To prospectively investigate and compare the long-term results of DB and SB ACL reconstruction with a 6- to 8-stranded HG.

STUDY DESIGN

Randomized controlled clinical trial;

LEVEL OF EVIDENCE

1.

METHODS

A total of 80 patients with chronic ACL rupture were randomized to SB or DB ACL reconstruction with a 6- to 8-stranded HG. In the SB group, both the semitendinosus tendon (ST) and the gracilis tendon (GT) were prepared in 3 or 4 strands, with a total of 6 to 8 strands. In the DB group, the ST was prepared in 3 or 4 strands used for the anteromedial bundle, and the GT was prepared in the same manner for the posterolateral bundle. Each graft was fixed with an EndoButton, a bioabsorbable interference screw, and a staple. Outcome assessment was performed by a blinded independent observer using International Knee Documentation Committee (IKDC), Tegner, and Lysholm scores, as well as range of motion (ROM), Lachman test, pivot-shift test, KT-2000 arthrometer side-to-side difference, and return-to-sport data.

RESULTS

A total of 68 patients (DB group, 34; SB group, 34) were observed for a mean of 80 months (range, 74-86 months). There were 2 traumatic instability failures and two 5° extension restrictions in the DB group, while no failures or 5° extension restrictions were observed in the SB group. The mean Lysholm, Tegner, and IKDC scores improved significantly in both groups compared with preoperation scores (P < .05). No patient had a positive Lachman test result. No significant differences were found between groups in functional scores, incidence of pivot shift, ROM, Lachman test, KT-2000 arthrometer anterior laxity, or time and level of return to sport.

CONCLUSION

Both SB and DB ACL reconstruction with 6- to 8-stranded HG showed satisfactory results in subjective scores and anteroposterior and rotational stability over a nearly 7-year follow-up; neither technique was superior.

The TMSB4 Pseudogene LncRNA Functions as a Competing Endogenous RNA to Promote Cartilage Degradation in Human Osteoarthritis

Mechanical stress plays a key role in the development of cartilage degradation in osteoarthritis (OA). Nevertheless, the role of long noncoding RNAs in mechanical stress-induced regulation of chondrocytes remains unclear. The aim of this study was to explore the function of mechanical stress-related long noncoding RNAs in cartilage. Tissue samples were collected from 50 patients and chondrocytes were exposed to cyclic tensile strain (CTS). A total of 107 lncRNAs were differentially expressed in damaged cartilage versus intact cartilage. Of these lncRNAs, 51 were upregulated and 56 were downregulated in the damaged tissue. The TMSB4 pseudogene, lncRNA-MSR, was upregulated in the damaged cartilage and was activated in chondrocytes in response to mechanical stress. Furthermore, lncRNA-MSR regulated the expression of TMSB4 by competing with miRNA-152 in chondrocytes. Our results demonstrated that upregulation of lncRNA-MSR initiates pathological changes that lead to cartilage degradation, and the inhibition of lncRNA-MSR could represent a potential therapeutic target for OA.

The diagnostic value of magnetic resonance imaging for different types of subscapularis lesions

PURPOSE

To investigate the accuracy of preoperative 1.5 T magnetic resonance imaging (MRI) interpreted with standardized procedure for diagnosing subscapularis (SSC) tears identified by arthroscopy. The diagnostic accuracy of MRI for different types of SSC lesions was also evaluated.

METHODS

Two-hundred and seventy-two consecutive patients with rotator cuff tears identified by arthroscopy were included into this study. All patients had preoperative MRI scans with 1.5 T strength. Totally, seven different signs of SSC tears were evaluated on MRI scans. The diagnostic value of MRI was evaluated, respectively, according to two classifications of SSC lesions. The definitive diagnosis for SSC lesions was based on the arthroscopic findings.

RESULTS

Among the 272 patients in this study, 107 (39 %) had SSC tears confirmed by arthroscopy. The surgeons correctly diagnosed 88 of 107 patients with SSC tears. The overall sensitivity was 82.2 %. The sensitivity of MRI for types I, II, III, IV and V was 70, 82.4, 96, 100 and 100 %, respectively, based on the classification by Lafosse. The sensitivity of MRI for partial-thickness and partial-width, full-thickness and partial-width, full-thickness and full-width tear was 75.3, 96.2, 100 %, respectively, according to the classification by Kim.

CONCLUSIONS

The sensitivity of MRI in predicting SSC tears preoperatively was improved with the current procedure. Understanding of certain MRI characteristics of SSC tears could increase the accuracy for diagnosing SSC lesions. 1.5 T MRI of the SSC was not reliable for predicting partial thickness and especially less than 1/3 width tears.

LEVEL OF EVIDENCE

III.

Circular RNA Related to the Chondrocyte ECM Regulates MMP13 Expression by Functioning as a MiR-136 'Sponge' in Human Cartilage Degradation

Circular RNAs (circRNAs) are involved in the development of various diseases, but there is little knowledge of circRNAs in osteoarthritis (OA). The aim of study was to identify circRNA expression in articular cartilage and to explore the function of chondrocyte extracellular matrix (ECM)-related circRNAs (circRNA-CER) in cartilage. To identify circRNAs that are specifically expressed in cartilage, we compared the expression of circRNAs in OA cartilage with that in normal cartilage. Bioinformatics was employed to predict the interaction of circRNAs and mRNAs in cartilage. Loss-of-function and rescue experiments for circRNA-CER were performed in vitro. A total of 71 circRNAs were differentially expressed in OA and normal cartilage. CircRNA-CER expression increased with interleukin-1 and tumor necrosis factor levels in chondrocytes. Silencing of circRNA-CER using small interfering RNA suppressed MMP13 expression and increased ECM formation. CircRNA-CER could compete for miR-136 with MMP13. Our results demonstrated that circRNA-CER regulated MMP13 expression by functioning as a competing endogenous RNA (ceRNA) and participated in the process of chondrocyte ECM degradation. We propose that circRNA-CER could be used as a potential target in OA therapy.

