Joint anatomy, design, and arthroses: insights of the Utah paradigm

Accelerometer-measured physical activity is associated with knee breadth in middle-aged Finns - a population-based study

Background

Articular surface size is traditionally considered to be a relatively stable trait throughout adulthood. Increased joint size reduces bone and cartilage tissue strains. Although physical activity (PA) has a clear association with diaphyseal morphology, the association between PA and articular surface size is yet to be confirmed. This cross-sectional study aimed to clarify the role of moderate-to-vigorous PA (MVPA) in knee morphology in terms of tibiofemoral joint size.

Methods

A sample of 1508 individuals from the population-based Northern Finland Birth Cohort 1966 was used. At the age of 46, wrist-worn accelerometers were used to monitor MVPA (≥3.5 METs) during a period of two weeks, and knee radiographs were used to obtain three knee breadth measurements (femoral biepicondylar breadth, mediolateral breadth of femoral condyles, mediolateral breadth of the tibial plateau). The association between MVPA and knee breadth was analyzed using general linear models with adjustments for body mass index, smoking, education years, and accelerometer weartime.

Results

Of the sample, 54.8% were women. Most individuals were non-smokers (54.6%) and had 9—12 years of education (69.6%). Mean body mass index was 26.2 (standard deviation 4.3) kg/m². MVPA was uniformly associated with all three knee breadth measurements among both women and men. For each 60 minutes/day of MVPA, the knee breadth dimensions were 1.8—2.0% (or 1.26—1.42 mm) larger among women (p < 0.001) and 1.4—1.6% (or 1.21—1.28 mm) larger among men (p < 0.001).

Conclusions

Higher MVPA is associated with larger tibiofemoral joint size. Our findings indicate that MVPA could potentially increase knee dimensions through similar biomechanical mechanisms it affects diaphyseal morphology, thus offering a potential target in reducing tissue strains and preventing knee problems. Further studies are needed to confirm and investigate the association between articulation area and musculoskeletal health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05475-7.

Cranial joint histology in the mallard duck (Anas platyrhynchos): new insights on avian cranial kinesis

The evolution of avian cranial kinesis is a phenomenon in part responsible for the remarkable diversity of avian feeding adaptations observable today. Although osteological, developmental and behavioral features of the feeding system are frequently studied, comparatively little is known about cranial joint skeletal tissue composition and morphology from a microscopic perspective. These data are key to understanding the developmental, biomechanical and evolutionary underpinnings of kinesis. Therefore, here we investigated joint microstructure in juvenile and adult mallard ducks (Anas platyrhynchos; Anseriformes). Ducks belong to a diverse clade of galloanseriform birds, have derived adaptations for herbivory and kinesis, and are model organisms in developmental biology. Thus, new insights into their cranial functional morphology will refine our understanding of avian cranial evolution. A total of five specimens (two ducklings and three adults) were histologically sampled, and two additional specimens (a duckling and an adult) were subjected to micro-computed tomographic scanning. Five intracranial joints were sampled: the jaw joint (quadrate-articular); otic joint (quadrate-squamosal); palatobasal joint (parasphenoid-pterygoid); the mandibular symphysis (dentary-dentary); and the craniofacial hinge (a complex flexion zone involving four different pairs of skeletal elements). In both the ducklings and adults, the jaw, otic and palatobasal joints are all synovial, with a synovial cavity and articular cartilage on each surface (i.e. bichondral joints) ensheathed in a fibrous capsule. The craniofacial hinge begins as an ensemble of patent sutures in the duckling, but in the adult it becomes more complex: laterally it is synovial; whereas medially, it is synostosed by a bridge of chondroid bone. We hypothesize that it is chondroid bone that provides some of the flexible properties of this joint. The heavily innervated mandibular symphysis is already fused in the ducklings and remains as such in the adult. The results of this study will serve as reference for documenting avian cranial kinesis from a microanatomical perspective. The formation of: (i) secondary articular cartilage on the membrane bones of extant birds; and (ii) their unique ability to form movable synovial joints within two or more membrane bones (i.e. within their dermatocranium) might have played a role in the origin and evolution of modern avian cranial kinesis during dinosaur evolution.

