51
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Fischer NG, Aparicio C. Junctional epithelium and hemidesmosomes: Tape and rivets for solving the "percutaneous device dilemma" in dental and other permanent implants. Bioact Mater 2022; 18:178-198. [PMID: 35387164 PMCID: PMC8961425 DOI: 10.1016/j.bioactmat.2022.03.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/14/2022] [Accepted: 03/12/2022] [Indexed: 02/06/2023] Open
Abstract
The percutaneous device dilemma describes etiological factors, centered around the disrupted epithelial tissue surrounding non-remodelable devices, that contribute to rampant percutaneous device infection. Natural percutaneous organs, in particular their extracellular matrix mediating the "device"/epithelium interface, serve as exquisite examples to inspire longer lasting long-term percutaneous device design. For example, the tooth's imperviousness to infection is mediated by the epithelium directly surrounding it, the junctional epithelium (JE). The hallmark feature of JE is formation of hemidesmosomes, cell/matrix adhesive structures that attach surrounding oral gingiva to the tooth's enamel through a basement membrane. Here, the authors survey the multifaceted functions of the JE, emphasizing the role of the matrix, with a particular focus on hemidesmosomes and their five main components. The authors highlight the known (and unknown) effects dental implant - as a model percutaneous device - placement has on JE regeneration and synthesize this information for application to other percutaneous devices. The authors conclude with a summary of bioengineering strategies aimed at solving the percutaneous device dilemma and invigorating greater collaboration between clinicians, bioengineers, and matrix biologists.
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Affiliation(s)
- Nicholas G. Fischer
- MDRCBB-Minnesota Dental Research Center for Biomaterials and Biomechanics, University of Minnesota, 16-212 Moos Tower, 515 Delaware St. SE, Minneapolis, MN, 55455, USA
| | - Conrado Aparicio
- MDRCBB-Minnesota Dental Research Center for Biomaterials and Biomechanics, University of Minnesota, 16-212 Moos Tower, 515 Delaware St. SE, Minneapolis, MN, 55455, USA
- Division of Basic Research, Faculty of Odontology, UIC Barcelona – Universitat Internacional de Catalunya, C/. Josep Trueta s/n, 08195, Sant Cugat del Valles, Barcelona, Spain
- Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), C/. Baldiri Reixac 10-12, 08028, Barcelona, Spain
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52
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Ayobami OO, Goldring SR, Goldring MB, Wright TM, van der Meulen MCH. Contribution of joint tissue properties to load-induced osteoarthritis. Bone Rep 2022; 17:101602. [PMID: 35899096 PMCID: PMC9309407 DOI: 10.1016/j.bonr.2022.101602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/29/2022] [Accepted: 07/11/2022] [Indexed: 11/27/2022] Open
Abstract
Objective Clinical evidence suggests that abnormal mechanical forces play a major role in the initiation and progression of osteoarthritis (OA). However, few studies have examined the mechanical environment that leads to disease. Thus, using a mouse tibial loading model, we quantified the cartilage contact stresses and examined the effects of altering tissue material properties on joint stresses during loading. Design Using a discrete element model (DEA) in conjunction with joint kinematics data from a murine knee joint compression model, the magnitude and distribution of contact stresses in the tibial cartilage during joint loading were quantified at levels ranging from 0 to 9 N in 1 N increments. In addition, a simplified finite element (FEA) contact model was developed to simulate the knee joint, and parametric analyses were conducted to investigate the effects of altering bone and cartilage material properties on joint stresses during compressive loading. Results As loading increased, the peak contact pressures were sufficient to induce fibrillations on the cartilage surfaces. The computed areas of peak contact pressures correlated with experimentally defined areas of highest cartilage damage. Only alterations in cartilage properties and geometry caused large changes in cartilage contact pressures. However, changes in both bone and cartilage material properties resulted in significant changes in stresses induced in the bone during compressive loading. Conclusions The level of mechanical stress induced by compressive tibial loading directly correlated with areas of biological change observed in the mouse knee joint. These results, taken together with the parametric analyses, are the first to demonstrate both experimentally and computationally that the tibial loading model is a useful preclinical platform with which to predict and study the effects of modulating bone and/or cartilage properties on attenuating OA progression. Given the direct correlation between computational modeling and experimental results, the effects of tissue-modifying treatments may be predicted prior to in vivo experimentation, allowing for novel therapeutics to be developed.
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Affiliation(s)
- Olufunmilayo O Ayobami
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, United States of America
| | - Steven R Goldring
- Research Division, Hospital for Special Surgery, New York, NY, United States of America
| | - Mary B Goldring
- Research Division, Hospital for Special Surgery, New York, NY, United States of America
| | - Timothy M Wright
- Research Division, Hospital for Special Surgery, New York, NY, United States of America
| | - Marjolein C H van der Meulen
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, United States of America.,Research Division, Hospital for Special Surgery, New York, NY, United States of America
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53
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Dickson DM, Smith SL, Hendry GJ. Strain sonoelastography in asymptomatic individuals and individuals with knee osteoarthritis: an evaluation of quadriceps and patellar tendon. Rheumatol Int 2022; 42:2241-2251. [PMID: 35974116 PMCID: PMC9548467 DOI: 10.1007/s00296-022-05184-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022]
Abstract
An advanced ultrasound imaging technique, sonoelastography (SE) is used to evaluate tissue elasticity. To determine SE potential to detect pathological-related changes, and characteristics related to tendon pathology we aimed to (1) compare quadriceps and patellar tendon findings in individuals with knee osteoarthritis (KOA) and asymptomatic older adults (AC), and (2) explore associations between SE, participant characteristics (age, BMI, and leg circumference) and KOA status. 84 participants (47; KOA and 37; asymptomatic older adults) underwent SE examination of quadriceps (distal) and patellar (distal, proximal) tendon in a supine position with the knee bent at 30°. Colour score (CS) and Elasticity Ratio (ER) analysis were performed by a blinded experienced operator using Esaote Mylab 70 XVG Ultrasound equipment. Significantly reduced elasticity in the distal quadriceps (median (IQR) 2(2), 3(1), p = 0.033 for KOA and AC, respectively) and proximal patellar (3(1), 3(0), p = 0.001) tendons and more elastic distal patellar (1.50 (0.55), 1.87 (0.72), p = 0.034) tendons were observed in the KOA group. Significant associations) were identified between SE and participant BMI (Rs = − 0.249–0.750, p < 0.05) and leg circumference (Rs = − 0.260–0.903, p < 0.05). Age, BMI and KOA status, were independent explanatory variables of SE CS findings at the distal quadriceps tendon patellar tendon, proximal patellar tendon and distal patellar tendon, explaining 66%, 81% and 64% of variance, respectively. Age, BMI and KOA status were independent explanatory variables of SE ER findings at the distal patellar tendon explaining 19% of variance. Potentially clinically relevant altered tendon stiffness were observed between individuals with KOA and asymptomatic controls. Key KOA risk factors and participant characteristics explained variance in tendon stiffness. Findings provide context for future studies to investigate the potential for targeted SE detected early clinical management based on associated participant characteristics.
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Affiliation(s)
- Diane M Dickson
- Research Centre for Health, Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow, G4 0BA, UK.
| | - Stephanie L Smith
- Research Centre for Health, Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow, G4 0BA, UK.,Pain Centre Versus Arthritis, Academic Rheumatology, Injury Recover and Inflammation Sciences, School of Medicine, University of Nottingham, Clinical Sciences Building, Nottingham, NG5 1PB, UK
| | - Gordon J Hendry
- Research Centre for Health, Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow, G4 0BA, UK
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54
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Long Z, Nakagawa K, Wang Z, Amadio PC, Zhao C, Gingery A. Age-related cellular and microstructural changes in the rotator cuff enthesis. J Orthop Res 2022; 40:1883-1895. [PMID: 34783060 PMCID: PMC9107523 DOI: 10.1002/jor.25211] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/21/2021] [Accepted: 10/30/2021] [Indexed: 02/04/2023]
Abstract
Rotator cuff injuries increase with age. The enthesis is the most frequent site of rotator cuff injury and degeneration. Understanding age-related changes of the enthesis are essential to determine the mechanism of rotator cuff injuries, degeneration, and to guide mechanistically driven therapies. In this study, we explored age-related cellular changes of the rotator cuff enthesis in young, mature, and aged rats. Here we found that the aged enthesis is typified by an increased mineralized zone and decreased nonmineralized zone. Proliferation, migration, and colony-forming potential of rotator cuff derived cells (RCECs) was attenuated with aging. The tenogenic and chondrogenic potential were significantly reduced, while the osteogenic potential increased in aged RCECs. The adipogenic potential increased in RCECs with age. This study explores the cellular differences found between young, mature, and aged rotator cuff enthesis cells and highlights the importance of using age-appropriate models, as well as provides a basis for further delineation of mechanisms and potential therapeutics for rotator cuff injuries.
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Affiliation(s)
- Zeling Long
- Tendon and Soft Tissue Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN,Department of Orthopedics, The Second People’s Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Koichi Nakagawa
- Tendon and Soft Tissue Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Zhanwen Wang
- Tendon and Soft Tissue Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN,Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Peter C. Amadio
- Tendon and Soft Tissue Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Chunfeng Zhao
- Tendon and Soft Tissue Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Anne Gingery
- Tendon and Soft Tissue Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN,Department of Orthopaedic Surgery, Indiana University Medical School, Indianapolis, IN
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55
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Vinestock RC, Felsenthal N, Assaraf E, Katz E, Rubin S, Heinemann-Yerushalmi L, Krief S, Dezorella N, Levin-Zaidman S, Tsoory M, Thomopoulos S, Zelzer E. Neonatal Enthesis Healing Involves Noninflammatory Acellular Scar Formation through Extracellular Matrix Secretion by Resident Cells. THE AMERICAN JOURNAL OF PATHOLOGY 2022; 192:1122-1135. [PMID: 35659946 PMCID: PMC9379688 DOI: 10.1016/j.ajpath.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/19/2022] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
Wound healing typically recruits the immune and vascular systems to restore tissue structure and function. However, injuries to the enthesis, a hypocellular and avascular tissue, often result in fibrotic scar formation and loss of mechanical properties, severely affecting musculoskeletal function and life quality. This raises questions about the healing capabilities of the enthesis. Herein, this study established an injury model to the Achilles entheses of neonatal mice to study the effectiveness of early-age enthesis healing. Histology and immunohistochemistry analyses revealed an atypical process that did not involve inflammation or angiogenesis. Instead, healing was mediated by secretion of collagen types I and II by resident cells, which formed a permanent hypocellular and avascular scar. Transmission electron microscopy showed that the cellular response to injury, including endoplasmic reticulum stress, autophagy, and cell death, varied between the tendon and cartilage ends of the enthesis. Single-molecule in situ hybridization, immunostaining, and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling assays verified these differences. Finally, gait analysis showed that these processes effectively restored function of the injured leg. These findings reveal a novel healing mechanism in neonatal entheses, whereby local extracellular matrix secretion by resident cells forms an acellular extracellular matrix deposit without inflammation, allowing gait restoration. These insights into the healing mechanism of a complex transitional tissue may lead to new therapeutic strategies for adult enthesis injuries.
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Affiliation(s)
- Ron C Vinestock
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | - Neta Felsenthal
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | - Eran Assaraf
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | - Eldad Katz
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | - Sarah Rubin
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | | | - Sharon Krief
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | - Nili Dezorella
- Department of Electron Microscopy Unit, Weizmann Institute of Science, Rehovot, Israel
| | - Smadar Levin-Zaidman
- Department of Electron Microscopy Unit, Weizmann Institute of Science, Rehovot, Israel
| | - Michael Tsoory
- Department of Veterinary Resources, Weizmann Institute of Science, Rehovot, Israel
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Columbia University, New York, New York; Department of Biomedical Engineering, Columbia University, New York, New York
| | - Elazar Zelzer
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel.
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56
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Mutsuzaki H, Yoshida Y, Nakajima H. Periostin Contributes to Fibrocartilage Layer Growth of the Patella Tendon Tibial Insertion in Mice. Medicina (B Aires) 2022; 58:medicina58070957. [PMID: 35888676 PMCID: PMC9319934 DOI: 10.3390/medicina58070957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: The influence of periostin on the growth of the patella tendon (PT) tibial insertion is unknown. The research described here aimed to reveal the contribution of periostin to the growth of fibrocartilage layers of the PT tibial insertion using periostin knockout mice. Materials and Methods: In both the wild-type (WD; C57BL/6N, periostin +/+; n = 54) and periostin knockout (KO; periostin −/−; n = 54) groups, six mice were euthanized on day 1 and at 1, 2, 3, 4, 6, 8, 10, and 12 weeks of age. Chondrocyte proliferation and apoptosis, number of chondrocytes, safranin O-stained glycosaminoglycan (GAG) area, staining area of type II collagen, and length of the tidemark were investigated. Results: Chondrocyte proliferation and apoptosis in KO were lower than those in WD on day 1 and at 1, 4, and 8 weeks and on day 1 and at 4, 6, and 12 weeks, respectively. Although the number of chondrocytes in both groups gradually decreased, it was lower in KO than in WD on day 1 and at 8 and 12 weeks. In the extracellular matrix, the GAG-stained area in KO was smaller than that in WD on day 1 and at 1, 4, 8, 10, and 12 weeks. The staining area of type II collagen in KO was smaller than that in WD at 8 weeks. The length of the tidemark in KO was shorter than that in WD at 4 and 6 weeks. Conclusion: Loss of periostin led to decreased chondrocyte proliferation, chondrocyte apoptosis, and the number of chondrocytes in the growth process of the PT tibial insertion. Moreover, periostin decreased and delayed GAG and type II collagen production and delayed tidemark formation in the growth process of the PT tibial insertion. Periostin can, therefore, contribute to the growth of fibrocartilage layers in the PT tibial insertion. Periostin deficiency may result in incomplete growth of the PT tibial insertion.
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Affiliation(s)
- Hirotaka Mutsuzaki
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami Ami-machi, Inashiki-gun, Ibaraki, Ami 300-0394, Japan
- Correspondence: ; Tel.: +81-29-888-4000
| | - Yuta Yoshida
- Department of Agriculture, Ibaraki University, 3-21-1 Chuo, Ibaraki, Ami 300-0393, Japan; (Y.Y.); (H.N.)
| | - Hiromi Nakajima
- Department of Agriculture, Ibaraki University, 3-21-1 Chuo, Ibaraki, Ami 300-0393, Japan; (Y.Y.); (H.N.)
