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Liu X, Chen R, Song Z, Sun Z. Exercise following joint distraction inhibits muscle wasting and delays the progression of post-traumatic osteoarthritis in rabbits by activating PGC-1α in skeletal muscle. J Orthop Surg Res 2024; 19:325. [PMID: 38822418 PMCID: PMC11141044 DOI: 10.1186/s13018-024-04803-y] [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: 02/18/2024] [Accepted: 05/21/2024] [Indexed: 06/03/2024] Open
Abstract
OBJECTIVE Muscle wasting frequently occurs following joint trauma. Previous research has demonstrated that joint distraction in combination with treadmill exercise (TRE) can mitigate intra-articular inflammation and cartilage damage, consequently delaying the advancement of post-traumatic osteoarthritis (PTOA). However, the precise mechanism underlying this phenomenon remains unclear. Hence, the purpose of this study was to examine whether the mechanism by which TRE following joint distraction delays the progression of PTOA involves the activation of peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α), as well as its impact on muscle wasting. METHODS Quadriceps samples were collected from patients with osteoarthritis (OA) and normal patients with distal femoral fractures, and the expression of PGC-1α was measured. The hinged external fixator was implanted in the rabbit PTOA model. One week after surgery, a PGC-1α agonist or inhibitor was administered for 4 weeks prior to TRE. Western blot analysis was performed to detect the expression of PGC-1α and Muscle atrophy gene 1 (Atrogin-1). We employed the enzyme-linked immunosorbent assay (ELISA) technique to examine pro-inflammatory factors. Additionally, we utilized quantitative real-time polymerase chain reaction (qRT-PCR) to analyze genes associated with cartilage regeneration. Synovial inflammation and cartilage damage were evaluated through hematoxylin-eosin staining. Furthermore, we employed Masson's trichrome staining and Alcian blue staining to analyze cartilage damage. RESULTS The decreased expression of PGC-1α in skeletal muscle in patients with OA is correlated with the severity of OA. In the rabbit PTOA model, TRE following joint distraction inhibited the expressions of muscle wasting genes, including Atrogin-1 and muscle ring finger 1 (MuRF1), as well as inflammatory factors such as interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) in skeletal muscle, potentially through the activation of PGC-1α. Concurrently, the production of IL-1β, IL-6, TNF-α, nitric oxide (NO), and malondialdehyde (MDA) in the synovial fluid was down-regulated, while the expression of type II collagen (Col2a1), Aggrecan (AGN), SRY-box 9 (SOX9) in the cartilage, and superoxide dismutase (SOD) in the synovial fluid was up-regulated. Additionally, histological staining results demonstrated that TRE after joint distraction reduced cartilage degeneration, leading to a significant decrease in OARSI scores.TRE following joint distraction could activate PGC-1α, inhibit Atrogin-1 expression in skeletal muscle, and reduce C-telopeptides of type II collagen (CTX-II) in the blood compared to joint distraction alone. CONCLUSION Following joint distraction, TRE might promote the activation of PGC-1α in skeletal muscle during PTOA progression to exert anti-inflammatory effects in skeletal muscle and joint cavity, thereby inhibiting muscle wasting and promoting cartilage regeneration, making it a potential therapeutic intervention for treating PTOA.
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Affiliation(s)
- Xinghui Liu
- School of Basic Medical Sciences, Hubei University of Arts and Science, Xiangyang, Hubei, 441000, China
| | - Rong Chen
- Department of Traumatic Orthopedics, Xiangyang Hospital of Traditional Chinese Medicine (Xiangyang Institute of Traditional Chinese Medicine), No. 24 Changzheng Road, Xiangyang, Hubei, 441001, China
| | - Zhenfei Song
- Department of Traumatic Orthopedics, Xiangyang Hospital of Traditional Chinese Medicine (Xiangyang Institute of Traditional Chinese Medicine), No. 24 Changzheng Road, Xiangyang, Hubei, 441001, China
| | - Zhibo Sun
- Department of Traumatic Orthopedics, Xiangyang Hospital of Traditional Chinese Medicine (Xiangyang Institute of Traditional Chinese Medicine), No. 24 Changzheng Road, Xiangyang, Hubei, 441001, China.