Femoral condyle curvature is correlated with knee walking kinematics in ungulates

The knee has been the focus of many studies linking mammalian postcranial form with locomotor behaviors and animal ecology. A more difficult task has been linking joint morphology with joint kinematics during locomotor tasks. Joint curvature represents one opportunity to link postcranial morphology with walking kinematics because joint curvature develops in response to mechanical loading. As an initial examination of mammalian knee joint curvature, the curvature of the medial femoral condyle was measured on femora representing 11 ungulate species. The position of a region of low curvature was measured using a metric termed the "angle to low curvature". This low-curvature region is important because it provides the greatest contact area between femoral and tibial condyles. Kinematic knee angles during walking were derived from the literature and kinematic knee angles across the gait cycle were correlated with angle to low curvature values. The highest correlation between kinematic knee angle and the angle to low curvature metric occurred at 20% of the walking gait cycle. This early portion of the walking gait cycle is associated with a peak in the vertical ground reaction force for some mammals. The chondral modeling theory predicts that frequent and heavy loading of particular regions of a joint surface during ontogeny will result in these regions being flatter than the surrounding joint surface. The locations of flatter regions of the femoral condyles of ungulates, and their association with knee angles used during the early stance phase of walking provides support for the chondral modeling theory.

Sarcopenia and fragility fractures: molecular and clinical evidence of the bone-muscle interaction

➤ Bone and muscle tissues are in close relationship, and the aging process is a factor involved in the loss of the functionality of both bones and muscles.➤ Sarcopenia and osteoporosis are linked from a biological and functional perspective and are related to an increased fracture risk in the elderly.➤ The increased fracture risk in sarcopenic and osteoporotic subjects is due to the decline of muscle mass and strength, the decrease in bone mineral density, and limited mobility.

The appositional articular morphology of the talo-crural joint: the influence of substrate use on joint shape

The appositional articular morphology of the talo-crural joint is the third component of the joint complex. It is a site of internal integration of this highly stable functional evolutionary unit. Prior studies of the other two components, tibia and talus, demonstrated that substrate preference influenced their articular shape. This effect was unrelated to physical attributes (size and mass) and phylogeny (superfamily). The effect of this behavioral factor, substrate preference, on shape and integration of the appositional articular morphology was investigated. Two hundred forty-five matched distal tibial and proximal talar landmarked surfaces from 12 diverse Catarrhine taxa were studied. Shape effects due to the same factors previously studied were examined in the tibial and talar subsets and were highly significant (P < 0.0001). These were assessed using Multivariate Regression and Relative Warps analysis, and Permutation tests, with results consistent with prior unmatched cohorts. Substrate preference influenced shape and was unrelated to the other factors across taxa. Singular Warp analysis of the cross-covariance matrix revealed sorting of taxa by substrate use, unrelated to physical attributes and phylogeny. Finally, the sorting demonstrated a signal of convergent evolution among distantly related taxa and divergent evolution among closely related taxa reflecting substrate use. Results were consistent with a behavioral influence, substrate use, affecting articular shape and integration in this highly stable functional evolutionary unit, and signals with evolutionary implications.

Differential limb loading in miniature pigs (Sus scrofa domesticus): a test of chondral modeling theory

Variation in mechanical loading is known to influence chondrogenesis during joint formation. However, the interaction among chondrocyte behavior and variation in activity patterns is incompletely understood, hindering our knowledge of limb ontogeny and function. Here, the role of endurance exercise in the development of articular and physeal cartilage in the humeral head was examined in 14 miniature swine (Sus scrofa domesticus). One group was subjected to graded treadmill running over a period of 17 weeks. A matched sedentary group was confined to individual pens. Hematoxylin and eosin staining was performed for histomorphometry of cartilage zone thickness, chondrocyte count and cell area, with these parameters compared multivariately between exercised and sedentary groups. Comparisons were also made with femora from the same sample, focusing on humerus-femur differences between exercised and sedentary groups, within-cohort comparisons of humerus-femur responses and correlated changes within and across joints. This study shows conflicting support for the chondral modeling theory. The humeral articular cartilage of exercised pigs was thinner than that of sedentary pigs, but their physeal cartilage was thicker. While articular and physeal cartilage demonstrated between-cohort differences, humeral physeal cartilage exhibited load-induced responses of greater magnitude than humeral articular cartilage. Controlling for cohort, the humerus showed increased chondrocyte mitosis and cell area, presumably due to relatively greater loading than the femur. This represents the first known effort to evaluate chondral modeling across multiple joints from the same individuals. Our findings suggest the chondral response to elevated loading is complex, varying within and among joints. This has important implications for understanding joint biomechanics and development.