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57
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BMSC-derived exosomes promote tendon-bone healing after anterior cruciate ligament reconstruction by regulating M1/M2 macrophage polarization in rats. Stem Cell Res Ther 2022; 13:295. [PMID: 35841008 PMCID: PMC9284827 DOI: 10.1186/s13287-022-02975-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/06/2022] [Indexed: 11/22/2022] Open
Abstract
Background Recent studies have shown that bone marrow stromal cell-derived exosomes (BMSC-Exos) can be used for tissue repair. However, whether the BMSC-Exos can promote tendon-bone healing after anterior cruciate ligament reconstruction (ACLR) is still unclear. In this study, we observed in vivo and in vitro the effect of rat BMSC-Exos on tendon-bone healing after ACLR and its possible mechanism. Methods Highly expressed miRNAs in rat BMSC-Exos were selected by bioinformatics and verified in vitro. The effect of overexpressed miRNA in BMSC-Exos on M2 macrophage polarization was observed. A rat model of ACLR was established. The experimental components were divided into three groups: the control group, the BMSC-Exos group, and the BMSC-Exos with miR-23a-3p overexpression (BMSC-Exos mimic) group. Biomechanical tests, micro-CT, and histological staining were performed for analysis. Results Bioinformatics analysis showed that miR-23a-3p was highly expressed in rat BMSC-Exos and could target interferon regulatory factor 1 (IRF1, a crucial regulator in M1 macrophage polarization). In vitro, compared with the control group or the BMSC-Exos group, the BMSC-Exos mimic more significantly promoted the polarization of macrophages from M1 to M2. In vivo, at 2 weeks, the number of M2 macrophages in the early local stage of ACLR was significantly increased in the BMSC-Exos mimic group; at 4 and 8 weeks, compared with the control group or the BMSC-Exos group, the bone tunnels of the tibia and femur sides of the rats in the BMSC-Exos mimic group were significantly smaller, the interface between the graft and the bone was narrowed, the bone volume/total volume ratio (BV/TV) increased, the collagen type II alpha 1 level increased, and the mechanical strength increased. Conclusions BMSC-Exos promoted M1 macrophage to M2 macrophage polarization via miR-23a-3p, reduced the early inflammatory reaction at the tendon-bone interface, and promoted early healing after ACLR. Supplementary Information The online version contains supplementary material available at 10.1186/s13287-022-02975-0.
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58
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Gulcu A, Turhan E, Aslan A, Çaylı S, Alimogullari E, Akcan G. Investigação do efeito do fator de crescimento epidérmico recombinante humano na cicatrização do manguito rotador: Um modelo experimental. Rev Bras Ortop 2022; 58:271-278. [DOI: 10.1055/s-0042-1750832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 04/28/2022] [Indexed: 10/17/2022] Open
Abstract
Resumo
Objetivo Investigar a eficácia do fator de crescimento epidérmico (EGF) recombinante humano na cicatrização da lesão do manguito rotador no ombro de coelhos.
Métodos As rupturas do manguito rotador (RMRs) foram criadas experimentalmente em ambos os ombros de 20 coelhos Nova Zelândia. Os coelhos foram divididos nos seguintes grupos: RMR (grupo controle; n = 5), RMR + EGF (grupo EGF; n = 5), RMR + reparo transósseo (grupo reparo; n = 5) e RMR + EGF + reparo transósseo (grupo reparo combinado + EGF; n = 5). Todos os coelhos foram observados por 3 semanas, e amostras de biópsias foram coletadas do ombro direito na 3ª semana. Após mais 3 semanas de observação, todos os coelhos foram submetidos à eutanásia, e uma amostra de biópsia foi coletada dos ombros esquerdos. Todo o material de biópsia foi corado com hematoxilina e eosina (H&E) para avaliação de vascularidade, celularidade, proporção de fibras e número de células fibrocartilaginosas à microscopia óptica.
Resultados O grupo reparo combinado + EGF apresentou a maior quantidade e a sequência mais regular de colágeno. O grupo reparo e o grupo EGF apresentaram maior atividade fibroblástica e formação capilar em comparação ao grupo controle, mas a maior atividade fibroblástica e a formação capilar com maior vascularidade foram detectadas no grupo reparo combinado + EGF (p < 0,001). O EGF parece melhorar a cicatrização da ferida no reparo da RMR. A aplicação isolada de EGF, mesmo sem cirurgia reparadora, parece melhorar a cicatrização da RMR.
Conclusão Além do reparo da RMR, a aplicação de EGF recombinante humano auxilia a cicatrização do manguito rotador dos ombros de coelhos.
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Affiliation(s)
- Anil Gulcu
- Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Alanya Alaaddin Keykubat University, Alanya/Antalya, Turquia
| | - Egemen Turhan
- Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Hacettepe University, Ankara, Turquia
| | - Ahmet Aslan
- Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Alanya Alaaddin Keykubat University, Alanya/Antalya, Turquia
| | - Sevil Çaylı
- Departamento de Histologia e Embriologia, Faculdade de Medicina, Ankara Yıldırım Beyazıt University, Ankara, Turquia
| | - Ebru Alimogullari
- Departamento de Histologia e Embriologia, Faculdade de Medicina, Ankara Yıldırım Beyazıt University, Ankara, Turquia
| | - Gülben Akcan
- Departamento de Histologia e Embriologia, Faculdade de Medicina, Ankara Yıldırım Beyazıt University, Ankara, Turquia
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59
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Öncü M, Genç E. The co-occurrence of calcaneal spur and hallux valgus: A radiological evaluation. J Back Musculoskelet Rehabil 2022; 35:539-544. [PMID: 34542057 DOI: 10.3233/bmr-200140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Calcaneal spur and hallux valgus are common foot deformities and both conditions have been shown to disrupt foot biomechanics. OBJECTIVES This study aimed to investigate the association between calcaneal spur and hallux valgus using radiographic and demographic data. METHODS A total of 1375 patients (1083 women; mean age: 45.5 years) with standard ankle lateral and foot conventional anteroposterior radiographs were evaluated. The following data were obtained: age, gender, laterality, hallux valgus angle (HVA), intermetatarsal angle (IMA), and calcaneal spur. Patients with a HVA of 15∘ and above were considered to have hallux valgus. Patients with hallux valgus were classified into three different groups according to the HVA. RESULTS The prevalence of calcaneal spur was higher in older age and women (45.8%, 30.2%; p< 0.01, p< 0.01, respectively). Subjects with and without calcaneal spurs had similarities in terms of their laterality, having a HVA of ⩾ 15∘ and an IMA of ⩾ 11∘ (p> 0.05). Hallux valgus severity was not associated with calcaneal spur (p> 0.05). In addition, the hallux valgus prevalence was higher in patients who were over 50 years old (58.2%, p= 0.046). CONCLUSIONS The presence of calcaneal spurs does not affect the prevalence of hallux valgus. The severity of hallux valgus determined according to the HVA was similar in patients with and without calcaneal spurs. In addition, female gender and older age were identified as risk factors for calcaneal spurs, while only older age was a risk factor for hallux valgus.
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Affiliation(s)
- Mehmet Öncü
- Department of Radiology, Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Erdinç Genç
- Department of Orthopaedics and Traumatology, Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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60
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Pachowsky ML, Raimondo MG, Xu C, Rauber S, Tascilar K, Labinsky H, Vogg M, Aziz Saad MS, Simon D, Rech J, Soare A, Braeuer L, Kleyer A, Schett G, Ramming A. Concise report: a minimal-invasive method to retrieve and identify entheseal tissue from psoriatic arthritis patients. Ann Rheum Dis 2022; 81:1131-1135. [PMID: 35459697 DOI: 10.1136/annrheumdis-2021-222061] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/06/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To establish a minimally invasive biopsy technique for the analysis of entheseal tissue in patients with psoriatic arthritis (PsA). METHODS Human cadavers were used for establishing the technique to retrieve tissue from the lateral humeral epicondyle enthesis (cadaveric biopsies). After biopsy, the entire enthesis was surgically resected (cadaveric resections). Biopsies and resections were assessed by label-free second harmonic generation (SHG) microscopy. The same technique was then applied in patients with PsA with definition of entheseal tissue by SHG, staining of CD45+immune cells and RNA extraction. RESULTS Entheseal biopsies from five cadavers allowed the retrieval of entheseal tissue as validated by the analysis of resection material. Microscopy of biopsy and resection sections allowed differentiation of entheseal, tendon and muscle tissue by SHG and definition of specific intensity thresholds for entheseal tissue. In subsequent entheseal biopsies of 10 PsA patients: the fraction of entheseal tissue was high (65%) and comparable to cadaveric biopsies (68%) as assessed by SHG microscopy. Furthermore, PsA biopsies showed immune cell infiltration and sufficient retrieval of RNA for further molecular analysis. CONCLUSION Entheseal biopsy of the lateral epicondyle is feasible in patients with PsA allowing reliable retrieval of entheseal tissue and its identification by SHG microscopy.
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Affiliation(s)
- Milena L Pachowsky
- Department of Internal Medicine 3, Rheumatology & Immunology, Friedrich-Alexander-University (FAU) Erlangen-Nurnberg and Universitatsklinikum Erlangen, Erlangen, Bayern, Germany.,Deutsches Zentrum Immuntherapie, Friedrich-Alexander-University (FAU) Erlangen-Nurnberg and Universitatsklinikum Erlangen, Erlangen, Germany
| | - Maria Gabriella Raimondo
- Department of Internal Medicine 3, Rheumatology & Immunology, Friedrich-Alexander-University (FAU) Erlangen-Nurnberg and Universitatsklinikum Erlangen, Erlangen, Bayern, Germany.,Deutsches Zentrum Immuntherapie, Friedrich-Alexander-University (FAU) Erlangen-Nurnberg and Universitatsklinikum Erlangen, Erlangen, Germany
| | - Cong Xu
- Department of Internal Medicine 3, Rheumatology & Immunology, Friedrich-Alexander-University (FAU) Erlangen-Nurnberg and Universitatsklinikum Erlangen, Erlangen, Bayern, Germany.,Deutsches Zentrum Immuntherapie, Friedrich-Alexander-University (FAU) Erlangen-Nurnberg and Universitatsklinikum Erlangen, Erlangen, Germany
| | - Simon Rauber
- Department of Internal Medicine 3, Rheumatology & Immunology, Friedrich-Alexander-University (FAU) Erlangen-Nurnberg and Universitatsklinikum Erlangen, Erlangen, Bayern, Germany.,Deutsches Zentrum Immuntherapie, Friedrich-Alexander-University (FAU) Erlangen-Nurnberg and Universitatsklinikum Erlangen, Erlangen, Germany
| | - Koray Tascilar
- Department of Internal Medicine 3, Rheumatology & Immunology, Friedrich-Alexander-University (FAU) Erlangen-Nurnberg and Universitatsklinikum Erlangen, Erlangen, Bayern, Germany.,Deutsches Zentrum Immuntherapie, Friedrich-Alexander-University (FAU) Erlangen-Nurnberg and Universitatsklinikum Erlangen, Erlangen, Germany
| | - Hannah Labinsky
- Department of Internal Medicine 3, Rheumatology & Immunology, Friedrich-Alexander-University (FAU) Erlangen-Nurnberg and Universitatsklinikum Erlangen, Erlangen, Bayern, Germany.,Deutsches Zentrum Immuntherapie, Friedrich-Alexander-University (FAU) Erlangen-Nurnberg and Universitatsklinikum Erlangen, Erlangen, Germany
| | - Mario Vogg
- Department of Internal Medicine 3, Rheumatology & Immunology, Friedrich-Alexander-University (FAU) Erlangen-Nurnberg and Universitatsklinikum Erlangen, Erlangen, Bayern, Germany.,Deutsches Zentrum Immuntherapie, Friedrich-Alexander-University (FAU) Erlangen-Nurnberg and Universitatsklinikum Erlangen, Erlangen, Germany
| | - Mina Saad Aziz Saad
- Department of Internal Medicine 3, Rheumatology & Immunology, Friedrich-Alexander-University (FAU) Erlangen-Nurnberg and Universitatsklinikum Erlangen, Erlangen, Bayern, Germany.,Deutsches Zentrum Immuntherapie, Friedrich-Alexander-University (FAU) Erlangen-Nurnberg and Universitatsklinikum Erlangen, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3, Rheumatology & Immunology, Friedrich-Alexander-University (FAU) Erlangen-Nurnberg and Universitatsklinikum Erlangen, Erlangen, Bayern, Germany.,Deutsches Zentrum Immuntherapie, Friedrich-Alexander-University (FAU) Erlangen-Nurnberg and Universitatsklinikum Erlangen, Erlangen, Germany
| | - Juergen Rech
- Department of Internal Medicine 3, Rheumatology & Immunology, Friedrich-Alexander-University (FAU) Erlangen-Nurnberg and Universitatsklinikum Erlangen, Erlangen, Bayern, Germany.,Deutsches Zentrum Immuntherapie, Friedrich-Alexander-University (FAU) Erlangen-Nurnberg and Universitatsklinikum Erlangen, Erlangen, Germany
| | - Alina Soare
- Department of Internal Medicine 3, Rheumatology & Immunology, Friedrich-Alexander-University (FAU) Erlangen-Nurnberg and Universitatsklinikum Erlangen, Erlangen, Bayern, Germany.,Deutsches Zentrum Immuntherapie, Friedrich-Alexander-University (FAU) Erlangen-Nurnberg and Universitatsklinikum Erlangen, Erlangen, Germany
| | - Lars Braeuer
- Institute of Anatomy, Chair II, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Rheumatology & Immunology, Friedrich-Alexander-University (FAU) Erlangen-Nurnberg and Universitatsklinikum Erlangen, Erlangen, Bayern, Germany.,Deutsches Zentrum Immuntherapie, Friedrich-Alexander-University (FAU) Erlangen-Nurnberg and Universitatsklinikum Erlangen, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology & Immunology, Friedrich-Alexander-University (FAU) Erlangen-Nurnberg and Universitatsklinikum Erlangen, Erlangen, Bayern, Germany.,Deutsches Zentrum Immuntherapie, Friedrich-Alexander-University (FAU) Erlangen-Nurnberg and Universitatsklinikum Erlangen, Erlangen, Germany
| | - Andreas Ramming
- Department of Internal Medicine 3, Rheumatology & Immunology, Friedrich-Alexander-University (FAU) Erlangen-Nurnberg and Universitatsklinikum Erlangen, Erlangen, Bayern, Germany .,Deutsches Zentrum Immuntherapie, Friedrich-Alexander-University (FAU) Erlangen-Nurnberg and Universitatsklinikum Erlangen, Erlangen, Germany
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61
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Connectivity Patterns of the Hindlimb Musculoskeletal System in Living and Fossil Diving Birds. Evol Biol 2022. [DOI: 10.1007/s11692-022-09568-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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62
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Calejo I, Reis RL, Domingues RMA, Gomes ME. Texturing Hierarchical Tissues by Gradient Assembling of Microengineered Platelet-Lysates Activated Fibers. Adv Healthc Mater 2022; 11:e2102076. [PMID: 34927396 DOI: 10.1002/adhm.202102076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/14/2021] [Indexed: 11/07/2022]
Abstract
The heterogeneity of hierarchical tissues requires designing multipart engineered constructs as suitable tissue replacements. Herein, the incorporation of platelet lysate (PL) within an electrospun fiber core is proposed aiming for the fabrication of functionally graded 3D scaffolds for heterotypic tissues regeneration, such as tendon-to-bone interfaces. First, anisotropic yarns (A-Yarns) and isotropic threads with nanohydroxyapatite (I-Threads/PL@nHAp) are fabricated to recreate the tendon- and bone-microstructures and both incorporated with PL using emulsion electrospinning for a sustained and local delivery of growth factors, cytokines, and chemokines. Biological performance using human adipose-derived stem cells demonstrates that A-Yarns/PL induce a higher expression of scleraxis, a tenogenic-marker, while in I-Threads/PL@nHAp, higher alkaline phosphatase activity and matrix mineralization suggest an osteogenic commitment without the need for biochemical supplementation compared to controls. As a proof-of-concept, functional 3D gradient scaffolds are fabricated using a weaving technique, resulting in 3D textured hierarchical constructs with gradients in composition and topography. Additionally, the precise delivery of bioactive cues together with in situ biophysical features guide the commitment into a phenotypic gradient exhibiting chondrogenic and osteochondrogenic profiles in the interface of scaffolds. Overall, a promising patch solution for the regeneration of tendon-to-bone tissue interface through the fabrication of PL-functional 3D gradient constructs is demonstrated.
