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Rohde MS, Trivedi S, Randhawa S, Wright CE, Vuong BB, Pham N, Stavinoha T, Ellis HB, Ganley TJ, Green DW, Fabricant PD, Tompkins M, Shea KG. Pediatric meniscus morphology varies with age: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 2023; 31:4179-4186. [PMID: 37178242 DOI: 10.1007/s00167-023-07447-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE In adolescent patients, meniscal tear injury can occur either in isolation (e.g., discoid lateral meniscus tears) or in association with other traumatic injuries including tibial eminence fracture or ACL tear. Damage to meniscal integrity has been shown to increase contact pressure in articular cartilage, increasing risk of early onset osteoarthritis. In symptomatic patients failing conservative management, surgical intervention via meniscus repair or meniscus transplant is indicated. The purpose of this study was to evaluate the radial dimensions of pediatric menisci throughout development. The hypothesis was that the average radial meniscus dimensions will increase as specimen age increases, and mean medial and lateral region measurements will increase at a linear rate. METHODS Seventy-eight skeletally immature knee cadaver specimens under age 12 years were included in this study. The meniscal specimens were photographed in the axial view with ruler in the plane of the tibial plateau and analyzed using computer-aided design (CAD) software (Autodesk Fusion 360). Measurements were taken from inner to outer meniscus rims at five 45 degree intervals using the clockface as a reference (12:00, 1:30, 3:00, 4:30, 6:00), and total area of meniscus and tibial plateau was recorded. Generalized linear models were used to evaluate the associations of radial width measurements with age, tibial coverage, and lateral vs. medial meniscus widths. RESULTS All radial width measurements increased significantly with specimen age (p ≤ 0.002), and all lateral-medial meniscal widths increased (p < 0.001). The anterior zones of the meniscus were found to increase at the slowest rate compared to other regions. Tibial plateau coverage was found to not significantly vary with age. CONCLUSIONS Meniscus radial width and lateral-medial meniscus width are related to age. The anterior width of the meniscus varied least with age. Improved anatomic understanding may help surgeons more effectively plan for meniscus repair, discoid resection/saucerization/repair, and also support appropriate selection of meniscus allograft for transplantation.
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Affiliation(s)
- Matthew S Rohde
- Department of Orthopedic Surgery, Stanford University School of Medicine, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA.
| | - Sunny Trivedi
- Department of Orthopedic Surgery, Stanford University School of Medicine, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
| | - Sahej Randhawa
- Department of Orthopedic Surgery, Stanford University School of Medicine, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
| | - Christian E Wright
- Department of Orthopedic Surgery, Stanford University School of Medicine, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
| | - Brian B Vuong
- Department of Orthopedic Surgery, Stanford University School of Medicine, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
| | - Nicole Pham
- Department of Orthopedic Surgery, Stanford University School of Medicine, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
| | | | | | | | | | | | - Marc Tompkins
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kevin G Shea
- Department of Orthopedic Surgery, Stanford University School of Medicine, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
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Modina SC, Aidos L, Millar VRH, Pallaoro M, Polito U, Veronesi MC, Peretti GM, Mangiavini L, Carnevale L, Boschetti F, Abbate F, Di Giancamillo A. Postnatal morpho-functional development of a dog's meniscus. Ann Anat 2023; 250:152141. [PMID: 37499701 DOI: 10.1016/j.aanat.2023.152141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023]
Abstract
This study evaluates the morpho-functional modifications that characterize meniscal development from neonatal to adult dogs. Even if menisci are recognized as essential structures for the knee joint, poor information is available about their morphogenesis, in particular in dog models. Menisci from a group of Dobermann Pinchers aged 0, 10, 30 days, and 4 years (T0, T10, T30, adult, respectively) were analyzed by SEM, histochemistry (Safranin O and Picro Sirius Red Staining analyzed under a polarized light microscope), immunofluorescences (collagen type I and II), biomechanical (compression) and biochemical analyses (glycosaminoglycans, GAGs, and DNA content). SEM analyses revealed that the T0 meniscus is a bulgy structure that during growth tends to flatten, firstly in the inner zone (T10) and then even in the outer zone (T30), until the achievement of the completely smooth adult final shape. These results were further supported by the histochemistry analyses in which the deposition of GAGs started from T30, and the presence of type I birefringent collagen fibers was observed from T0 to T30, while poorly refringent type III collagen fibers were observed in the adult dogs. Double immunofluorescence analyses also evidenced that the neonatal meniscus contains mainly type I collagen fibers, as well as the T10 meniscus, and demonstrated a more evident regionalization and crimping in the T30 and adult meniscus. Young's elastic modulus of the meniscus in T0 and T10 animals was lower than the T30 animals, and this last group was also lower than adult ones (T0-T10 vs T30 vs adult). Biochemical analysis confirmed that cellularity decreases over time from neonatal to adult (p < 0.01). The same decreasing trend was observed in GAGs deposition. These results may suggest that the postnatal development of canine meniscus may be related to the progressive functional locomotory development: after birth, the meniscus acquires its functionality over time, through movement, load, and growth itself.
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Affiliation(s)
- Silvia Clotilde Modina
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università, 6, 26900 Lodi, Italy
| | - Lucia Aidos
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università, 6, 26900 Lodi, Italy
| | | | - Margherita Pallaoro
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università, 6, 26900 Lodi, Italy
| | - Umberto Polito
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università, 6, 26900 Lodi, Italy
| | - Maria Cristina Veronesi
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università, 6, 26900 Lodi, Italy
| | - Giuseppe Maria Peretti
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli, 31, 20133 Milan, Italy; IRCCS, Ospedale Galeazzi - Sant'Ambrogio, Via Cristina Belgioioso 173, 20157, Milan, Italy
| | - Laura Mangiavini
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli, 31, 20133 Milan, Italy; IRCCS, Ospedale Galeazzi - Sant'Ambrogio, Via Cristina Belgioioso 173, 20157, Milan, Italy
| | - Liliana Carnevale
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università, 6, 26900 Lodi, Italy
| | - Federica Boschetti
- IRCCS, Ospedale Galeazzi - Sant'Ambrogio, Via Cristina Belgioioso 173, 20157, Milan, Italy; Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Polytechnic University of Milan, 20133 Milan, Italy
| | - Francesco Abbate
- Department of Veterinary Sciences, University of Messina, Polo Universitario S.S. Annunziata, 98168 Messina, Italy
| | - Alessia Di Giancamillo
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli, 31, 20133 Milan, Italy.
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Kakoulidis P, Panagiotidou S, Profitiliotis G, Papavasiliou K, Tsiridis E, Topalis C. Medial pivot design does not yield superior results compared to posterior-stabilised total knee arthroplasty: a systematic review and meta-analysis of randomised control trials. Knee Surg Sports Traumatol Arthrosc 2023; 31:3684-3700. [PMID: 36522493 DOI: 10.1007/s00167-022-07238-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/10/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE The aim of this meta-analysis was a comparison between medial pivot (MP) and posterior-stabilised (PS) knee designs regarding functional and radiological outcomes as well as gait parameters. METHODS A systematic literature search was conducted in PubMed, Cochrane Library, Science Direct and Clinical Trials.gov from conception up to April 2022, to identify eligible randomised control trials (RCTs). The extracted data were analysed according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement. RESULTS Fifteen studies met inclusion criteria, enrolling 1101 patients who underwent 1242 total knee arthroplasties (TKAs). A total of 1158 TKAs (581 MP/577 PS) were included in the quantitative analysis. Mean follow-up ranged from 6 months up to 6.6 years. MP knees showed comparable range of motion (ROM) with PS design 1, 2 and 4 years postoperatively (p = 0.2, p = 0.25, p = 0.34, respectively). No statistical difference was found in patient-related outcome measures (PROMs) (p > 0.05). Mean walking speed (MWS), length of stay (LOS), radiographic alignment and complications rates were also similar between the two groups (p > 0.05). DISCUSSION The present meta-analysis demonstrated that the theoretical biomechanical advantage of MP implants does not have a better impact on patient satisfaction compared to the traditional PS knees. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Panagiotis Kakoulidis
- School of Medicine, Aristotle University of Thessaloniki, Academic Orthopaedic Unit, Papageorgiou General Hospital, Thessaloniki Ring Road West, Nea Efkarpia, 56403, Thessaloniki, Greece.
| | - Sousana Panagiotidou
- School of Medicine, Aristotle University of Thessaloniki, Academic Orthopaedic Unit, Papageorgiou General Hospital, Thessaloniki Ring Road West, Nea Efkarpia, 56403, Thessaloniki, Greece
| | | | - Kyriakos Papavasiliou
- School of Medicine, Aristotle University of Thessaloniki, Academic Orthopaedic Unit, Papageorgiou General Hospital, Thessaloniki Ring Road West, Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- School of Medicine, Aristotle University of Thessaloniki, Academic Orthopaedic Unit, Papageorgiou General Hospital, Thessaloniki Ring Road West, Nea Efkarpia, 56403, Thessaloniki, Greece
- Center of Orthopaedics and Regenerative Medicine (C.O.RE.)-Center of Interdisciplinary Research and Innovation (C.I.R.I.)-Aristotle University Thessaloniki, Balkan Center, Buildings A and B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Christos Topalis
- School of Medicine, Aristotle University of Thessaloniki, Academic Orthopaedic Unit, Papageorgiou General Hospital, Thessaloniki Ring Road West, Nea Efkarpia, 56403, Thessaloniki, Greece
- Center of Orthopaedics and Regenerative Medicine (C.O.RE.)-Center of Interdisciplinary Research and Innovation (C.I.R.I.)-Aristotle University Thessaloniki, Balkan Center, Buildings A and B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
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Lemmon EA, Bonnevie ED, Patel JM, Miller LM, Mauck RL. Transient inhibition of meniscus cell migration following acute inflammatory challenge. J Orthop Res 2023; 41:2055-2064. [PMID: 36866823 PMCID: PMC10750267 DOI: 10.1002/jor.25545] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 01/23/2023] [Accepted: 03/01/2023] [Indexed: 03/04/2023]
Abstract
Meniscus tears represent a common orthopedic injury that often requires surgery to restore pain-free function. The need for surgical intervention is due, in part, to the inflammatory and catabolic environment that inhibits meniscus healing after injury. In other organ systems, healing is dependent on the migration of cells to the site of injury; however, in the meniscus, it is currently unknown how the microenvironment dictates cell migration in the postinjury inflamed setting. Here, we investigated how inflammatory cytokines alter meniscal fibrochondrocyte (MFC) migration and sensation of microenvironmental stiffness. We further tested whether an FDA approved interleukin-1 receptor antagonist (IL-1Ra; Anakinra) could rescue migratory deficits caused by inflammatory challenge. When cultured in the presence of inflammatory cytokines (tumor necrosis factor-α [TNF-α] or interleukin-1β [IL-1β]) for 1 day, MFC migration was inhibited for 3 days before returning to control levels at Day 7. This migratory deficit was clear in three-dimensional as well, where fewer MFCs exposed to inflammatory cytokines migrated from a living meniscal explant compared with control. Notably, addition of IL-1Ra to MFCs previously exposed to IL-1β restored migration to baseline levels. This study demonstrates that joint inflammation can have negative impacts on meniscus cell migration and mechanosensation, affecting their potential for repair, and that resolution of this inflammation with concurrent anti-inflammatories can reverse these deficits. Future work will apply these findings to mitigate the negative consequences of joint inflammation and promote repair in a clinically relevant meniscus injury model.
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Affiliation(s)
- Elisabeth A. Lemmon
- University of Pennsylvania Perelman School of Medicine, Department of Orthopaedic Surgery, Philadelphia, Pennsylvania, USA
| | - Edward D. Bonnevie
- University of Pennsylvania Perelman School of Medicine, Department of Orthopaedic Surgery, Philadelphia, Pennsylvania, USA
| | - Jay M. Patel
- Department of Orthopaedics, Emory University, Decatur, Georgia, USA
| | - Liane M. Miller
- University of Pennsylvania Perelman School of Medicine, Department of Orthopaedic Surgery, Philadelphia, Pennsylvania, USA
| | - Robert L. Mauck
- University of Pennsylvania Perelman School of Medicine, Department of Orthopaedic Surgery, Philadelphia, Pennsylvania, USA
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Sheng H, Huang M, Li H, Sun L, Feng S, Du X, Wang Y, Tong X, Feng Y, Chen J, Li Y. Three-Dimensional Imaging and Quantitative Analysis of Blood Vessel Distribution in The Meniscus of Transgenic Mouse after Tissue Clearing. CELL JOURNAL 2023; 25:570-578. [PMID: 37641419 PMCID: PMC10542206 DOI: 10.22074/cellj.2023.1988973.1220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE Blood supply to the meniscus determines its recovery and is a reference for treatment planning. This study aimed to apply tissue clearing and three-dimensional (3D) imaging in exploring the quantitative distribution of blood vessels in the mouse meniscus. MATERIALS AND METHODS In this experimental study, tissue clearing was performed to treat the bilateral knee joints of transgenic mice with fluorescent vascular endothelial cells. Images were acquired using a light sheet microscope and the vascular endothelial cells in the meniscus was analysed using 3D imaging. Quantitative methods were employed to further analyse the blood vessel distribution in the mouse meniscus. RESULTS The traditional three-equal-width division of the meniscus is as follows: the outer one-third is the red-red zone (RR), the inner one-third is the white-white zone (WW), and the transition area is the red-white zone (RW). The division revealed significant signal differences between the RW and WW (P<0.05) zones, but no significant differences between the RR and RW zones, which indicated that the division might not accurately reflect the blood supply of the meniscus. According to the modified division (4:2:1) in which significant differences were ensured between the adjacent zones, we observed that the width ratio of each zone was 38 ± 1% (RR), 24 ± 1% (RW), and 38 ± 2% (WW). Furthermore, the blood supply to each region was verified. The anterior region had the most abundant blood supply. The fluorescence count in the anterior region was significantly higher than in the central and posterior regions (P<0.05). The blood supply of the medial meniscus was superior to the lateral meniscus (P<0.05). CONCLUSION Analysis of the blood supply to the mouse meniscus under tissue clearing and 3D imaging reflect quantitative blood vessel distribution, which would facilitate future evaluations of the human meniscus and provide more anatomical references for clinicians.
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Affiliation(s)
- Huaixuan Sheng
- Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Mingru Huang
- Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Huizhu Li
- Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Luyi Sun
- Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Sijia Feng
- Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiner Du
- Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yicong Wang
- Department of Integrative Medicine and Neurobiology, School of Basic Medical Sciences, Institutes of Brain Science, Brain Science Collaborative Innovation Centre, State Key Laboratory of Medical Neurobiology, Institute of Acupuncture and Moxibustion, Fudan Institutes of Integrative Medicine, Fudan University, Shanghai, China
- China Shanghai Key Laboratory of Acupuncture Mechanism and Acupoint Function, Shanghai, China
| | - Xiaoyu Tong
- Department of Integrative Medicine and Neurobiology, School of Basic Medical Sciences, Institutes of Brain Science, Brain Science Collaborative Innovation Centre, State Key Laboratory of Medical Neurobiology, Institute of Acupuncture and Moxibustion, Fudan Institutes of Integrative Medicine, Fudan University, Shanghai, China
- China Shanghai Key Laboratory of Acupuncture Mechanism and Acupoint Function, Shanghai, China
| | - Yi Feng
- Department of Integrative Medicine and Neurobiology, School of Basic Medical Sciences, Institutes of Brain Science, Brain Science Collaborative Innovation Centre, State Key Laboratory of Medical Neurobiology, Institute of Acupuncture and Moxibustion, Fudan Institutes of Integrative Medicine, Fudan University, Shanghai, China
- China Shanghai Key Laboratory of Acupuncture Mechanism and Acupoint Function, Shanghai, China
| | - Jun Chen
- Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China.
| | - Yunxia Li
- Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China.