Runx2-Modified Adipose-Derived Stem Cells Promote Tendon Graft Integration in Anterior Cruciate Ligament Reconstruction

Runx2 is a powerful osteo-inductive factor and adipose-derived stem cells (ADSCs) are multipotent. However, it is unknown whether Runx2-overexpressing ADSCs (Runx2-ADSCs) could promote anterior cruciate ligament (ACL) reconstruction. We evaluated the effect of Runx2-ADSCs on ACL reconstruction in vitro and in vivo. mRNA expressions of osteocalcin (OCN), bone sialoprotein (BSP) and collagen I (COLI) increased over time in Runx2-ADSCs. Runx2 overexpression inhibited LPL and PPARγ mRNA expressions. Runx2 induced alkaline phosphatase activity markedly. In nude mice injected with Runx2-ADSCs, promoted bone formation was detected by X-rays 8 weeks after injection. The healing of tendon-to-bone in a rabbit model of ACL reconstruction treated with Runx2-ADSCs, fibrin glue only and an RNAi targeting Runx2, was evaluated with CT 3D reconstruction, histological analysis and biomechanical methods. CT showed a greater degree of new bone formation around the bone tunnel in the group treated with Runx2-ADSCs compared with the fibrin glue group and RNAi Runx2 group. Histology showed that treatment with Runx2-ADSCs led to a rapid and significant increase at the tendon-to-bone compared with the control groups. Biomechanical tests demonstrated higher tendon pullout strength in the Runx2-ADSCs group at early time points. The healing of the attachment in ACL reconstruction was enhanced by Runx2-ADSCs.

A composite scaffold of MSC affinity peptide-modified demineralized bone matrix particles and chitosan hydrogel for cartilage regeneration

Articular cartilage injury is still a significant challenge because of the poor intrinsic healing potential of cartilage. Stem cell-based tissue engineering is a promising technique for cartilage repair. As cartilage defects are usually irregular in clinical settings, scaffolds with moldability that can fill any shape of cartilage defects and closely integrate with the host cartilage are desirable. In this study, we constructed a composite scaffold combining mesenchymal stem cells (MSCs) E7 affinity peptide-modified demineralized bone matrix (DBM) particles and chitosan (CS) hydrogel for cartilage engineering. This solid-supported composite scaffold exhibited appropriate porosity, which provided a 3D microenvironment that supports cell adhesion and proliferation. Cell proliferation and DNA content analysis indicated that the DBM-E7/CS scaffold promoted better rat bone marrow-derived MSCs (BMMSCs) survival than the CS or DBM/CS groups. Meanwhile, the DBM-E7/CS scaffold increased matrix production and improved chondrogenic differentiation ability of BMMSCs in vitro. Furthermore, after implantation in vivo for four weeks, compared to those in control groups, the regenerated issue in the DBM-E7/CS group exhibited translucent and superior cartilage-like structures, as indicated by gross observation, histological examination, and assessment of matrix staining. Overall, the functional composite scaffold of DBM-E7/CS is a promising option for repairing irregularly shaped cartilage defects.

[Comparison of clinical results between middle-aged patients and young patients after anterior cruciate ligament reconstruction]

OBJECTIVE

To compare the outcomes of anterior cruciate ligament (ACL) reconstruction in patients aged over 40 years and under 25 years at least 24 months follow-up after operation.

METHODS

Fifty-seven patients who underwent ACL reconstruction for ACL rupture in Institute of Sports Medicine, Peking University Third Hospital, from October 2010 to December 2012 were selected for this retrospective study.The patients aged over 40 years consisted of 13 men and 15 women with an average age of 46.5 years (range, 41 to 63 years). The patients younger than 25 years consisted of 19 men and 10 women with an average age of 21.0 years (range, 18 to 24 years). The average follow-up time was 26.0 months (range, 24 to 45 months). Clinical functional evaluation for all patients was performed according to Lysholm, Tegner and IKDC scores both before and after surgery.In addition, a pre- and post-operative arthrometric evaluation was also performed with KT-2000.

RESULTS

The average postoperative Lysholm, Tegner and IKDC scores in patients aged over 40 years and under 25 years were 89 (74 to 100), 5 (3 to 6), 90 (70 to 100) and 94 (79 to 100), 5 (4 to 7), 93 (74 to 100) respectively.The average postoperative KT-2000 arthrometer anterior laxity in 30° and 90° in both groups was 2 mm (0 to 4 mm), 1 mm (-1 to 4 mm) and 2 mm (0 to 4 mm), 1 mm (0 to 4 mm) respectively.The postoperative functional scores and side-to-side difference improved more significantly than preoperative values, with no significant difference in both groups.

CONCLUSION

ACL reconstruction provides the comparable clinical outcomes between middle-aged patients and young patients.