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Affiliation(s)
- Isabel Calejo
- 3B's Research Group i3Bs – Research Institute on Biomaterials, Biodegradables and Biomimetics University of Minho Barco Guimarães 4805‐017 Portugal
| | - Rui L. Reis
- 3B's Research Group i3Bs – Research Institute on Biomaterials, Biodegradables and Biomimetics University of Minho Barco Guimarães 4805‐017 Portugal
| | - Rui M. A. Domingues
- 3B's Research Group i3Bs – Research Institute on Biomaterials, Biodegradables and Biomimetics University of Minho Barco Guimarães 4805‐017 Portugal
| | - Manuela E. Gomes
- 3B's Research Group i3Bs – Research Institute on Biomaterials, Biodegradables and Biomimetics University of Minho Barco Guimarães 4805‐017 Portugal
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63
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Kenmoku T, Nakai D, Nagura N, Onuma K, Sukegawa K, Tazawa R, Otake Y, Takahira N, Takaso M. Tenodesis with bone marrow venting under local anesthesia for recalcitrant lateral epicondylitis: Results of 2 years of follow-up. JSES Int 2022; 6:696-703. [PMID: 35813152 PMCID: PMC9264004 DOI: 10.1016/j.jseint.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Hypothesis We hypothesized that the treatment of recalcitrant lateral epicondylitis requires accurate identification of the painful area to promote remodeling of the degenerated extensor insertion and to stabilize the tendon origin during tendon healing. Thus, we performed tenodesis with bone marrow venting under local anesthesia for recalcitrant lateral epicondylitis. Methods Twenty patients (21 elbows) were treated with bone marrow venting at the painful area of the lateral epicondyle of the elbow and tenodesis using 2 soft anchors lateral to the capitellum (immediately distal to the painful area) and were followed up for ≥2 years. Patients were assessed using the numerical rating scale for pain and the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire, and objective evaluation included active range of motion. Results The mean preoperative and postoperative pain scores were 7.5 and 0.5, respectively, indicating significant pain relief (P < .001). The mean preoperative and postoperative Quick Disabilities of the Arm, Shoulder, and Hand questionnaire scores were 44.2 and 1.0, respectively (P < .001). Two elbows had a slightly positive Thomsen test at the final visit. No recurrence of intra-articular symptoms induced by synovial fringe impingement was observed. Patients experienced more pain at the bone-tendon junction of extensors than at the tendon parenchyma. Conclusion Tenodesis with bone marrow venting under local anesthesia was effective for subjective patient satisfaction and positive clinical outcomes at ≥2 years of follow-up in patients with recalcitrant lateral epicondylitis. Intra-articular symptoms can be improved by stabilization of the lateral soft tissue without treatment for intra-articular lesions.
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64
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Nakajima K. Fluoroscopic and Endoscopic Calcaneal Spur Resection Without Plantar Fascial Release for Recalcitrant Plantar Fasciitis. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221108104. [PMID: 35754745 PMCID: PMC9218475 DOI: 10.1177/24730114221108104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Studies on endoscopic calcaneal spur resection (CSR) without plantar fascial release (PFR) are limited. This study aimed to review the data of patients who underwent fluoroscopic and endoscopic CSR without PFR for plantar fasciitis with a calcaneal spur to assess the effectiveness of CSR. Methods Medical records of consecutive patients with plantar fasciitis with ≥2 mm calcaneal spur who underwent endoscopic CSR without PFR from November 2017 to December 2019 were reviewed. Patients with ≥2 years of follow-up were included, whereas those who underwent another surgery on the operated foot were excluded. Age, body mass index (BMI), follow-up duration, calcaneal spur length, duration to full weightbearing postoperatively, Japanese Society for Surgery of the Foot (JSSF) score, visual analog scale (VAS) score for pain, and complications were assessed. Results The mean follow-up duration was 2.7 years. A total of 47 patients (31 female, 16 male; mean age, 56.4 years; mean BMI, 25.5) were included. The mean calcaneal spur length was 5.7 mm. The VAS score improved from 79.6 ± 12.9 mm preoperatively to 5.3 ± 7.3 mm postoperatively. The JSSF score improved from 54.0 ± 19.1 points preoperatively to 97.5 ± 5.7 points postoperatively (Wilcoxon signed-rank test, P < .001, respectively). The mean duration to full weightbearing postoperatively was 4.4 ± 4.2 days. Two patients presented with tenderness, and one presented with hypesthesia at the portal site. Conclusion Endoscopic CSR without PFR resulted in good outcomes, early return to full weightbearing, and few complications in patients with plantar fasciitis with ≥2 mm calcaneal spur. The results suggested that CSR was sufficient to relieve symtoms and improve function. PFR may not be necessary for treating plantar fasciitis with calcaneal spur. Level of Evidence Level IV, retrospective case series.
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Affiliation(s)
- Kenichiro Nakajima
- Department of Orthopedic Surgery, Yashio Central General Hospital, Saitama, Japan
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65
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Growth and mechanobiology of the tendon-bone enthesis. Semin Cell Dev Biol 2022; 123:64-73. [PMID: 34362655 PMCID: PMC8810906 DOI: 10.1016/j.semcdb.2021.07.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/17/2021] [Accepted: 07/20/2021] [Indexed: 12/15/2022]
Abstract
Tendons are cable-like connective tissues that transfer both active and passive forces generated by skeletal muscle to bone. In the mature skeleton, the tendon-bone enthesis is an interfacial zone of transitional tissue located between two mechanically dissimilar tissues: compliant, fibrous tendon to rigid, dense mineralized bone. In this review, we focus on emerging areas in enthesis development related to its structure, function, and mechanobiology, as well as highlight established and emerging signaling pathways and physiological processes that influence the formation and adaptation of this important transitional tissue.
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66
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Shimada M, Wada K, Tanaka S, Murakami S, Kanno N, Hayashi K, Hara Y. Effects of long-term and high-dose administration of glucocorticoids on the cranial cruciate ligament in healthy beagle dogs. PLoS One 2022; 17:e0262206. [PMID: 35061786 PMCID: PMC8782538 DOI: 10.1371/journal.pone.0262206] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/20/2021] [Indexed: 11/23/2022] Open
Abstract
This study aimed to determine the effects of long-term and high-dose administration of glucocorticoids (GCs) on the histological and mechanical properties of the cranial cruciate ligament (CrCL) in healthy beagle dogs. A synthetic corticosteroid at 2 mg/kg every 12 h was administered for 84 days in nine dogs (18 CrCLs) (GC group). Twenty CrCLs from 12 healthy male beagles were used as the normal control (control group). CrCLs were histologically examined (n = 12 in the GC group and n = 14 in the control group) using hematoxylin-eosin, Alcian-Blue, Elastica-Eosin stains, and immunohistological staining of type 1 collagen and elastin. An additional 12 CrCLs were mechanically tested (n = 6 in the GC and n = 6 in the control groups) to determine failure pattern, maximum tensile strength, maximum stress, elastic modulus, and stress and strain at the transition point. The histological examination revealed a significant increase in interfascicular area and fibrillar disorientation at the tibial attachment in both groups. The ratios of mucopolysaccharide-positive area and positive areas of elastic fibers were significantly higher in the control group than in the GC group. The biomechanical examination demonstrated significantly lower stress at the transition point in the GC group than in the control group. The present study results indicate that high-dose corticosteroids may affect metabolism, such as mucopolysaccharides and elastic fibers production, although the effect on type 1 collagen production is small. These changes of the extracellular matrix had a small effect on the strength of the ligament. This study suggested that the ligamentous changes associated with GC are different from the degeneration observed in spontaneous canine CrCL disease.
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Affiliation(s)
- Masakazu Shimada
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
- * E-mail:
| | - Koki Wada
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
| | - Sachiyo Tanaka
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
| | - Sawako Murakami
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
| | - Nobuo Kanno
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
| | - Kei Hayashi
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States of America
| | - Yasushi Hara
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
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67
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MRI signal and morphological alterations of the suprapatellar fat pad in asymptomatic subjects: are these normal variants? Skeletal Radiol 2022; 51:1995-2007. [PMID: 35426502 PMCID: PMC9381489 DOI: 10.1007/s00256-022-04055-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/23/2022] [Accepted: 04/01/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To study the prevalence of suprapatellar fat pad (SPFP) MR alterations in asymptomatic subjects, in relation to a wide range of clinical/imaging parameters, including muscle performance tests and physical activity data. MATERIALS AND METHODS We prospectively included 110 asymptomatic subjects as part of a cohort study. Inclusion criteria were no knee pain in the last year. Exclusion criteria were any medical/surgical history of a knee disorder. Subjects underwent knee and low-dose posture radiographs [EOS®], 3 T MRI, clinical examination including muscle performance tests, and physical activity monitoring. The presence/absence of SPFP alterations (hyperintensity and mass effect) were assessed through consensus reading on fluid-sensitive sequences. Differences between groups of knees with SPFP alterations and controls were tested for a total of 55 categorical/continuous clinical/imaging parameters, including SPFP relative-T2-signal, trochlear/patellar/lower-limb morphologic measurements. Wilcoxon-rank-sum and chi-square tests were used to compare groups of patients. The histological correlation was obtained in a cadaveric specimen. RESULTS SPFP alterations were common in asymptomatic subjects: hyperintensity 57% (63/110) and mass effect 37% (41/110), with 27% (30/110) showing both. Among the 55 imaging, clinical, or activity parameters tested, only increased patellar tilt angle (p = 0.02) and TT-TG distance (p = 0.03) were statistically different between groups of SPFP alterations and controls. The histological correlation showed more abundant connective tissue in SPFP compared to the prefemoral fat pad. CONCLUSIONS SPFP hyperintensity and mass effect are common MRI findings in asymptomatic knees, and they are not related to most imaging, clinical, and activity parameters. Care should be taken not to overcall them pathological findings as they most likely represent normal variants.
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68
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Turcotte CM, Rabey KN, Green DJ, McFarlin SC. Muscle attachment sites and behavioral reconstruction: An experimental test of muscle-bone structural response to habitual activity. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2022; 177:63-82. [PMID: 36787715 DOI: 10.1002/ajpa.24410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/11/2021] [Accepted: 09/13/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Behavioral reconstruction from muscle attachment sites (entheses) is a common practice in anthropology. However, experimental evidence provides mixed support for the assumed association between enthesis size and shape with changes in habitual activity. In this study, a laboratory mouse model was used to experimentally test whether activity level and type alters muscle architecture and the underlying bone cross-sectional geometry of entheses in order to assess the underlying assumption that behavioral changes lead to quantifiable differences in both muscle and enthesis morphology. MATERIALS AND METHODS Female wild-type mice were separated into one control group and two experimentally increased activity groups (running, climbing) over an 11-week study period. At the start of the experiment, half of the mice were 4 weeks and half were 7 weeks of age. The postmortem deltoideus and biceps brachii muscles were measured for potential force production (physiological cross-sectional area) and potential muscle excursion (fiber length). Bone cross-sectional geometry variables were measured from microCT scans of the humerus and radius at the enthesis and non-enthesis regions of interest across activity groups. RESULTS Activity level and type altered potential force production and potential muscle excursion of both muscles in the younger cohort. We observed differences in cortical bone geometry in both the humerus enthesis and radius non-enthesis region driven exclusively among the younger wheel-running mice. DISCUSSION These results indicate that in addition to muscle architectural changes, bone structural properties at the enthesis do show an adaptive response to increased activity, such as running but only during earlier development. However, further research is required in order to apply these findings to the reconstruction of living behavior from anthropological specimens.
