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Impact of Simulated Knee Injuries on the Patellofemoral and Tibiofemoral Kinematics Investigated with an Electromagnetic Tracking Approach: A Cadaver Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7189714. [PMID: 29850554 PMCID: PMC5937613 DOI: 10.1155/2018/7189714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/13/2018] [Accepted: 03/12/2018] [Indexed: 01/01/2023]
Abstract
Purpose The purpose of this study was to evaluate the approach of using an electromagnetic tracking (EMT) system for measuring the effects of stepwise, simulated knee injuries on patellofemoral (PF) and tibiofemoral (TF) kinematics. Methods Three cadaver knees were placed in a motion rig. EMT sensors were mounted on the patella, the medial/lateral femoral epicondyles, the tibial condyle, and the tibial tuberosity (TT). After determining the motion of an intact knee, three injuries were simulated and the resulting bony motion was tracked. Results Starting with the intact knee fully extended (0° flexion) and bending it to approximately 20°, the patella shifted slightly in the medial direction. Then, while bending the knee to the flexed position (90° flexion), the patella shifted progressively more laterally. After transecting the anterior cruciate ligament (ACL), the base of the medial menisci (MM) at the pars intermedia, and the medial collateral ligament (MCL), individual changes were observed. For example, the medial femoral epicondyle displayed a medial lift-off in all knees. Conclusion We demonstrated that our EMT approach is an acceptable method to accurately measure PF joint motion. This method could also enable visualization and in-depth analysis of in vivo patellar function in total knee arthroplasty, if it is established for routine clinical use.
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Southam BR, Colosimo AJ, Grawe B. Underappreciated Factors to Consider in Revision Anterior Cruciate Ligament Reconstruction: A Current Concepts Review. Orthop J Sports Med 2018; 6:2325967117751689. [PMID: 29399591 PMCID: PMC5788104 DOI: 10.1177/2325967117751689] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Primary anterior cruciate ligament (ACL) reconstructions (ACLRs) are being performed with increasing frequency. While many of these will have successful outcomes, failures will occur in a subset of patients who will require revision ACLRs. As such, the number of revision procedures will continue to rise as well. While many reviews have focused on factors that commonly contribute to failure of primary ACLR, including graft choice, patient factors, early return to sport, and technical errors, this review focused on several factors that have received less attention in the literature. These include posterior tibial slope, varus malalignment, injury to the anterolateral ligament, and meniscal injury or deficiency. This review also appraised several emerging techniques that may be useful in the context of revision ACL surgery. While outcomes of revision ACLR are generally inferior to those of primary procedures, identifying these potentially underappreciated contributing factors preoperatively will allow the surgeon to address them at the time of revision, ideally improving patient outcomes and preventing recurrent ACL failure.
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Affiliation(s)
- Brendan R Southam
- Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Angelo J Colosimo
- Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Brian Grawe
- Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA
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Yin P, Li JS, Kernkamp WA, Tsai TY, Baek SH, Hosseini A, Lin L, Tang P, Li G. Analysis of in-vivo articular cartilage contact surface of the knee during a step-up motion. Clin Biomech (Bristol, Avon) 2017; 49:101-106. [PMID: 28910722 PMCID: PMC5681875 DOI: 10.1016/j.clinbiomech.2017.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 09/04/2017] [Accepted: 09/07/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Numerous studies have reported on the tibiofemoral articular cartilage contact kinematics, however, no data has been reported on the articular cartilage geometry at the contact area. This study investigated the in-vivo tibiofemoral articular cartilage contact biomechanics during a dynamic step-up motion. METHODS Ten healthy subjects were imaged using a validated magnetic resonance and dual fluoroscopic imaging technique during a step-up motion. Three-dimensional bone and cartilage models were constructed from the magnetic resonance images. The cartilage contact along the motion path was analyzed, including cartilage contact location and the cartilage surface geometry at the contact area. FINDINGS The cartilage contact excursions were similar in anteroposterior and mediolateral directions in the medial and lateral compartments of the tibia plateau (P>0.05). Both medial and lateral compartments were under convex (femur) to convex (tibia) contact in the sagittal plane, and under convex (femur) to concave (tibia) contact in the coronal plane. The medial tibial articular contact radius was larger than the lateral side in the sagittal plane along the motion path (P<0.001). INTERPRETATIONS These data revealed that both the medial and lateral compartments of the knee experienced convex (femur) to convex (tibia) contact in sagittal plane (or anteroposterior direction) during the dynamic step-up motion. These data could provide new insight into the in-vivo cartilage contact biomechanics research, and may provide guidelines for development of anatomical total knee arthroplasties that are aimed to reproduce normal knee joint kinematics.