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Mallory N, Qin C, Gibbs D, Milliron E, Cavendish P, Magnussen RA, Flanigan DC. Horizontal Cleavage Meniscus Tears: Biomechanics, Indications, Techniques, and Outcomes. JBJS Rev 2023; 11:01874474-202308000-00006. [PMID: 37561839 DOI: 10.2106/jbjs.rvw.23.00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
» Accounting for up to 24% of all meniscus tears, horizontal cleavage tears (HCTs) are a common pathology orthopaedic practitioners should be comfortable managing.» Historically, HCTs were treated with partial meniscectomy; however, recent studies have demonstrated that these procedures have an adverse biomechanical effect, while HCT repairs restore the knee's natural biomechanics.» Indications for the surgical repair of HCTs remain disputed, but surgery is generally considered for young, active patients and older patients without significant concomitant osteoarthritis.» Early clinical findings surrounding HCT repair are promising. They suggest that this treatment adequately restores meniscus mechanics, leads to good knee functional outcomes, and results in a high likelihood of return to preinjury activity levels.
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Affiliation(s)
- Noah Mallory
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Charles Qin
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - David Gibbs
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Eric Milliron
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Parker Cavendish
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Robert A Magnussen
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - David C Flanigan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Paz-González R, Lourido L, Calamia V, Fernández-Puente P, Quaranta P, Picchi F, Blanco FJ, Ruiz-Romero C. An Atlas of the Knee Joint Proteins and Their Role in Osteoarthritis Defined by Literature Mining. Mol Cell Proteomics 2023; 22:100606. [PMID: 37356495 PMCID: PMC10393810 DOI: 10.1016/j.mcpro.2023.100606] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/14/2023] [Accepted: 06/18/2023] [Indexed: 06/27/2023] Open
Abstract
Osteoarthritis (OA) is the most prevalent rheumatic pathology. However, OA is not simply a process of wear and tear affecting articular cartilage but rather a disease of the entire joint. One of the most common locations of OA is the knee. Knee tissues have been studied using molecular strategies, generating a large amount of complex data. As one of the goals of the Rheumatic and Autoimmune Diseases initiative of the Human Proteome Project, we applied a text-mining strategy to publicly available literature to collect relevant information and generate a systematically organized overview of the proteins most closely related to the different knee components. To this end, the PubPular literature-mining software was employed to identify protein-topic relationships and extract the most frequently cited proteins associated with the different knee joint components and OA. The text-mining approach searched over eight million articles in PubMed up to November 2022. Proteins associated with the six most representative knee components (articular cartilage, subchondral bone, synovial membrane, synovial fluid, meniscus, and cruciate ligament) were retrieved and ranked by their relevance to the tissue and OA. Gene ontology analyses showed the biological functions of these proteins. This study provided a systematic and prioritized description of knee-component proteins most frequently cited as associated with OA. The study also explored the relationship of these proteins to OA and identified the processes most relevant to proper knee function and OA pathophysiology.
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Affiliation(s)
- Rocío Paz-González
- Grupo de Investigación de Reumatología (GIR) - Unidad de Proteómica, Instituto de Investigación Biomédica de A Coruña (INIBIC), Sergas, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Lucía Lourido
- Grupo de Investigación de Reumatología (GIR) - Unidad de Proteómica, Instituto de Investigación Biomédica de A Coruña (INIBIC), Sergas, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Valentina Calamia
- Grupo de Investigación de Reumatología (GIR) - Unidad de Proteómica, Instituto de Investigación Biomédica de A Coruña (INIBIC), Sergas, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Patricia Fernández-Puente
- Departamento de Fisioterapia, Medicina y Ciencias Biomédicas, Grupo de Investigación de Reumatología y Salud (GIR-S), Centro Interdisciplinar de Química e Bioloxía (CICA), Universidade da Coruña (UDC), A Coruña, Spain
| | - Patricia Quaranta
- Grupo de Investigación de Reumatología (GIR) - Unidad de Proteómica, Instituto de Investigación Biomédica de A Coruña (INIBIC), Sergas, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Florencia Picchi
- Grupo de Investigación de Reumatología (GIR) - Unidad de Proteómica, Instituto de Investigación Biomédica de A Coruña (INIBIC), Sergas, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Francisco J Blanco
- Grupo de Investigación de Reumatología (GIR) - Unidad de Proteómica, Instituto de Investigación Biomédica de A Coruña (INIBIC), Sergas, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain; Departamento de Fisioterapia, Medicina y Ciencias Biomédicas, Grupo de Investigación de Reumatología y Salud (GIR-S), Centro Interdisciplinar de Química e Bioloxía (CICA), Universidade da Coruña (UDC), A Coruña, Spain.
| | - Cristina Ruiz-Romero
- Grupo de Investigación de Reumatología (GIR) - Unidad de Proteómica, Instituto de Investigación Biomédica de A Coruña (INIBIC), Sergas, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain.
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Ganokroj P, Fossum BW, Hollenbeck J, Whalen RJ, Garcia AR, Foster MJ, Provencher CAPTMT. Biomechanical Analysis Evaluating Meniscal Extrusion After Knotless Suture Anchor Fixation for Segmental Medial Meniscal Allograft Transplantation. Orthop J Sports Med 2023; 11:23259671231182978. [PMID: 37655248 PMCID: PMC10467413 DOI: 10.1177/23259671231182978] [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] [Received: 03/15/2023] [Accepted: 04/05/2023] [Indexed: 09/02/2023] Open
Abstract
Background Segmental medial meniscal allograft transplantation (MAT) has been shown to restore knee biomechanics; however, stable fixation of the transplantation is critical to avoid extrusion and maximize healing. Purpose To evaluate the degree of meniscal extrusion and biomechanical function of segmental medial MAT performed with meniscocapsular sutures versus repair augmentation with knotless suture anchors. Study Design Controlled laboratory study. Methods Segmental midbody medial meniscectomy and subsequent segmental medial MAT were performed on 10 fresh-frozen cadaveric knees. The knees were then loaded in a dynamic tensile testing machine to 1000 N for 60 seconds at 0°, 30°, 60°, and 90° of flexion, and 4 conditions were tested: (1) intact, (2) segmental defect, (3) inside-out segmental repair, and (4) anchor plus inside-out segmental repair of the medial MAT. Meniscal extrusion was measured using high-fidelity ultrasound imaging. The mean contact area and the mean and peak contact pressures were assessed with submeniscal pressure-mapping sensors. Data from testing conditions were compared with 2-way repeated-measures analysis of variance, with pairwise comparison using the Bonferroni method. Results At 90° of flexion, the segmental defect state showed a higher degree of meniscal extrusion compared with all other states (P ≤ .012). There was no difference in the degree of meniscal extrusion between the intact state and the inside-out repair or anchor plus inside-out segmental repair states at all knee flexion angles (P > .05). There was no significant difference in the mean and peak contact pressures among the 4 states at all flexion angles except that at 0° of knee flexion there was significantly lower peak contact pressure at the medial compartment after anchor plus inside-out segmental repair compared with the segmental defect state (P = .048). Conclusion Meniscal extrusion was not significantly increased at any flexion angle after segmental resection. The addition of knotless anchors did not improve meniscal extrusion or contact pressures/area compared with capsular repair alone. The addition of knotless anchors did improve contact mechanics from the segmental defect state, but only at 0° of flexion. Clinical Relevance The addition of knotless suture anchors to segmental meniscal transplantation increased stabilization of the meniscus at full extension compared with repair with sutures alone. This increased stabilization may lead to better long-term outcomes.
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Affiliation(s)
- Phob Ganokroj
- Steadman Philippon Research Institute, Vail, Colorado, USA
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Ryan J. Whalen
- Steadman Philippon Research Institute, Vail, Colorado, USA
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Naruse K, Takegami Y, Tokutake K, Shimizu K, Sudo Y, Shinohara T, Imagama S. What is the Radiographic Factor Associated with Meniscus Injury in Tibial Plateau Factures? Multicenter Retrospective (TRON) Study. Indian J Orthop 2023; 57:1076-1082. [PMID: 37384016 PMCID: PMC10293136 DOI: 10.1007/s43465-023-00888-5] [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] [Received: 08/11/2022] [Accepted: 04/01/2023] [Indexed: 06/30/2023]
Abstract
Purpose Tibial plateau fracture (TPF) is a complex intra-articular injury involving comminution and depression of the joint, which can be accompanied by meniscal tears. The aims of this study were (1) to demonstrate the rate at which surgical treatment for lateral meniscal injury and (2) to clarify the explanatory radiographic factors associated with meniscal injury in patients with TPF. Methods We extracted the patients who received surgical treatment for TPF from our multicenter database (named TRON) included from 2011 to 2020. We analyzed 79 patients who were received surgical treatment for TPF with Schatzker type II and III and evaluation for meniscal injury on arthroscopy. We investigated the rate at which surgical treatment of the lateral meniscus was required in patients with TPF and the explanatory radiographic factors associated with meniscal injury. Radiographs and CT scans were evaluated to measure the following parameters: tibial plateau slope, distance from lateral edge of the articular surface to fracture line (DLE), articular step, and width of articular bone fragment (WDT). Meniscus tears were classified according to whether surgery was necessary. The results were analyzed by multivariate Logistic analyses. Results We showed that 27.7% (22/79) of cases of TPF with Schatzker type II and III had lateral meniscal injury that required repair. WDT ≥ 10 mm (odds ratio 10.9; p = 0.005) and DLE ≥ 5 mm (odds ratio 5.7; p = 0.05) were independent explanatory factors for meniscal injury with TPF. Conclusion Bone fragment size and the location of fracture line on radiographs in patients with TPF are associated with meniscus injuries requiring surgery. Supplementary Information The online version contains supplementary material available at 10.1007/s43465-023-00888-5.
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Affiliation(s)
- Keita Naruse
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Yasuhiko Takegami
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Katsuhiro Tokutake
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keita Shimizu
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Yoshito Sudo
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | | | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
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60
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Schwartz G, Morejon A, Gracia J, Best TM, Jackson AR, Travascio F. Heterogeneity of dynamic shear properties of the meniscus: A comparison between tissue core and surface layers. J Orthop Res 2023; 41:1607-1617. [PMID: 36448086 PMCID: PMC10225479 DOI: 10.1002/jor.25495] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/18/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022]
Abstract
Damage to the meniscus has been associated with excessive shear loads. Aimed at elucidating meniscus pathophysiology, previous studies have investigated the shear properties of the meniscus fibrocartilaginous core. However, the meniscus is structurally inhomogeneous, with an external cartilaginous envelope (tibial and femoral surface layers) wrapping the tissue core. To date, little is known about the shear behavior of the surface layers. The objective of this study was to measure the dynamic shear properties of the surface layers and derive empirical relations with their composition. Specimens were harvested from tibial and femoral surface layers and core of porcine menisci (medial and lateral, n = 10 each). Frequency sweep tests yielded complex shear modulus (G*) and phase shifts (δ). Mechanical behavior of regions was described by a generalized Maxwell model. Correlations between shear moduli with water and glycosaminoglycans content of the tissue regions were investigated. The femoral surface had the lowest shear modulus, when compared to core and tibial regions. A 3-relaxation times Maxwell model satisfactorily interpreted the shear behavior of all tissue regions. Inhomogeneous tissue composition was also observed, with water content in the surface layers being higher when compared with tissue core. Water content negatively correlated with shear properties in all regions. The lower measured shear properties in the femoral layer may explain the higher prevalence of meniscal tears on the superior surface of the tissue. The heterogenous behavior of the tissue in shear provides insight into meniscus pathology and has important implications for efforts to tissue engineer replacement tissues.
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Affiliation(s)
- Gabi Schwartz
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL
| | - Andy Morejon
- Department of Mechanical and Aerospace Engineering, University of Miami, Coral Gables, FL
| | - Julissa Gracia
- Department of Mechanical and Aerospace Engineering, University of Miami, Coral Gables, FL
| | - Thomas M. Best
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL
- Department of Orthopaedic Surgery, University of Miami, Miami, FL
- UHealth Sports Medicine Institute, Coral Gables, FL
| | - Alicia R. Jackson
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL
| | - Francesco Travascio
- Department of Mechanical and Aerospace Engineering, University of Miami, Coral Gables, FL
- Department of Orthopaedic Surgery, University of Miami, Miami, FL
- Max Biedermann Institute for Biomechanics at Mount Sinai Medical Center, Miami Beach, FL
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Weaver AP, Walaszek MC, Roman DP, Harkey MS, Kuenze C. The Impact of Meniscal Tear Type and Surgical Treatment on Quadriceps Strength: A Study of Adolescent Patients Post Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2023; 51:2357-2365. [PMID: 37272684 PMCID: PMC10865339 DOI: 10.1177/03635465231177626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Treatment of meniscal injuries at the time of anterior cruciate ligament reconstruction (ACLR) can result in restrictions on weightbearing and range of motion in the early rehabilitative phases. What is unknown is the effect of (1) meniscal tear type and location at the time of anterior cruciate ligament injury and (2) meniscal treatment at the time of ACLR on quadriceps strength in adolescents during the late rehabilitative phase. HYPOTHESIS Meniscal tears involving the root and requiring repair would adversely affect quadriceps strength at 6 to 9 months postoperatively. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients who underwent ACLR at 1 of 2 research sites between 2013 and 2021 were identified. Adolescent participants were included if they were between the ages of 12 and 20 years at the time of assessment and had undergone primary unilateral ACLR in the previous 6 to 9 months. Participants were subgrouped by meniscal tear type (no tear, nonroot tear, root tear) and meniscal treatment at the time of ACLR (no treatment, meniscectomy, meniscal repair), which were confirmed via chart review. Isokinetic strength testing occurred at 60 deg/s, and quadriceps strength and quadriceps strength limb symmetry index were compared between the meniscal tear type and meniscal procedure subgroups using analysis of covariance while controlling for the effects of age, sex, and ACLR graft source. RESULTS An overall 236 patients were included in this analysis (109 male, 127 female; mean ± SD age, 16.0 ± 1.9 years). There were no significant differences in ACLR limb quadriceps strength based on meniscal tear type (P = .61) or meniscal procedure at the time of ACLR (P = .61), after controlling for age, biological sex, and ACLR graft source. Similarly, quadriceps strength limb symmetry index did not differ by meniscal tear type (P = .38) or meniscal procedure at the time of ACLR (P = .40). CONCLUSION Meniscal tear type and treatment at the time of ACLR did not affect quadriceps strength or quadriceps strength symmetry in adolescents 6 to 9 months after ACLR.
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Affiliation(s)
- Adam P. Weaver
- Address correspondence to Adam P. Weaver, PT, DPT, Sports Physical Therapy, Connecticut Children’s, 399 Farmington Ave, Farmington, CT 06032, USA () (Twitter: @adampweaver)
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Lipson SE, Morris A, Chan FJ. The "Under, Over" Technique for Repair of a Peripheral Bucket-Handle Meniscus Tear With Circumferential Compression Stitches. Arthrosc Tech 2023; 12:e1139-e1143. [PMID: 37533922 PMCID: PMC10390879 DOI: 10.1016/j.eats.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 03/02/2023] [Indexed: 08/04/2023] Open
Abstract
The benefits of preserving the meniscus are well-established. Several arthroscopic meniscal repair techniques have been described, such as the inside-out, outside-in, and all-inside. All-inside self-retrieving suture devices can be used to repair vertical, horizontal, and radial tears. However, this technique becomes difficult with large tears, as the jaw of the device cannot reach the peripheral edge of the meniscal tear. We present an all-inside technique using circumferential compression stitches to address large peripheral meniscus tears.