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Affiliation(s)
- Cassandra M Turcotte
- Department of Anthropology, New York University, New York, New York, USA.,New York Consortium in Evolutionary Primatology, New York, New York, USA.,Department of Anthropology, Center for the Advanced Study of Human Paleobiology, The George Washington University, Washington, District of Columbia, USA
| | - Karyne N Rabey
- Division of Anatomy, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.,Department of Anthropology, University of Alberta, Edmonton, Alberta, Canada
| | - David J Green
- Department of Anthropology, Center for the Advanced Study of Human Paleobiology, The George Washington University, Washington, District of Columbia, USA.,Department of Anatomy, Campbell University School of Osteopathic Medicine, Buies Creek, North Carolina, USA
| | - Shannon C McFarlin
- Department of Anthropology, Center for the Advanced Study of Human Paleobiology, The George Washington University, Washington, District of Columbia, USA
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Chatterjee M, Muljadi PM, Andarawis-Puri N. The role of the tendon ECM in mechanotransduction: disruption and repair following overuse. Connect Tissue Res 2022; 63:28-42. [PMID: 34030531 DOI: 10.1080/03008207.2021.1925663] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose: Tendon overuse injuries are prevalent conditions with limited therapeutic options to halt disease progression. The specialized extracellular matrix (ECM) both enables joint function and mediates mechanical signals to tendon cells, driving biological responses to exercise or injury. With overuse, tendon ECM composition and structure changes at multiple scales, disrupting mechanotransduction and resulting in inadequate repair and disease progression. This review highlights the multiscale ECM changes that occur with tendon overuse and corresponding effects on cell-matrix interactions and cellular response to load.Results: Different functional joint requirements and tendon types experience a wide range of loading profiles, creating varied downstream mechanical stimuli. Distinct ECM structure and mechanical properties within the fascicle matrix, interfascicle matrix, and enthesis and their varied disruption with overuse are considered. The pericellular matrix (PCM) comprising the microscale tendon cell environment has a unique composition that changes with overuse injury and exercise, suggesting an important role in mechanotransduction and promoting repair. Cell-matrix interactions are mediated by structures including cilia, integrins, connexins and cytoskeleton that signal downstream homeostasis, adaptation, or repair. ECM disruption with tendon overuse may cause altered mechanical loading and cell-matrix interactions, resulting in mechanobiological understimulation, apoptosis, and ineffective repair. Current interventions to promote repair of tendon overuse injuries including exercise, targeting cell signaling, and modulating inflammation are considered.Conclusion: Future therapeutics should be assessed with regard of their effects on multiscale mechanotransduction in addition to joint function, with consideration of the central role of ECM.
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Affiliation(s)
- Monideepa Chatterjee
- Nancy E. And Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA
| | - Patrick M Muljadi
- Nancy E. And Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA
| | - Nelly Andarawis-Puri
- Nancy E. And Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA.,Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York, USA.,Hospital for Special Surgery, New York, New York, USA
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70
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Houssaye A, de Perthuis A, Houée G. Sesamoid bones also show functional adaptation in their microanatomy-The example of the patella in Perissodactyla. J Anat 2022; 240:50-65. [PMID: 34402049 PMCID: PMC8655183 DOI: 10.1111/joa.13530] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/21/2021] [Accepted: 07/21/2021] [Indexed: 11/27/2022] Open
Abstract
The patella is the largest sesamoid bone of the skeleton. It is strongly involved in the knee, improving output force and velocity of the knee extensors, and thus plays a major role in locomotion and limb stability. However, the relationships between its structure and functional constraints, that would enable a better understanding of limb bone functional adaptations, are poorly known. This contribution proposes a comparative analysis, both qualitative and quantitative, of the microanatomy of the whole patella in perissodactyls, which show a wide range of morphologies, masses, and locomotor abilities, in order to investigate how the microanatomy of the patella adapts to evolutionary constraints. The inner structure of the patella consists of a spongiosa surrounded by a compact cortex. Contrary to our expectations, there is no increase in compactness with bone size, and thus body size and weight, but only an increase in the tightness of the spongiosa. No particular thickening of the cortex associated with muscle insertions is noticed but a strong thickening is observed anteriorly at about mid-length, where the strong intermediate patellar ligament inserts. The trabeculae are mainly oriented perpendicularly to the posterior articular surface, which highlights that the main stress is anteroposteriorly directed, maintaining the patella against the femoral trochlea. Conversely, anteriorly, trabeculae are rather circumferentially oriented, following the insertion of the patellar ligament and, possibly also, of the quadriceps tendon. A strong variation is observed among perissodactyl families but also intraspecifically, which is in accordance with previous studies suggesting a higher variability in sesamoid bones. Clear trends are nevertheless observed between the three families. Equids have a much thinner cortex than ceratomorphs. Rhinos and equids, both characterized by a development of the medial border, show an increase in trabecular density laterally suggesting stronger stresses laterally. The inner structure in tapirs is more homogeneous despite the absence of medial development of the medial border with no "compensation" of the inner structure, which suggests different stresses on their knees associated with a different morphology of their patellofemoral joint.
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Affiliation(s)
- Alexandra Houssaye
- Département Adaptations du vivantUMR 7179 CNRS/Muséum National d'Histoire NaturelleParisFrance
| | - Adrien de Perthuis
- Département Adaptations du vivantUMR 7179 CNRS/Muséum National d'Histoire NaturelleParisFrance
| | - Guillaume Houée
- Département Adaptations du vivantUMR 7179 CNRS/Muséum National d'Histoire NaturelleParisFrance
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71
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Titan AL, Davitt M, Foster D, Salhotra A, Menon S, Chen K, Fahy E, Lopez M, Jones RE, Baiu I, Burcham A, Januszyk M, Gurtner G, Fox P, Chan C, Quarto N, Longaker M. OUP accepted manuscript. Stem Cells Transl Med 2022; 11:715-726. [PMID: 35640155 PMCID: PMC9299518 DOI: 10.1093/stcltm/szac027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/09/2022] [Indexed: 11/24/2022] Open
Abstract
The tendon enthesis plays a critical role in facilitating movement and reducing stress within joints. Partial enthesis injuries heal in a mechanically inferior manner and never achieve healthy tissue function. The cells responsible for tendon-to-bone healing remain incompletely characterized and their origin is unknown. Here, we evaluated the putative role of mouse skeletal stem cells (mSSCs) in the enthesis after partial-injury. We found that mSSCs were present at elevated levels within the enthesis following injury and that these cells downregulated TGFβ signaling pathway elements at both the RNA and protein levels. Exogenous application of TGFβ post-injury led to a reduced mSSC response and impaired healing, whereas treatment with a TGFβ inhibitor (SB43154) resulted in a more robust mSSC response. Collectively, these data suggest that mSSCs may augment tendon-to-bone healing by dampening the effects of TGFβ signaling within the mSSC niche.
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Affiliation(s)
| | | | - Deshka Foster
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Ankit Salhotra
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Siddharth Menon
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Kellen Chen
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Evan Fahy
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael Lopez
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - R Ellen Jones
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Ioana Baiu
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Austin Burcham
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael Januszyk
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Geoffrey Gurtner
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Paige Fox
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Charles Chan
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Natalina Quarto
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael Longaker
- Corresponding author: Michael T. Longaker, M.D., M.B.A. D.Sc. (hon), FACS, 257 Campus Drive, MC 5148 Stanford, CA 94305-5148, USA. Tel: +1 650 736 1707; Fax: +1 650 736 1705;
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Mortimer JW, Alsaykhan H, Vadibeler S, Rust PA, Paxton JZ. Anatomy and histomorphology of the flexor digitorum profundus enthesis: functional implications for tissue engineering and surgery. BMC Musculoskelet Disord 2021; 22:1032. [PMID: 34893040 PMCID: PMC8665545 DOI: 10.1186/s12891-021-04922-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/12/2021] [Indexed: 11/28/2022] Open
Abstract
Background The enthesis possesses morphological adaptations across the soft-hard tissue junction which are not fully restored during surgical avulsion repairs. This loss of anatomical structure, highly related to function, contributes to poor clinical outcomes. Investigating the native macro- and micro-structure of a specific enthesis can provide functional and biomechanical insights to develop specialised, novel tissue-engineered therapeutic options and potentially improve current surgical treatments for avulsion injuries. Methods This study examines the anatomy and histomorphology of the flexor digitorum profundus (FDP) enthesis in 96 fresh-frozen human cadaveric fingers, quantitatively and qualitatively analyzing the shape, size, angle of tendon fibres and histological architecture, and explores differences in sex, finger and distance along the enthesis using linear mixed effects models. Results Macroscopically, results showed a consistent trapezoidal insertion shape of 29.29 ± 2.35 mm2 mean surface area, but with significant morphometric size differences influenced primarily by the smaller dimensions of the little finger. Microscopically, a fibrocartilaginous enthesis was apparent with a 30.05 ± 0.72o mean angle of inserting tendon fibres, although regional variation in fibrocartilage and the angle change of tendon fibres before insertion existed. Conclusions The implication of these findings on native and specific FDP enthesis function is discussed whilst providing recommendations for optimal FDP enthesis recreation for interfacial tissue engineers and hand surgeons. The study emphasizes the importance of region-specific knowledge whilst also describing methods applicable to assessing any soft tissue insertion. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04922-1.
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Affiliation(s)
- Jeremy W Mortimer
- Anatomy@Edinburgh, Deanery of Biomedical Sciences, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Hamad Alsaykhan
- Anatomy@Edinburgh, Deanery of Biomedical Sciences, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Subashan Vadibeler
- Anatomy@Edinburgh, Deanery of Biomedical Sciences, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Philippa A Rust
- Anatomy@Edinburgh, Deanery of Biomedical Sciences, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK.,Hooper Hand Unit, St John's Hospital, Livingston, Edinburgh, UK
| | - Jennifer Z Paxton
- Anatomy@Edinburgh, Deanery of Biomedical Sciences, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK.
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Liew MY, Mortimer JW, Paxton JZ, Tham S, Rust PA. Histomorphology of the Subregions of the Scapholunate Interosseous Ligament and Its Enthesis. J Wrist Surg 2021; 10:467-475. [PMID: 34881102 PMCID: PMC8635837 DOI: 10.1055/s-0041-1723792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
Background The scapholunate interosseous ligament (SLIL) has three subregions: dorsal, proximal, and volar. The SLIL enthesis has not previously been studied despite its important mechanical function in wrist joint biomechanics. Questions/Purposes This study aims to compare the histomorphological differences between the SLIL subregions, including at their entheses. Three questions are explored: Do the gross dimensions differ between SLIL subregions? Does the enthesis qualitatively, and its calcified fibrocartilage (CF) quantitatively, differ between (a) SLIL subregions and (b) scaphoid and lunate attachments? Methods Twelve fresh-frozen human cadaveric wrists were dissected and the gross dimensions of the SLIL subregions measured. Subregions were histologically processed for morphological and compositional analyses, including quantification of enthesis CF area. Results The dorsal subregion was the thickest. The dorsal and volar subregions had fibrocartilaginous entheses, while the proximal subregion was attached to articular cartilage. The dorsal subregion had significantly more CF than the volar subregion. There was no significant difference in the enthesis CF between scaphoid and lunate attachments in the three subregions. Conclusions There are significant morphological differences between the SLIL subregions. The dorsal subregion has the largest amount of CF, which is consistent with the greater biomechanical force subjected to this subregion. The similar histomorphology of the ligament at the scaphoid and lunate entheses suggests that similar biomechanical forces are applied to both attachments. Clinical Relevance The histomorphological results confirm that the dorsal subregion is the strongest of the three subregions. The results from the entheseal region may have important implications in the study of graft incorporation during SLIL reconstruction.
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Affiliation(s)
- Mei Yen Liew
- Department Plastic Surgery, Hooper Hand Unit, St John's Hospital, Livingston, United Kingdom
- Department of Anatomy, Edinburgh Medical School: Biomedical Sciences, University of Edinburgh, Scotland, United Kingdom
| | - Jeremy W. Mortimer
- Department of Anatomy, Edinburgh Medical School: Biomedical Sciences, University of Edinburgh, Scotland, United Kingdom
| | - Jennifer Z. Paxton
- Department of Anatomy, Edinburgh Medical School: Biomedical Sciences, University of Edinburgh, Scotland, United Kingdom
| | - Stephen Tham
- Department of Plastic and Hand Surgery, St Vincent's Hospital, Hand and Wrist Biomechanics Laboratory/O'Brien Institute, Melbourne, Australia
| | - Philippa A. Rust
- Department Plastic Surgery, Hooper Hand Unit, St John's Hospital, Livingston, United Kingdom
- Department of Anatomy, Edinburgh Medical School: Biomedical Sciences, University of Edinburgh, Scotland, United Kingdom
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Perrin C. Focal Synovial Inflammation Versus Enthesitis Theory in Distal Psoriatic Arthritis: A Pioneer Histopathologic Study. Am J Dermatopathol 2021; 43:898-902. [PMID: 33795559 DOI: 10.1097/dad.0000000000001947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The aim of this analysis was to re-examine the classical concept of distal interphalangeal joint (DIP) psoriatic arthritis (PsA) as an entheseal-driven disease. Two cadaveric fingers with severe psoriatic arthritis were analyzed. Our results demonstrate that inflammation of DIP PsA is multifocal without interconnection between entheses and articular cartilage of the DIP. We found a clear association between synovitis and focal loss of articular cartilage at the head of the intermediate phalanx. By contrast, the articular cartilage adjacent to the zone of severe enthesitis did not show notable damage. Fibrocartilaginous destructions of enthesis were characterized by either a multifocal lymphocytic inflammation, accompanied by osteoclastic resorption, beginning on the interface between the uncalcified and calcified fibrocartilage and then extending into the bone or a subchondral bone inflammation which insidiously destroyed first the bone and then the fibrocartilage. Some sections well showed an inflammation either mild or prominent starting at the level of vascular foramina of flexor enthesis, with secondary invading into the interface between bone and enthesis. The different anatomic sites examined showed a slight predominance of CD8+ T cells over CD4+ T cells: 52% up to 63% for CD8+ T cells vs. to 36% up to 48% for CD4+ T cells. Sparse interspersed CD1a+cells and PS100+cells were also seen with a predominance of PS100+ cells on CD1a+ cells. CD20+ B cells, plasmocytes, neutrophils, and mastocytes were absent or rare. CD123 positive cells were not observed. In DIP PsA, 3 findings predominate: (1) cartilage invasion by the thin pannus offers a more rational explanation for the focal joint destruction than does inflammation of the enthesis which is independent from articular cartilage, (2) the thick ventral plate and to a lesser extend the thin dorsal plate constitute a barrier between the inflamed entheses and the articular cartilage, and (3) an unusual form of minute vascular foramen contributes to the early stage of enthesitis. This small study suggests that DIP PsA is a complex disease. It affects anatomical micro sites which, although close, are in fact relatively independent of each other. Further studies are needed to test this hypothesis.