Evaluation of the chondral modeling theory using fe-simulation and numeric shape optimization

The chondral modeling theory proposes that hydrostatic pressure within articular cartilage regulates joint size, shape, and congruence through regional variations in rates of tissue proliferation. The purpose of this study is to develop a computational model using a nonlinear two-dimensional finite element analysis in conjunction with numeric shape optimization to evaluate the chondral modeling theory. The model employed in this analysis is generated from an MR image of the medial portion of the tibiofemoral joint in a subadult male. Stress-regulated morphological changes are simulated until skeletal maturity and evaluated against the chondral modeling theory. The computed results are found to support the chondral modeling theory. The shape-optimized model exhibits increased joint congruence, broader stress distributions in articular cartilage, and a relative decrease in joint diameter. The results for the computational model correspond well with experimental data and provide valuable insights into the mechanical determinants of joint growth. The model also provides a crucial first step toward developing a comprehensive model that can be employed to test the influence of mechanical variables on joint conformation.

Changes in proximal femoral mineral geometry precede the onset of radiographic hip osteoarthritis: The study of osteoporotic fractures

OBJECTIVE

Radiographic hip osteoarthritis (RHOA) is associated with increased hip areal bone mineral density (aBMD). This study was undertaken to examine whether femoral geometry is associated with RHOA independent of aBMD.

METHODS

Participants in the Study of Osteoporotic Fractures in whom pelvic radiographs had been obtained at visits 1 and 5 (mean 8.3 years apart) and hip dual x-ray absorptiometry (DXA) had been performed (2 years after baseline) were included. Prevalent and incident RHOA phenotypes were defined as composite (osteophytes and joint space narrowing [JSN]), atrophic (JSN without osteophytes), or osteophytic (femoral osteophytes without JSN). Analogous definitions of progression were based on minimum joint space and total osteophyte score. Hip DXA scans were assessed using the Hip Structural Analysis program to derive geometric measures, including femoral neck length, width, and centroid position. Relative risks and 95% confidence intervals for prevalent, incident, and progressive RHOA per SD increase in geometric measure were estimated in a hip-based analysis using multinomial logistic regression with adjustment for age, body mass index, knee height, and total hip aBMD.

RESULTS

In 5,245 women (mean age 72.6 years), a wider femoral neck with a more medial centroid position was associated with prevalent and incident osteophytic and composite RHOA phenotypes (P < 0.05). Increased neck width and centroid position were associated with osteophyte progression (both P < 0.05). No significant geometric associations with atrophic RHOA were found.

CONCLUSION

Differences in proximal femoral bone geometry and spatial distribution of bone mass occur early in hip OA and predict prevalent, incident, and progressive osteophytic and composite phenotypes, but not the atrophic phenotype. These bone differences may reflect responses to loading occurring early in the natural history of RHOA.

The effect of labour on somatotype of males during the adolescent growth period

Although the effect of labour and physical stress on the height and weight of growing children is relatively well known, rather limited information concerning the influences of the work environment on the physique of working children and adolescents is available. The purpose of this study was to increase our knowledge of the effects of mechanical stress on the human physique via somatotype during the adolescent growth period. Anthropometric measurements of 509 male apprentices aged 13.50-18.49 years and measurements of 451 nonworking youth (control group) of the same age group were taken. The members of both groups were from the lower socioeconomic strata and had similar living conditions. The apprentices were working an average of 11h per day in vocations requiring intense physical effort. The subjects were somatotyped using the Heath-Carter anthropometric protocol. The overall mean somatotypes were 2.3-4.4-3.3 for working adolescents, and 2.5-3.9-3.6 for the nonworking controls. A one-way multivariate analysis of variance (MANOVA) indicated significant differences between the groups. Working adolescents were more mesomorphic and less ectomorphic than their nonworking peers. In both groups, endomorphy decreased with age up to age 15; then remained stable for the labourers but increased for the nonworking peers. In both groups, mesomorphy was stable, but decreased with ectomorphy. These results indicate that physical stress not only causes retardation in linear growth, but also produces changes in human physique during the growth period.