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2
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Fainor M, Orozco BS, Muir VG, Mahindroo S, Gupta S, Mauck RL, Burdick JA, Smith HE, Gullbrand SE. Mechanical crosstalk between the intervertebral disc, facet joints, and vertebral endplate following acute disc injury in a rabbit model. JOR Spine 2023; 6:e1287. [PMID: 38156057 PMCID: PMC10751980 DOI: 10.1002/jsp2.1287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/21/2023] [Accepted: 09/06/2023] [Indexed: 12/30/2023] Open
Abstract
Background Vertebral endplate sclerosis and facet osteoarthritis have been documented in animals and humans. However, it is unclear how these adjacent pathologies engage in crosstalk with the intervertebral disc. This study sought to elucidate this crosstalk by assessing each compartment individually in response to acute disc injury. Methods Eleven New Zealand White rabbits underwent annular disc puncture using a 16G or 21G needle. At 4 and 10 weeks, individual compartments of the motion segment were analyzed. Discs underwent T 1 relaxation mapping with MRI contrast agent gadodiamide as well T 2 mapping. Both discs and facets underwent mechanical testing via vertebra-disc-vertebra tension-compression creep testing and indentation testing, respectively. Endplate bone density was quantified via μCT. Discs and facets were sectioned and stained for histology scoring. Results Intervertebral discs became more degenerative with increasing needle diameter and time post-puncture. Bone density also increased in endplates adjacent to both 21G and 16G punctured discs leading to reduced gadodiamide transport at 10 weeks. The facet joints, however, did not follow this same trend. Facets adjacent to 16G punctured discs were less degenerative than facets adjacent to 21G punctured discs at 10 weeks. 16G facets were more degenerative at 4 weeks than at 10, suggesting the cartilage had recovered. The formation of severe disc osteophytes in 16G punctured discs between 4 and 10 weeks likely offloaded the facet cartilage, leading to the recovery observed. Conclusions Overall, this study supports that degeneration spans the whole spinal motion segment following disc injury. Vertebral endplate thickening occurred in response to disc injury, which limited the diffusion of small molecules into the disc. This work also suggests that altered disc mechanics can induce facet degeneration, and that extreme bony remodeling adjacent to the disc may promote facet cartilage recovery through offloading of the articular cartilage.
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Affiliation(s)
- Matthew Fainor
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Brianna S. Orozco
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Victoria G. Muir
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Sonal Mahindroo
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
- Department of BiologySt. Bonaventure UniversitySt. BonaventureNew YorkUSA
| | - Sachin Gupta
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Robert L. Mauck
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Jason A. Burdick
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- BioFrontiers Institute and Department of Chemical and Biological EngineeringUniversity of Colorado BoulderBoulderColoradoUSA
| | - Harvey E. Smith
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Sarah E. Gullbrand
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
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3
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Teunissen M, Meij B, Snel L, Coeleveld K, Popov-Celeketic J, Ludwig I, Broere F, Lafeber F, Tryfonidou M, Mastbergen S. The catabolic-to-anabolic shift seen in the canine osteoarthritic cartilage treated with knee joint distraction occurs after the distraction period. J Orthop Translat 2022; 38:44-55. [PMID: 36313973 PMCID: PMC9589009 DOI: 10.1016/j.jot.2022.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 11/25/2022] Open
Abstract
Background Methods Results Conclusion The Translational Potential of this Article
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Affiliation(s)
- M. Teunissen
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht the Netherlands
| | - B.P. Meij
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht the Netherlands
| | - L. Snel
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht the Netherlands
| | - K. Coeleveld
- Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht University, Utrecht the Netherlands
| | - J. Popov-Celeketic
- Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht University, Utrecht the Netherlands
| | - I.S. Ludwig
- Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht the Netherlands
| | - F. Broere
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht the Netherlands,Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht the Netherlands
| | - F.P.J.G. Lafeber
- Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht University, Utrecht the Netherlands
| | - M.A. Tryfonidou
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht the Netherlands
| | - S.C. Mastbergen
- Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht University, Utrecht the Netherlands,Corresponding author. Rheumatology & Clinical Immunology, UMC Utrecht, F02.127, PO Box 85500, 3508 GA Utrecht, the Netherlands.