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Affiliation(s)
- Christophe Perrin
- Laboratoire Central d'Anatomie Pathologique, Hôpital L. Pasteur, University of Nice, Nice, France
- Nail's Dermatology Consultations, Cannes, France
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Golman M, Birman V, Thomopoulos S, Genin GM. Enthesis strength, toughness and stiffness: an image-based model comparing tendon insertions with varying bony attachment geometries. J R Soc Interface 2021; 18:20210421. [PMID: 34932930 PMCID: PMC8692040 DOI: 10.1098/rsif.2021.0421] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Tendons of the body differ dramatically in their function, mechanics and range of motion, but all connect to bone via an enthesis. Effective force transfer at the enthesis enables joint stability and mobility, with strength and stiffness arising from a fibrous architecture. However, how enthesis toughness arises across tendons with diverse loading orientations remains unclear. To study this, we performed simultaneous imaging of the bone and tendon in entheses that represent the range of tendon-to-bone insertions and extended a mathematical model to account for variations in insertion and bone geometry. We tested the hypothesis that toughness, across a range of tendon entheses, could be explained by differences observed in interactions between fibre architecture and bone architecture. In the model, toughness arose from fibre reorientation, recruitment and rupture, mediated by interactions between fibres at the enthesis and the bony ridge abutting it. When applied to tendons sometimes characterized as either energy-storing or positional, the model predicted that entheses of the former prioritize toughness over strength, while those of the latter prioritize consistent stiffness across loading directions. Results provide insight into techniques for surgical repair of tendon-to-bone attachments, and more broadly into mechanisms for the attachment of highly dissimilar materials.
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Affiliation(s)
- Mikhail Golman
- Columbia University, Black Building, Room 1408, 650 W 168 ST, New York, NY 10032-3702, USA
| | - Victor Birman
- Missouri University of Science and Technology, Rolla, MO 65409, USA
| | - Stavros Thomopoulos
- Columbia University, Black Building, Room 1408, 650 W 168 ST, New York, NY 10032-3702, USA
| | - Guy M. Genin
- Washington University, Jubel Hall, Room 103F, 1 Brookings Drive, St Louis, MO 63130, USA
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Chanlalit C, Mahasupachai N, Sakdapanichkul C. Arthroscopic Lateral Collateral Ligament Complex Reconstruction for Posterolateral Rotatory Instability of the Elbow, the Operative Technique. Arthrosc Tech 2021; 10:e2805-e2812. [PMID: 35004164 PMCID: PMC8719306 DOI: 10.1016/j.eats.2021.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/15/2021] [Indexed: 02/03/2023] Open
Abstract
Posterolateral rotatory instability is concerning pathology in patients with recalcitrant lateral elbow pain. An arthroscopic technique can be used to perform reconstruction of lateral collateral ligament for eradicating the instability and also to manage concomitant lesions in a simultaneous operation. Similar to the modified Brostrӧm procedure using an inferior extensor retinaculum to augment the lateral collateral ligament for lateral ankle instability, in our Technical Note, we use anconeus muscles and annular ligament to augment the lateral collateral ligament for elbow instability during the reconstruction, allowing all tissue to heal with the bone by using a knotless technique.
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Affiliation(s)
- Cholawish Chanlalit
- Address correspondence to Cholawish Chanlalit, M.D., Department of Orthopedics, 6th floor of Faculty of Medicine Building, Srinakharinwirot University, 62 Moo 7 Ongkharak, Ongkharak, Nakhon Nayok 26120.
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Rodríguez-Merchán EC. Anterior Cruciate Ligament Reconstruction: Is Biological Augmentation Beneficial? Int J Mol Sci 2021; 22:ijms222212566. [PMID: 34830448 PMCID: PMC8625610 DOI: 10.3390/ijms222212566] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 12/28/2022] Open
Abstract
Surgical reconstruction in anterior cruciate ligament (ACL) ruptures has proven to be a highly effective technique that usually provides satisfactory results. However, despite the majority of patients recovering their function after this procedure, ACL reconstruction (ACLR) is still imperfect. To improve these results, various biological augmentation (BA) techniques have been employed mostly in animal models. They include: (1) growth factors (bone morphogenetic protein, epidermal growth factor, granulocyte colony-stimulating factor, basic fibroblast growth factor, transforming growth factor-β, hepatocyte growth factor, vascular endothelial growth factor, and platelet concentrates such as platelet-rich plasma, fibrin clot, and autologous conditioned serum), (2) mesenchymal stem cells, (3) autologous tissue, (4) various pharmaceuticals (matrix metalloproteinase-inhibitor alpha-2-macroglobulin bisphosphonates), (5) biophysical/environmental methods (hyperbaric oxygen, low-intensity pulsed ultrasound, extracorporeal shockwave therapy), (6) biomaterials (fixation methods, biological coatings, biosynthetic bone substitutes, osteoconductive materials), and (7) gene therapy. All of them have shown good results in experimental studies; however, the clinical studies on BA published so far are highly heterogeneous and have a low degree of evidence. The most widely used technique to date is platelet-rich plasma. My position is that orthopedic surgeons must be very cautious when considering using PRP or other BA methods in ACLR.
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Affiliation(s)
- Emerito Carlos Rodríguez-Merchán
- Department of Orthopedic Surgery, La Paz University Hospital—IdiPaz, 28046 Madrid, Spain;
- Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research—IdiPAZ (La Paz University Hospital—Autonomous University of Madrid), 28046 Madrid, Spain
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Tie K, Cai J, Qin J, Xiao H, Shangguan Y, Wang H, Chen L. Nanog/NFATc1/Osterix signaling pathway-mediated promotion of bone formation at the tendon-bone interface after ACL reconstruction with De-BMSCs transplantation. Stem Cell Res Ther 2021; 12:576. [PMID: 34775995 PMCID: PMC8591902 DOI: 10.1186/s13287-021-02643-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/25/2021] [Indexed: 11/10/2022] Open
Abstract
Background Bone formation plays an important role in early tendon–bone healing after anterior cruciate ligament reconstruction (ACLR). Dedifferentiated osteogenic bone marrow mesenchymal stem cells (De-BMSCs) have enhanced osteogenic potential. This study aimed to investigate the effect of De-BMSCs transplantation on the promotion of bone formation at the tendon–bone interface after ACLR and to further explore the molecular mechanism of the enhanced osteogenic potential of De-BMSCs. Methods BMSCs from the femurs and tibias of New Zealand white rabbits were subjected to osteogenic induction and then cultured in medium without osteogenic factors; the obtained cell population was termed De-BMSCs. De-BMSCs were induced to undergo osteo-, chondro- and adipo-differentiation in vitro to examine the characteristics of primitive stem cells. An ACLR model with a semitendinosus tendon was established in rabbits, and the animals were divided into a control group, BMSCs group, and De-BMSCs group. At 12 weeks after surgery, the rabbits in each group were sacrificed to evaluate tendon–bone healing by histologic staining, micro-computed tomography (micro-CT) examination, and biomechanical testing. During osteogenic differentiation of De-BMSCs, an siRNA targeting nuclear factor of activated T-cells 1 (NFATc1) was used to verify the molecular mechanism of the enhanced osteogenic potential of De-BMSCs. Results De-BMSCs exhibited some properties similar to BMSCs, including multiple differentiation potential and cell surface markers. Bone formation at the tendon–bone interface in the De-BMSCs group was significantly increased, and biomechanical strength was significantly improved. During the osteogenic differentiation of De-BMSCs, the expression of Nanog and NFATc1 was synergistically increased, which promoted the interaction of NFATc1 and Osterix, resulting in increased expression of osteoblast marker genes such as COL1A, OCN, and OPN. Conclusions De-BMSCs transplantation could promote bone formation at the tendon–bone interface after ACLR and improve the biomechanical strength of the reconstruction. The Nanog/NFATc1/Osterix signaling pathway mediated the enhanced osteogenic differentiation efficiency of De-BMSCs. Supplementary Information The online version contains supplementary material available at 10.1186/s13287-021-02643-9.
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Affiliation(s)
- Kai Tie
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Jinghang Cai
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Jun Qin
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Hao Xiao
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Yangfan Shangguan
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Hui Wang
- Department of Pharmacology, Basic Medical School of Wuhan University, Wuhan, 430071, China.
| | - Liaobin Chen
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
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Yamada AF, Puchnick A, Filho FRP, Narahashi E, Arliani GG, de Castro Pochini A, da Rocha Correa Fernandes A. Hip apophyseal injuries in soccer players: can MRI findings be useful to define when to return to play? Skeletal Radiol 2021; 50:2273-2280. [PMID: 33970287 DOI: 10.1007/s00256-021-03797-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 04/05/2021] [Accepted: 04/25/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe magnetic resonance imaging (MRI) findings in professional soccer players with acute apophyseal injury of the hip and to assess their relationship with return to sports. MATERIAL AND METHODS Adolescent soccer players with diagnosis of apophyseal injury in the anterosuperior and anteroinferior iliac spine were retrospectively evaluated between 2008 and 2016. All athletes underwent hip MRI examination within 4 days after onset of clinical complaint. Images were independently analyzed by two radiologists. Medical records were reviewed to obtain clinical data. RESULTS Mean displacement of the apophysis was 4.8 ± 4.6 mm. Bone edema was present in 82% of athletes and muscular edema in 41%. The mean time to return to sports was 37.3 ± 14.7 days. The difference between the measurements of the two radiologists was close to zero with agreement limits below 1.0 mm (p < 0.001). There was a significant correlation between displacement of the apophysis and return to sports, as well as between both and the presence of muscular edema. A displacement of the apophysis of 3.0 mm might serve as a parameter to predict return to sports/activity before 40 days, with a sensitivity of 92% and specificity of 96%, considering conservative physiotherapy treatment. CONCLUSION Displacement of the apophysis and presence of muscular edema evaluated by MRI showed a significant correlation with return to sports in athletes with acute apophyseal injuries of the anterosuperior and anteroinferior iliac spines.
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Affiliation(s)
- Andre Fukunishi Yamada
- Department of Radiology and Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Napoleão de Barros, 800, São Paulo, SP, 04024-002, Brazil.
- Department of Radiology, Hospital do Coração - HCor and Teleimagem, Rua Desembargador Eliseu Guilherme, 53, 7th Floor, São Paulo, 04004-030, Brazil.
- ALTA Diagnostic Center (DASA Group), São Paulo, Brazil.
| | - Andrea Puchnick
- Department of Radiology and Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Napoleão de Barros, 800, São Paulo, SP, 04024-002, Brazil
| | - Frederico Roberto Pollack Filho
- Department of Radiology and Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Napoleão de Barros, 800, São Paulo, SP, 04024-002, Brazil
| | - Erica Narahashi
- Department of Radiology and Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Napoleão de Barros, 800, São Paulo, SP, 04024-002, Brazil
| | - Gustavo Gonçalves Arliani
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Napoleão de Barros, 715, 1st Floor, São Paulo, 04024-002, Brazil
| | - Alberto de Castro Pochini
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Napoleão de Barros, 715, 1st Floor, São Paulo, 04024-002, Brazil
| | - Artur da Rocha Correa Fernandes
- Department of Radiology and Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Napoleão de Barros, 800, São Paulo, SP, 04024-002, Brazil
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80
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Merkel MFR, Hellsten Y, Magnusson SP, Kjaer M. Tendon blood flow, angiogenesis, and tendinopathy pathogenesis. TRANSLATIONAL SPORTS MEDICINE 2021. [DOI: 10.1002/tsm2.280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Max Flemming Ravn Merkel
- Institute of Sports Medicine Department of Orthopedic Surgery Copenhagen University Hospital ‐ Bispebjerg‐Frederiksberg University of Copenhagen Copenhagen Denmark
- Department of Nutrition, Exercise and Sports University of Copenhagen Copenhagen Denmark
| | - Ylva Hellsten
- Department of Nutrition, Exercise and Sports University of Copenhagen Copenhagen Denmark
| | - Stig Peter Magnusson
- Institute of Sports Medicine Department of Orthopedic Surgery Copenhagen University Hospital ‐ Bispebjerg‐Frederiksberg University of Copenhagen Copenhagen Denmark
- Center for Healthy Aging Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Michael Kjaer
- Institute of Sports Medicine Department of Orthopedic Surgery Copenhagen University Hospital ‐ Bispebjerg‐Frederiksberg University of Copenhagen Copenhagen Denmark
- Center for Healthy Aging Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
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Logerstedt DS, Ebert JR, MacLeod TD, Heiderscheit BC, Gabbett TJ, Eckenrode BJ. Effects of and Response to Mechanical Loading on the Knee. Sports Med 2021; 52:201-235. [PMID: 34669175 DOI: 10.1007/s40279-021-01579-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 11/30/2022]
Abstract
Mechanical loading to the knee joint results in a differential response based on the local capacity of the tissues (ligament, tendon, meniscus, cartilage, and bone) and how those tissues subsequently adapt to that load at the molecular and cellular level. Participation in cutting, pivoting, and jumping sports predisposes the knee to the risk of injury. In this narrative review, we describe different mechanisms of loading that can result in excessive loads to the knee, leading to ligamentous, musculotendinous, meniscal, and chondral injuries or maladaptations. Following injury (or surgery) to structures around the knee, the primary goal of rehabilitation is to maximize the patient's response to exercise at the current level of function, while minimizing the risk of re-injury to the healing tissue. Clinicians should have a clear understanding of the specific injured tissue(s), and rehabilitation should be driven by knowledge of tissue-healing constraints, knee complex and lower extremity biomechanics, neuromuscular physiology, task-specific activities involving weight-bearing and non-weight-bearing conditions, and training principles. We provide a practical application for prescribing loading progressions of exercises, functional activities, and mobility tasks based on their mechanical load profile to knee-specific structures during the rehabilitation process. Various loading interventions can be used by clinicians to produce physical stress to address body function, physical impairments, activity limitations, and participation restrictions. By modifying the mechanical load elements, clinicians can alter the tissue adaptations, facilitate motor learning, and resolve corresponding physical impairments. Providing different loads that create variable tensile, compressive, and shear deformation on the tissue through mechanotransduction and specificity can promote the appropriate stress adaptations to increase tissue capacity and injury tolerance. Tools for monitoring rehabilitation training loads to the knee are proposed to assess the reactivity of the knee joint to mechanical loading to monitor excessive mechanical loads and facilitate optimal rehabilitation.