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Affiliation(s)
- Sophie E. Lipson
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A
| | - Allyn Morris
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York, U.S.A
| | - Ferdinand J. Chan
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York, U.S.A
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Wei J, Zhang W, Ding X. Design and Finite Element Analysis of Artificial Braided Meniscus Model. MATERIALS (BASEL, SWITZERLAND) 2023; 16:4775. [PMID: 37445089 DOI: 10.3390/ma16134775] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/20/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023]
Abstract
Currently, artificial meniscus prostheses are mostly homogenous, low strength, and difficult to mimic the distribution of internal fibers in the native meniscus. To promote the overall mechanical performance of meniscus prostheses, this paper designed a new artificial braided meniscus model and conducted finite element analysis. Firstly, we designed the spatial fiber interweaving structure of meniscus model to mimic the internal fiber distribution of the native meniscus. Secondly, we provided the detailed braiding steps and forming process principles based on the weaving structure. Thirdly, we adopted the models of the fiber-embedded matrix and multi-scale methods separately for finite element analysis to achieve the reliable elastic properties. Meanwhile, we compared the results for two models, which are basically consistent, and verified the accuracy of analysis. Finally, we conducted the comparative simulation analysis of the meniscus model and the pure matrix meniscus model based on the solved elastic constants through Abaqus, which indicated a 60% increase in strength.
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Affiliation(s)
- Jiakai Wei
- School of Mechanical Engineering and Automation, Beihang University, Beijing 100191, China
| | - Wuxiang Zhang
- School of Mechanical Engineering and Automation, Beihang University, Beijing 100191, China
- Ningbo Institute of Technology, Beihang University, Ningbo 315832, China
| | - Xilun Ding
- School of Mechanical Engineering and Automation, Beihang University, Beijing 100191, China
- Ningbo Institute of Technology, Beihang University, Ningbo 315832, China
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Moon HS, Choi CH, Jung M, Chung K, Jung SH, Kim YH, Kim SH. Medial Meniscus Posterior Root Tear: How Far Have We Come and What Remains? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1181. [PMID: 37511993 PMCID: PMC10386469 DOI: 10.3390/medicina59071181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023]
Abstract
Medial meniscus posterior root tears (MMRTs), defined as tears or avulsions that occur within 1 cm of the tibial attachment of the medial meniscus posterior root, lead to biomechanically detrimental knee conditions by creating a functionally meniscal-deficient status. Given their biomechanical significance, MMRTs have recently been gaining increasing interest. Accordingly, numerous studies have been conducted on the anatomy, biomechanics, clinical features, diagnosis, and treatment of MMRTs, and extensive knowledge has been accumulated. Although a consensus has not yet been reached on several issues, such as surgical indications, surgical techniques, and rehabilitation protocols, this article aimed to comprehensively review the current knowledge on MMRTs and to introduce the author's treatment strategies.
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Affiliation(s)
- Hyun-Soo Moon
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Chong-Hyuk Choi
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Min Jung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Kwangho Chung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Orthopedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin 16995, Republic of Korea
| | - Se-Han Jung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Yun-Hyeok Kim
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Sung-Hwan Kim
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
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Kambara S, Yoshiya S, Onishi S, Yasumizu R, Tachibana T. Persistent Hemarthrosis of the Knee after Arthroscopic Meniscal Repair. Case Rep Orthop 2023; 2023:8806299. [PMID: 37359349 PMCID: PMC10290563 DOI: 10.1155/2023/8806299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/20/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction In this case report, we report a patient with complicated with persistent hemarthrosis following arthroscopic meniscal repair. Case Presentation. A 41-year-old male patient presented with persistent swelling of the knee 6 months after arthroscopic meniscal repair and partial meniscectomy performed for lateral discoid meniscal tear. The initial surgery was performed at another hospital. Four months after the surgery, swelling of the knee was noted when he resumed running. At his initial visit to our hospital, intra-articular blood accumulation was revealed via joint aspiration. A second arthroscopic examination performed 7 months after the initial procedure showed healing of the meniscal repair site and synovial proliferation. The suture materials identified during the arthroscopy were removed. Histological examination of the resected synovial tissue showed inflammatory cell infiltration and neovascularization. In addition, a multinucleated giant cell was identified in the superficial layer. After the second arthroscopic surgery, the hemarthrosis did not recur, and the patient was able to resume running without symptom one and a half years post-surgery. Conclusion Bleeding from the proliferated synovia at or near the periphery of the lateral meniscus was thought to be the cause of the hemarthrosis as a rare complication following arthroscopic meniscal repair.
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Affiliation(s)
- Shunichiro Kambara
- Department of Orthopaedic Surgery, JCHO Kobe Central Hospital, Hyogo, Japan
| | - Shinichi Yoshiya
- Department of Orthopaedic Surgery, Nishinomiya Kaisei Hospital, Hyogo, Japan
| | - Shintaro Onishi
- Department of Orthopaedic Surgery, Nishinomiya Kaisei Hospital, Hyogo, Japan
| | - Ryoji Yasumizu
- Department of Pathology, JCHO Kobe Central Hospital, Hyogo, Japan
| | - Toshiya Tachibana
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Hyogo, Japan
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McLaughlin WM, Gillinov SM, Joo PY, Moran J, Jimenez AE, Grauer JN, Gardner EC. Previous Isolated Medial Bucket-Handle Meniscus Repair Significantly Increases Risk of Subsequent Ipsilateral Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2023; 5:e671-e678. [PMID: 37388885 PMCID: PMC10300536 DOI: 10.1016/j.asmr.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 03/27/2023] [Indexed: 07/01/2023] Open
Abstract
Purpose (1) To define the incidence of surgically treated isolated bucket-handle meniscus tears (BHMTs); (2) to investigate risk of subsequent ipsilateral anterior cruciate ligament reconstruction (ACLR) in patients who underwent previous isolated bucket handle (BH) meniscus repair; and (3) to investigate the risk of subsequent ACLR for various types of surgically treated meniscal tears. Methods A retrospective review of a national database was conducted to identify patients, aged 10 to 40 years, who underwent primary isolated BH meniscus surgery from 2015 to 2020. Patients were stratified by operative method. A control group of 500,000 age-matched patients was randomly selected to establish a benchmark rate of ACLR. Kaplan-Meier analysis was performed to compare the timing and incidence of subsequent ipsilateral ACLR after primary isolated BH meniscus surgery to the control group within 2 and 5 years. Results In total, 1,767 patients with isolated BHMTs treated with surgery were identified and met inclusion criteria. The incidence of isolated BHMTs among all surgically treated (repair or meniscectomy) meniscal injuries was 1.67%. Isolated BH repairs had significantly greater odds of ACLR within 5 years compared to the control group (odds ratio [OR] 6.09; 95% confidence interval [CI] 2.86-12.99; P < .001). Medial BH repairs had the greatest odds of ACLR within 5 years (OR 9.15; 95% CI 4.27-19.57; P < .001). Lateral BH repair was not associated with subsequent ipsilateral ACLR within 5 years (OR 2.63; CI 0.37-18.90; P = .340). Conclusions Isolated BHMTs comprised 1.67% of all surgically treated meniscal injuries. Patients who underwent prior surgery for isolated BHMT were at increased risk of undergoing subsequent ipsilateral ACLR compared with the general population. Isolated medial BHMTs treated with repair had the highest risk for subsequent ACLR. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- William M. McLaughlin
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Stephen M. Gillinov
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Peter Y. Joo
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Jay Moran
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Andrew E. Jimenez
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Jonathan N. Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Elizabeth C. Gardner
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
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Morejon A, Dalbo PL, Best TM, Jackson AR, Travascio F. Tensile energy dissipation and mechanical properties of the knee meniscus: relationship with fiber orientation, tissue layer, and water content. Front Bioeng Biotechnol 2023; 11:1205512. [PMID: 37324417 PMCID: PMC10264653 DOI: 10.3389/fbioe.2023.1205512] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/22/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction: The knee meniscus distributes and dampens mechanical loads. It is composed of water (∼70%) and a porous fibrous matrix (∼30%) with a central core that is reinforced by circumferential collagen fibers enclosed by mesh-like superficial tibial and femoral layers. Daily loading activities produce mechanical tensile loads which are transferred through and dissipated by the meniscus. Therefore, the objective of this study was to measure how tensile mechanical properties and extent of energy dissipation vary by tension direction, meniscal layer, and water content. Methods: The central regions of porcine meniscal pairs (n = 8) were cut into tensile samples (4.7 mm length, 2.1 mm width, and 0.356 mm thickness) from core, femoral and tibial components. Core samples were prepared parallel (circumferential) and perpendicular (radial) to the fibers. Tensile testing consisted of frequency sweeps (0.01-1Hz) followed by quasi-static loading to failure. Dynamic testing yielded energy dissipation (ED), complex modulus (E*), and phase shift (δ) while quasi-static tests yielded Young's Modulus (E), ultimate tensile strength (UTS), and strain at UTS (εUTS). To investigate how ED is influenced by the specific mechanical parameters, linear regressions were performed. Correlations between sample water content (φw) and mechanical properties were investigated. A total of 64 samples were evaluated. Results: Dynamic tests showed that increasing loading frequency significantly reduced ED (p < 0.05). Circumferential samples had higher ED, E*, E, and UTS than radial ones (p < 0.001). Stiffness was highly correlated with ED (R2 > 0.75, p < 0.01). No differences were found between superficial and circumferential core layers. ED, E*, E, and UTS trended negatively with φw (p < 0.05). Discussion: Energy dissipation, stiffness, and strength are highly dependent on loading direction. A significant amount of energy dissipation may be associated with time-dependent reorganization of matrix fibers. This is the first study to analyze the tensile dynamic properties and energy dissipation of the meniscus surface layers. Results provide new insights on the mechanics and function of meniscal tissue.
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Affiliation(s)
- Andy Morejon
- Department of Mechanical and Aerospace Engineering, University of Miami, Coral Gables, FL, United States
| | - Pedro L. Dalbo
- School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Thomas M. Best
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL, United States
- Department of Orthopedic Surgery, University of Miami, Coral Gables, FL, United States
- UHealth Sports Medicine Institute, Coral Gables, FL, United States
| | - Alicia R. Jackson
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL, United States
| | - Francesco Travascio
- Department of Mechanical and Aerospace Engineering, University of Miami, Coral Gables, FL, United States
- Department of Orthopedic Surgery, University of Miami, Coral Gables, FL, United States
- Max Biedermann Institute for Biomechanics at Mount Sinai Medical Center, Miami Beach, FL, United States
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Barceló X, Garcia O, Kelly DJ. Chondroitinase ABC Treatment Improves the Organization and Mechanics of 3D Bioprinted Meniscal Tissue. ACS Biomater Sci Eng 2023. [PMID: 37192278 DOI: 10.1021/acsbiomaterials.3c00101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
The meniscus is a fibrocartilage tissue that is integral to the correct functioning of the knee joint. The tissue possesses a unique collagen fiber architecture that is integral to its biomechanical functionality. In particular, a network of circumferentially aligned collagen fibers function to bear the high tensile forces generated in the tissue during normal daily activities. The limited regenerative capacity of the meniscus has motivated increased interest in meniscus tissue engineering; however, the in vitro generation of structurally organized meniscal grafts with a collagen architecture mimetic of the native meniscus remains a significant challenge. Here we used melt electrowriting (MEW) to produce scaffolds with defined pore architectures to impose physical boundaries upon cell growth and extracellular matrix production. This enabled the bioprinting of anisotropic tissues with collagen fibers preferentially oriented parallel to the long axis of the scaffold pores. Furthermore, temporally removing glycosaminoglycans (sGAGs) during the early stages of in vitro tissue development using chondroitinase ABC (cABC) was found to positively impact collagen network maturation. Specially we found that temporal depletion of sGAGs is associated with an increase in collagen fiber diameter without any detrimental effect on the development of a meniscal tissue phenotype or subsequent extracellular matrix production. Moreover, temporal cABC treatment supported the development of engineered tissues with superior tensile mechanical properties compared to empty MEW scaffolds. These findings demonstrate the benefit of temporal enzymatic treatments when engineering structurally anisotropic tissues using emerging biofabrication technologies such as MEW and inkjet bioprinting.
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Affiliation(s)
- Xavier Barceló
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin D02 R590, Ireland
- Department of Mechanical, Manufacturing, & Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin D02 R590, Ireland
- Advanced Materials & Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland & Trinity College Dublin, Dublin D02 F6N2, Ireland
| | - Orquidea Garcia
- Johnson & Johnson 3D Printing Innovation & Customer Solutions, Johnson & Johnson Services, Inc., Dublin D02 R590, Ireland
| | - Daniel J Kelly
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin D02 R590, Ireland
- Department of Mechanical, Manufacturing, & Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin D02 R590, Ireland
- Advanced Materials & Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland & Trinity College Dublin, Dublin D02 F6N2, Ireland
- Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin D02 YN77, Ireland
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Langhans MT, Lamba A, Saris DBF, Smith P, Krych AJ. Meniscal Extrusion: Diagnosis, Etiology, and Treatment Options. Curr Rev Musculoskelet Med 2023:10.1007/s12178-023-09840-4. [PMID: 37191818 DOI: 10.1007/s12178-023-09840-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE OF REVIEW The concept of meniscal extrusion has recently been recognized as a hallmark of meniscus dysfunction. This review examines contemporary literature regarding the pathophysiology, classification, diagnosis, treatment, and future directions for investigation regarding meniscus extrusion. RECENT FINDINGS Meniscus extrusion, defined as >3 mm of radial displacement of the meniscus, leads to altered knee biomechanics and accelerated knee joint degeneration. Meniscus extrusion has been associated with degenerative joint disease, posterior root and radial meniscal tears, and acute trauma. Meniscus centralization and meniscotibial ligament repair have been proposed as techniques to address meniscal extrusion with promising biomechanical, animal model, and early clinical reports. Further studies on the epidemiology of meniscus extrusion and associated long-term nonoperative outcomes will help to elucidate its role in meniscus dysfunction and resultant arthritic development. Understanding and appreciation for the anatomic attachments of the meniscus will help to inform future repair techniques. Long-term reporting on the clinical outcomes of meniscus centralization techniques will yield insights into the clinical significance of meniscus extrusion correction.
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Affiliation(s)
- Mark T Langhans
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Abhinav Lamba
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Daniel B F Saris
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | | | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
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Demott C, Jones MR, Chesney CD, Grunlan MA. Adhesive Hydrogel Building Blocks to Reconstruct Complex Cartilage Tissues. ACS Biomater Sci Eng 2023; 9:1952-1960. [PMID: 36881710 PMCID: PMC10848198 DOI: 10.1021/acsbiomaterials.2c01438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/14/2023] [Indexed: 03/09/2023]
Abstract
Cartilage has an intrinsically low healing capacity, thereby requiring surgical intervention. However, limitations of biological grafting and existing synthetic replacements have prompted the need to produce cartilage-mimetic substitutes. Cartilage tissues perform critical functions that include load bearing and weight distribution, as well as articulation. These are characterized by a range of high moduli (≥1 MPa) as well as high hydration (60-80%). Additionally, cartilage tissues display spatial heterogeneity, resulting in regional differences in stiffness that are paramount to biomechanical performance. Thus, cartilage substitutes would ideally recapitulate both local and regional properties. Toward this goal, triple network (TN) hydrogels were prepared with cartilage-like hydration and moduli as well as adhesivity to one another. TNs were formed with either an anionic or cationic 3rd network, resulting in adhesion upon contact due to electrostatic attractive forces. With the increased concentration of the 3rd network, robust adhesivity was achieved as characterized by shear strengths of ∼80 kPa. The utility of TN hydrogels to form cartilage-like constructs was exemplified in the case of an intervertebral disc (IVD) having two discrete but connected zones. Overall, these adhesive TN hydrogels represent a potential strategy to prepare cartilage substitutes with native-like regional properties.