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Alves JC, Santos A, Jorge P, Lavrador C, Miguel Carreira L. The influence of IL-1 and C-reactive protein levels in synovial fluid of companion dogs with bilateral hip osteoarthritis on various clinical disease parameters. Am J Vet Res 2022; 83:1-10. [PMID: 36087306 DOI: 10.2460/ajvr.22.05.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To evaluate IL-1 and C-reactive protein (CRP) levels in the synovial fluid in dogs with bilateral hip osteoarthritis and their relation to animals' clinical, radiographic, and thermographic disease signs. SAMPLE 100 joints from police working dogs. PROCEDURES Synovial fluid, IL-1, and CRP levels, weight distribution, joint range of motion, thigh girth, digital thermography, and radiographic signs of the joints were recorded. Data from 4 clinical metrology instruments (CMIs) were collected. Results were compared by age, sex, and Orthopedic Foundation for Animals hip scores with the independent samples t test, ANOVA, and Pearson correlation coefficient (P < .05). RESULTS The sample included 100 pelvic limbs, equally distributed between left and right pelvic limbs 30 males and 20 females, with a mean age of 6.5 ± 2.4 years and body weight of 26.7 ± 5.2 kg. IL-1 levels, particularly above 200 pg/mL, may be related to the development of caudolateral curvilinear osteophyte, which then expresses a toll on the patient's levels of pain and activity. It was unclear if the CRP levels were a consequence of inflammatory activity within the joint or a reflection of a better prognosis. Increasing body weight was related to worse CMI scores. CLINICAL RELEVANCE We described the relation of IL-1 and CRP synovial concentration levels with several clinical signs, diagnostic imaging, laboratory findings, and CMI results of animals with osteoarthritis. Further studies are required to determine the interest of each parameter for the prognosis and treatment monitoring.
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Affiliation(s)
- J C Alves
- Divisão de Medicina Veterinária, Guarda Nacional Republicana, Lisbon, Portugal.,Instituto Mediterráneo de Agricultura, Medio Ambiente y Desarrollo, Instituto de Investigação e Formação Avançada, Universidade de Évora, Pólo da Mitra, Évora, Portugal
| | - A Santos
- Divisão de Medicina Veterinária, Guarda Nacional Republicana, Lisbon, Portugal
| | - P Jorge
- Divisão de Medicina Veterinária, Guarda Nacional Republicana, Lisbon, Portugal
| | - C Lavrador
- Instituto Mediterráneo de Agricultura, Medio Ambiente y Desarrollo, Instituto de Investigação e Formação Avançada, Universidade de Évora, Pólo da Mitra, Évora, Portugal
| | - L Miguel Carreira
- Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal.,Interdisciplinary Centre for Research in Animal Health, University of Lisbon, Lisbon, Portugal.,Anjos of Assis Veterinary Medicine Centre, Barreiro, Portugal
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5
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Vincent TL, McClurg O, Troeberg L. The Extracellular Matrix of Articular Cartilage Controls the Bioavailability of Pericellular Matrix-Bound Growth Factors to Drive Tissue Homeostasis and Repair. Int J Mol Sci 2022; 23:6003. [PMID: 35682681 PMCID: PMC9181404 DOI: 10.3390/ijms23116003] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/24/2022] [Accepted: 05/24/2022] [Indexed: 11/24/2022] Open
Abstract
The extracellular matrix (ECM) has long been regarded as a packing material; supporting cells within the tissue and providing tensile strength and protection from mechanical stress. There is little surprise when one considers the dynamic nature of many of the individual proteins that contribute to the ECM, that we are beginning to appreciate a more nuanced role for the ECM in tissue homeostasis and disease. Articular cartilage is adapted to be able to perceive and respond to mechanical load. Indeed, physiological loads are essential to maintain cartilage thickness in a healthy joint and excessive mechanical stress is associated with the breakdown of the matrix that is seen in osteoarthritis (OA). Although the trigger by which increased mechanical stress drives catabolic pathways remains unknown, one mechanism by which cartilage responds to increased compressive load is by the release of growth factors that are sequestered in the pericellular matrix. These are heparan sulfate-bound growth factors that appear to be largely chondroprotective and displaced by an aggrecan-dependent sodium flux. Emerging evidence suggests that the released growth factors act in a coordinated fashion to drive cartilage repair. Thus, we are beginning to appreciate that the ECM is the key mechano-sensor and mechano-effector in cartilage, responsible for directing subsequent cellular events of relevance to joint health and disease.
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Affiliation(s)
- Tonia L. Vincent
- Centre for OA Pathogenesis Versus Arthritis, Kennedy Institute of Rheumatology, University of Oxford, Oxford OX3 7FY, UK
| | - Oliver McClurg
- Norwich Medical School, University of East Anglia, Norwich, Norwich NR4 7UQ, UK; (O.M.); (L.T.)
| | - Linda Troeberg
- Norwich Medical School, University of East Anglia, Norwich, Norwich NR4 7UQ, UK; (O.M.); (L.T.)