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Affiliation(s)
- David S Logerstedt
- Department of Physical Therapy, University of the Sciences in Philadelphia, Philadelphia, PA, USA.
| | - Jay R Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, WA, Australia.,Orthopaedic Research Foundation of Western Australia, Perth, WA, Australia.,Perth Orthopaedic and Sports Medicine Research Institute, Perth, WA, Australia
| | - Toran D MacLeod
- Department of Physical Therapy, Sacramento State University, Sacramento, CA, USA
| | - Bryan C Heiderscheit
- Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
| | - Tim J Gabbett
- Gabbett Performance Solutions, Brisbane, QLD, Australia.,Centre for Health Research, University of Southern Queensland, Ipswich, QLD, Australia
| | - Brian J Eckenrode
- Department of Physical Therapy, Arcadia University, Glenside, PA, USA
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Gorb SN, Krings W. Mechanical property gradients of taenioglossan radular teeth are associated with specific function and ecological niche in Paludomidae (Gastropoda: Mollusca). Acta Biomater 2021; 134:513-530. [PMID: 34329785 DOI: 10.1016/j.actbio.2021.07.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/16/2021] [Accepted: 07/22/2021] [Indexed: 02/07/2023]
Abstract
Biological tissues may exhibit graded heterogeneities in structure and mechanical properties that are crucial to their function. One biological structure that shows variation in both structure and function is the molluscan radula: the organ comprises a chitinous membrane with embedded teeth and serves to process and gather food. The tooth morphologies had been well studied in the last decades, but the mechanical properties of the teeth are not known for the vast majority of molluscs. This knowledge gap restricts our understanding of how the radula is able to act effectively on a target surface whilst simultaneously resisting structural failure. Here we employed nanoindentation technique to measure mechanical properties (hardness and Young's modulus) on distinct localities of individual radular teeth from 24 species of African paludomid gastropods. These species have distinct ecological niches as they forage on algae on different feeding substrates. A gradual distribution of measured properties along the teeth was found in species foraging on solid or mixed feeding substrates, but soft substrate feeders exhibit teeth almost homogeneous in their biomechanical properties. The presence or absence of large-scale gradients in these taenioglossan teeth could directly be linked with their specific function and in general with the species ecology, whereas the radular tooth morphologies do not always and fully reflect ecology. STATEMENT OF SIGNIFICANCE: African Lake Tanganyika is well known for harbouring endemic and morphologically distinct genera. Its paludomid gastropods form a flock of high interest because of its diversity. As they show distinct radular tooth morphologies hypotheses about potential trophic specializations had always been at hand. Here we evaluated the mechanical properties Young's modulus and hardness of 9027 individual teeth from 24 species along the tooth by nanoindentation and related them with the gastropods' specific feeding substrate. We find that hard substrate feeders have teeth that are hard at the tips but much less stiff at the base and thus heterogeneous with respect to material properties, whereas soft substrate feeders have teeth that are flexible and homogenous with respect to material properties.
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Shimada M, Kanno N, Ichinohe T, Suzuki S, Harada Y, Hara Y. Prophylactic Efficacy of Tibial Plateau Levelling Osteotomy for a Canine Model with Experimentally Induced Degeneration of the Cranial Cruciate Ligament. Vet Comp Orthop Traumatol 2021; 35:18-25. [PMID: 34547788 DOI: 10.1055/s-0041-1735318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to clarify the histological effects of tibial plateau levelling osteotomy on cranial cruciate ligament degeneration induced by excessive tibial plateau angle. STUDY DESIGN Five female Beagles were used to bilaterally create excessive tibial plateau angle models surgically. A second tibial plateau levelling osteotomy was performed 11 months after the first surgery on the right stifle (tibial plateau levelling osteotomy group), and a sham operation that did not change the tibial plateau angle was performed on the left stifle (excessive tibial plateau angle group). At 6 months after the second surgery, the dogs were euthanatized. The cranial cruciate ligament was stained with haematoxylin-eosin to assess the cell density, Alcian-Blue to assess proteoglycans and Elastica-Eosin to assess elastic fibres, and immunohistochemically stained to assess type I (COL1) and type II collagen and SRY-type HMG box 9 (SOX9) expression. RESULTS In each group, the cranial cruciate ligament degeneration, especially on the tibial side, including the presence of Alcian-Blue- and Elastica-Eosin-positive regions, decreased in COL1-positive regions, and enhancement of SOX9 expression was observed. Besides, compared with the tibial plateau levelling osteotomy group, the excessive tibial plateau angle group showed increases in Alcian-Blue- and Elastica-Eosin-positive regions and a decrease in the COL1-positive regions. CONCLUSION The results suggested that excessive tibial plateau angle-induced cranial cruciate ligament degeneration can be suppressed by reducing the biomechanical load on the cranial cruciate ligament by performing tibial plateau levelling osteotomy.
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Affiliation(s)
- Masakazu Shimada
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
| | - Nobuo Kanno
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
| | - Tom Ichinohe
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan.,Veterinary Teaching Hospital, Azabu University, Chuou-ku, Sagamihara-shi, Kanagawa, Japan
| | - Shuji Suzuki
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
| | - Yasuji Harada
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
| | - Yasushi Hara
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
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84
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Naghieh S, Lindberg G, Tamaddon M, Liu C. Biofabrication Strategies for Musculoskeletal Disorders: Evolution towards Clinical Applications. Bioengineering (Basel) 2021; 8:123. [PMID: 34562945 PMCID: PMC8466376 DOI: 10.3390/bioengineering8090123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 08/30/2021] [Accepted: 09/03/2021] [Indexed: 12/26/2022] Open
Abstract
Biofabrication has emerged as an attractive strategy to personalise medical care and provide new treatments for common organ damage or diseases. While it has made impactful headway in e.g., skin grafting, drug testing and cancer research purposes, its application to treat musculoskeletal tissue disorders in a clinical setting remains scarce. Albeit with several in vitro breakthroughs over the past decade, standard musculoskeletal treatments are still limited to palliative care or surgical interventions with limited long-term effects and biological functionality. To better understand this lack of translation, it is important to study connections between basic science challenges and developments with translational hurdles and evolving frameworks for this fully disruptive technology that is biofabrication. This review paper thus looks closely at the processing stage of biofabrication, specifically at the bioinks suitable for musculoskeletal tissue fabrication and their trends of usage. This includes underlying composite bioink strategies to address the shortfalls of sole biomaterials. We also review recent advances made to overcome long-standing challenges in the field of biofabrication, namely bioprinting of low-viscosity bioinks, controlled delivery of growth factors, and the fabrication of spatially graded biological and structural scaffolds to help biofabricate more clinically relevant constructs. We further explore the clinical application of biofabricated musculoskeletal structures, regulatory pathways, and challenges for clinical translation, while identifying the opportunities that currently lie closest to clinical translation. In this article, we consider the next era of biofabrication and the overarching challenges that need to be addressed to reach clinical relevance.
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Affiliation(s)
- Saman Naghieh
- Division of Biomedical Engineering, University of Saskatchewan, Saskatoon, SK S7N 5A9, Canada
| | - Gabriella Lindberg
- Christchurch Regenerative Medicine and Tissue Engineering (CReaTE) Group, Department of Orthopaedic Surgery, University of Otago Christchurch, Christchurch 8011, New Zealand
- Knight Campus for Accelerating Scientific Impact, University of Oregon, Eugene, OR 97403, USA
| | - Maryam Tamaddon
- Institute of Orthopaedic & Musculoskeletal Science, Royal National Orthopaedic Hospital, University College London, Stanmore HA7 4LP, UK
| | - Chaozong Liu
- Institute of Orthopaedic & Musculoskeletal Science, Royal National Orthopaedic Hospital, University College London, Stanmore HA7 4LP, UK
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85
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Holmes M, Thomas R, Hamerow H. Lesions in sheep elbows: Insights from a large-scale study. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2021; 34:50-62. [PMID: 34146820 DOI: 10.1016/j.ijpp.2021.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 04/29/2021] [Accepted: 05/21/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Enthesophytes on sheep elbow joints are commonly reported in archaeological material. Although these lesions are often described as 'penning elbow', little is known of their aetiology. In this study, a new method for recording these lesions is presented, and the effect of age, sex and body size is explored to understand their potential for informing upon past human-animal interactions. MATERIALS 1133 distal humerii and proximal radii from 16 archaeological sites. METHODS The presence and severity of enthesophytes were recorded and findings compared with modern data from a group of 17 complete Soay sheep skeletons. RESULTS Significant, positive correlations between age and body size and the presence of enthesophytes were demonstrated. Environmental factors and trauma may also play a role in their formation. CONCLUSION The aetiology of enthesophytes on sheep elbows is complex and varied, affected by age, body size and environment. SIGNIFICANCE This is the first study of enthesophytes on sheep elbows to combine archaeological data with modern animals of known age and sex. Blanket explanations of husbandry methods for the cause of these lesions are dispelled, and use of the term 'penning elbow' is redundant. LIMITATIONS The sample of modern specimens is relatively small and would benefit from the inclusion of older individuals and those raised in different environments. FUTURE RESEARCH The method developed here can be adopted in future studies. Interpretations should take age, size and environmental factors into consideration, and only when these variables are established can the role of husbandry be evaluated.
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Affiliation(s)
- Matilda Holmes
- School of Archaeology and Ancient History, University of Leicester, University Road, Leicester LE1 7RH, United Kingdom.
| | - Richard Thomas
- School of Archaeology and Ancient History, University of Leicester, University Road, Leicester LE1 7RH, United Kingdom
| | - Helena Hamerow
- School of Archaeology, University of Oxford, 1 South Parks Rd, Oxford OX1 3TG, United Kingdom
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86
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Tits A, Plougonven E, Blouin S, Hartmann MA, Kaux JF, Drion P, Fernandez J, van Lenthe GH, Ruffoni D. Local anisotropy in mineralized fibrocartilage and subchondral bone beneath the tendon-bone interface. Sci Rep 2021; 11:16534. [PMID: 34400706 PMCID: PMC8367976 DOI: 10.1038/s41598-021-95917-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/02/2021] [Indexed: 12/19/2022] Open
Abstract
The enthesis allows the insertion of tendon into bone thanks to several remarkable strategies. This complex and clinically relevant location often features a thin layer of fibrocartilage sandwiched between tendon and bone to cope with a highly heterogeneous mechanical environment. The main purpose of this study was to investigate whether mineralized fibrocartilage and bone close to the enthesis show distinctive three-dimensional microstructural features, possibly to enable load transfer from tendon to bone. As a model, the Achilles tendon-calcaneus bone system of adult rats was investigated with histology, backscattered electron imaging and micro-computed tomography. The microstructural porosity of bone and mineralized fibrocartilage in different locations including enthesis fibrocartilage, periosteal fibrocartilage and bone away from the enthesis was characterized. We showed that calcaneus bone presents a dedicated protrusion of low porosity where the tendon inserts. A spatially resolved analysis of the trabecular network suggests that such protrusion may promote force flow from the tendon to the plantar ligament, while partially relieving the trabecular bone from such a task. Focusing on the tuberosity, highly specific microstructural aspects were highlighted. Firstly, the interface between mineralized and unmineralized fibrocartilage showed the highest roughness at the tuberosity, possibly to increase failure resistance of a region carrying large stresses. Secondly, fibrochondrocyte lacunae inside mineralized fibrocartilage, in analogy with osteocyte lacunae in bone, had a predominant alignment at the enthesis and a rather random organization away from it. Finally, the network of subchondral channels inside the tuberosity was highly anisotropic when compared to contiguous regions. This dual anisotropy of subchondral channels and cell lacunae at the insertion may reflect the alignment of the underlying collagen network. Our findings suggest that the microstructure of fibrocartilage may be linked with the loading environment. Future studies should characterize those microstructural aspects in aged and or diseased conditions to elucidate the poorly understood role of bone and fibrocartilage in enthesis-related pathologies.
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Affiliation(s)
- Alexandra Tits
- Mechanics of Biological and Bioinspired Materials Laboratory, Department of Aerospace and Mechanical Engineering, University of Liège, Quartier Polytech 1, Allée de la Découverte 9, 4000, Liège, Belgium
| | - Erwan Plougonven
- Chemical Engineering Department, University of Liège, Liège, Belgium
| | - Stéphane Blouin
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria
| | - Markus A Hartmann
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria
| | - Jean-François Kaux
- Department of Physical Medicine and Sports Traumatology, University of Liège and University Hospital of Liège, Liège, Belgium
| | - Pierre Drion
- Experimental Surgery Unit, GIGA and Credec, University of Liege, Liege, Belgium
| | - Justin Fernandez
- Auckland Bioengineering Institute and Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | | | - Davide Ruffoni
- Mechanics of Biological and Bioinspired Materials Laboratory, Department of Aerospace and Mechanical Engineering, University of Liège, Quartier Polytech 1, Allée de la Découverte 9, 4000, Liège, Belgium.