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Affiliation(s)
- Connor
J. Demott
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843-3003, United States
| | - McKenzie R. Jones
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843-3003, United States
| | - Caleb D. Chesney
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843-3003, United States
| | - Melissa A. Grunlan
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843-3003, United States
- Department
of Materials Science & Engineering, Texas A&M University, College
Station, Texas 77843-3003, United States
- Department
of Chemistry, Texas A&M University, College Station, Texas 77843-3003, United States
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71
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Panchal KA, Moharana AK, Angrish S, Ts D. A Single-Centre, Retrospective, Observational Study to Assess Safety and Functional Outcomes of Arthroscopic Meniscal Repair Using Surestitch All Inside Implant. Cureus 2023; 15:e38221. [PMID: 37252500 PMCID: PMC10224793 DOI: 10.7759/cureus.38221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction The meniscus plays a vital role in maintaining knee stability. It acts as a shock absorber and knee filler. The incidence of meniscal tears is estimated to be 60 per 100,000 people. Due to lack of awareness among patients, only 10% of the meniscus tears were treated through partial or total meniscectomy. Recently, the concept of meniscus preservation surgery has emerged to preserve early degeneration of the knee joint. In the current retrospective study, safety and functional outcomes of arthroscopic meniscal repair surgery using Surestitch All inside implants (Sironix Arthroscopy Solutions, Healthium Medtech Limited, Bengalaru, India) were assessed. Methods Fifty-two patients who underwent arthroscopic meniscal repair surgery between January 2019 to July 2022 at Epic Hospital in Gujarat, India, were enrolled in the study. Retrospective data including demographics, injury details, surgery details, and post-surgery complications were collected from the medical records of the patients. Then, the patients were followed up telephonically to document safety and functional outcomes using patient-reported instruments such as International Knee Documentation Committee (IKDC) score, Single Assessment Numeric Evaluation (SANE) score, Tegner activity level, and Lysholm knee score. Results The recruited patients had the mean age, height, and weight of 37.56 ± 12.52 years, 167.61 ± 7.28 cm, and 75.87 ± 10.7 kgs, respectively. Seventy-one percent of patients were male and 29% were female. Majority of the patients had the routine of doing mild exercise. During pre-surgery representations, medial meniscal tear was observed in majority of patients. The mean length of the tear was 1.32 ± 0.84 cm. In addition, patients were also diagnosed with anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL) tears, and osteochondral defects. Surgeries for meniscal repair were performed using Surestitch All inside implant. In patient-reported outcomes, the mean IKDC, SANE, and Lysholm scores were 81.72 ± 14.23, 94.02 ± 13.79, and 93.32 ± 14.63, respectively. When the mean Tegner scores of pre-injury and post-surgery periods were compared, this resulted in no significant difference (p>0.05) in the activity levels of the patients. Conclusion Based on our findings, arthroscopic meniscal repair with Surestitch All inside meniscal repair implant provides satisfactory and favorable functional outcomes with no remarkable adverse events.
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Affiliation(s)
| | | | - Sachin Angrish
- Clinical Affairs, Healthium Medtech Limited, Bengaluru, IND
| | - Deepak Ts
- Clinical Affairs, Healthium Medtech Limited, Bengaluru, IND
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72
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Sequeira SB, Ayan S, Kushare I, Gould HP, Fillar A, Dreese J. Posterior Root Tears of the Lateral Meniscus Only Affect Tibiofemoral Contact Forces when the Meniscofemoral Ligament Is Involved: A Cadaveric Study. Arthrosc Sports Med Rehabil 2023; 5:e515-e521. [PMID: 37101864 PMCID: PMC10123502 DOI: 10.1016/j.asmr.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 02/02/2023] [Indexed: 04/28/2023] Open
Abstract
Purpose The objective of this study was to examine the impact of progressive radial tears in the lateral meniscal root on the lateral compartment contact forces and joint surface area through a range of motion of knee and evaluate the role of the meniscofemoral ligament (MFL) in preventing adverse tibiofemoral joint forces. Methods Ten fresh frozen cadaveric knees were tested using 6 experimental conditions (0% lateral meniscal posterior root tear, 25% tear, 50% tear, 75% tear, 100% tear, 100% tear and resection of MFL) at five flexion angles (0°, 30°, 45°, 60°, and 90°) under 100-1,000-N axial load. Contact joint pressure and lateral compartment surface area were measured using Tekscan sensors. Statistical analysis, including descriptive, ANOVA, and post hoc Tukey analysis, was performed. Results Progressive radial tears of the lateral meniscal root were not associated with an increase in tibiofemoral contact pressure or decrease in lateral compartment surface area. Complete lateral root tear and resection of MFL were associated with increased joint contact pressure (P < .001) at knee flexion angles of 30, 45, 60, and 90° and decreased lateral compartment surface (P < .001) at all knee flexion angles area compared to complete lateral meniscectomy alone. Conclusion Isolated complete tears of lateral meniscus root and progressive radial tears of the lateral meniscus posterior root were not associated with any change to tibiofemoral contact forces. However, additional resection of the MFL increased contact pressure and decreased lateral compartment surface area.
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Affiliation(s)
- Sean B. Sequeira
- Address correspondence to Sean B. Sequeira, M.D., Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, 3333 North Calvert St., Suite 400, Baltimore, MD 21218, U.S.A.
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73
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Kim J, Bonassar LJ. Controlling collagen gelation pH to enhance biochemical, structural, and biomechanical properties of tissue-engineered menisci. J Biomed Mater Res A 2023; 111:478-487. [PMID: 36300869 DOI: 10.1002/jbm.a.37464] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/16/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022]
Abstract
Collagen-based hydrogels have been widely used in biomedical applications due to their biocompatibility. Enhancing mechanical properties of collagen gels remains challenging while maintaining biocompatibility. Here, we demonstrate that gelation pH has profound effects on cellular activity, collagen fibril structure, and mechanical properties of the fibrochondrocyte-seeded collagen gels in both short- and long-terms. Acidic and basic gelation pH, below pH 7.0 and above 8.5, resulted in dramatic cell death. Gelation pH ranging from 7.0 to 8.5 showed a relatively high cell viability. Furthermore, physiologic gelation (pH 7.5) showed the greatest collagen deposition while glycosaminoglycan deposition appeared independent of gelation pH. Scanning electron microscopy showed that neutral and physiologic gelation pH, 7.0 and 7.5, exhibited well-aligned collagen fibril structure on day 0 and enhanced collagen fibril structure with laterally joined fibrils on day 30. However, basic pH, 8.0 and 8.5, displayed a densely packed collagen fibril structure on day 0, which was also persistent on day 30. Initial equilibrium modulus increased with increasing gelation pH. Notably, after 30 days of culture, gelation pH of 7.5 and 8.0 showed the highest equilibrium modulus, reaching 150 -160 kPa. While controlling gelation pH is simply achieved compared with other strategies to improve mechanical properties, its influences on biochemical and biomechanical properties of the collagen gel are long-lasting. As such, gelation pH is a useful means to modulate both biochemical and biomechanical properties of the collagen-based hydrogels and can be utilized for diverse types of tissue engineering due to its simple application.
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Affiliation(s)
- Jongkil Kim
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA
| | - Lawrence J Bonassar
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA.,Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York, USA
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74
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Nakanishi Y, Matsushita T, Nagai K, Araki D, Hoshino Y, Kuroda R. Fibrin clot and Leukocyte-rich platelet-rich fibrin show similar release kinetics and amount of growth factors: a pilot study. J Orthop Surg Res 2023; 18:238. [PMID: 36964579 PMCID: PMC10039559 DOI: 10.1186/s13018-023-03709-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/13/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND In knee arthroscopic surgery, fibrin clot (FC) and leukocyte-rich platelet-rich fibrin (L-PRF) may be used in augmentation for meniscal repair. Studies have investigated growth factors released from FC and L-PRF; however, it is difficult to compare FC and L-PRF between different studies. Direct comparison of growth factors that may support meniscal healing released from FC and L-PRF may be beneficial in deciding whether to use FC or L-PRF. If no significant difference is seen, the surgeon may decide to use FC which is easier to prepare compared to L-PRF. The purpose of this pilot study is to investigate the release amount and pattern of basic fibroblast growth factor (bFGF), platelet-derived growth factor AB (PDGF-AB), transforming growth factor β1 (TGF-β1), vascular endothelial growth factor (VEGF), and stromal cell-derived factor 1 (SDF-1) from FC and L-PRF. METHOD Twenty milliliters (ml) of whole blood was collected from each of the four volunteers. Ten milliliters of whole blood was allocated for preparation of FC and 10 ml for L-PRF. FC and L-PRF were separately placed in 5 ml of culture media. Five milliliters of the culture media was sampled and refilled at 15 min, 1 day, 3 days, 1 week and 2 weeks. The collected culture was used to quantify bFGF, PDGF-AB, TGF-β1, VEGF, and SDF-1 release by Enzyme-linked immune-sorbent assay (ELISA). Mann-Whitney U test was performed to assess significance of differences in amount of each growth factor released between FC and L-PRF. Significance was accepted at P value less than 0.05. RESULTS At two weeks, the cumulative release of TGF-β1 was the highest among all the growth factors in both FC and L-PRF (FC:19,738.21 pg/ml, L-PRF: 16,229.79 pg/ml). PDGF-AB (FC: 2328 pg/ml, L-PRF 1513.57 pg/ml) had the second largest amount, followed by VEGF (FC: 702.06 pg/ml, L-PRF 595.99 pg/ml) and bFGF (FC: 23.48 pg/ml, L-PRF 18.2 pg/ml), which order was also common in both FC and L-PRF. No significant difference in final release amount and pattern was seen between FC and L-PRF. CONCLUSION The current pilot study showed that cumulative release amount and release pattern of PDGF-AB, VEGF, TGF-β1, and bFGF did not significantly differ between FC and L-PRF during the two weeks of observation.
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Affiliation(s)
- Yuta Nakanishi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan.
| | - Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Daisuke Araki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
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Wang X, Du G, Liu Y. Lateral meniscal body extrusion is associated with MRI-defined knee structural damage progression over 4 years: Data from the osteoarthritis initiative. Eur J Radiol 2023; 162:110791. [PMID: 36963331 DOI: 10.1016/j.ejrad.2023.110791] [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: 09/09/2022] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE To investigate the association of lateral meniscal body extrusion (LMBE) with OA-related knee structural damage progression over 4 years and to obtain thresholds of LMBE in predicting knee structural damage progression. METHOD We studied 196 subjects (67 male) with a mean age of 59.5 ± 7.9 (SD) years (range45-78 years) that were randomly selected from the Osteoarthritis Initiative. Radiological assessment was performed using the Osteoarthritis Research Society International grading system. Baseline LMBE was quantified on coronal sections of intermediate-weighted MRI sequences obtained at 3.0 T scanner. Knee structural damages were measured using the whole-organ MRI score. Linear regression analysis and binary logistic regression analysis was used to assess the correlation between LMBE and knee structural damage. ROC analysis and Youden index were used for calculating thresholds. RESULTS Cross-sectionally, increased LMBE was significantly associated with more severe lateral meniscal damage, patellofemoral and lateral compartment cartilage damage, and posterior cruciate ligament damage. Longitudinally, LMBE was statistically associated with progression of lateral meniscal damage, lateral compartment cartilage damage and bone marrow edema patterns, posterior cruciate ligament lesions and popliteal cysts. The thresholds of LMBE in suggesting progression of lateral meniscal lesions and lateral compartment cartilage lesions were 1.4 mm and 1.3 mm, respectively. CONCLUSION Baseline LMBE was associated with structural damage progression over 4 years in knees with or at risks for OA. Thresholds of 1.4 mm and 1.3 mm could be used in predicting progression over 4 years of lateral meniscal damage and lateral compartment cartilage damage, respectively.
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Affiliation(s)
- Xiaohong Wang
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Guiying Du
- Department of Radiology, Teda International Cardiovascular Hospital, Tianjin, China.
| | - Yao Liu
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
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76
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Nesbitt DQ, Burruel DE, Henderson BS, Lujan TJ. Finite element modeling of meniscal tears using continuum damage mechanics and digital image correlation. Sci Rep 2023; 13:4039. [PMID: 36899069 PMCID: PMC10006193 DOI: 10.1038/s41598-023-29111-z] [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: 07/25/2022] [Accepted: 01/31/2023] [Indexed: 03/12/2023] Open
Abstract
Meniscal tears are a common, painful, and debilitating knee injury with limited treatment options. Computational models that predict meniscal tears may help advance injury prevention and repair, but first these models must be validated using experimental data. Here we simulated meniscal tears with finite element analysis using continuum damage mechanics (CDM) in a transversely isotropic hyperelastic material. Finite element models were built to recreate the coupon geometry and loading conditions of forty uniaxial tensile experiments of human meniscus that were pulled to failure either parallel or perpendicular to the preferred fiber orientation. Two damage criteria were evaluated for all experiments: von Mises stress and maximum normal Lagrange strain. After we successfully fit all models to experimental force-displacement curves (grip-to-grip), we compared model predicted strains in the tear region at ultimate tensile strength to the strains measured experimentally with digital image correlation (DIC). In general, the damage models underpredicted the strains measured in the tear region, but models using von Mises stress damage criterion had better overall predictions and more accurately simulated experimental tear patterns. For the first time, this study has used DIC to expose strengths and weaknesses of using CDM to model failure behavior in soft fibrous tissue.
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Affiliation(s)
- Derek Q Nesbitt
- Biomedical Engineering Doctoral Program, Boise State University, Boise, ID, USA
| | - Dylan E Burruel
- Department of Mechanical and Biomedical Engineering, Boise State University, 1910 University Drive, Boise, ID, 83725-2085, USA
| | - Bradley S Henderson
- Department of Mechanical and Biomedical Engineering, Boise State University, 1910 University Drive, Boise, ID, 83725-2085, USA
| | - Trevor J Lujan
- Department of Mechanical and Biomedical Engineering, Boise State University, 1910 University Drive, Boise, ID, 83725-2085, USA.
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77
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Barceló X, Eichholz KF, Gonçalves IF, Garcia O, Kelly DJ. Bioprinting of structurally organized meniscal tissue within anisotropic melt electrowritten scaffolds. Acta Biomater 2023; 158:216-227. [PMID: 36638941 DOI: 10.1016/j.actbio.2022.12.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/15/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023]
Abstract
The meniscus is characterised by an anisotropic collagen fibre network which is integral to its biomechanical functionality. The engineering of structurally organized meniscal grafts that mimic the anisotropy of the native tissue remains a significant challenge. In this study, inkjet bioprinting was used to deposit a cell-laden bioink into additively manufactured scaffolds of differing architectures to engineer fibrocartilage grafts with user defined collagen architectures. Polymeric scaffolds consisting of guiding fibre networks with varying aspect ratios (1:1; 1:4; 1:16) were produced using either fused deposition modelling (FDM) or melt electrowriting (MEW), resulting in scaffolds with different internal architectures and fibre diameters. Scaffold architecture was found to influence the spatial organization of the collagen network laid down by the jetted cells, with higher aspect ratios (1:4 and 1:16) supporting the formation of structurally anisotropic tissues. The MEW scaffolds supported the development of a fibrocartilaginous tissue with compressive mechanical properties similar to that of native meniscus, while the anisotropic tensile properties of these constructs could be tuned by altering the fibre network aspect ratio. This MEW framework was then used to generate scaffolds with spatially distinct fibre patterns, which in turn supported the development of heterogenous tissues consisting of isotropic and anisotropic collagen networks. Such bioprinted tissues could potentially form the basis of new treatment options for damaged and diseased meniscal tissue. STATEMENT OF SIGNIFICANCE: This study describes a multiple tool biofabrication strategy which enables the engineering of spatially organized fibrocartilage tissues. The architecture of MEW scaffolds can be tailored to not only modulate the directionality of the collagen fibres laid down by cells, but also to tune the anisotropic tensile mechanical properties of the resulting constructs, thereby enabling the engineering of biomimetic meniscal-like tissues. Furthermore, the inherent flexibility of MEW enables the development of zonally defined and potentially patient-specific implants.