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Affiliation(s)
- Peng Yin
- Orthopaedic Biomechanics Laboratory, Harvard Medical School and Massachusetts General Hospital, Boston, MA, 02114, USA,Department of Orthopaedics, Beijing Chao-Yang Hospital, China Capital Medical University, No. 8 GongTiNanLu, Chao-Yang District, Beijing, 100020, China
| | - Jing-Sheng Li
- Orthopaedic Biomechanics Laboratory, Harvard Medical School and Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Willem A. Kernkamp
- Orthopaedic Biomechanics Laboratory, Harvard Medical School and Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Tsung-Yuan Tsai
- Orthopaedic Biomechanics Laboratory, Harvard Medical School and Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Seung-Hoon Baek
- Orthopaedic Biomechanics Laboratory, Harvard Medical School and Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Ali Hosseini
- Orthopaedic Biomechanics Laboratory, Harvard Medical School and Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Lin Lin
- Institute of Sports Medicine, Peking University Third hospital, North Garden Road, Haidian District, Beijing, 100191, PR China
| | - Peifu Tang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, P.R. China
| | - Guoan Li
- Orthopaedic Biomechanics Laboratory, Harvard Medical School and Massachusetts General Hospital, Boston, MA, 02114, USA,CORRESPONDING AUTHOR. Guoan Li, Orthopaedic Biomechanics Laboratory, Harvard Medical School and Newton-Wellesley Hospital, 159 Wells Avenue, Newton, MA 02459, USA. (G. Li)
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Abram SGF, Middleton R, Beard DJ, Price AJ, Hopewell S. Patient-reported outcome measures for patients with meniscal tears: a systematic review of measurement properties and evaluation with the COSMIN checklist. BMJ Open 2017; 7:e017247. [PMID: 29030413 PMCID: PMC5652504 DOI: 10.1136/bmjopen-2017-017247] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/23/2017] [Accepted: 08/25/2017] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Meniscal tears occur frequently in the population and the most common surgical treatment, arthroscopic partial meniscectomy, is performed in approximately two million cases worldwide each year. The purpose of this systematic review is to summarise and critically appraise the evidence for the use of patient-reported outcome measures (PROMs) in patients with meniscal tears. DESIGN A systematic review was undertaken. Data on reported measurement properties were extracted and the quality of the studies appraised according to Consensus-based Standards for the Selection of Health Measurement Instruments. DATA SOURCES A search of MEDLINE, Embase, AMED and PsycINFO, unlimited by language or publication date (last search 20 February 2017). ELIGIBILITY CRITERIA FOR SELECTING STUDIES Development and validation studies reporting the measurement properties of PROMs in patients with meniscal tears were included. RESULTS 11 studies and 10 PROMs were included. The overall quality of studies was poor. For measurement of symptoms and functional status, there is only very limited evidence supporting the selection of either the Lysholm Knee Scale, International Knee Documentation Committee Subjective Knee Form or the Dutch version of the Knee injury and Osteoarthritis Outcome Score. For measuring health-related quality of life, only limited evidence supports the selection of the Western Ontario Meniscal Evaluation Tool (WOMET). Of all the PROMs evaluated, WOMET has the strongest evidence for content validity. CONCLUSION For patients with meniscal tears, there is poor quality and incomplete evidence regarding the validity of the currently available PROMs. Further research is required to ensure these PROMs truly reflect the symptoms, function and quality of life of patients with meniscal tears. PROPERO REGISTRATION NUMBER CRD42017056847.
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Affiliation(s)
- Simon G F Abram
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Robert Middleton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David J Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Monibi FA, Cook JL. Tissue-Derived Extracellular Matrix Bioscaffolds: Emerging Applications in Cartilage and Meniscus Repair. TISSUE ENGINEERING PART B-REVIEWS 2017; 23:386-398. [DOI: 10.1089/ten.teb.2016.0431] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Farrah A. Monibi
- Thompson Laboratory for Regenerative Orthopedics, Department of Orthopedic Surgery, Missouri Orthopedic Institute, University of Missouri, Columbia, Missouri
| | - James L. Cook
- Thompson Laboratory for Regenerative Orthopedics, Department of Orthopedic Surgery, Missouri Orthopedic Institute, University of Missouri, Columbia, Missouri
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Bhadra AK, Altman R, Dasa V, Myrick K, Rosen J, Vad V, Vitanzo P, Bruno M, Kleiner H, Just C. Appropriate Use Criteria for Hyaluronic Acid in the Treatment of Knee Osteoarthritis in the United States. Cartilage 2017; 8:234-254. [PMID: 28618868 PMCID: PMC5625860 DOI: 10.1177/1947603516662503] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE A workgroup of clinical experts has developed an Appropriate Use Criteria (AUC) for the use of hyaluronic acid (HA) in the treatment of osteoarthritis (OA) of the knee. The increasingly broad and varied use of HA injections, lack of published clinical guidance, and limited coverage for their use has created the imperative to establish appropriateness criteria. METHODS The experts of this workgroup represent rheumatology, orthopedic surgery, physiatry, sports medicine, and nursing clinicians with substantive knowledge of intra-articular HA therapy. This workgroup utilized the results of a systematic review of evidence, expert clinical opinion, and current evidence-based clinical practice guidelines to develop appropriateness criteria for the use of intra-articular HA for knee OA in 17 real-world clinical scenarios. RESULTS The workgroup scored the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as appropriate (7-9), uncertain (4-6), or inappropriate (1-3). Six scenarios were scored as appropriate, 10 scenarios were scored as uncertain, and 1 scenario was scored as inappropriate. CONCLUSION This article can assist clinicians in shared decision-making by providing best practices in considering HA injections for knee OA treatment. Moreover, this AUC article can aid payers and policy makers in determining reimbursement and preauthorization policies and more appropriately managing health care resources. It is clear that further research is still necessary-particularly in patient populations differentiated by OA severity-that may benefit the greatest from the use of HA injections for the treatment of knee OA.