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87
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Vila Pouca MCP, Parente MPL, Jorge RMN, Ashton-Miller JA. Injuries in Muscle-Tendon-Bone Units: A Systematic Review Considering the Role of Passive Tissue Fatigue. Orthop J Sports Med 2021; 9:23259671211020731. [PMID: 34395681 PMCID: PMC8361535 DOI: 10.1177/23259671211020731] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/25/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Low-cycle fatigue damage accumulating to the point of structural failure has been recently reported at the origin of the human anterior cruciate ligament under strenuous repetitive loading. If this can occur in a ligament, low-cycle fatigue damage may also occur in the connective tissue of muscle-tendon units. To this end, we reviewed what is known about how, when, and where injuries of muscle-tendon units occur throughout the body. Purpose: To systematically review injuries in the muscle-tendon-bone complex; assess the site of injury (muscle belly, musculotendinous junction [MTJ], tendon/aponeurosis, tendon/aponeurosis–bone junction, and tendon/aponeurosis avulsion), incidence, muscles and tendons involved, mechanism of injury, and main symptoms; and consider the hypothesis that injury may often be consistent with the accumulation of multiscale material fatigue damage during repetitive submaximal loading regimens. Methods: PubMed, Web of Science, Scopus, and ProQuest were searched on July 24, 2019. Quality assessment was undertaken using ARRIVE, STROBE, and CARE (Animal Research: Reporting In Vivo Experiments, Strengthening the Reporting of Observational Studies in Epidemiology, and the Case Report Statement and Checklist, respectively). Results: Overall, 131 studies met the inclusion criteria, including 799 specimens and 2,823 patients who sustained 3,246 injuries. Laboratory studies showed a preponderance of failures at the MTJ, a viscoelastic behavior of muscle-tendon units, and damage accumulation at the MTJ with repetitive loading. Observational studies showed that 35% of injuries occurred in the tendon midsubstance; 28%, at the MTJ; 18%, at the tendon-bone junction; 13%, within the muscle belly and that 6% were tendon avulsions including a bone fragment. The biceps femoris was the most injured muscle (25%), followed by the supraspinatus (12%) and the Achilles tendon (9%). The most common symptoms were hematoma and/or swelling, tenderness, edema and muscle/tendon retraction. The onset of injury was consistent with tissue fatigue at all injury sites except for tendon avulsions, where 63% of the injuries were caused by an evident trauma. Conclusion: Excluding traumatic tendon avulsions, most injuries were consistent with the hypothesis that material fatigue damage accumulated during repetitive submaximal loading regimens. If supported by data from better imaging modalities, this has implications for improving injury detection, prevention, and training regimens.
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Affiliation(s)
- Maria C P Vila Pouca
- Faculty of Engineering of University of Porto, Porto, Portugal.,Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | - Marco P L Parente
- Faculty of Engineering of University of Porto, Porto, Portugal.,Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | - Renato M Natal Jorge
- Faculty of Engineering of University of Porto, Porto, Portugal.,Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | - James A Ashton-Miller
- Departments of Mechanical and Biomedical Engineering, College of Engineering and School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
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88
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Xu Y, Zhang WX, Wang LN, Ming YQ, Li YL, Ni GX. Stem cell therapies in tendon-bone healing. World J Stem Cells 2021; 13:753-775. [PMID: 34367476 PMCID: PMC8316867 DOI: 10.4252/wjsc.v13.i7.753] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/08/2021] [Accepted: 06/23/2021] [Indexed: 02/06/2023] Open
Abstract
Tendon-bone insertion injuries such as rotator cuff and anterior cruciate ligament injuries are currently highly common and severe. The key method of treating this kind of injury is the reconstruction operation. The success of this reconstructive process depends on the ability of the graft to incorporate into the bone. Recently, there has been substantial discussion about how to enhance the integration of tendon and bone through biological methods. Stem cells like bone marrow mesenchymal stem cells (MSCs), tendon stem/progenitor cells, synovium-derived MSCs, adipose-derived stem cells, or periosteum-derived periosteal stem cells can self-regenerate and potentially differentiate into different cell types, which have been widely used in tissue repair and regeneration. Thus, we concentrate in this review on the current circumstances of tendon-bone healing using stem cell therapy.
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Affiliation(s)
- Yue Xu
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing 100084, China
| | - Wan-Xia Zhang
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing 100084, China
| | - Li-Na Wang
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing 100084, China
| | - Yue-Qing Ming
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing 100084, China
| | - Yu-Lin Li
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing 100084, China
| | - Guo-Xin Ni
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing 100084, China
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89
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The transition from enthesis physiological responses in health to aberrant responses that underpin spondyloarthritis mechanisms. Curr Opin Rheumatol 2021; 33:64-73. [PMID: 33229975 DOI: 10.1097/bor.0000000000000768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Despite immunology and translational therapeutics advances in inflammatory arthritis over the past two decades, the enthesis, which is the epicentric of the spondyloarthritis family pathological process, retains many mysteries because of tissue inaccessibility that hampers direct immune study. As entheses are subject to almost continuous mechanical stress and spondyloarthritis is linked to microdamage or injury and joint stress, it is cardinal to understand the physiological changes occurring within the entheses not only to be able to differentiate disease from health but also to understand the transition normal physiology break down and its merges into spondyloarthritis-related disease. RECENT FINDINGS Imaging has played a major role in understanding the enthesis in human. Remarkable insights from enthesis functioning and microdamage in normal and with ageing including those linked to body mass index is emerging. The impact of mechanical stress and degenerative conditions on the development of the secondary entheseal vascular changes is not understood. Of note, ultrasound studies in psoriasis have shown higher power Doppler changes compared to controls pointing towards a role for vascular changes in the development of enthesitis in psoriatic arthritis. SUMMARY The literature pertaining to normal entheses changes with age, microdamage and vascular changes in health is providing a roadmap for understanding of the enthesis and its potential role in evolution of spondyloarthritis including psoriatic arthritis.
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90
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Zhang Z, Zeng J, Li Y, Liao Q, Huang D, Zou Y, Liu G. Tail suspension delays ectopic ossification in proteoglycan-induced ankylosing spondylitis in mice via miR-103/DKK1. Exp Ther Med 2021; 22:965. [PMID: 34335907 PMCID: PMC8290398 DOI: 10.3892/etm.2021.10397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 06/15/2021] [Indexed: 11/14/2022] Open
Abstract
Ankylosing spondylitis (AS), characterized by inflammatory lesions and osteophyte formation, is a common immune rheumatic disease affecting the sacroiliac and axial joints. A high-intensity mechanical load is known to accelerate the heterotopic ossification associated with enthesitis in AS. Thus, the present study explored whether decreased mechanical load could delay the heterotopic ossification in AS. First, 24-week-old female BALB/c mice were induced with proteoglycan (PG) to establish an AS model. The AS-induced pathological and bone morphological changes of the sacroiliac joint were confirmed by hematoxylin and eosin staining and microCT analysis, respectively. Subsequently, the mice were treated with interventions of different mechanical loads. Using reverse transcription-quantitative PCR, it was revealed that expression levels of the osteogenesis-related genes bone morphogenetic protein-2, runt-related transcription factor 2 and osteocalcin were significantly reduced in sacroiliac bone tissue after intervention with a reduced mechanical load. The level of mechanosensory microRNA (miR)-103 increased in response to reduced mechanical loads. Consistently, in groups with reduced mechanical load, proteins with mechanical functions, including ρ-associated coiled-coil-containing protein kinase 1 (ROCK1), phosphorylated (p)-Erk1/2 and β-catenin, were reduced compared with the PG control. A dual-luciferase assay verified that miR-103 binds to the 3'-untranslated region end of Rock1 mRNA, thus negatively regulating the activity of Rock1 and affecting pathological ossification during AS. However, immunohistochemical staining indicated that the expression of dickkopf Wnt signaling pathway inhibitor 1, an inhibitor of the Wnt/β-catenin pathway, was increased in sacroiliac tissues. The results indicated that tail suspension decreased the mechanical load, thus reducing the bone formation in AS mice. Furthermore, tail suspension could inhibit the activation of mechanical kinase ROCK1 and p-Erk1/2 in the MAPK signaling pathway by upregulating miR-103, thereby inhibiting the classical osteogenesis-related Wnt/β-catenin pathway in AS. In summary, the present study uncovered the ameliorative effect of suspension on AS and its therapeutic potential for AS.
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Affiliation(s)
- Zhenzhen Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510000, P.R. China.,Department of Rehabilitation Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China.,Department of Rehabilitation, Hankou Hospital, Wuhan, Hubei 430015, P.R. China
| | - Jing Zeng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Yang Li
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Qing Liao
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Dongdong Huang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Yucong Zou
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Gang Liu
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510000, P.R. China.,Department of Rehabilitation Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
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91
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Saka N, Nimura A, Tsutsumi M, Nozaki T, Watanabe Y, Akita K. Anatomic study of fibrous structures attached to the volar ulnar corner of the radius: implications in the volar rim fracture. J Hand Surg Eur Vol 2021; 46:637-646. [PMID: 33459139 DOI: 10.1177/1753193420982192] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study aimed to clarify the bone and soft tissue morphological features at the volar ulnar corner of the radius. Micro-computed tomography, macroscopic and histological analyses were conducted using 12 cadaveric wrists, and in vivo MRI studies of the wrist were evaluated in five healthy volunteers. The volar ulnar corner of the distal radius has a protrusion volar to the sigmoid notch. The capsule elements of the radiolunate and radioulnar joints merge and this conjoined capsule attaches to the radius at the ulnar protrusion. Histologically, this capsule attaches to the radius via fibrocartilage, with fibres running in the radioulnar direction. In-vivo MRI studies showed that the capsule attaching to the volar ulnar corner could be traced to the dorsal side of the ulnar styloid. Our findings indicate that, given the direction of the fibres, an avulsion force in the radioulnar direction could be a cause for volar rim fractures.
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Affiliation(s)
- Natsumi Saka
- Department of Clinical Anatomy, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Orthopaedics, Teikyo University School of Medicine, Tokyo, Japan
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masahiro Tsutsumi
- Department of Clinical Anatomy, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taiki Nozaki
- Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
| | - Yoshinobu Watanabe
- Department of Orthopaedics, Teikyo University School of Medicine, Tokyo, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Tokyo Medical and Dental University, Tokyo, Japan
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92
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Mutsuzaki H, Nakajima H. Development of fibrocartilage layers in Achilles tendon enthesis in rabbits. J Rural Med 2021; 16:160-164. [PMID: 34239628 PMCID: PMC8249365 DOI: 10.2185/jrm.2021-015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 04/15/2021] [Indexed: 11/27/2022] Open
Abstract
Objective: The details regarding the development of fibrocartilage layers in
Achilles tendon (AT) enthesis are unknown. Therefore, we evaluated the development of
fibrocartilage layers in AT enthesis using a rabbit model. Materials and Methods: Forty-eight male Japanese white rabbits were used in
this study. Six of them were euthanized at different stages (day 1, and 1, 2, 4, 6, 8, 12,
and 24 weeks of age). The proliferation, apoptosis, Sox9-positivity rates, and chondrocyte
number were evaluated. Additionally, safranin O-stained glycosaminoglycan (GAG) areas,
width of AT enthesis, and calcaneus length were assessed. All parameters were compared to
those at 24 weeks of age. Results: The level of chondrocyte apoptosis was high from 1 to 8 weeks of
age, and high expression level of Sox9 was maintained from day 1 to 6 weeks of age, which
decreased gradually. Safranin O-stained GAG areas increased up to 12 weeks, calcaneus
length increased up to 6 weeks, and the width of AT enthesis increased up to 1 week of
age. Conclusion: The changes in chondrocyte and extracellular matrix were
completed by 8 and 12 weeks of age, respectively. The development of fibrocartilage layers
in AT enthesis was completed by 12 weeks of age. Our results contribute to the
administration of appropriate treatments based on age and aid in the development of novel
methods for regenerating AT enthesis.
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Affiliation(s)
- Hirotaka Mutsuzaki
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences, Japan
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93
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Leek CC, Soulas JM, Bhattacharya I, Ganji E, Locke RC, Smith MC, Bhavsar JD, Polson SW, Ornitz DM, Killian ML. Deletion of Fibroblast growth factor 9 globally and in skeletal muscle results in enlarged tuberosities at sites of deltoid tendon attachments. Dev Dyn 2021; 250:1778-1795. [PMID: 34091985 PMCID: PMC8639753 DOI: 10.1002/dvdy.383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The growth of most bony tuberosities, like the deltoid tuberosity (DT), rely on the transmission of muscle forces at the tendon-bone attachment during skeletal growth. Tuberosities distribute muscle forces and provide mechanical leverage at attachment sites for joint stability and mobility. The genetic factors that regulate tuberosity growth remain largely unknown. In mouse embryos with global deletion of fibroblast growth factor 9 (Fgf9), the DT size is notably enlarged. In this study, we explored the tissue-specific regulation of DT size using both global and targeted deletion of Fgf9. RESULTS We showed that cell hypertrophy and mineralization dynamics of the DT, as well as transcriptional signatures from skeletal muscle but not bone, were influenced by the global loss of Fgf9. Loss of Fgf9 during embryonic growth led to increased chondrocyte hypertrophy and reduced cell proliferation at the DT attachment site. This endured hypertrophy and limited proliferation may explain the abnormal mineralization patterns and locally dysregulated expression of markers of endochondral development in Fgf9null attachments. We then showed that targeted deletion of Fgf9 in skeletal muscle leads to postnatal enlargement of the DT. CONCLUSION Taken together, we discovered that Fgf9 may play an influential role in muscle-bone cross-talk during embryonic and postnatal development.