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Affiliation(s)
- Xavier Barceló
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, D02 R590, Ireland; Department of Mechanical, Manufacturing, & Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin, D02 R590, Ireland; Advanced Materials & Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland & Trinity College Dublin, Dublin, D02 F6N2, Ireland
| | - Kian F Eichholz
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, D02 R590, Ireland; Department of Mechanical, Manufacturing, & Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin, D02 R590, Ireland; Advanced Materials & Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland & Trinity College Dublin, Dublin, D02 F6N2, Ireland
| | - Inês F Gonçalves
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, D02 R590, Ireland; Department of Mechanical, Manufacturing, & Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin, D02 R590, Ireland; Advanced Materials & Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland & Trinity College Dublin, Dublin, D02 F6N2, Ireland
| | - Orquidea Garcia
- Johnson & Johnson 3D Printing Innovation & Customer Solutions, Johnson & Johnson Services, Inc., Irvine, CA, USA
| | - Daniel J Kelly
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, D02 R590, Ireland; Department of Mechanical, Manufacturing, & Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin, D02 R590, Ireland; Advanced Materials & Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland & Trinity College Dublin, Dublin, D02 F6N2, Ireland; Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, D02 YN77, Ireland.
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El Helou A, Gousopoulos L, Shatrov J, Hopper GP, Philippe C, Ayata M, Thaunat M, Fayard JM, Freychet B, Vieira TD, Sonnery-Cottet B. Failure Rates of Repaired Bucket-Handle Tears of the Medial Meniscus Concomitant With Anterior Cruciate Ligament Reconstruction: A Cohort Study of 253 Patients From the SANTI Study Group With a Mean Follow-up of 94 Months. Am J Sports Med 2023; 51:585-595. [PMID: 36734511 DOI: 10.1177/03635465221148497] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Failure rates of repaired bucket-handle medial meniscal tears (BHMMTs) concomitant with anterior cruciate ligament reconstruction (ACLR) are as high as 20%. The outcomes of posteromedial portal suture hook repair have not been compared with all-inside repair techniques for this subtype of meniscal lesion. PURPOSE/HYPOTHESIS The aim of this study was to evaluate the outcomes and failure rates of patients who underwent BHMMT repair concomitant with ACLR using an all-inside technique, suture hook + all-inside technique, or suture hook + outside-in technique. It was hypothesized that no significant differences in failure rates would be found between the groups. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective analysis was performed on patients diagnosed with a BHMMT who underwent meniscal repair during primary ACLR and had a minimum follow-up of 2 years. Patients were grouped based on the meniscal repair technique used: all-inside repair, suture hook + all-inside repair, or suture hook + outside-in repair. At the end of the study period, secondary medial meniscectomy rates were determined. RESULTS The study population comprised 253 patients who underwent repair of a BHMMT with concomitant ACLR with a mean follow-up of 94.0 ± 47.6 months. A total of 114 patients (45.1%) underwent all-inside repair, 61 patients (24.1%) underwent suture hook + all-inside repair, and 78 patients (30.8%) underwent suture hook + outside-in repair. Overall, there were 36 failures. The failure rates were 20.2%, 14.8%, and 5.1%, respectively (P = .0135). All-inside repairs were >4 times more likely to fail than suture hook + outside-in repairs (hazard ratio [HR], 4.103; 95% CI, 1.369-12.296; P = .0117). Failure was also 3 times higher (HR, 2.943; 95% CI, 1.224-7.075; P = .0159) for patients <30 years of age compared with those aged ≥30 years. An additional anterolateral ligament reconstruction (ALLR) was also found to reduce the failure rate of repaired BHMMTs concomitant with ACLR. CONCLUSION Combined suture hook + outside-in repair of BHMMTs resulted in significantly fewer failures than all other techniques. Furthermore, age <30 years and no additional ALLR were associated with higher failure rates.
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Affiliation(s)
- Abdo El Helou
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Lampros Gousopoulos
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Jobe Shatrov
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Graeme P Hopper
- NHS Glasgow and Clyde South Glasgow University Hospitals NHS Trust Glasgow, Glasgow, UK
| | - Corentin Philippe
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Merwane Ayata
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Mathieu Thaunat
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Jean-Marie Fayard
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Benjamin Freychet
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Thais Dutra Vieira
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
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Gouldin AG, Patel NK, Golladay GJ, Puetzer JL. Advanced glycation end-product accumulation differs by location and sex in aged osteoarthritic human menisci. Osteoarthritis Cartilage 2023; 31:363-373. [PMID: 36494052 PMCID: PMC10088070 DOI: 10.1016/j.joca.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/15/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE There is a clear link between increasing age and meniscus degeneration, leading to increased injury, osteoarthritis (OA) progression, and often total knee replacement. Advanced glycation end-products (AGEs) are non-enzymatic crosslinks and adducts that accumulate in collagen with age, altering tissue mechanics and cell function, ultimately leading to increased injury and inflammation. AGEs, both fluorescent and non-fluorescent, play a central role in age-related degradation of tissues throughout the body; however, little is known about their role in meniscus degeneration. The objective of this study was to characterize changes in aged OA menisci, specifically evaluating zonal AGE accumulation, to gain a better understanding of changes that may lead to age-related meniscal degeneration. METHOD Deidentified human menisci (N = 48, 52-84 years old) were obtained from subjects undergoing total knee replacement. Changes in extracellular matrix (ECM) were assessed by gross morphology, confocal analysis, and biochemical assays. Deoxyribonucleic acid (DNA), glycosaminoglycan (GAG), collagen, and AGE accumulation were compared with patient age, zonal region, and patient sex. RESULTS There were minimal changes in DNA, GAG, and collagen concentration with age or zone. However, collagen fraying and AGEs increased with age, with more AGEs accumulating in the meniscal horns compared to the central body and in male menisci compared to females. CONCLUSIONS Overall, this work provides greater insights into regional changes that occur in human menisci with age and OA. These results suggest AGEs may play a role in the degeneration of the meniscus, with AGEs being a possible target to reduce age-related tears, degeneration, and OA progression.
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Affiliation(s)
- A G Gouldin
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, United States.
| | - N K Patel
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, United States.
| | - G J Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, United States.
| | - J L Puetzer
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, United States; Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, United States.
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Farivar D, Knapik DM, Vadhera AS, Condron NB, Hevesi M, Shewman EF, Ralls M, White GM, Chahla J. Isolated Posterior Lateral Meniscofemoral Ligament Tears Show Greater Meniscal Extrusion in Knee Extension, and Isolated Posterior Lateral Meniscal Root Tears Show Greater Meniscal Extrusion at 30° Using Ultrasound: A Cadaveric Study. Arthroscopy 2023:S0749-8063(23)00171-8. [PMID: 36813008 DOI: 10.1016/j.arthro.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 01/27/2023] [Accepted: 02/02/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To quantify the effects that posterior meniscofemoral ligament (pMFL) lesions have on lateral meniscal extrusion (ME) both with and without concomitant posterior lateral meniscal root (PLMR) tears and describe how lateral ME varied along the length of the lateral meniscus. METHODS Ultrasonography was used to measure ME of human cadaveric knees (n = 10) under the following conditions: control, isolated pMFL sectioning, isolated PLMR sectioning, pMFL+PLMR sectioning, and PLMR repair. ME was measured anterior to the fibular collateral ligament (FCL), at the FCL, and posterior to the FCL in both unloaded and axially loaded states at 0° and 30° of flexion. RESULTS Isolated and combined pMFL and PLMR sectioning consistently demonstrated significantly greater ME when measured posterior to the FCL compared with other image locations. Isolated pMFL tears demonstrated greater ME at 0° compared with 30° of flexion (P < .05), whereas isolated PLMR tears demonstrated greater ME at 30° compared with 0° of flexion (P < .001). All specimens with isolated PLMR deficiencies demonstrated greater than 2 mm of ME at 30° flexion, whereas only 20% of specimens did so at 0°. When the pMFL was sectioned following an isolated PLMR tear, there was a significant increase in ME at 0° (P < .001). PLMR repair after combined sectioning restored ME to levels similar to that of controls in all specimens when measured at and posterior to the FCL (P < .001). CONCLUSIONS The pMFL protects against ME primarily in full extension, whereas the presence of ME in the setting of PLMR injuries may be better appreciated in knee flexion. With combined tears, isolated repair of the PLMR can restore near-native meniscus position. CLINICAL RELEVANCE The stabilizing properties of intact pMFL may mask the presentation of PLMR tears and delay appropriate management. Additionally, the MFL is not routinely assessed during arthroscopy due to difficult visualization and access. Understanding the ME pattern of these pathologies in isolation and combination may improve detection rates so that the source of patients' symptoms can be addressed to satisfaction.
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Affiliation(s)
- Daniel Farivar
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Amar S Vadhera
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nolan B Condron
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Mario Hevesi
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Elizabeth F Shewman
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Michael Ralls
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Gregory M White
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A..
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A Comparative Study on Outcomes of Partial Meniscectomy for Horizontal Cleavage Tear of Medial Meniscus: Complete versus Partial Resection of Inferior Leaf. J Clin Med 2023; 12:jcm12041439. [PMID: 36835973 PMCID: PMC9961094 DOI: 10.3390/jcm12041439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/30/2023] [Accepted: 02/08/2023] [Indexed: 02/15/2023] Open
Abstract
The extent to which resection of unstable leaf should be performed in horizontal cleavage meniscus tear has not yet been elucidated. The purpose of this study was to compare the clinical outcomes of partial meniscectomy for horizontal cleavage tear of medial meniscus between complete resection of inferior leaf including the periphery up to the joint capsule and partial resection leaving stable peripheral torn meniscal tissue. A total of 126 patients who underwent partial meniscectomy for horizontal cleavage tear of medial meniscus were divided into two groups: group C (n = 34), treated with the complete resection of the inferior leaf; and group P (n = 92), treated with partial resection of the inferior leaf. The minimum follow-up duration was 3 years. Functional outcomes were evaluated using the Lysholm knee scoring scale, International Knee Documentation Committee (IKDC) subjective knee evaluation form, and knee injury and osteoarthritis outcome score (KOOS). Radiologic assessments were performed using the IKDC radiographic assessment scale and measurement of the height of the joint space in the medial compartment of the tibiofemoral joint. The functional outcomes including the Lysholm knee, IKDC subjective score, activities of daily living and sport and recreation subscale of KOOS were worse in group C than in group P (p < 0.001). The radiologic outcomes including postoperative IKDC radiographic scale (p = 0.003) and the postoperative joint space on the affected side (p < 0.001) were also worse in group C than in group P. In the horizontal cleavage tear of medial meniscus, complete resection of the inferior leaf including the periphery up to the joint capsule showed inferior clinical outcomes compared with partial resection leaving stable peripheral rim of torn meniscus at minimum 3-year follow-up. If the peripheral part of the inferior leaf is stable in horizontal cleavage tear of medial meniscus, partial resection of the inferior leaf preserving peripheral rim can be recommended.
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82
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Bradley PX, Thomas KN, Kratzer AL, Robinson AC, Wittstein JR, DeFrate LE, McNulty AL. The Interplay of Biomechanical and Biological Changes Following Meniscus Injury. Curr Rheumatol Rep 2023; 25:35-46. [PMID: 36479669 PMCID: PMC10267895 DOI: 10.1007/s11926-022-01093-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Meniscus injury often leads to joint degeneration and post-traumatic osteoarthritis (PTOA) development. Therefore, the purpose of this review is to outline the current understanding of biomechanical and biological repercussions following meniscus injury and how these changes impact meniscus repair and PTOA development. Moreover, we identify key gaps in knowledge that must be further investigated to improve meniscus healing and prevent PTOA. RECENT FINDINGS Following meniscus injury, both biomechanical and biological alterations frequently occur in multiple tissues in the joint. Biomechanically, meniscus tears compromise the ability of the meniscus to transfer load in the joint, making the cartilage more vulnerable to increased strain. Biologically, the post-injury environment is often characterized by an increase in pro-inflammatory cytokines, catabolic enzymes, and immune cells. These multi-faceted changes have a significant interplay and result in an environment that opposes tissue repair and contributes to PTOA development. Additionally, degenerative changes associated with OA may cause a feedback cycle, negatively impacting the healing capacity of the meniscus. Strides have been made towards understanding post-injury biological and biomechanical changes in the joint, their interplay, and how they affect healing and PTOA development. However, in order to improve clinical treatments to promote meniscus healing and prevent PTOA development, there is an urgent need to understand the physiologic changes in the joint following injury. In particular, work is needed on the in vivo characterization of the temporal biomechanical and biological changes that occur in patients following meniscus injury and how these changes contribute to PTOA development.
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Affiliation(s)
- Patrick X Bradley
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA
| | - Karl N Thomas
- Department of Orthopaedic Surgery, Duke University School of Medicine, DUMC Box 3093, Durham, NC, 27710, USA
| | - Avery L Kratzer
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Allison C Robinson
- Department of Orthopaedic Surgery, Duke University School of Medicine, DUMC Box 3093, Durham, NC, 27710, USA
| | - Jocelyn R Wittstein
- Department of Orthopaedic Surgery, Duke University School of Medicine, DUMC Box 3093, Durham, NC, 27710, USA
| | - Louis E DeFrate
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA
- Department of Orthopaedic Surgery, Duke University School of Medicine, DUMC Box 3093, Durham, NC, 27710, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Amy L McNulty
- Department of Orthopaedic Surgery, Duke University School of Medicine, DUMC Box 3093, Durham, NC, 27710, USA.
- Department of Biomedical Engineering, Duke University, Durham, NC, USA.
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA.
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83
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Li W, Li T, Xi X, Zhang R, Sun W, Zhang D, Gong W. Does higher knee hyperextension in patients with hemiplegia affect lateral and medial meniscus volume in the paretic leg? A cross-sectional study. BMC Sports Sci Med Rehabil 2023; 15:4. [PMID: 36600322 DOI: 10.1186/s13102-022-00611-1] [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: 08/01/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND After stroke, an abnormal gait pattern gradually leads to knee pain and joint lesions, resulting the gait instability. However, the correlation between the knee hyperextension and gait pattern, the meniscus volume, and the water content of meniscus in paretic and non-paretic legs has not been fully investigated. Moreover, most of physicians tend to ignore this knee hyperextension. This study attempted to emphasize the importance of knee hyperextension using gait analysis and Magnetic resonance imaging (Trial registration number ChiCTR2000039641, date of registration 04/11/2020). METHODS Eight patients with chronic hemiplegic (6 male, 2 female) volunteered to participate in this study. Participants was recruited if they had a hemiplegia following a stroke occurring more than 6 months, had an ability to walk 10 m without aids, had a Function Ambulation Category level at least 3 and above, and had a hemiplegic lower extremity identified as Brunnstrom state III or above identification. The spatial-temporal gait parameters and kinematic parameters in the paretic and the non-paretic legs and the percentage of free water content in deep and shallow layers. RESULTS Longer time since hemiplegia led to larger angles of knee hyperextension (R = 0.56, p = 0.016), larger angles of knee hyperextension led to more tears in meniscus (R = - 0.53, - 0,57 and - 0.70), and larger angles of knee hyperextension decreased water content of the lateral meniscus in the non-paretic leg (R = - 0.91) but increased water content of the medial meniscus (R = 0.53 and 0.63). CONCLUSIONS The knee hyperextension could not be ignored by physicians and needed to be diagnosed and treated as early as possible, the time since hemiplegia could be an indicator of sign of knee hyperextension.