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6
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Alves JC, Santos A, Jorge P, Lavrador C, Carreira LM. Effect of a single intra-articular administration of stanozolol in a naturally occurring canine osteoarthritis model: a randomised trial. Sci Rep 2022; 12:5887. [PMID: 35393497 PMCID: PMC8989994 DOI: 10.1038/s41598-022-09934-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/23/2022] [Indexed: 11/21/2022] Open
Abstract
Osteoarthritis (OA) is a disease with a high negative impact on patient’s quality of life and a high financial burden. It is a source of chronic pain and affects all mammals, including humans and dogs. As the dog is a common model for translation research of human OA, and exploring spontaneous dog OA can improve the health and well-being of both humans and dogs. To describe the effect of the intra-articular administration of stanozolol in a naturally occurring canine OA model, forty canine (N = 40) hip joints were randomly assigned to receive stanozolol or saline (control). On treatment day and at 8, 15, 30, 90, and 180 days post-treatment, several evaluations were conducted: weight distribution, joint range of motion, thigh girth, digital thermography, and radiographic signs. Also, synovial fluid C-reactive protein and interleukin-1 levels were evaluated. Results from four Clinical Metrology Instruments was also gathered. Results were compared with Repeated Measures ANOVA, with a Huynh–Feldt correction, paired-samples t-test, or Wilcoxon signed-rank test, with p < 0.05. OA was graded as mild (90%), moderate (5%), and severe (5%), including both sexes. They had a mean age of 6.5 ± 2.4 years and a bodyweight of 26.7 ± 5.2 kg. No differences were found between groups at treatment day in all considered evaluations. Weight distribution showed significant improvements with stanozolol from 15 days (p < 0.05) up to 180 days (p < 0.01). Lower values during thermographic evaluation in both views taken and improved joint extension at 90 (p = 0.02) and 180 days (p < 0.01) were observed. Pain and function scores improved up to 180 days. In the control group, radiographic signs progressed, in contrast with stanozolol. The use of stanozolol was safe and produced significant improvements in weight-bearing, pain score, and clinical evaluations in a naturally occurring canine OA model.
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Affiliation(s)
- J C Alves
- Divisão de Medicina Veterinária, Guarda Nacional Republicana (GNR), Rua Presidente Arriaga, 9, 1200-771, Lisbon, Portugal. .,MED - Mediterranean Institute for Agriculture, Environment and Development, Instituto de Investigação e Formação Avançada, Universidade de Évora, Pólo da Mitra, Ap. 94, 7006-554, Évora, Portugal.
| | - A Santos
- Divisão de Medicina Veterinária, Guarda Nacional Republicana (GNR), Rua Presidente Arriaga, 9, 1200-771, Lisbon, Portugal
| | - P Jorge
- Divisão de Medicina Veterinária, Guarda Nacional Republicana (GNR), Rua Presidente Arriaga, 9, 1200-771, Lisbon, Portugal
| | - C Lavrador
- MED - Mediterranean Institute for Agriculture, Environment and Development, Instituto de Investigação e Formação Avançada, Universidade de Évora, Pólo da Mitra, Ap. 94, 7006-554, Évora, Portugal
| | - L Miguel Carreira
- Faculty of Veterinary Medicine, University of Lisbon (FMV/ULisboa), Lisbon, Portugal.,Interdisciplinary Centre for Research in Animal Health (CIISA), University of Lisbon (FMV/ULisboa), Lisbon, Portugal.,Anjos of Assis Veterinary Medicine Centre (CMVAA), Barreiro, Portugal
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7
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Suda AJ, Kientopf D, Leithner A, Streeck J, Colshorn T, Dorotka R, Schneider M, Höppchen I. [No Evidence for the Biomechanical and Pathophysiological Explanatory Models of Musculoskeletal Diseases According to Liebscher & Bracht]. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2022; 160:13-18. [PMID: 35144293 PMCID: PMC8831037 DOI: 10.1055/a-1716-2274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Arnold J Suda
- AUVA Trauma Center Salzburg, Department of Orthopaedics and Trauma Surgery, Allgemeine Unfallversicherungsanstalt, Salzburg, Austria.,Center for Orthopaedics and Trauma Surgery, Ruprecht Karls University Heidelberg Faculty of Medicine Mannheim, Mannheim, Germany
| | - Dale Kientopf
- Moversity, Fit by Dale, Kaltenkirchen, Germany.,Medical Faculty, Albert-Ludwigs-Universität Freiburg Medizinische Fakultät, Freiburg, Germany
| | - Andreas Leithner
- Department of Orthopedics and Trauma Surgery, Hospital of the Federal State of Styria and University Hospital Graz, Graz, Austria.,President, Österreichische Gesellschaft für Orthopädie und orthopädische Chirurgie, Vienna, Austria