Different tenogenic differentiation capacities of different mesenchymal stem cells in the presence of BMP-12

BACKGROUND

Mesenchymal stem cells (MSCs) are regarded as a promising cell-based therapeutic tool for tendon repair. This study aimed to compare the different tenogenic differentiation capacities of the three types of MSCs in the presence of bone morphogenic protein 12 (BMP-12).

METHODS

MSCs were isolated from rat bone marrow (BM), inguinal adipose tissue (AD), and synovium (SM) from the knee joint. MSCs were characterized by morphology, proliferation, trilineage differentiation, and surface marker analysis. Tenogenic differentiation potential was initially assessed using real-time polymerase chain reaction, Western blot, and enzyme-linked immunosorbent assay in vitro. Histological assessments were also performed after subcutaneous implantation of BMP-12 recombinant adenovirus-infected MSCs in nude mice in vivo.

RESULTS

The three types of MSCs exhibited similar fibroblast-like morphology and surface markers but different differentiation potentials toward adipogenic, osteogenic, and chondrogenic lineage fates. Bone marrow-derived MSCs (BM-MSCs) showed the most superior in vitro tenogenic differentiation capacity, followed by synovial membrane-derived MSCs (SM-MSCs) and then adipose-derived MSCs (AD-MSCs). After implantation, all three types of MSC masses infected with BMP-12 recombinant adenovirus emerged in the form of fiber-like matrix, especially in 6-week specimens, compared with the control MSCs in vivo. BM-MSCs and SM-MSCs revealed more intense staining for collagen type I (Col I) compared with AD-MSCs. Differences were not observed between BM-MSCs and SM-MSCs. However, SM-MSCs demonstrated higher proliferation capacity than BM-MSCs.

CONCLUSION

BM-MSCs exhibited the most superior tenogenic differentiation capacity, followed by SM-MSCs. By contrast, AD-MSCs demonstrated the inferior capacity among the three types of MSCs in the presence of BMP-12 both in vivo and in vitro.

Intra-articular delivery of anti-Hif-2α siRNA by chondrocyte-homing nanoparticles to prevent cartilage degeneration in arthritic mice

Hypoxia-inducible factor-2α (Hif-2α) is a potential therapeutic target for osteoarthritis (OA), but the application of this target in the delivery of therapeutic agents to chondrocytes remains a challenge. A chondrocyte-targeting vector was constructed in a previous study to enhance transfection efficiency and specificity of chondrocytes in vivo. This study used vectors to deliver small-interfering RNA (siRNA) and silenced Hif-2α expression to prevent cartilage degeneration in OA-affected mice. After siRNA transfection was conducted by cartilage-targeting nanoparticles, the protein levels of Hif-2α, matrix metalloproteinases (MMP-13, -9), a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS-4, -5), vascular endothelial growth factor (VEGF), type X collagen and nuclear factor (NF)-κB in interleukin-1-beta (IL-1β)-stimulated chondrocytes were determined. Chondrocyte-targeting ability was also determined by fluorescein isothiocyanate (FITC)-labeled siRNA tracking under a confocal microscope. OA model was established by surgically destabilizing the knee joints of a mouse. Hif-2α siRNA was then delivered intra-articularly with nanoparticles in vivo. Cartilage degeneration and synovium inflammation in the knee joints were analyzed by histomorphometry. IL-1β levels in the synovial fluid were also measured by enzyme-linked immunosorbent assay. In vitro assay results showed that catabolic factors, including Hif-2α, MMP-13 and -9, ADAMTS-4, VEGF, collagen type X and NF-κB, were downregulated after Hif-2α-siRNA transfection by chondrocyte-targeting nanoparticles. In vivo assay results with FITC-labeled siRNA tracking also confirmed that nanoparticles promoted the local concentration and prolonged the retention time of siRNA in the cartilage. Histological analysis results confirmed that nanoparticle-mediated siRNA maintained cartilage integrity and alleviated synovium inflammation. IL-1β levels decreased after siRNA was silenced by nanoparticles. Thus, chondrocyte-targeting nanoparticles could deliver Hif-2α siRNA to cartilage and specifically inhibit the expression of catabolic proteins.

Dextran-coated fluorapatite crystals doped with Yb3+/Ho3+ for labeling and tracking chondrogenic differentiation of bone marrow mesenchymal stem cells in vitro and in vivo

Upconversion fluorescent nanoparticles are becoming more widely used as imaging contrast agents, owing to their high resolution and penetration depth, and avoidance of tissue auto-fluorescence and photodamage to cells. Here, we synthesized upconversion fluorescent crystals from rare-earth Yb3+ and Ho3+ co-doped fluorapatite (FA:Yb3+/Ho3+) suitable for long-term tracking and monitoring cartilage development (chondrogenesis) in bone marrow mesenchymal stem cells (BMSCs) in vitro and in vivo. We initially determined the structure, morphology and luminescence of the products using X-ray powder diffraction, transmission electron microscopy and two-photon confocal microscopy. When excited at 980 nm, FA:Yb3+/Ho3+ crystals exhibited distinct upconversion fluorescence peaks at 543 nm and 654 nm. We then conjugated FA:Yb3+/Ho3+ crystals with dextran to enhance hydrophilicity, biocompatibility and cell penetration. Next, we employed the dextran-coated FA:Yb3+/Ho3+ crystals in labeling and tracking chondrogenic differentiation processes in BMSCs stably expressing green fluorescent protein (BMSCsGFP) in vitro and in vivo. Labeled BMSCsGFP were shown to reproducibly exhibit chondrogenic differentiation potential in RT-PCR analysis, histological assessment and immunohistochemistry. We observed continuous luminescence from the FA:Yb3+/Ho3+ upconversion crystals at 4 weeks and 12 weeks post transplantation in BMSCsGFP, while GFP fluorescence in both control and crystal-treated groups significantly decreased at 12 weeks after BMSCsGFP transplantation. We therefore demonstrate the high biocompatibility and stability of FA:Yb3+/Ho3+ crystals in tracking and monitoring BMSCs chondrogenesis in vitro and in vivo, highlighting their excellent cell labeling potential in cartilage tissue engineering.