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Affiliation(s)
- Wenshan Li
- Beijing Rehabilitation Medicine Academy, Capital Medical University, Beijing, 100144, China
| | - Tiancong Li
- Beijing Rehabilitation Medicine Academy, Capital Medical University, Beijing, 100144, China
| | - Xiaoshuang Xi
- Beijing Rehabilitation Medicine Academy, Capital Medical University, Beijing, 100144, China
| | - Rong Zhang
- Second Clinical Medical Academy, Yunnan University of Chinese Medicine, Kunming, Yunnan, 650500, China
| | - Weishuang Sun
- Rehabilitation Medicine Academy, Weifang Medical University, Weifang, Shandong, 261053, China
| | - Dan Zhang
- Rehabilitation Medicine Academy, Weifang Medical University, Weifang, Shandong, 261053, China
| | - Weijun Gong
- Department of Neurological Rehabilitation, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, 100144, China.
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84
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Phua SKA, Tham SYY, Ho SWL. Does laterality matter? a systematic review and meta-analysis of clinical and survival outcomes of medial versus lateral meniscal scaffolds. Knee 2023; 40:227-237. [PMID: 36512894 DOI: 10.1016/j.knee.2022.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/08/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Meniscal scaffold implants have gained interestas a therapeutic alternative for irreparable partial meniscal defects and post-meniscectomy syndrome. However, the effect of laterality on outcomes is unclear. This study aimsto assess the hypothesis that lateral meniscal scaffold implants have worse clinical or survival outcomes compared with medial scaffold implants. METHODS The study was performedaccording to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and registered with PROSPERO. Three databases (PubMed, Embase, Scopus) were searched from date of database establishment to 21 January 2022. Human studies reporting clinical or survival outcomedata specific to the medial or lateral meniscal scaffold implant were included. Random-effects model was used to analyse survival outcome data. RESULTS Ten studies comprising 568 patients (mean age 29.2-40 years, follow up duration 1-14 years) were included. There were 483 medial and 85 lateral meniscal scaffold implants. Amongst two studies directly comparing the survival rate of medial and lateral meniscal scaffolds, there was no significant difference in survival rates between medial and lateral meniscus scaffolds (hazard ratio = 1.24, 95 % confidence interval: 0.51-3.03, P = 0.63). There were no consistent statistically significant differences between medial and lateral meniscal scaffolds in terms of postoperative Visual Analog Scale pain,Tegner Activity, Lysholm, International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome, and Knee Society Scores. CONCLUSION Despite anatomical and biomechanical differences between the medial and lateral meniscus, there are no significant differences in clinical outcomes or survival rates between medial and lateral meniscal scaffold implants for irreparable partial meniscal defects at short- or mid-term follow up. Lateral meniscal scaffold implants are therefore non-inferior to medial meniscal scaffold implants.
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Affiliation(s)
| | | | - Sean Wei Loong Ho
- Department of Orthopedic Surgery, Tan Tock Seng Hospital, Singapore.
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85
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Zhang J, Zhu J, Zhao B, Nie D, Wang W, Qi Y, Chen L, Li B, Chen B. LTF induces senescence and degeneration in the meniscus via the NF-κB signaling pathway: A study based on integrated bioinformatics analysis and experimental validation. Front Mol Biosci 2023; 10:1134253. [PMID: 37168259 PMCID: PMC10164984 DOI: 10.3389/fmolb.2023.1134253] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/04/2023] [Indexed: 05/13/2023] Open
Abstract
Background: The functional integrity of the meniscus continually decreases with age, leading to meniscal degeneration and gradually developing into osteoarthritis (OA). In this study, we identified diagnostic markers and potential mechanisms of action in aging-related meniscal degeneration through bioinformatics and experimental verification. Methods: Based on the GSE98918 dataset, common differentially expressed genes (co-DEGs) were screened using differential expression analysis and the WGCNA algorithm, and enrichment analyses based on Gene Ontology (GO) terms and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were further performed. Next, the co-DEGs were imported into the STRING database and Cytoscape to construct a protein‒protein interaction (PPI) network and further validated by three algorithms in cytoHubba, receiver operating characteristic (ROC) curve analysis and the external GSE45233 dataset. Moreover, the diagnostic marker lactotransferrin (LTF) was verified in rat models of senescence and replicative cellular senescence via RT‒qPCR, WB, immunohistochemistry and immunofluorescence, and then the potential molecular mechanism was explored by loss of function and overexpression of LTF. Results: According to the analysis of the GSE98918 dataset, we identified 52 co-DEGs (42 upregulated genes and 10 downregulated genes) in the OA meniscus. LTF, screened out by Cytoscape, ROC curve analysis in the GSE98918 dataset and another external GSE45233 dataset, might have good predictive power in meniscal degeneration. Our experimental results showed that LTF expression was statistically increased in the meniscal tissue of aged rats (24 months) and senescent passage 5th (P5) meniscal cells. In P5 meniscal cells, LTF knockdown inhibited the NF-κB signaling pathway and alleviated senescence. LTF overexpression in passage 0 (P0) meniscal cells increased the expression of senescence-associated secretory phenotype (SASP) and induced senescence by activating the NF-κB signaling pathway. However, the senescence phenomenon caused by LTF overexpression could be reversed by the NF-κB inhibitor pyrrolidine dithiocarbamate (PDTC). Conclusion: For the first time, we found that increased expression of LTF was observed in the aging meniscus and could induce meniscal senescence and degeneration by activating the NF-κB signaling pathway. These results revealed that LTF could be a potential diagnostic marker and therapeutic target for age-related meniscal degeneration.
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Affiliation(s)
- Jun Zhang
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jiayong Zhu
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Boming Zhao
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Daibang Nie
- Department of Immunology, College of Basic Medicine, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Basic and Translational Research of Tumor Immunology, Chongqing Medical University, Chongqing, China
| | - Wang Wang
- Department of Immunology, College of Basic Medicine, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Basic and Translational Research of Tumor Immunology, Chongqing Medical University, Chongqing, China
| | - Yongjian Qi
- Department of Spine Surgery and Musculoskeletal Tumor, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Liaobin Chen
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
- *Correspondence: Liaobin Chen, ; Bin Li, ; Biao Chen,
| | - Bin Li
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
- *Correspondence: Liaobin Chen, ; Bin Li, ; Biao Chen,
| | - Biao Chen
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
- *Correspondence: Liaobin Chen, ; Bin Li, ; Biao Chen,
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86
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Rasheed B, Ayyalasomayajula V, Schaarschmidt U, Vagstad T, Schaathun HG. Region- and layer-specific investigations of the human menisci using SHG imaging and biaxial testing. Front Bioeng Biotechnol 2023; 11:1167427. [PMID: 37143602 PMCID: PMC10151675 DOI: 10.3389/fbioe.2023.1167427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/04/2023] [Indexed: 05/06/2023] Open
Abstract
In this paper, we examine the region- and layer-specific collagen fiber morphology via second harmonic generation (SHG) in combination with planar biaxial tension testing to suggest a structure-based constitutive model for the human meniscal tissue. Five lateral and four medial menisci were utilized, with samples excised across the thickness from the anterior, mid-body, and posterior regions of each meniscus. An optical clearing protocol enhanced the scan depth. SHG imaging revealed that the top samples consisted of randomly oriented fibers with a mean fiber orientation of 43.3 o . The bottom samples were dominated by circumferentially organized fibers, with a mean orientation of 9.5 o . Biaxial testing revealed a clear anisotropic response, with the circumferential direction being stiffer than the radial direction. The bottom samples from the anterior region of the medial menisci exhibited higher circumferential elastic modulus with a mean value of 21 MPa. The data from the two testing protocols were combined to characterize the tissue with an anisotropic hyperelastic material model based on the generalized structure tensor approach. The model showed good agreement in representing the material anisotropy with a mean r 2 = 0.92.
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Affiliation(s)
- Bismi Rasheed
- Cyber-Physical Systems Laboratory, Department of ICT and Natural Sciences, Norwegian University of Science and Technology (NTNU), Ålesund, Norway
- Ålesund Biomechanics Lab, Ålesund General Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
- *Correspondence: Bismi Rasheed,
| | - Venkat Ayyalasomayajula
- Division of Biomechanics, Department of Structural Engineering, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Ute Schaarschmidt
- Cyber-Physical Systems Laboratory, Department of ICT and Natural Sciences, Norwegian University of Science and Technology (NTNU), Ålesund, Norway
| | - Terje Vagstad
- Cyber-Physical Systems Laboratory, Department of ICT and Natural Sciences, Norwegian University of Science and Technology (NTNU), Ålesund, Norway
- Ålesund Biomechanics Lab, Ålesund General Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Department of Orthopaedic Surgery, Medi3, Ålesund, Norway
| | - Hans Georg Schaathun
- Cyber-Physical Systems Laboratory, Department of ICT and Natural Sciences, Norwegian University of Science and Technology (NTNU), Ålesund, Norway
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Intra-Articular Mesenchymal Stem Cell Injection for Knee Osteoarthritis: Mechanisms and Clinical Evidence. Int J Mol Sci 2022; 24:ijms24010059. [PMID: 36613502 PMCID: PMC9819973 DOI: 10.3390/ijms24010059] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Knee osteoarthritis presents higher incidences than other joints, with increased prevalence during aging. It is a progressive process and may eventually lead to disability. Mesenchymal stem cells (MSCs) are expected to repair damaged issues due to trilineage potential, trophic effects, and immunomodulatory properties of MSCs. Intra-articular MSC injection was reported to treat knee osteoarthritis in many studies. This review focuses on several issues of intra-articular MSC injection for knee osteoarthritis, including doses of MSCs applied for injection and the possibility of cartilage regeneration following MSC injection. Intra-articular MSC injection induced hyaline-like cartilage regeneration, which could be seen by arthroscopy in several studies. Additionally, anatomical, biomechanical, and biochemical changes during aging and other causes participate in the development of knee osteoarthritis. Conversely, appropriate intervention based on these anatomical, biomechanical, biochemical, and functional properties and their interactions may postpone the progress of knee OA and facilitate cartilage repair induced by MSC injection. Hence, post-injection rehabilitation programs and related mechanisms are discussed.
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88
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Aggad WS, El-Aziz GSA, Hamdy RM, Saleh HA, Alyazidi AS. Comparative Morphological and Morphometric Study between Medial and Lateral Menisci in Aged Male and Female Human Cadavers. J Microsc Ultrastruct 2022; 10:159-167. [PMID: 36687326 PMCID: PMC9846920 DOI: 10.4103/jmau.jmau_91_21] [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: 11/26/2021] [Revised: 12/19/2021] [Accepted: 01/21/2022] [Indexed: 12/13/2022] Open
Abstract
Background The meniscal cartilages are fibrous discs that are important for knee structures and have the ability to bear weight and stabilize joints. However, morphological and standard data for the meniscus are limited. Therefore, this work will compare anatomical and histological parameters of meniscal cartilages. The results will be important for the different measurements that are necessary for knee joint surgery. Materials and Methods A total of 24 aged cadavers (12 males and 12 females) were included. Knee joints were dissected and the menisci were excised and labeled as medial or lateral, right or left, male or female. Then, the menisci were kept in 10% formalin solution. Morphological variations of the meniscal shapes were macroscopically categorized. Different measurements, including the distance between anterior and posterior horns, outer and inner circumferences, width (breadth), and thickness, were done using a digital Vernier caliper and recorded manually. Results 48 medial menisci (MMi) cartilages were studied, they were 54.6% crescent-shaped, 34.6% V-shaped, and 10.8% U-shaped. 48 lateral menisci (LMi) cartilages were studied, 41.6% were crescent-shaped, 56.4% were C-shaped, and 2% were disc-shaped articular cartilage. Findings included differences in their lengths and thickness. Conclusion The findings of this study were significant in providing new information on various morphological and morphometric parameters of the MMi and LMi in aged males and females, which are necessary to require more precise and comprehensive fundamental data that will be helpful for many specialists for better diagnostic and therapeutic approaches; aiming to restore normal joint conditions in senile people complaining of different meniscal pathologies.
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Affiliation(s)
- Waheeb Sami Aggad
- Department Anatomy and Histology, Faculty of Medicine, King Abdulaziz University, Jeddah, KSA,Address for correspondence: Dr. Waheeb Sami Aggad, Department of Anatomy, Faculty of Medicine, King Abdulaziz University, Jeddah, KSA. E-mail:
| | - Gamal S. Abd El-Aziz
- Department Anatomy and Histology, Faculty of Medicine, King Abdulaziz University, Jeddah, KSA
| | - Raid M. Hamdy
- Department Anatomy and Histology, Faculty of Medicine, King Abdulaziz University, Jeddah, KSA
| | - Hamid A. Saleh
- Department Anatomy and Histology, Faculty of Medicine, King Abdulaziz University, Jeddah, KSA
| | - Anas S. Alyazidi
- Department Anatomy and Histology, Faculty of Medicine, King Abdulaziz University, Jeddah, KSA
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89
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Spierings J, Velthuijs W, Mansoor A, Bertrand ME, Uquillas JA, Ito K, Janssen RPA, Foolen J. A decellularized and sterilized human meniscus allograft for off-the-shelf meniscus replacement. J Exp Orthop 2022; 9:116. [PMID: 36464727 PMCID: PMC9719875 DOI: 10.1186/s40634-022-00555-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Meniscus tears are one of the most frequent orthopedic knee injuries, which are currently often treated performing meniscectomy. Clinical concerns comprise progressive degeneration of the meniscus tissue, a change in knee biomechanics, and an early onset of osteoarthritis. To overcome these problems, meniscal transplant surgery can be performed. However, adequate meniscal replacements remain to be a great challenge. In this research, we propose the use of a decellularized and sterilized human meniscus allograft as meniscal replacement. METHODS Human menisci were subjected to a decellularization protocol combined with sterilization using supercritical carbon dioxide (scCO2). The decellularization efficiency of human meniscus tissue was evaluated via DNA quantification and Hematoxylin & Eosin (H&E) and DAPI staining. The mechanical properties of native, decellularized, and decellularized + sterilized meniscus tissue were evaluated, and its composition was determined via collagen and glycosaminoglycan (GAG) quantification, and a collagen and GAG stain. Additionally, cytocompatibility was determined in vitro. RESULTS Human menisci were decellularized to DNA levels of ~ 20 ng/mg of tissue dry weight. The mechanical properties and composition of human meniscus were not significantly affected by decellularization and sterilization. Histologically, the decellularized and sterilized meniscus tissue had maintained its collagen and glycosaminoglycan structure and distribution. Besides, the processed tissues were not cytotoxic to seeded human dermal fibroblasts in vitro. CONCLUSIONS Human meniscus tissue was successfully decellularized, while maintaining biomechanical, structural, and compositional properties, without signs of in vitro cytotoxicity. The ease at which human meniscus tissue can be efficiently decellularized, while maintaining its native properties, paves the way towards clinical use.