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Affiliation(s)
- Connor C Leek
- College of Engineering, University of Delaware, Newark, Delaware, USA.,Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Jaclyn M Soulas
- College of Engineering, University of Delaware, Newark, Delaware, USA.,College of Agriculture and Natural Resources, University of Delaware, Newark, Delaware, USA
| | - Iman Bhattacharya
- College of Engineering, University of Delaware, Newark, Delaware, USA.,Center for Bioinformatics and Computational Biology, University of Delaware, Newark, Delaware, USA
| | - Elahe Ganji
- College of Engineering, University of Delaware, Newark, Delaware, USA.,Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Ryan C Locke
- College of Engineering, University of Delaware, Newark, Delaware, USA
| | - Megan C Smith
- College of Engineering, University of Delaware, Newark, Delaware, USA.,Department of Biological Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Cell Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jaysheel D Bhavsar
- Center for Bioinformatics and Computational Biology, University of Delaware, Newark, Delaware, USA
| | - Shawn W Polson
- College of Engineering, University of Delaware, Newark, Delaware, USA.,Center for Bioinformatics and Computational Biology, University of Delaware, Newark, Delaware, USA
| | - David M Ornitz
- Department of Developmental Biology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Megan L Killian
- College of Engineering, University of Delaware, Newark, Delaware, USA.,Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
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94
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Tits A, Ruffoni D. Joining soft tissues to bone: Insights from modeling and simulations. Bone Rep 2021; 14:100742. [PMID: 34150954 PMCID: PMC8190669 DOI: 10.1016/j.bonr.2020.100742] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 12/14/2020] [Accepted: 12/18/2020] [Indexed: 01/16/2023] Open
Abstract
Entheses are complex multi-tissue regions of the musculoskeletal system serving the challenging task of connecting highly dissimilar materials such as the compliant tendon to the much stiffer bone, over a very small region. The first aim of this review is to highlight mathematical and computational models that have been developed to investigate the many attachment strategies present at entheses at different length scales. Entheses are also relevant in the medical context due to the high prevalence of orthopedic injuries requiring the reattachment of tendons or ligaments to bone, which are associated with a rather poor long-term clinical outcome. The second aim of the review is to report on the computational works analyzing the whole tendon to bone complex as well as targeting orthopedic relevant issues. Modeling approaches have provided important insights on anchoring mechanisms and surgical repair strategies, that would not have been revealed with experiments alone. We intend to demonstrate the necessity of including, in future models, an enriched description of enthesis biomechanical behavior in order to unravel additional mechanical cues underlying the development, the functioning and the maintaining of such a complex biological interface as well as to enhance the development of novel biomimetic adhesive, attachment procedures or tissue engineered implants.
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Affiliation(s)
- Alexandra Tits
- Mechanics of Biological and Bioinspired Materials Laboratory, Department of Aerospace and Mechanical Engineering, University of Liège, Liège, Belgium
| | - Davide Ruffoni
- Mechanics of Biological and Bioinspired Materials Laboratory, Department of Aerospace and Mechanical Engineering, University of Liège, Liège, Belgium
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95
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Arthroscopic lateral capsule resection is enough for the management of lateral epicondylitis. Knee Surg Sports Traumatol Arthrosc 2021; 29:2000-2005. [PMID: 32870386 DOI: 10.1007/s00167-020-06255-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Controversy exists with regards to the etiology and treatment of lateral epicondylitis and the role of the lateral capsule in this pathology. The aim of this study was to compare arthroscopic lateral capsule resection with or without extensor carpi radialis brevis (ECRB) tendon debridement for treatment of lateral epicondylitis. METHODS This is a retrospective study of 38 patients who underwent arthroscopic surgery for LE with two different techniques: Eighteen patients were treated with arthroscopic lateral capsular resection (LCR) + ECRB debridement and 20 patients were treated with arthroscopic LCR alone, without ECRB debridement. Both groups were assessed with Quick Disabilities of the Arm, Shoulder and Hand (QDASH) score for function and Visual Analog Scale (VAS) score for pain. RESULTS Quick DASH scores were 12 [Formula: see text] 5 and 13 [Formula: see text] 4 at Groups 1 and 2, respectively, without any statistically significant difference. VAS pain scores were 15 [Formula: see text] 2 for both groups. VAS function scores were 85 [Formula: see text] 22 and 86 [Formula: see text] 18 at Groups 1 and 2 respectively. Sick leave periods in terms of weeks were 7 [Formula: see text] 5 and 7 [Formula: see text] 4 at Groups 1 and 2, respectively. There was no statistically significant difference in outcome of the two groups compared in terms of VAS pain, function scores, failure (re-operation) rates and sick leave period at the end of final follow-up. CONCLUSION Both arthroscopic LCR alone and Arthroscopic LCR with ECRB debridement for the management of refractory LE provide significant improvement in pain and function. Isolated Arthroscopic LCR could be a sufficient surgical treatment for refractory LE. Thus, ECRB debridement or release may not be necessary in every case. LEVEL OF EVIDENCE IV.
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96
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Hoehmann CL, Beatty BL. Surface metrology of bone surface attachments of knee ligaments. Anat Rec (Hoboken) 2021; 305:52-65. [PMID: 34021967 DOI: 10.1002/ar.24684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 04/09/2021] [Accepted: 04/21/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Textural differences between entheses reflect biomechanical activities of the musculoskeletal system. Methods used to measure these surfaces have limitations. Here, the surface metrology of roughness of articular and entheseal surfaces of the knee are investigated with an optical profiler. METHODS Osteological specimens of six femora and seven tibiae were prepared from cadavers. Measurements were obtained to surrogate body mass. Specimens were molded with polyvinylsiloxane and casts prepared with resin, which were scanned using a white light optical profiler. Scans were processed by a computer program. Each scan produced 32 variables, categorized into 6 groups for each location. RESULTS The distribution of data was mostly normal. Analysis of variance (ANOVA) identified Ssk significant (p-value .002); post hoc Tukey testing indicated significance between femoral PCL and tibial ACL entheses groups (p-value .007), and between tibial ACL and tibial entheses groups (p-value .002) suggesting the ability to differentiate anterior and posterior cruciate ligament entheses. Sku was found significant with a t test between articular and entheseal surfaces. Correlation coefficients were significant between surface metrology parameters and measurements related to body mass. CONCLUSIONS This study distinguished differences between entheses of the anterior and posterior cruciate ligaments, with the Ssk parameter most useful. Differences in articular and entheseal surfaces were found with the Sku parameter most useful. Correlations indicated a relationship between body mass and surface metrology parameters. Finally, these findings suggest this method can be used for further investigation of spondyloarthropathies.
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Affiliation(s)
- Christopher L Hoehmann
- Department of Orthopaedic Surgery, Nassau University Medical Center, East Meadow, New York, USA.,New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York, USA
| | - Brian Lee Beatty
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York, USA.,United States National Museum, Smithsonian Institution, Washington, District of Columbia, USA
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97
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Alves-Cardoso F, Assis S. Exploring "wear and tear" of joints and "muscle function" assumptions in skeletons with known occupation at death. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2021; 175:689-700. [PMID: 34013541 DOI: 10.1002/ajpa.24334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 04/13/2021] [Accepted: 05/02/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Changes in the joints are believed to result from "wear and tear," a consequence of activity, as entheseal changes (EC) result from muscle use. However, clinical data showed that activity does not necessarily increase the likelihood of degenerative joint changes (DJC) and that exercise results in healthier joints. We tested whether individuals with continuous repetitive biomechanical efforts (Group 1) were more likely to exhibit EC and if occupations known to exert strenuous but discontinued efforts (Group 2) would more likely cause DJC. MATERIALS AND METHODS Eighty-nine males with known occupations from Portuguese identified collections were used: shoemakers and carpenters (Group 1), workers (Group 2), and civil servants, and shop assistants as a control group. Major upper and lower limb joints and entheses sites were used. DJC and EC were tested between occupations - while controlling for age (overall approach) - and within occupation (occupation-specific approach). RESULTS The overall approach showed that age - as a covariant - had a significant impact on DJC and EC development (p < 0.05), with occupation being non-significant (p > 0.05) despite the variability in the mean-values of lesions. The occupation-specific approach showed a significant variability of DJC and EC correlations, within and between occupations, with no clear trend of DJC and EC development according to occupation. DISCUSSION The results showed that exploring overall patterns might conceal occupation-specific joint and muscle use, emphasizing age as a major contributor of changes; and that the occupation-specific approach highlighted particular aspects associated with occupations, allowing for a more informative assessment of strenuous repetitive or discontinuous activity-related technical gestures and their impact on skeletal biology.
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Affiliation(s)
- Francisca Alves-Cardoso
- Laboratório de Antropologia Biológica e Osteologia Humana (LABOH), Centro em Rede de Investigação em Antropologia (CRIA), Faculdade de Ciências Sociais e Humanas, Universidade NOVA de Lisboa (FCSH/NOVA), Lisbon, Portugal
| | - Sandra Assis
- Laboratório de Antropologia Biológica e Osteologia Humana (LABOH), Centro em Rede de Investigação em Antropologia (CRIA), Faculdade de Ciências Sociais e Humanas, Universidade NOVA de Lisboa (FCSH/NOVA), Lisbon, Portugal.,CIAS-Research Center for Anthropology and Health, University of Coimbra, Coimbra, Portugal
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98
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Van den Broeck M, Stock E, Duchateau L, Cornillie P. The sesamoid bone in the long abductor muscle tendon of the first digit in the dog. Anat Rec (Hoboken) 2021; 305:37-51. [PMID: 33943018 DOI: 10.1002/ar.24648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/29/2021] [Accepted: 04/03/2021] [Indexed: 01/27/2023]
Abstract
The sesamoid bone in the tendon of the m. abductor digiti primi longus is considered present in most dog breeds and is described to be radiologically detectable at the level of the carpus from the age of 4 months. However, an extensive investigation of this sesamoid bone has not been conducted before. The aim of this study was therefore to determine its prevalence in different dog breeds, to describe its histological development, and to determine the age at which it becomes radiologically visible. The prevalence of the sesamoid bone was assessed on radiographic images of the carpus or by dissection of the carpal region in 743 adult dogs of 115 breeds. Its development was studied by dissection and histological analysis in 45 puppies and its timing of radiological appearance was evaluated in 209 puppies. At least one sesamoid bone was present in all adult dogs, except for 14 dogs of six breeds of predominantly the small breed category. The lowest prevalence rate of 38.46% was exhibited in the French bulldog. The histological development could be divided into five stages. The first radiographic appearance corresponded to the coalescence of smaller ossification centers into one big nucleus (stage 4). The mean time of radiographic appearance was 108.4 days. This study provides extensive data on the prevalence and timing of the radiographic appearance of a sesamoid at the carpus of the dog. The data on radiographic appearance may be helpful in the age estimation of puppies.
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Affiliation(s)
- Martine Van den Broeck
- Department of Morphology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Emmelie Stock
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Luc Duchateau
- Biometrics Research Center, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Pieter Cornillie
- Department of Morphology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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99
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Osborn ML, Cornille JL, Blas‐Machado U, Uhl EW. The equine navicular apparatus as a premier enthesis organ: Functional implications. Vet Surg 2021; 50:713-728. [PMID: 33710628 PMCID: PMC8251969 DOI: 10.1111/vsu.13620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 01/26/2021] [Accepted: 02/21/2021] [Indexed: 12/23/2022]
Abstract
Navicular syndrome has been traditionally characterized by progressive lameness with chronic degeneration of the navicular bone. Advances in imaging techniques have revealed that its associated soft tissue structures are also affected. This distribution of lesions is explained by conceptualizing the equine navicular apparatus as an enthesis organ that facilitates the dissemination of mechanical stress throughout the tissues of the foot. The navicular apparatus has the same structural adaptations to mechanical stress as the human Achilles tendon complex. These adaptations efficiently dissipate mechanical force away from the tendon's bony attachment site, thereby protecting it from failure. The comparison of these two anatomically distinct structural systems demonstrates their similar adaptations to mechanical forces, and illustrates that important functional insights can be gained from studying anatomic convergences and cross-species comparisons of function. Such a functional conceptualization of the equine navicular apparatus resolves confusion about the diagnosis of navicular syndrome and offers insights for the development of mechanically based therapies. Through comparison with the human Achilles complex, this review (1) re-conceptualizes the equine navicular apparatus as an enthesis organ in which mechanical forces are distributed throughout the structures of the organ; (2) describes the relationship between failure of the navicular enthesis organ and lesions of navicular syndrome; (3) considers the therapeutic implications of navicular enthesis organ degeneration as a form of chronic osteoarthritis; and based upon these implications (4) proposes a focus on whole body posture/motion for the development of prehabilitative and rehabilitative therapies similar to those that have already proven effective in humans.
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Affiliation(s)
- Michelle L. Osborn
- Department of Comparative Biomedical SciencesSchool of Veterinary Medicine, Louisiana State UniversityBaton RougeLouisianaUSA
| | | | - Uriel Blas‐Machado
- Department of PathologyCollege of Veterinary Medicine, University of GeorgiaAthensGeorgiaUSA
| | - Elizabeth W. Uhl
- Department of PathologyCollege of Veterinary Medicine, University of GeorgiaAthensGeorgiaUSA
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100
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Roffino S, Camy C, Foucault-Bertaud A, Lamy E, Pithioux M, Chopard A. Negative impact of disuse and unloading on tendon enthesis structure and function. LIFE SCIENCES IN SPACE RESEARCH 2021; 29:46-52. [PMID: 33888287 DOI: 10.1016/j.lssr.2021.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/19/2021] [Accepted: 03/05/2021] [Indexed: 06/12/2023]
Abstract
Exposure to chronic skeletal muscle disuse and unloading that astronauts experience results in muscle deconditioning and bone remodeling. Tendons involved in the transmission of force from muscles to skeleton are also affected. Understanding the changes that occur in muscle, tendon, and bone is an essential step toward limiting or preventing the deleterious effects of chronic reduction in mechanical load. Numerous reviews have reported the effects of this reduction on both muscle and bone, and to a lesser extent on the tendon. However, none focused on the tendon enthesis, the tendon-to-bone attachment site. While the enthesis structure appears to be determined by mechanical stress, little is known about enthesis plasticity. Our review first looks at the relationship between entheses and mechanical stress, exploring how tensile and compressive loads determine and influence enthesis structure and composition. The second part of this review addresses the deleterious effects of skeletal muscle disuse and unloading on enthesis structure, composition, and function. We discuss the possibility that spaceflight-induced enthesis remodeling could impact both the capacity of the enthesis to withstand compressive stress and its potential weakness. Finally, we point out how altered compressive strength at entheses could expose astronauts to the risk of developing enthesopathies.
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Affiliation(s)
- S Roffino
- ISM Inst Movement Sci, Aix-Marseille University, CNRS, Marseille, France.
| | - C Camy
- ISM Inst Movement Sci, Aix-Marseille University, CNRS, Marseille, France
| | - A Foucault-Bertaud
- INSERM 1263, INRA 1260, C2VN, Aix-Marseille University, Marseille, France
| | - E Lamy
- ISM Inst Movement Sci, Aix-Marseille University, CNRS, Marseille, France
| | - M Pithioux
- ISM Inst Movement Sci, Aix-Marseille University, CNRS, Marseille, France
| | - A Chopard
- DMEM, Montpellier University, INRAE, Montpellier, France
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