C-reactive protein and erythrocyte sedimentation rate changes after arthroscopic anterior cruciate ligament reconstruction: guideline to diagnose and monitor postoperative infection

PURPOSE

The purposes of our study were to determine normative C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values from a retrospective review of patients with and without infection after anterior cruciate ligament (ACL) reconstruction and to determine CRP and ESR threshold levels that can serve as diagnostic indicators of infection. We also tried to draw a curve of CRP and ESR value changes after treatment of ACL infection to evaluate the response to treatment of the infection.

METHODS

A retrospective chart review was performed of arthroscopic ACL reconstruction patients from 2007 to 2008 (noninfection group) and all patients with postoperative intra-articular infection from 1997 to 2010 (infection group). We collected the CRP and ESR values on the third and fifth postoperative days in the noninfection group and before infection treatment and on the first, third, fifth, seventh, 10th, 14th, 21st, 28th, and 35th days after infection treatment in the infection group. Sensitivity, specificity, and Youden's index were calculated for different threshold values of CRP and ESR as predictors of infection. Receiver operator curves were obtained for CRP and ESR on the fifth postoperative day.

RESULTS

Of 122 patients, 83 had normal joints and 39 had septic joints. The mean CRP and ESR values in patients with septic joints were 101.9 mg/L and 57.1 mm/h, respectively, which were significantly higher than those in the noninfection group (P < .01). A CRP value of 41 mg/L and ESR value of 32 mm/h were the optimal thresholds to predict an infection, which had the highest Youden's index of all calculated values and had sensitivity values of 94.1% and 91.2%, respectively, and specificity values of 97.6% and 80.5%, respectively. The peak CRP level after infection treatment occurred earlier than the peak ESR level (first day v third day) and returned to normal more quickly (21st day v 28th day).

CONCLUSIONS

Both CRP and ESR were helpful in determining the presence of a normal or septic joint. The threshold values of 41 mg/L for CRP and 32 mm/h for ESR had the most optimal sensitivity and specificity. The peak CRP level occurred earlier than the peak ESR level after treatment of postoperative infection and returned to normal more quickly. In this study CRP was more useful than ESR to evaluate the response of infection to treatment.

LEVEL OF EVIDENCE

Level IV, diagnostic study.

Long noncoding RNA related to cartilage injury promotes chondrocyte extracellular matrix degradation in osteoarthritis

OBJECTIVE

Long noncoding RNAs (lncRNAs) play crucial regulatory roles in diverse biologic processes, but knowledge of lncRNAs in osteoarthritis (OA) is limited. The aim of this study was to identify lncRNA expression in articular cartilage and to explore the function of cartilage injury-related lncRNAs (lncRNA-CIR) in OA.

METHODS

To identify lncRNAs specifically expressed in OA cartilage, we compared the expression of lncRNAs in OA cartilage with that in normal cartilage using microarray and quantitative polymerase chain reaction (qPCR) analyses. In OA cartilage, lncRNA-CIR was specifically, differentially, and highly expressed. The function of lncRNA-CIR was determined by silencing and overexpression in vitro. Extracellular matrix (ECM)-related molecules were detected by qPCR, Western blot, and immunofluorescence analyses.

RESULTS

Up to 152 lncRNAs were found to be differentially expressed (>8-fold) in OA and normal cartilage (82 lncRNAs more highly expressed and 70 less highly expressed in OA cartilage than in normal cartilage). A specific differentially expressed lncRNA-CIR was selected according to the results of the higher expression in OA cartilage and OA chondrocytes. The expression of lncRNA-CIR increased in chondrocytes with in vitro treatment with interleukin-1β and tumor necrosis factor α. Silencing of lncRNA-CIR by small interfering RNA promoted the formation of collagen and aggrecan and reduced the expression of matrix-degrading enzymes, such as MMP13 and ADAMTS5. The expression of collagen and aggrecan was reduced, whereas the expression of matrix-degrading enzymes was increased, after overexpression of lncRNA-CIR.

CONCLUSION

The results indicate that lncRNA-CIR contributes to ECM degradation and plays a key role in the pathogenesis of OA. We propose that lncRNA-CIR could be used as a potential target in OA therapy.

[Predisposing factors of patellofemoral articular cartilage injury after anterior cruciate ligament reconstruction]

OBJECTIVE

To evaluate the effects of age, gender, tibial anterior laxity and time from surgery to follow-up on patellofemoral articular cartilage status after anterior cruciate ligament reconstruction by second-look arthroscopy.