Conceptual fracture parameters for articular cartilage

BACKGROUND

Superficial cracks can occur in articular cartilage due to trauma or wear and tear. Our understanding of the behaviour of such cracks in a loaded matrix is limited. A notable study investigated the growth of cracks induced in the bottom layer of the matrix. This paper extends existing studies, characterizing the propagation of superficial cracks and matrix resistance under tension at varying rates of loading.

METHODS

Cartilage strips with artificially induced superficial cracks were subjected to tensile loading at different loading velocities using a miniature tensile testing device. Load-displacement data, video and still images were recorded for analysis.

FINDINGS

The propagation of superficial cracks in articular cartilage does not follow the classical crack tip advance that is characteristic of most engineering materials. Instead, the crack tip exhibited a negligible movement while the side edges of the crack rotated about it, accompanied by matrix stretching and an upward pull (necking) of the bottom layer of the sample. As loading progresses, the crack edges stretch and rotate to assume a position parallel to the articular surface, followed by the final fracture of the matrix at a point just below the crack tip. Using the recorded mechanical data and images, an analogous poroelastic fracture toughness, Kp(Ic)=1.83 MPa.square root mm (SD 0.8) is introduced.

INTERPRETATION

It is extremely difficult for a superficial crack to propagate through articular cartilage. This may be because of the energy dissipation from the crack due to the movement and exudation of water, and large stretching of the matrix.

Functional adaptation of the femoral head to voluntary exercise

The functional adaptation of limb joints during postnatal ontogeny is necessary to maintain proper joint function. Joint form is modified primarily through differential rates of articular cartilage proliferation across articular surfaces during endochondral growth. This process is hypothesized to be mechanically regulated by the magnitude and orientation of stresses in the articular cartilage. However, the adaptation of limb joint morphology to the mechanical environment is poorly understood. We investigate the effects of voluntary exercise on femoral head morphology in 7-week-old female mice of the inbred strain C57BL/6J. The mice were divided into a control group and a group treated with voluntary access to an activity wheel for the duration of the 4-week study. Histomorphometric comparisons of chondral and osseous joint tissue of the proximal femur were made between control and exercise treatment groups. We find that exercised mice have significantly thicker articular cartilage with greater chondral tissue area and cellularity. Exercised mice also exhibit significantly greater bone tissue area and longer and flatter subchondral surfaces. No significant difference is found in the curvature of the articular cartilage or the length of the chondral articular surface between groups. These data suggest that a complex mechanistic relationship exists between joint stress and joint form. Joint tissue response to loading is multifaceted, involving both size and shape changes. Our data support the hypothesis that joint growth is ontogenetically plastic. Mechanical loading significantly influences chondral and subchondral tissue proliferation to provide greater support against increased mechanical loading.

Cancellous bone changes in hip osteoarthritis: a short-term longitudinal study using fractal signature analysis

OBJECTIVE

To quantify changes to the trabecular structure in the femoral heads of patients with hip osteoarthritis (OA).

METHODS

Patients with OA (n=14; F=7), mean (standard deviation age) 50.6 (10.1) years, had macroradiographs at approximately x4 magnification at baseline and 18 months later using a standardized protocol. Following digitization, computerized measurement was obtained of minimum hip joint space width and fractal signature analysis (FSA) measured longitudinal changes separately in the principal compressive (vertical) and horizontal trabeculae at the region of interest within the centre of the head.

RESULTS

The patient group had mean annual rate of joint space narrowing of 0.14+/-0.36 mm/yr. FSA detected no significant changes in horizontal trabeculae, whereas the larger principal compressive (vertical) trabeculae (0.96 mm to 1.02 mm) increased significantly in thickness and the fine to medium trabeculae (0.18 mm to 0.54 mm) decreased significantly in number.

CONCLUSION

The increased thickness of the larger trabeculae within the compressive structural element of the femoral head is a response to the increase in stress associated with an overall loss of trabeculae in this region, suggesting the presence of an osteoporosis within the femoral head in OA patients.