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Affiliation(s)
- Janne Spierings
- grid.6852.90000 0004 0398 8763Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, the Netherlands ,grid.6852.90000 0004 0398 8763Institute of Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Wietske Velthuijs
- grid.6852.90000 0004 0398 8763Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, the Netherlands
| | - Amal Mansoor
- grid.6852.90000 0004 0398 8763Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, the Netherlands ,grid.6852.90000 0004 0398 8763Institute of Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | - Jorge Alfredo Uquillas
- grid.6852.90000 0004 0398 8763Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, the Netherlands ,grid.6852.90000 0004 0398 8763Institute of Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Keita Ito
- grid.6852.90000 0004 0398 8763Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, the Netherlands ,grid.6852.90000 0004 0398 8763Institute of Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Rob P. A. Janssen
- grid.6852.90000 0004 0398 8763Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, the Netherlands ,grid.414711.60000 0004 0477 4812Maxima Medical Centre Eindhoven/Veldhoven, Eindhoven, The Netherlands ,grid.448801.10000 0001 0669 4689Health Innovations and Technology, Department of Paramedical Sciences, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Jasper Foolen
- grid.6852.90000 0004 0398 8763Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, the Netherlands ,grid.6852.90000 0004 0398 8763Institute of Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
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90
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Schwartz G, Morejon A, Best TM, Jackson AR, Travascio F. Strain-Dependent Diffusivity of Small and Large Molecules in Meniscus. J Biomech Eng 2022; 144:111010. [PMID: 35789377 PMCID: PMC9309715 DOI: 10.1115/1.4054931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/28/2022] [Indexed: 11/08/2022]
Abstract
Due to lack of full vascularization, the meniscus relies on diffusion through the extracellular matrix to deliver small (e.g., nutrients) and large (e.g., proteins) to resident cells. Under normal physiological conditions, the meniscus undergoes up to 20% compressive strains. While previous studies characterized solute diffusivity in the uncompressed meniscus, to date, little is known about the diffusive transport under physiological strain levels. This information is crucial to fully understand the pathophysiology of the meniscus. The objective of this study was to investigate strain-dependent diffusive properties of the meniscus fibrocartilage. Tissue samples were harvested from the central portion of porcine medial menisci and tested via fluorescence recovery after photobleaching to measure diffusivity of fluorescein (332 Da) and 40 K Da dextran (D40K) under 0%, 10%, and 20% compressive strain. Specifically, average diffusion coefficient and anisotropic ratio, defined as the ratio of the diffusion coefficient in the direction of the tissue collagen fibers to that orthogonal, were determined. For all the experimental conditions investigated, fluorescein diffusivity was statistically faster than that of D40K. Also, for both molecules, diffusion coefficients significantly decreased, up to ∼45%, as the strain increased. In contrast, the anisotropic ratios of both molecules were similar and not affected by the strain applied to the tissue. This suggests that compressive strains used in this study did not alter the diffusive pathways in the meniscus. Our findings provide new knowledge on the transport properties of the meniscus fibrocartilage that can be leveraged to further understand tissue pathophysiology and approaches to tissue restoration.
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Affiliation(s)
- Gabi Schwartz
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL 33146
| | - Andy Morejon
- Department of Mechanical and Aerospace Engineering, University of Miami, Coral Gables, FL 33146
| | - Thomas M Best
- Department of Orthopaedic Surgery, University of Miami, Miami, FL 33136; Department of Biomedical Engineering, University of Miami, Coral Gables, FL 33146;UHealth Sports Medicine Institute, Coral Gables, FL 33146
| | - Alicia R Jackson
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL 33146
| | - Francesco Travascio
- Department of Mechanical and Aerospace Engineering, University of Miami, Coral Gables, FL 33146; Department of Orthopaedic Surgery, University of Miami, Miami, FL 33136; Max Biedermann Institute for Biomechanics at Mount, Sinai Medical Center, Miami Beach, FL 33140
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91
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Marmura H, Firth A, Batty L, Bryant DM, Getgood AMJ, Bryant D, Litchfield R, Willits K, Birmingham T, Hewison C, Wanlin S, Firth A, Pinto R, Martindale A, O’Neill L, Jennings M, Daniluk M, Boyer D, McCormack B, Zomar M, Moon K, Moon R, Fan B, Mohan B, Heard M, Buchko GM, Hiemstra LA, Kerslake S, Tynedal J, MacDonald P, Stranges G, Mcrae S, Gullett L, Brown H, Legary A, Longo A, Christian M, Ferguson C, Rezansoff A, Mohtadi N, Barber R, Chan D, Campbell C, Garven A, Pulsifer K, Mayer M, Peterson D, Simunovic N, Duong A, Robinson D, Levy D, Skelly M, Shanmugaraj A, Bardana D, Howells F, Tough M, Spalding T, Thompson P, Metcalfe A, Asplin L, Dube A, Clarkson L, Brown J, Bolsover A, Bradshaw C, Belgrove L, Millan F, Turner S, Verdugo S, Lowe J, Dunne D, McGowan K, Suddens CM, Verdonk P, Declerq G, Vuylsteke K, Van Haver M. Meniscal repair at the time of primary ACLR does not negatively influence short term knee stability, graft rupture rates, or patient-reported outcome measures: the STABILITY experience. Knee Surg Sports Traumatol Arthrosc 2022; 30:3689-3699. [PMID: 35451638 DOI: 10.1007/s00167-022-06962-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 03/24/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess how meniscal repair and excision impact short term patient-reported outcome measures (PROMs), knee stability, and early graft rupture rates following primary hamstring anterior cruciate ligament reconstruction (ACLR) with or without lateral extra-articular tenodesis (LET) in a group of young active patients where meniscal repair is commonly advocated. METHODS Six hundred and eighteen patients under 25 years of age at high-risk of graft failure following ACLR were recruited to the Stability 1 study. Multivariable regression models were developed to identify statistically and clinically significant surgical and demographic predictors of Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee Subjective Knee Form (IKDC), ACL Quality of Life Questionnaire (ACL-QOL) and Marx Activity Rating Scale (MARS) scores. Chi-Square tests of independence were used to explore the association between meniscal status (torn, not torn), meniscal treatment (excision or repair), graft rupture, and rotatory knee laxity. RESULTS Medial meniscus repair was associated with worse outcomes on the KOOS (β = -1.32, 95% CI: -1.57 to -1.10, p = 0.003), IKDC (β = -1.66, 95% CI: -1.53 to -1.02, p = 0.031) and ACL-QOL (β = -1.25, 95% CI: -1.61 to 1.02, p = n.s.). However, these associations indicated small, clinically insignificant changes based on reported measures of clinical relevance. Other important predictors of post-operative PROMs included age, sex, and baseline scores. Medial meniscus excision and lateral meniscus treatment (repair or excision) did not have an important influence on PROMs. There was no significant association between meniscal treatment and graft rupture or rotatory knee laxity. CONCLUSION While repairing the medial meniscus may result in a small reduction in PROM scores at two-year follow-up, these differences are not likely to be important to patients or clinicians. Any surgical morbidity associated with meniscal repair appears negligible in terms of PROMs. Meniscal repair does not affect rotatory laxity or graft failure rates in the short term. Therefore, meniscal repair should likely be maintained as the standard of care for concomitant meniscal tears with ACLR. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hana Marmura
- Faculty of Health Sciences, Western University, London, Canada.,Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, London, ON, N6K 4P3, Canada.,Bone and Joint Institute, Western University, London, Canada.,Lawson Research, London Health Sciences Centre, London, Canada
| | - Andrew Firth
- Faculty of Health Sciences, Western University, London, Canada.,Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, London, ON, N6K 4P3, Canada.,Bone and Joint Institute, Western University, London, Canada.,Lawson Research, London Health Sciences Centre, London, Canada
| | - Lachlan Batty
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, London, ON, N6K 4P3, Canada.,OrthoSport Victoria Research Unit, Richmond, Australia.,St. Vincent's Hospital, Melbourne, Australia
| | - Dianne M Bryant
- Faculty of Health Sciences, Western University, London, Canada.,Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, London, ON, N6K 4P3, Canada.,Bone and Joint Institute, Western University, London, Canada.,Lawson Research, London Health Sciences Centre, London, Canada.,Schulich School of Medicine and Dentistry, Western University, London, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Alan M J Getgood
- Faculty of Health Sciences, Western University, London, Canada. .,Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, London, ON, N6K 4P3, Canada. .,Bone and Joint Institute, Western University, London, Canada. .,Lawson Research, London Health Sciences Centre, London, Canada. .,Schulich School of Medicine and Dentistry, Western University, London, Canada.
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92
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McCloskey MC, Zhang VZ, Ahmad SD, Walker S, Romanick SS, Awad HA, McGrath JL. Sourcing cells for in vitro models of human vascular barriers of inflammation. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:979768. [PMID: 36483299 PMCID: PMC9724237 DOI: 10.3389/fmedt.2022.979768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/29/2022] [Indexed: 07/20/2023] Open
Abstract
The vascular system plays a critical role in the progression and resolution of inflammation. The contributions of the vascular endothelium to these processes, however, vary with tissue and disease state. Recently, tissue chip models have emerged as promising tools to understand human disease and for the development of personalized medicine approaches. Inclusion of a vascular component within these platforms is critical for properly evaluating most diseases, but many models to date use "generic" endothelial cells, which can preclude the identification of biomedically meaningful pathways and mechanisms. As the knowledge of vascular heterogeneity and immune cell trafficking throughout the body advances, tissue chip models should also advance to incorporate tissue-specific cells where possible. Here, we discuss the known heterogeneity of leukocyte trafficking in vascular beds of some commonly modeled tissues. We comment on the availability of different tissue-specific cell sources for endothelial cells and pericytes, with a focus on stem cell sources for the full realization of personalized medicine. We discuss sources available for the immune cells needed to model inflammatory processes and the findings of tissue chip models that have used the cells to studying transmigration.
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Affiliation(s)
- Molly C. McCloskey
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States
| | - Victor Z. Zhang
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States
| | - S. Danial Ahmad
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States
| | - Samuel Walker
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States
| | - Samantha S. Romanick
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States
| | - Hani A. Awad
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, United States
| | - James L. McGrath
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States
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93
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Wang J, Roberts S, Li W, Wright K. Phenotypic characterization of regional human meniscus progenitor cells. Front Bioeng Biotechnol 2022; 10:1003966. [PMID: 36338137 PMCID: PMC9629835 DOI: 10.3389/fbioe.2022.1003966] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/28/2022] [Indexed: 10/31/2023] Open
Abstract
Stimulating meniscus regeneration using meniscal progenitor cells has been suggested as a promising new strategy. However, there is a lack of studies which decisively identify and characterize progenitor cell populations in human meniscus tissues. In this study, donor-matched progenitor cells were isolated via selective fibronectin adhesion from the avascular and vascular regions of the meniscus and chondroprogenitors from articular cartilage (n = 5). The mixed populations of cells from these regions were obtained by standard isolation techniques for comparison. The colony formation efficacy of avascular progenitors, vascular progenitors and chondroprogenitors was monitored using Cell-IQ® live cell imaging. Proliferation rates of progenitors were compared with their mixed population counterparts. Cell surface markers indicative of mesenchymal stromal cells profile and progenitor markers were characterized by flow cytometry in all populations. The fibrochondrogenic capacity was assessed via fibrochondrogenic differentiation and measuring GAG/DNA content and morphology. All meniscal progenitor and chondroprogenitor populations showed superior colony forming efficacy and faster proliferation rates compare to their mixed populations. Progenitor populations showed significantly higher positivity for CD49b and CD49c compared to their mixed population counterparts and chondroprogenitors had a higher positivity level of CD166 compared to mixed chondrocytes. GAG/DNA analysis demonstrated that progenitor cells generally produced more GAG than mixed populations. Our study demonstrates that the human meniscus contains meniscal progenitor populations in both the avascular and vascular regions. Meniscal progenitors derived from the vascular region exhibit enhanced proliferative and fibrochondrogenic characteristics compared to those from the avascular region; this may associate with the enhanced meniscal healing potential in the vascular region. These findings build on the body of evidence which suggests that meniscal progenitors represent an attractive cell therapy strategy for meniscal regeneration.
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Affiliation(s)
- Jingsong Wang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Spinal Studies & Cartilage Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust, Oswestry, United Kingdom
- School of Pharmacy and Bioengineering, Keele University, Staffordshire, United Kingdom
| | - Sally Roberts
- Spinal Studies & Cartilage Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust, Oswestry, United Kingdom
- School of Pharmacy and Bioengineering, Keele University, Staffordshire, United Kingdom
| | - Weiping Li
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Karina Wright
- Spinal Studies & Cartilage Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust, Oswestry, United Kingdom
- School of Pharmacy and Bioengineering, Keele University, Staffordshire, United Kingdom
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94
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Trisolino G, Stallone S, Grassi A, Olivotto E, Battistelli M, Zarantonello P, Gallone G, Ferrari D, Di Gennaro GL, Zaffagnini S. The discoid lateral meniscus in children: a narrative review of pathology, diagnosis and treatment. ANNALS OF JOINT 2022; 7:38. [PMID: 38529145 PMCID: PMC10929324 DOI: 10.21037/aoj-21-31] [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: 11/17/2021] [Accepted: 06/01/2022] [Indexed: 03/27/2024]
Abstract
Background and Objective The discoid lateral meniscus (DLM) is a congenital abnormality of the meniscal shape, characterized by a typical central hypertrophy and a diameter larger than a regular meniscus, potentially leading to knee pain and symptoms, especially in children. The present study provides an update and a general review of this uncommon meniscal pathology. The incidence of discoid meniscus is about 0.4-17% for the lateral and 0.1-0.3% for the medial, although, being often asymptomatic, the true prevalence is unknown. We aim to enhance awareness on this subject to medical care provider. Methods A literature search was performed on PubMed, including articles written in English until October 2021. Key Content and Findings The articles regarding etiology, diagnosis and management of DLM in children or in patients younger than 18 years were reviewed using the narrative approach. Conclusions Recent literature has shown that DLM is one of the most frequent congenital anomalies of the knee encountered during childhood. While asymptomatic children with incidental finding can be managed nonoperatively, symptomatic painful DLM should be addressed surgically, restoring typical anatomy using saucerization, tear repair, and stable fixation of the meniscus. The risk of osteoarthritis progression seems to be higher in children with operated DLM, imposing prolonged follow-up and cartilage preserving strategies for these patients.
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Affiliation(s)
- Giovanni Trisolino
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Stallone
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Grassi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Eleonora Olivotto
- RAMSES Laboratory, RIT Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Michela Battistelli
- Department of Biomolecular Sciences, University of Urbino “Carlo Bo”, Urbino, Italy
| | - Paola Zarantonello
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giovanni Gallone
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Daniele Ferrari
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Stefano Zaffagnini
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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95
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Desai S, Dooner M, Newberry J, Twomey-Kozak J, Molino J, Trivedi J, Patel JM, Owens BD, Jayasuriya CT. Stable human cartilage progenitor cell line stimulates healing of meniscal tears and attenuates post-traumatic osteoarthritis. Front Bioeng Biotechnol 2022; 10:970235. [PMID: 36312551 PMCID: PMC9596807 DOI: 10.3389/fbioe.2022.970235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/03/2022] [Indexed: 11/22/2022] Open
Abstract
Meniscal tearing in the knee increases the risk of post-traumatic osteoarthritis (OA) in patients. The therapeutic application of tissue-specific mesenchymal progenitor cells is currently being investigated as an emerging biologic strategy to help improve healing of musculoskeletal tissues like meniscal fibrocartilage and articular hyaline cartilage. However, many of these approaches involve isolating cells from healthy tissues, and the low yield of rare progenitor populations (< 1% of total cells residing in tissues) can make finding a readily available cell source for therapeutic use a significant logistical challenge. In the present study, we investigated the therapeutic efficacy of using expanded cartilage-derived and bone marrow-derived progenitor cell lines, which were stabilized using retroviral SV40, for repair of meniscus injury in a rodent model. Our findings indicate that these cell lines express the same cell surface marker phenotype of primary cells (CD54+, CD90+, CD105+, CD166+), and that they exhibit improved proliferative capacity that is suitable for extensive expansion. Skeletally mature male athymic rats treated with 3.2 million cartilage-derived progenitor cell line exhibited approximately 79% greater meniscal tear reintegration/healing, compared to injured animals that left untreated, and 76% greater compared to animals treated with the same number of marrow-derived stromal cells. Histological analysis of articular surfaces also showed that cartilage-derived progenitor cell line treated animals exhibited reduced post-traumatic OA associated articular cartilage degeneration. Stable cell line treatment did not cause tumor formation or off-target engraftment in animals. Taken together, we present a proof-of-concept study demonstrating, for the first time, that intra-articular injection of a stable human cartilage-derived progenitor cell line stimulates meniscus tear healing and provide chondroprotection in an animal model. These outcomes suggest that the use of stable cell lines may help overcome cell source limitations for cell-based medicine.