METHODS

A total of 102 patients undergoing arthroscopic anterior cruciate ligament reconstruction received second-look arthroscopy at least one year after operation. There were 71 males and 31 females with an average age of 27.1 (16-41) years. The average time from primary operation to second-look arthroscopy was 23 (12-51) months. Arthroscopic evaluations of patella and trochlea cartilage status for all patients were performed at initial anterior cruciate ligament reconstruction and second-look arthroscopy. The effects of age, gender, tibial anterior laxity and time from surgery to follow-up on patellofemoral articular cartilage status were retrospectively examined.

RESULTS

Patellofemoral articular cartilage degeneration continued to aggravate after anterior cruciate ligament reconstruction. There was no significant gender difference in patella and trochlear cartilage status. The patellar cartilage of patients under 30 years was worse than that of patients aged 30 years and above. Even though there was no significant difference. However, no significant inter-group difference existed in trochlear cartilage damage. With regard to KT-2000 side-to-side differences (0-3 mm vs >3 mm), no significant difference existed in patella and trochlear cartilage status. No significant difference was also found in the status of patella and trochlear cartilage between patients with body mass index under 24 kg/m(2) and patients 24 kg/m(2) and higher. The patellar cartilage of patients within 24 months after operation was significantly worse than that of patients 24 months and longer. However it did not apply to trochlear cartilage.

CONCLUSION

The degeneration of patellofemoral articular cartilage worsens after anterior cruciate ligament reconstruction. And significantly more severe lesions are found in patellar cartilage of patients within 24 months after operation.

Directing chondrogenic differentiation of mesenchymal stem cells with a solid-supported chitosan thermogel for cartilage tissue engineering

Hydrogels are attractive for cartilage tissue engineering because of their high plasticity and similarity with the native cartilage matrix. However, one critical drawback of hydrogels for osteochondral repair is their inadequate mechanical strength. To address this limitation, we constructed a solid-supported thermogel comprising a chitosan hydrogel system and demineralized bone matrix. Scanning electron microscopy, the equilibrium scanning ratio, the biodegradation rate, biomechanical tests, biochemical assays, metabolic activity tests, immunostaining and cartilage-specific gene expression analysis were used to evaluate the solid-supported thermogel. Compared with pure hydrogel or demineralized matrix, the hybrid biomaterial showed superior porosity, equilibrium swelling and degradation rate. The hybrid scaffolds exhibited an increased mechanical strength: 75% and 30% higher compared with pure hydrogels and demineralized matrix, respectively. After three days culture, bone-derived mesenchymal stem cells (BMSCs) maintained viability above 90% in all three materials; however, the cell retention of the hybrid scaffolds was more efficient and uniform than the other materials. Matrix production and chondrogenic differentiation of BMSCs in the hybrid scaffolds were superior to its precursors, based on glycosaminoglycan quantification and hyaline cartilage marker expression after three weeks in culture. Its easy preparation, favourable biophysical properties and chondrogenic capacity indicated that this solid-supported thermogel could be an attractive biomaterial framework for cartilage tissue engineering.

Surface modification on polycaprolactone electrospun mesh and human decalcified bone scaffold with synovium-derived mesenchymal stem cells-affinity peptide for tissue engineering

Synovium-derived mesenchymal stem cells (SMSC) have been studied for over a decade since first being successfully isolated in 2001. These cells demonstrate the most promising therapeutic efficacy for musculoskeletal regeneration of the MSC family, particularly for cartilage regeneration. However, the mobilization and transfer of MSCs to defective or damaged tissues and organs in vivo with high accuracy and efficiency has been a major problem in tissue engineering (TE). In the present study, we identified a seven amino acid peptide sequence [SMSCs-affinity peptide (LTHPRWP; L7)] through phage display technology that has a high specific affinity to SMSCs. Our analysis suggested that L7 efficiently and specifically interacted with SMSCs without any species specificity. Thereafter, L7 was covalently conjugated onto both polycaprolactone (PCL) electrospun meshes and human decalcified bone scaffolds (hDBSc) to investigate its TE applications. After 24 h coculture with human SMSCs (hSMSCs), L7-conjugated PCL electrospun meshes had significantly more adherent hSMSCs than the control group, and the cells expanded well. Similar results were obtained using hDBSs. These results suggest that the novel L7 peptide sequence has a high specific affinity to SMSCs. Covalently conjugating this peptide to either artificial polymer material (PCL mesh) or natural material (hDBS) significantly enhances the adhesion of SMSCs. This method is applicable to a wide range of potential SMSC-based TE applications, particularly to cartilage regeneration, via surface modification on various type of materials.

One-step repair for cartilage defects in a rabbit model: a technique combining the perforated decalcified cortical-cancellous bone matrix scaffold with microfracture

BACKGROUND

Cartilage repair still presents a challenge to clinicians and researchers alike. A more effective, simpler procedure that can produce hyaline-like cartilage is needed for articular cartilage repair.

HYPOTHESIS

A technique combining microfracture with a biomaterial scaffold of perforated decalcified cortical-cancellous bone matrix (DCCBM; composed of cortical and cancellous parts) would create a 1-step procedure for hyaline-like cartilage repair.

STUDY DESIGN

Controlled laboratory study.