Bilateral variation in limb articular surface dimensions

Joint form is frequently used to interpret locomotor and manipulative adaptations and infer physical behavioral patterns in past humans, yet the precise genetic and environmental determinants of joint size are incompletely understood. The aim of this research is to assess the plasticity of limb articular dimension through the use of directional asymmetry as an indicator of mechanical stress during skeletal development. Directional asymmetry is largely attributable to differential mechanical loading during bone growth related to handedness. Because the large majority of individuals are right-handed, it is hypothesized that joint dimensions will be significantly larger in the upper right limb and lower left limb in the crossed symmetry pattern that is typically exhibited in bone lengths. Patterns of bilateral variation were explored by sex and skeletal location. Significant levels of directional asymmetry (P < 0.05) suggest that limb articular surfaces are adapted to the mechanical environment. Biomechanical factors are important in the development and maintenance of articular morphology. Further research, however, is needed to establish the exact relationship between joint size and the mechanical environment.

Subchondral bone changes in hand and knee osteoarthritis detected by radiography

OBJECTIVE

To describe the changes in subchondral bone that occur with the onset and progression of osteoarthritis (OA) from macroradiographic assessment of patient's hand and knee joints.

DESIGN

The high magnification and spatial resolution of macroradiography permits detailed anatomical changes to be detected in OA joints. Data on the subchondral cortical and cancellous bone, recorded from both cross-sectional and longitudinal studies of hand and knee OA, are described and discussed with reference to recent findings on the altered biomechanical properties of OA bone.

RESULTS

In OA joints, both subchondral cortical plate and subjacent horizontal trabeculae increase in thickness early, prior to joint space narrowing (JSN). With progression, cortical plate sclerosis increased in 60% of OA hands and did not change in knee OA until JSN <1.5mm in the medial diseased compartment. In knee OA, trabeculae, at sites of tibial subchondral sclerosis, increased in number and extent, changes that overlay a subarticular region that was osteoporotic. With cartilage loss, the articular surfaces in some knees appeared corrugated, and later, with bone-on-bone, the surfaces became flattened and deformed.

CONCLUSIONS

The weaker than normal bone within thickened subchondral cortical plate and trabeculae of OA joints leads, in advanced OA, to deformation of the articular surfaces and absorption of local stresses producing an effect similar to stress-shielding. This effect, it is suggested, results in the subarticular osteoporosis.

The aging of Wolff's ?law?: Ontogeny and responses to mechanical loading in cortical bone

The premise that bones grow and remodel throughout life to adapt to their mechanical environment is often called Wolff's law. Wolff's law, however, is not always true, and in fact comprises a variety of different processes that are best considered separately. Here we review the molecular and physiological mechanisms by which bone senses, transduces, and responds to mechanical loads, and the effects of aging processes on the relationship (if any) between cortical bone form and mechanical function. Experimental and comparative evidence suggests that cortical bone is primarily responsive to strain prior to sexual maturity, both in terms of the rate of new bone growth (modeling) as well as rates of turnover (Haversian remodeling). Rates of modeling and Haversian remodeling, however, vary greatly at different skeletal sites. In addition, there is no simple relationship between the orientation of loads in long bone diaphyses and their cross-sectional geometry. In combination, these data caution against assuming without testing adaptationist views about form-function relationships in order to infer adult activity patterns from skeletal features such as cross-sectional geometry, cortical bones density, and musculo-skeletal stress markers. Efforts to infer function from shape in the human skeleton should be based on biomechanical and developmental models that are experimentally tested and validated.

Articular area responses to mechanical loading: effects of exercise, age, and skeletal location

How reliable are reconstructions of body mass and joint function based on articular surface areas? While the dynamic relationship between mechanical loading and cross-sectional geometry in long bones is well-established, the effect of loading on the subchondral articular surface area of epiphyses (hereafter, articular surface area, or ASA) has not been experimentally tested. The degree to which ASA can change in size and shape is important, because articular dimensions are frequently used to estimate body mass and positional behavior in fossil species. This study tests the hypothesis that mechanical loading influences ASA by comparing epiphyses of exercised and sedentary sheep from three age categories: juvenile, subadult, and adult (n = 44). ASA was measured on latex molds of subchondral articular surfaces of 10 epiphyses from each sheep. Areas were standardized by body mass, and compared to diaphyseal cross-sectional geometrical data. Nonparametric statistical comparisons of exercised and control individuals found no increases in ASA in response to mechanical loading in any age group. In contrast, significant differences in diaphyseal cross-sectional geometry were detected between exercised and control groups, but mostly in juveniles. The conservatism of ASA supports the hypothesis that ASA is ontogenetically constrained, and related to locomotor behavior at the species level and to body mass at the individual level, while variations in diaphyseal cross-sectional geometry are more appropriate proxies for individual variations in activity level.