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Affiliation(s)
- Salomi Desai
- Department of Orthopaedics, Warren Alpert Medical School of Brown University and the Rhode Island Hospital, Providence, RI, United States
| | - Mark Dooner
- Department of Medicine, Division of Hematology Oncology, Rhode Island Hospital, Providence, RI, United States
| | - Jake Newberry
- Department of Orthopaedics, Warren Alpert Medical School of Brown University and the Rhode Island Hospital, Providence, RI, United States
| | - John Twomey-Kozak
- Department of Orthopaedics, Warren Alpert Medical School of Brown University and the Rhode Island Hospital, Providence, RI, United States
| | - Janine Molino
- Department of Orthopaedics, Warren Alpert Medical School of Brown University and the Rhode Island Hospital, Providence, RI, United States
| | - Jay Trivedi
- Department of Orthopaedics, Warren Alpert Medical School of Brown University and the Rhode Island Hospital, Providence, RI, United States
| | - Jay M. Patel
- Department of Orthopaedics, Emory University, Atlanta, GA, United States
| | - Brett D. Owens
- Department of Orthopaedics, Warren Alpert Medical School of Brown University and the Rhode Island Hospital, Providence, RI, United States
| | - Chathuraka T. Jayasuriya
- Department of Orthopaedics, Warren Alpert Medical School of Brown University and the Rhode Island Hospital, Providence, RI, United States
- *Correspondence: Chathuraka T. Jayasuriya,
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96
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Wang S, Hase K, Kita S, Ogaya S. Biomechanical effects of medial meniscus radial tears on the knee joint during gait: A concurrent finite element musculoskeletal framework investigation. Front Bioeng Biotechnol 2022; 10:957435. [PMID: 36299291 PMCID: PMC9589217 DOI: 10.3389/fbioe.2022.957435] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/26/2022] [Indexed: 11/22/2022] Open
Abstract
The biomechanical variation in the knee during walking that accompanies medial meniscal radial tears stemming from knee osteoarthritis (OA) has not been explored. This study introduced a finite element musculoskeletal model using concurrent lower limb musculoskeletal dynamics and knee joint finite element analysis in a single framework and expanded the models to include knees with medial meniscal radial tears and total medial meniscectomy. The radial tears involved three locations: anterior horn, midbody, and posterior horn with grades of 33%, 50%, and 83% of the meniscus width. The shear and hoop stresses of the tear meniscus and tibial cartilage contact load, accompanying tears, and postmeniscectomy were evaluated during the stance phase of the gait cycle using the models. In the 83% width midbody tear group, shear stress at the end of the tear was significantly greater than in the intact meniscus and other tear groups, and the maximum shear stress was increased by 310% compared to the intact meniscus. A medial meniscus radial tear has a much smaller effect on the tibial cartilage load (even though in the 83% width tear, the cartilage/total load ratio increased by only 9%). However, the contact force on the tibial cartilage with total postmeniscectomy was increased by 178.93% compared with a healthy intact meniscus, and the peak contact pressure after meniscectomy increased from 11.94 to 12.45 MPa to 17.64 and 13.76 MPa, at the maximum weight acceptance and push-off, respectively. Our study shows that radial tears with larger medial meniscus widths are prone to high stress concentrations at the end of the tears, leading to the potential risk of complete meniscal rupture. Furthermore, although the tears did not change the cartilage load distribution, they disrupted the circumferential stress-transmitting function of the meniscus, thus greatly increasing the likelihood of the onset of knee OA. The significant increase in the tibial cartilage load with total postmeniscectomy indicates a potential risk of OA flare-ups. This study contributes to a better understanding of meniscal tear-induced OA biomechanical changes during human activities and offers some potential directions for surgical guidance of meniscectomies and the prophylaxis and treatment of OA.
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Affiliation(s)
- Sentong Wang
- Human-Mechanical System Laboratory, Graduate School of Systems Design, Tokyo Metropolitan University, Hachioji, Japan
- *Correspondence: Sentong Wang, ; Kazunori Hase,
| | - Kazunori Hase
- Human-Mechanical System Laboratory, Faculty of Systems Design, Tokyo Metropolitan University, Hachioji, Japan
- *Correspondence: Sentong Wang, ; Kazunori Hase,
| | - Shunsuke Kita
- Biomechanics of Exercise and Sports in Physical Therapy Laboratory, Graduate Course of Health and Social Services, Saitama Prefectural University, Koshigaya, Japan
- Department of Rehabilitation, Soka Orthopedics Internal Medicine, Saitama, Japan
| | - Shinya Ogaya
- Biomechanics of Exercise and Sports in Physical Therapy Laboratory, Department of Physical Therapy, Saitama Prefectural University, Koshigaya, Japan
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97
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Ghouri A, Muzumdar S, Barr AJ, Robinson E, Murdoch C, Kingsbury SR, Conaghan PG. The relationship between meniscal pathologies, cartilage loss, joint replacement and pain in knee osteoarthritis: a systematic review. Osteoarthritis Cartilage 2022; 30:1287-1327. [PMID: 35963512 DOI: 10.1016/j.joca.2022.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 08/01/2022] [Accepted: 08/01/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We conducted a systematic review in order to understand the relationship between imaging-visualised meniscus pathologies, hyaline cartilage, joint replacement and pain in knee osteoarthritis (OA). DESIGN A search of the Medline, Excerpta Medica database (EMBASE) and Cochrane library databases was performed for original publications reporting association between imaging-detected meniscal pathology (extrusion or tear/damage) and longitudinal and cross-sectional assessments of hyaline articular cartilage loss [assessed on magnetic resonance imaging (MRI)], incident joint replacement and pain (longitudinal and cross-sectional) in knee OA. Each association was qualitatively characterised by a synthesis of data from each analysis, based upon study design and quality scoring (including risk of bias assessment and adequacy of covariate adjustment using Cochrane recommended methodology). RESULTS In total 4,878 abstracts were screened and 82 publications were included (comprising 72 longitudinal analyses and 49 cross-sectional). Using high quality, well-adjusted data, meniscal extrusion and meniscal tear/damage were associated with longitudinal progression of cartilage loss, cross-sectional cartilage loss severity and joint replacement, independently of age, sex and body mass index (BMI). Medial and lateral meniscal tears were associated with cartilage loss when they occurred in the body and posterior horns, but not the anterior horns. There was a lack of high quality, well-adjusted meniscal pathology and pain publications and no clear independent association between meniscal extrusion or tear/damage with pain severity, progression in pain or incident frequent knee symptoms. CONCLUSION Meniscal features have strong associations with cartilage loss and joint replacement in knee OA, but weak associations with knee pain. Systematic review PROSPERO registration number: CRD 42020210910.
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Affiliation(s)
- A Ghouri
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK.
| | | | - A J Barr
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK.
| | - E Robinson
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK.
| | - C Murdoch
- Calderdale and Huddersfield NHS Foundation Trust, UK.
| | - S R Kingsbury
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK.
| | - P G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK.
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98
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Peng Y, Lu M, Zhou Z, Wang C, Liu E, Zhang Y, Liu T, Zuo J. Natural biopolymer scaffold for meniscus tissue engineering. Front Bioeng Biotechnol 2022; 10:1003484. [PMID: 36246362 PMCID: PMC9561892 DOI: 10.3389/fbioe.2022.1003484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/16/2022] [Indexed: 11/26/2022] Open
Abstract
Meniscal injuries caused by trauma, degeneration, osteoarthritis, or other diseases always result in severe joint pain and motor dysfunction. Due to the unique anatomy of the human meniscus, the damaged meniscus lacks the ability to repair itself. Moreover, current clinical treatments for meniscal injuries, including meniscal suturing or resection, have significant limitations and drawbacks. With developments in tissue engineering, biopolymer scaffolds have shown promise in meniscal injury repair. They act as templates for tissue repair and regeneration, interacting with surrounding cells and providing structural support for newly formed meniscal tissue. Biomaterials offer tremendous advantages in terms of biocompatibility, bioactivity, and modifiable mechanical and degradation kinetics. In this study, the preparation and composition of meniscal biopolymer scaffolds, as well as their properties, are summarized. The current status of research and future research prospects for meniscal biopolymer scaffolds are reviewed in terms of collagen, silk, hyaluronic acid, chitosan, and extracellular matrix (ECM) materials. Overall, such a comprehensive summary provides constructive suggestions for the development of meniscal biopolymer scaffolds in tissue engineering.
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Affiliation(s)
- Yachen Peng
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Meng Lu
- Department of Nursing, The First Bethune Hospital of Jilin University, Changchun, China
| | - Zhongsheng Zhou
- Scientific Research Center, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Chenyu Wang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Enbo Liu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yanbo Zhang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
- *Correspondence: Yanbo Zhang, ; Tong Liu, ; Jianlin Zuo,
| | - Tong Liu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
- *Correspondence: Yanbo Zhang, ; Tong Liu, ; Jianlin Zuo,
| | - Jianlin Zuo
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
- *Correspondence: Yanbo Zhang, ; Tong Liu, ; Jianlin Zuo,
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99
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Filbay SR, Skou ST, Bullock GS, Le CY, Räisänen AM, Toomey C, Ezzat AM, Hayden A, Culvenor AG, Whittaker JL, Roos EM, Crossley KM, Juhl CB, Emery C. Long-term quality of life, work limitation, physical activity, economic cost and disease burden following ACL and meniscal injury: a systematic review and meta-analysis for the OPTIKNEE consensus. Br J Sports Med 2022; 56:1465-1474. [PMID: 36171078 DOI: 10.1136/bjsports-2022-105626] [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] [Accepted: 09/19/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Determine the long-term health-related quality-of-life (HRQoL), work limitation, physical activity, health/economic cost and disease burden of traumatic ACL and/or meniscal injury. Findings will inform OPTIKNEE evidence-based consensus recommendations. DESIGN Random-effects meta-analysis evaluated HRQoL (SF-36/SF-12/VR-12 Physical Component Scores (PCS) and Mental Component Scores (MCS), EuroQol-5D (EQ-5D)) stratified by time postinjury, and pooled mean differences (95% CI) between ACL-injured and uninjured controls. Other outcomes were synthesised descriptively. Risk-of-bias (RoB) and certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation) were assessed. DATA SOURCES MEDLINE, EMBASE, CENTRAL, SPORTDiscus, CINAHL searched inception: 22 November 2021. ELIGIBILITY Studies reporting HRQoL, work limitations, physical activity levels, health/economic costs or disease burden, ≥2 years post-ACL and/or meniscal injury. RESULTS Fifty studies were included (10 high-RoB, 28 susceptible-to-some-bias and 12 low-RoB). Meta-analysis (27 studies, very low certainty of evidence) estimated a pooled mean (95% CI) PCS of 52.4 (51.4 to 53.4) and MCS of 54.0 (53.0 to 55.0) 2-14 years post-ACL injury. Pooled PCS scores were worse >10 years (50.8 (48.7 to 52.9)) compared with 2-5 years (53.9 (53.1 to 54.7)) postinjury. Excluding high-RoB studies, PCS scores were worse in ACL-injured compared with uninjured controls (-1.5 (-2.9 to -0.1)). Six studies (low certainty of evidence) informed a pooled EQ-5D score of 0.83 (0.81 to 0.84). Some individuals experienced prolonged work absenteeism and modified activities ≥2 years post-ACL injury. ACL injury was associated with significant direct and indirect costs, and early ACL reconstruction may be less cost-effective than rehabilitation. Only three studies evaluated meniscal injury outcomes (all evaluated HRQoL). CONCLUSION There is a very-low certainty of evidence that PCS scores ≥2 years post-ACL injury are worse than uninjured controls and decline over time, whereas MCS scores remain high. ACL injury can result in prolonged work absenteeism and high health/economic costs. Further studies are needed to determine the long-term burden of traumatic meniscal injury.
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Affiliation(s)
- Stephanie Rose Filbay
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Garrett S Bullock
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Christina Y Le
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.,Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Anu M Räisänen
- Department of Physical Therapy Education, Oregon, Western University of Health Sciences College of Health Sciences, Northwest, Lebanon, Oregon, USA.,Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Clodagh Toomey
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,School of Allied Health, University of Limerick, Limerick, Ireland
| | - Allison M Ezzat
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia.,Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Adam G Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Jackie L Whittaker
- Arthritis Research Canada, Richmond, British Columbia, Canada.,Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ewa M Roos
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Carsten Bogh Juhl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark
| | - Carolyn Emery
- Kinesiology, University of Calgary, Calgary, Alberta, Canada
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100
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Herrera Millar VR, Canciani B, Mangiavini L, Filipe JFS, Aidos L, Pallaoro M, Peretti GM, Pocar P, Modina SC, Di Giancamillo A. Endostatin in 3D Fibrin Hydrogel Scaffolds Promotes Chondrogenic Differentiation in Swine Neonatal Meniscal Cells. Biomedicines 2022; 10:biomedicines10102415. [PMID: 36289678 PMCID: PMC9598439 DOI: 10.3390/biomedicines10102415] [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: 07/28/2022] [Revised: 09/16/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
The success of cell-based approaches for the treatment of cartilage or fibro-cartilaginous tissue defects requires an optimal cell source with chondrogenic differentiation ability that maintains its differentiated properties and stability following implantation. For this purpose, the aim of this study was to evaluate the use of endostatin (COL18A1), an anti-angiogenic factor, which is physiologically involved in cell differentiation during meniscus development. Swine neonatal meniscal cells not yet subjected to mechanical stimuli were extracted, cultured in fibrin hydrogel scaffolds, and treated at two different time points (T1 = 9 days and T2 = 21 days) with different concentrations of COL18A1 (10 ng/mL; 100 ng/mL; 200 ng/mL). At the end of the treatments, the scaffolds were examined through biochemical, molecular, and histochemical analyses. The results showed that the higher concentration of COL18A1 promotes a fibro-chondrogenic phenotype and improves cellularity index (DNA content, p < 0.001) and cell efficiency (GAGs/DNA ratio, p < 0.01) after 21 days. These data are supported by the molecular analysis of collagen type I (COL1A1, a marker of fibrous-like tissue, p < 0.001), collagen type II (COL2A1, a marker of cartilaginous-like tissue, p < 0.001) and SRY-Box Transcription Factor 9 (SOX9, an early marker of chondrogenicity, p < 0.001), as well as by histological analysis (Safranin-O staining), laying the foundations for future studies evaluating the involvement of 3D endostatin hydrogel scaffolds in the differentiation of avascular tissues.
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Affiliation(s)
| | - Barbara Canciani
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161 Milano, Italy
| | - Laura Mangiavini
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli 31, 20133 Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161 Milano, Italy
| | - Joel Fernando Soares Filipe
- Department of Veterinary Medicine and Animal Sciences (DIVAS), University of Milan, Via dell’Università 6, 26900 Lodi, Italy
| | - Lucia Aidos
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli 31, 20133 Milan, Italy
| | - Margherita Pallaoro
- Department of Veterinary Medicine and Animal Sciences (DIVAS), University of Milan, Via dell’Università 6, 26900 Lodi, Italy
| | - Giuseppe Maria Peretti
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli 31, 20133 Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161 Milano, Italy
| | - Paola Pocar
- Department of Veterinary Medicine and Animal Sciences (DIVAS), University of Milan, Via dell’Università 6, 26900 Lodi, Italy
| | - Silvia Clotilde Modina
- Department of Veterinary Medicine and Animal Sciences (DIVAS), University of Milan, Via dell’Università 6, 26900 Lodi, Italy
| | - Alessia Di Giancamillo
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli 31, 20133 Milan, Italy
- Correspondence:
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