METHODS

For the in vitro portion of this study, mesenchymal stem cells (MSCs) were isolated from bone marrow aspirates of New Zealand White rabbits. Scanning electron microscopy (SEM), confocal microscopy, and 1,9-dimethylmethylene blue assay were used to assess the attachment, proliferation, and cartilage matrix production of MSCs grown on a DCCBM scaffold. For the in vivo experiment, full-thickness defects were produced in the articular cartilage of the trochlear groove of 45 New Zealand White rabbits, and the rabbits were then assigned to 1 of 3 treatment groups: perforated DCCBM combined with microfracture (DCCBM+M group), perforated DCCBM alone (DCCBM group), and microfracture alone (M group). Five rabbits in each group were sacrificed at 6, 12, or 24 weeks after the operation, and the repair tissues were analyzed by histological examination, assessment of matrix staining, SEM, and nanoindentation of biomechanical properties.

RESULTS

The DCCBM+M group showed hyaline-like articular cartilage repair, and the repair tissues appeared to have better matrix staining and revealed biomechanical properties close to those of the normal cartilage. Compared with the DCCBM+M group, there was unsatisfactory repair tissues with less matrix staining in the DCCBM group and no matrix staining in the M group, as well as poor integration with normal cartilage and poor biomechanical properties.

CONCLUSION

The DCCBM scaffold is suitable for MSC growth and hyaline-like cartilage repair induction when combined with microfracture.

CLINICAL RELEVANCE

Microfracture combined with a DCCBM scaffold is a promising method that can be performed and adopted into clinical treatment for articular cartilage injuries.

Histone deacetylase inhibitor sodium butyrate promotes the osteogenic differentiation of rat adipose-derived stem cells

Adult stem cells hold great promise for use in tissue repair and regeneration. Recently, adipose tissue-derived stem cells (ADSCs) were found to be an appealing alternative to bone marrow stem cells (BMSCs) for bone tissue engineering. The main benefit of ADSCs is that they can be easily and abundantly available from adipose tissue. However, our prior study discovered an important phenomenon that BMSCs have greater osteogenic potential than ADSCs in vitro and epigenetic regulation plays a critical role in runt-related transcription factor 2 (Runx2) expression and thus osteogenesis. In this study, we aimed to improve the osteogenic potential of ADSCs by histone deacetylase inhibitor sodium butyrate (NaBu). We found that NaBu promoted rat ADSC osteogenic differentiation by altering the epigenetic modifications on the Runx2 promoter.

Anatomic, arthroscopically assisted, mini-open fibular collateral ligament reconstruction: an in vitro biomechanical study

BACKGROUND

The fibular collateral ligament (FCL) is the primary restraint to varus rotation of the knee joint. Arthroscopic techniques are widely used and minimally invasive, but anatomic arthroscopic reconstruction of an isolated FCL injury has not been reported.

HYPOTHESIS

Anatomic reconstruction of an isolated FCL injury can be performed arthroscopically and will restore the knee to near-normal stability.

STUDY DESIGN

Controlled laboratory study.

METHODS

A total of 12 nonpaired, fresh-frozen cadaveric knees were biomechanically subjected to a 10-N·m varus moment and 5-N·m external and internal rotation torques at 0°, 15°, 30°, 60°, 90°, and 120° of knee flexion, respectively (0° only for varus loading). Testing was performed with an intact and sectioned FCL and also after an anatomic reconstruction of the FCL by arthroscopic technique. Kinematics of each knee under various loading conditions was determined with a robotic universal force/moment sensor testing system.

RESULTS

After sectioning, significant increases were found in varus rotation at 0°, 15°, 30°, 60°, 90°, and 120° of knee flexion; in external rotation at 15°, 30°, and 60° of knee flexion; and in internal rotation at 30°, 60°, and 90° of knee flexion. After reconstruction, full recovery of knee stability was observed in varus rotation at 0°, 15°, 30°, and 60°; in external rotation at 0°, 15°, 30°, 60°, 90°, and 120°; and in internal rotation at 0°, 15°, 30°, 60°, 90°, and 120°. When the sectioned and intact FCL knee conditions were compared, significant increases of 3.4° at 90° of flexion and 3.4° at 120° of flexion were found (P < .001, both conditions); when the reconstructed and sectioned FCL knee conditions were compared, significant decreases of 1.7° at 90° of flexion and 1.7° at 120° of knee flexion were found (P = .033 and .043, respectively).

CONCLUSION

An anatomic reconstruction of the FCL can be performed by an arthroscopically assisted mini-open technique with an isolated FCL injury, and near-normal stability of the knee can be restored.

CLINICAL RELEVANCE

Anatomic reconstruction of the FCL by an arthroscopically assisted mini-open technique is a viable, less invasive option to treat nonrepairable isolated FCL injury.

Nanoparticle delivery of the bone morphogenetic protein 4 gene to adipose-derived stem cells promotes articular cartilage repair in vitro and in vivo

PURPOSE

To evaluate the effect of poly(lactic-co-glycolic acid) (PLGA) nanoparticles delivering pDC316-BMP4-EGFP plasmid into rabbit adipose-derived stem cells (ADSCs) in vitro and chondrogenesis of the bone morphogenetic protein 4 (BMP-4)--transfected ADSCs seeded onto poly(L-lactic-co-glycolic acid) (PLLGA) scaffold in a rabbit model.