Some highlights in the emergence of modern concepts of osteoarthritis

The present-day concept that osteoarthritis may be amenable to biological modification rather than a hopeless expression of old age or injury has historical roots in the period of 1935 through the early 1970s. One root was the structural and chemical delineation of the connective tissues: discovery of the proteoglycans and multiple molecular species of collagen. Another was the recognition of the ability of mature articular chondrocytes to replicate themselves rather than being terminally differentiated. A third was the elucidation of the engineering physiology of the joint: the role of matrix hydrophilia to the material properties of articular cartilage and biolubrication. Each root has direct relevance to ongoing therapeutic approaches to degenerative joint disease. The early epidemiological studies of Kellgren and Lawrence evolved into new techniques for testing their validity in clinical practice. Along the way there was a rich 2-way interaction between scientists and clinicians in arriving at these ideas.

On longitudinal bone growth, short stature, and related matters: insights about cartilage physiology from the Utah paradigm

Precursor cell division in growing cartilage determines human height, the lengths of the spine and limb bones, the alignment of joints, spines and limbs, and the ratio of spinal length to limb length. That division also helps to determine the sizes and shapes of joints, apophyses and epiphyses. Ideas about what controls those facts are changing. To former views, in which mainly genetic and humoral factors controlled them, the Utah paradigm of skeletal physiology adds long-overlooked biomechanical including muscular factors. These three kinds of factors would collaborate in controlling the precursor cell division that determines the above skeletal features. Problems with that control clearly cause or help to cause many clinical disorders. Examples include short stature, gigantism, premature and delayed skeletal maturation, some changes in fracture patterns associated with puberty, joint malalignments, congenital hip dysplasia, scoliosis, limb torsions, the ball-and-socket ankle, and some skeletal abnormalities in Marfan's syndrome and the osteochondrodystrophies. The physiology such things depend on has matured sufficiently to justify a review for pediatricians, endocrinologists and other clinical specialists, and many basic scientists.

From Wolff's law to the Utah paradigm: insights about bone physiology and its clinical applications

Efforts to understand our anatomy and physiology can involve four often overlapping phases. We study what occurs, then how, then ask why, and then seek clinical applications. In that regard, in 1960 views, bone's effector cells (osteoblasts and osteoclasts) worked chiefly to maintain homeostasis under the control of nonmechanical agents, and that physiology had little to do with anatomy, biomechanics, tissue-level things, muscle, and other clinical applications. But it seems later-discovered tissue-level mechanisms and functions (including biomechanical ones, plus muscle) are the true key players in bone physiology, and homeostasis ranks below the mechanical functions. Adding that information to earlier views led to the Utah paradigm of skeletal physiology that combines varied anatomical, clinical, pathological, and basic science evidence and ideas. While it explains in a general way how strong muscles make strong bones and chronically weak muscles make weak ones, and while many anatomists know about the physiology that fact depends on, poor interdisciplinary communication left people in many other specialties unaware of it and its applications. Those applications concern 1.) healing of fractures, osteotomies, and arthrodeses; 2.) criteria that distinguish mechanically competent from incompetent bones; 3.) design criteria that should let load-bearing implants endure; 4.) how to increase bone strength during growth, and how to maintain it afterwards on earth and in microgravity situations in space; 5.) how and why healthy women only lose bone next to marrow during menopause; 6.) why normal bone functions can cause osteopenias; 7.) why whole-bone strength and bone health are different matters; 8.) why falls can cause metaphyseal and diaphyseal fractures of the radius in children, but mainly metaphyseal fractures of that bone in aged adults; 9.) which methods could best evaluate whole-bone strength, "osteopenias" and "osteoporoses"; 10.) and why most "osteoporoses" should not have bone-genetic causes and some could have extraosseous genetic causes. Clinical specialties that currently require this information include orthopaedics, endocrinology, radiology, rheumatology, pediatrics, neurology, nutrition, dentistry, and physical, space and sports medicine. Basic science specialties include absorptiometry, anatomy, anthropology, biochemistry, biomechanics, biophysics, genetics, histology, pathology, pharmacology, and cell and molecular biology. This article reviews our present general understanding of this new bone physiology and some of its clinical applications and implications. It must leave to other times, places, and people the resolution of questions about that new physiology, and to understand the many devils that should lie in its details. (Thompson D'Arcy, 1917).