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Affiliation(s)
- Arup K. Bhadra
- Northeast Orthopedics and Sports Medicine, Airmont, NY, USA
| | - Roy Altman
- Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Vinod Dasa
- LSU Health Sciences Center Department of Orthopaedics, New Orleans, LA, USA
- LSU School of Medicine, New Orleans, LA, USA
| | - Karen Myrick
- Quinnipiac University School of Nursing, Joint Appointment Frank Netter School of Medicine, North Haven, CT, USA
- Orthopedic Associates, Farmington, CT, USA
| | - Jeffrey Rosen
- Department of Orthopaedics and Rehabilitation, New York-Presbyterian/Queens Hospital, New York, NY, USA
- Weill Medical College of Cornell University, New York, NY, USA
| | - Vijay Vad
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA
| | - Peter Vitanzo
- Rothman Institute at Jefferson, Philadelphia, PA, USA
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Rothrauff BB, Shimomura K, Gottardi R, Alexander PG, Tuan RS. Anatomical region-dependent enhancement of 3-dimensional chondrogenic differentiation of human mesenchymal stem cells by soluble meniscus extracellular matrix. Acta Biomater 2017; 49:140-151. [PMID: 27876676 PMCID: PMC5543932 DOI: 10.1016/j.actbio.2016.11.046] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/12/2016] [Accepted: 11/18/2016] [Indexed: 02/07/2023]
Abstract
Extracellular matrix (ECM) derived from decellularized tissues has been found to promote tissue neogenesis, most likely mediated by specific biochemical and physical signaling motifs that promote tissue-specific differentiation of progenitor cells. Decellularized ECM has been suggested to be efficacious for the repair of tissue injuries. However, decellularized meniscus contains a dense collagenous structure, which impedes cell seeding and infiltration and is not readily applicable for meniscus repair. In addition, the meniscus consists of two distinct anatomical regions that differ in vascularity and cellular phenotype. The purpose of this study was to explore the region-specific bioactivity of solubilized ECM derived from the inner and outer meniscal regions as determined in 2D and 3D cultures of adult mesenchymal stem cells (MSCs). When added as a medium supplement to 2D cultures of MSCs, urea-extracted fractions of the inner (imECM) and outer meniscal ECM (omECM) enhanced cell proliferation while imECM most strongly upregulated fibrochondrogenic differentiation on the basis of gene expression profiles. When added to 3D cultures of MSCs seeded in photocrosslinked methacrylated gelatin (GelMA) hydrogels, both ECM fractions upregulated chondrogenic differentiation as determined by gene expression and protein analyses, as well as elevated sulfated glycosaminoglycan sGAG content, compared to ECM-free controls. The chondrogenic effect at day 21 was most pronounced with imECM supplementation, but equivalent between ECM groups by day 42. Despite increased cartilage matrix, imECM and omECM constructs possessed compressive moduli similar to controls. In conclusion, soluble meniscal ECM may be considered for use as a tissue-specific reagent to enhance chondrogenesis for MSC-based 3D cartilage tissue engineering. STATEMENT OF SIGNIFICANCE The inner region of the knee meniscus is frequently injured and possesses a poor intrinsic healing capacity. Solubilized extracellular matrix (ECM) derived from decellularized meniscus tissue may promote homologous differentiation of progenitor cells, thereby enhancing fibrocartilage formation within a meniscal lesion. However, the meniscus possesses regional variation in ultrastructure, biochemical composition, and cell phenotype, which may affect the bioactivity of soluble ECM derived from different regions of decellularized menisci. In this study, we demonstrate that urea-extracted fractions of ECM derived from the inner and outer regions of menisci enhance chondrogenesis in mesenchymal stem cells seeded in 3-dimensional photocrosslinkable hydrogels and that this effect is more strongly mediated by inner meniscal ECM. These findings suggest region-specific bioactivity of decellularized meniscal ECM.
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Affiliation(s)
- Benjamin B Rothrauff
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15219, USA; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Kazunori Shimomura
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15219, USA; Medicine for Sports and Performing Arts, Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Riccardo Gottardi
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15219, USA; Fondazione RiMED, Italy
| | - Peter G Alexander
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Rocky S Tuan
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15219, USA; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15219, USA.
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