METHODS

Cell viability and transfection efficiency of PLGA nanoparticles were measured by Cell Counting Kit-8 (Dojindo, Kumamoto, Japan) and flow cytometry. The BMP-4 and chondrogenesis markers were detected by real-time polymerase chain reaction and enzyme-linked immunosorbent assay. Thirty rabbits (60 knees) with full-thickness cylinder articular cartilage defects (diameter, 4.5 mm; depth, 0.8 mm) on the femoral trochlea were divided into a group in which the BMP-4--transfected ADSCs were seeded onto PLLGA scaffold and implanted into the defects (group ABNP), a group with untransfected ADSCs seeded onto scaffold (group ABP), and a group with a scaffold without cells (group P). Outcomes were evaluated by histology, Rudert score, Pineda score, and scanning electronic microscopy by 2 blinded observers at weeks 6 and 12 postoperatively. Statistical analyses were performed with analysis of variance and the Kruskal-Wallis test. The statistical significance level was set at P < .05.

RESULTS

The expression of chondrogenesis-related genes and proteins was significantly increased in BMP-4--transfected ADSCs in vitro (P < .05). The cell viability was 79.86% ± 5.04% after 24 hours. The transfection efficiency was 25.86% ± 4.27% after 72 hours. Defects in group ABNP showed the best in vivo cartilage regeneration. At week 12, the Rudert scores in group ABNP (7.00 ± 1.75) were better than those in group ABP (6.00 ± 2.00) or group P (5.00 ± 1.75) (P < .05), as were the Pineda scores (2.50 ± 3.00, 5.00 ± 2.00, and 6.00 ± 1.75, respectively; P < .001).

CONCLUSIONS

BMP-4 plasmid can be successfully delivered into ADSCs by PLGA nanoparticles and promoted in vitro chondrogenesis. When compared with the control cells, BMP-4--transfected ADSCs seeded onto PLLGA scaffold significantly improve in vivo chondrogenesis in a rabbit articular defect model.

CLINICAL RELEVANCE

PLGA nanoparticles and BMP-4 have potential for gene therapy in the treatment of chondral defects of the knee.

Detection of ADAMTS-4 activity using a fluorogenic peptide-conjugated Au nanoparticle probe in human knee synovial fluid

A disintegrin and metalloproteinase with thrombospondin motif-4 (ADAMTS-4) plays a pivotal role in degrading aggrecan, which is an early event in cartilage degrading joint diseases such as osteoarthritis (OA). Detection of ADAMTS-4 activity could provide useful clinical information for early diagnosis of such diseases and disease-modifying therapy. Therefore, we developed a ADAMTS-4 detective fluorescent turn-on AuNP probe (ADAMTS-4-D-Au probe) by conjugating gold nanoparticles with a FITC-modified ADAMTS-4-specific peptide (DVQEFRGVTAVIR). When the ADAMTS-4-D-Au probe was incubated with ADAMTS-4, the fluorescence recovered and fluorescence intensity markedly increased in proportion to concentrations of ADAMTS-4 and the probe. A nearly 3-fold increase in fluorescent intensity in response to only 3.9 pM of ADAMTS-4 was detected, whereas almost no fluorescence recovery was observed when the probe was incubated with matrix metalloproteinase (MMP)-1, -3, and -13. These results indicate a relative high sensitivity and specificity of the probe. Moreover, ADAMTS-4-D-Au probe was used to detect ADAMTS-4 activity in synovial fluid from 11 knee surgery patients. A substantial increase in fluorescent intensity was observed in the acute joint injury group as compared to the chronic joint injury and end-stage OA groups, indicating that this simple and low-cost sensing system might serve as a new detection method for ADAMTS-4 activity in biological samples and in screens for inhibitors for ADAMTS-4-related joint diseases. Additionally, this probe could be a potential biomarker for early diagnosis of cartilage-degrading joint diseases.

Proinflammatory Cytokines Stimulate Mitochondrial Superoxide Flashes in Articular Chondrocytes In Vitro and In Situ

OBJECTIVE

Mitochondria play important roles in many types of cells. However, little is known about mitochondrial function in chondrocytes. This study was undertaken to explore possible role of mitochondrial oxidative stress in inflammatory response in articular chondrocytes.

METHODS

Chondrocytes and cartilage explants were isolated from wild type or transgenic mice expressing the mitochondrial superoxide biosensor - circularly permuted yellow fluorescent protein (cpYFP). Cultured chondrocytes or cartilage explants were incubated in media containing interleukin-1β (10 ng/ml) or tumor necrosis factor-α (10 ng/ml) to stimulate an inflammatory response. Mitochondrial imaging was carried out by confocal and two-photon microscopy. Mitochondrial oxidative status was evaluated by "superoxide flash" activity recorded with time lapse scanning.

RESULTS

Cultured chondrocytes contain abundant mitochondria that show active motility and dynamic morphological changes. In intact cartilage, mitochondrial abundance as well as chondrocyte density declines with distance from the surface. Importantly, sudden, bursting superoxide-producing events or "superoxide flashes" occur at single-mitochondrion level, accompanied by transient mitochondrial swelling and membrane depolarization. The superoxide flash incidence in quiescent chondrocytes was ∼4.5 and ∼0.5 events/1000 µm(2)*100 s in vitro and in situ, respectively. Interleukin-1β or tumor necrosis factor-α stimulated mitochondrial superoxide flash activity by 2-fold in vitro and 5-fold in situ, without altering individual flash properties except for reduction in spatial size due to mitochondrial fragmentation.

CONCLUSIONS

The superoxide flash response to proinflammatory cytokine stimulation in vitro and in situ suggests that chondrocyte mitochondria are a significant source of cellular oxidants and are an important previously under-appreciated mediator in inflammatory cartilage diseases.