Three-dimensional loading and growth of the zygomatic arch

Despite a number of previous biomechanical studies on the zygomatic arch, unanswered questions remain about its three-dimensional loading and growth. Using young miniature swine, we have for the first time recorded strains from both the medial and lateral aspects of the squamosal bone during mastication and masseter muscle stimulation. Strains from the zygomatic bone flange and zygomatic arch growth data were also obtained from the same animals. A second study on a younger group of animals examined the growth of the zygomatic flange following partial removal of the masseter. Strain data indicated that the squamosal bone is bent out-of-plane and that this pattern of loading is quite different from that of the adjacent zygomatic bone, which experiences much lower strains with little evidence of out-of-plane bending. Surprisingly, strains were higher in the zygomatic flange during contralateral chews and contralateral masseter stimulations than during ipsilateral chews/stimulations. These strains proved to arise from movement of the condyle, explaining why partial removal of the masseter had little effect on the growth of the flange. Other growth results indicated an approximately threefold greater rate of subperiosteal deposition on the lateral surface of the squamosal bone than on the zygomatic bone. This difference in growth rate is attributed to the presence of sutures that contribute to the lateral displacement of the zygomatic bone but not the squamosal bone. This explanation does not exclude the possibility that the rapid apposition on the lateral squamosal surface is regulated by the high surface strains that result from out-of-plane bending.

The "muscle-bone unit" in children and adolescents: a 2000 overview

In former views hormones, calcium, vitamin D and other humoral and nonmechanical agents dominated control of postnatal bone strength (and "mass") in children and adolescents. However later evidence that led to the Utah paradigm of skeletal physiology revealed that this control depends strongly on the largest mechanical loads on bones. Trauma excepted, muscles cause the largest loads and the largest bone strains, and these strains help to control the biological mechanisms that determine whole-bone strength. That makes the strength of children's load-bearing bones depend strongly on growing muscle strength and how bones respond to it. Most hormones and other nonmechanical agents that affect bone strength can help or hinder that "bone strength-muscle strength" relationship but cannot replace it. In addition some agents long thought to exert bone effects by acting directly on bone cells, affect muscle strength too. In that way they could affect bone strength indirectly. Such agents include growth hormone, adrenalcorticosteroid analogs, androgens, calcium, genes, vitamin D and its metabolites, etc. Thus bone and muscle do form a kind of operational unit. It is part of the Utah paradigm that supplements earlier views with later evidence and concepts. The paradigm explains how the "bone strength-muscle strength" relationship works. This article provides an overview of that physiology, and some of its implications for pediatric endocrinologists.

A chondral modeling theory revisited

The mechanical environment of limb joints constantly changes during growth due to growth-related changes in muscle and tendon lengths, long bone dimensions, and body mass. The size and shape of limb joint surfaces must therefore also change throughout post-natal development in order to maintain normal joint function. Frost's (1979, 1999) chondral modeling theory proposed that joint congruence is maintained in mammalian limbs throughout postnatal ontogeny because cartilage growth in articular regions is regulated in part by mechanical load. This paper incorporates recent findings concerning the distribution of stress in developing articular units, the response of chondrocytes to mechanically induced deformation, and the development of articular cartilage in order to expand upon Frost's chondral modeling theory. The theory presented here assumes that muscular contraction during post-natal locomotor development produces regional fluctuating, intermittent hydrostatic pressure within the articular cartilage of limb joints. The model also predicts that peak levels of hydrostatic pressure in articular cartilage increase between birth and adulthood. Finally, the chondral modeling theory proposes that the cell-cell and cell-extracellular matrix interactions within immature articular cartilage resulting from mechanically induced changes in hydrostatic pressure regulate the metabolic activity of chondrocytes. Site-specific rates of articular cartilage growth are therefore regulated in part by the magnitude, frequency, and orientation of prevailing loading vectors. The chondral modeling response maintains a normal kinematic pathway as the magnitude and direction of joint loads change throughout ontogeny. The chondral modeling theory also explains ontogenetic scaling patterns of limb joint curvature observed in mammals. The chondral modeling response is therefore an important physiological mechanism that maintains the match between skeletal structure, function, and locomotor performance throughout mammalian ontogeny and phylogeny.