Food-intake dysregulation in type 2 diabetic Goto-Kakizaki rats: hypothesized role of dysfunctional brainstem thyrotropin-releasing hormone and impaired vagal output

Thyrotropin-releasing hormone (TRH), a neuropeptide contained in neural terminals innervating brainstem vagal motor neurons, enhances vagal outflow to modify multisystemic visceral functions and food intake. Type 2 diabetes (T2D) and obesity are accompanied by impaired vagal functioning. We examined the possibility that impaired brainstem TRH action may contribute to the vagal dysregulation of food intake in Goto-Kakizaki (GK) rats, a T2D model with hyperglycemia and impaired central vagal activation by TRH. Food intake induced by intracisternal injection of TRH analog was reduced significantly by 50% in GK rats, compared to Wistar rats. Similarly, natural food intake in the dark phase or food intake after an overnight fast was reduced by 56-81% in GK rats. Fasting (48h) and refeeding (2h)-associated changes in serum ghrelin, insulin, peptide YY, pancreatic polypeptide and leptin, and the concomitant changes in orexigenic or anorexigenic peptide expression in the brainstem and hypothalamus, all apparent in Wistar rats, were absent or markedly reduced in GK rats, with hormone release stimulated by vagal activation, such as ghrelin and pancreatic polypeptide, decreased substantially. Fasting-induced Fos expression accompanying endogenous brainstem TRH action decreased by 66% and 91%, respectively, in the nucleus tractus solitarius (NTS) and the dorsal motor nucleus of the vagus (DMV) in GK rats, compared to Wistar rats. Refeeding abolished fasting-induced Fos-expression in the NTS, while that in the DMV remained in Wistar but not GK rats. These findings indicate that dysfunctional brainstem TRH-elicited vagal impairment contributes to the disturbed food intake in T2D GK rats, and may provide a pathophysiological mechanism which prevents further weight gain in T2D and obesity.

Silencing of microRNA-101 prevents IL-1β-induced extracellular matrix degradation in chondrocytes

Introduction

Extracellular matrix (ECM) degradation leads to malfunction of the cartilage in osteoarthritis (OA). Inflammatory cytokine interleukin-1 beta (IL-1β) functions in ECM degradation and prevents ECM synthesis by down-regulating the key transcription factor, Sox9, and consequently inhibiting ECM gene expression. Evidence reveals that microRNAs (miRNA) have been associated with OA, but little is known of their function in chondrocyte ECM degradation. This study aimed to identify possible miRNAs that mediate IL-1β-induced down-regulation of Sox9 as well as its known down-stream genes, collagen type II and aggrecan.

Methods

The miRNAs were predicted based on three classical databases. The expression levels of the predicted miRNAs were assessed in IL-1β stimulated chondrocytes by real-time PCR. A luciferase reporter was used to test the binding of the miRNAs to the 3' untranslated regions (3'UTR) of Sox9. The predicted miRNAs were transfected into chondrocytes to validate their relationship with Sox9. Functional analysis of the miRNAs on chondrocytes ECM degradation was performed at both the mRNA and protein levels after miRNA transfection and IL-1β treatment.

Results

Six miRNAs were predicted to target Sox9, and their expression in IL-1β-stimulated chondrocytes was revealed by real-time PCR. The luciferase reporter assay indicated that only miR-101 could bind to the 3'UTR of Sox9. The expression of Sox9 was likewise negatively regulated by miR-101 in rat chondrocytes. Functional analysis showed that miR-101 could aggravate chondrocyte ECM degradation, whereas miR-101 inhibition could reverse IL-1β-induced ECM degradation.

Conclusion

miR-101 participates in IL-1β-induced chondrocyte ECM degradation. Down-regulating miR-101 expression can prevent the IL-1β-induced ECM degradation in chondrocytes. miR-101 probably functions by directly targeting Sox9 mRNA.

Histone deacetylase inhibitor trichostatin A promotes the osteogenic differentiation of rat adipose-derived stem cells by altering the epigenetic modifications on Runx2 promoter in a BMP signaling-dependent manner

Adult stem cells reside in many types of tissues and adult stem cell-based regenerative medicine holds great promise for repair of diseased tissues. Recently, adipose-derived stem cells (ADSCs) were found to be an appealing alternative to bone marrow stem cells (BMSCs) for tissue-engineered bone regeneration. Compared with BMSCs, ADSCs can be easily and abundantly available from adipose tissue. However, our previous study has discovered an important phenomenon that BMSCs have greater osteogenic potential than ADSCs in vitro. In this study, we aimed to explore its mechanism and improve the osteogenic potential of ADSCs for bone tissue regeneration. It has been reported that the epigenetic states could contribute to lineage-specific differentiation of adult stem cells. We observed that the epigenetic changes of BMSCs were much greater compared with ADSCs after a 3-day osteogenic induction. Runt-related transcription factor 2 (Runx2) is essential for osteoblast differentiation and bone formation. We found that BMSCs underwent more obvious epigenetic changes on the Runx2 promoter than ADSCs after osteogenic induction. These results suggest the epigenetic regulation involvement in Runx2 expression, and thus osteogenesis. We subsequently used a histone deacetylase inhibitor, trichostatin A (TSA), to promote the osteogenesis capacity of ADSCs. The results showed that TSA promoted rat ADSCs osteogenic differentiation by altering the epigenetic modifications on the Runx2 promoter in a bone morphogenetic protein signaling-dependent manner.