| | - Jesko Streeck
- Physiotherapy, Manumed - Streeck, Bobenheim-Roxheim, Germany
| | - Thomas Colshorn
- Physiotherapist and Sports Science, Physiotherapy, Bremen, Germany
| | - Ronald Dorotka
- Orthopadic Surgery, Orthopädie-Zentrum Innere Stadt, Vienna, Austria.,Präsident, Berufsverband Österreichischer Fachärzte für Orthopädie, Vienna, Austria
| | - Markus Schneider
- Pain Therapy, alphaMED/alphaSPINE, Bamberg, Germany.,Interdisziplinäre Gesellschaft für orthopädisch-unfallchirurgische und allgemeine Schmerztherapie, President of IGOST, Ravensburg, Germany.,Leiter der Sektion Schmerztherapie, DGOOC, Frankfurt/Main, Germany
| | - Isabel Höppchen
- Ludwig Boltzmann Institute for Digital Health and Prevention, Ludwig Boltzmann Gesellschaft, Wien, Austria.,Center for Human-Computer Interaction, Paris Lodron University of Salzburg, Salzburg, Austria
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8
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Jansen MP, Mastbergen SC. Joint distraction for osteoarthritis: clinical evidence and molecular mechanisms. Nat Rev Rheumatol 2022; 18:35-46. [PMID: 34616035 DOI: 10.1038/s41584-021-00695-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 12/20/2022]
Abstract
Joint distraction, the prolonged mechanical separation of the bones at a joint, has emerged as a joint-preserving treatment for end-stage osteoarthritis, with the gradually growing promise of implementation in regular clinical practice. Joint distraction of the knee has been most extensively studied, with these studies showing prolonged symptomatic improvement in combination with repair of cartilage tissue in degenerated knee joints, supporting the concept that cartilage repair can translate into real clinical benefit. The reversal of tissue degeneration observed with joint distraction could be the result of one or a combination of various proposed mechanisms, including partial unloading, synovial fluid pressure oscillation, mechanical and biochemical changes in subchondral bone, adhesion and chondrogenic commitment of joint-derived mesenchymal stem cells or a change in the molecular milieu of the joint. The overall picture that emerges from the combined evidence is relevant for future research and treatment-related improvements of joint distraction and for translation of the insights gained about tissue repair to other joint-preserving techniques. It remains to be elucidated whether optimizing the biomechanical conditions during joint distraction can actually cure osteoarthritis rather than only providing temporary symptomatic relief, but even temporary relief might be relevant for society and patients, as it will delay joint replacement with a prosthesis at an early age and thereby avert revision surgery later in life. Most importantly, improved insights into the underlying mechanisms of joint repair might provide new leads for more targeted treatment options.
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Affiliation(s)
- Mylène P Jansen
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Simon C Mastbergen
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.
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9
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Teunissen M, Miranda Bedate A, Coeleveld K, Riemers FM, Meij BP, Lafeber FPJG, Tryfonidou MA, Mastbergen SC. Enhanced Extracellular Matrix Breakdown Characterizes the Early Distraction Phase of Canine Knee Joint Distraction. Cartilage 2021; 13:1654S-1664S. [PMID: 34014119 PMCID: PMC8721609 DOI: 10.1177/19476035211014595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Joint distraction triggers intrinsic cartilage repair in animal models of osteoarthritis (OA), corroborating observations in human OA patients treated with joint distraction. The present study explores the still largely elusive mechanism initiating this repair process. DESIGN Unilateral OA was induced in the knee joint of 8 dogs using the groove model; the contralateral joint served as a control. After 10 weeks, 4 animals received joint distraction, the other 4 serving as OA controls. Halfway the distraction period (after 4 weeks of a standard 8-week distraction treatment), all animals were euthanized, and joint tissues were collected. A targeted quantitative reverse transcription polymerase chain reaction (qRT-PCR) analysis was performed of commonly involved processes including matrix catabolism/anabolism, inflammation, and known signaling pathways in OA. In addition, cartilage changes were determined on tissue sections using the canine OARSI (Osteoarthritis Research Society International) histopathology score and collagen type II (COL2A1) immunostaining. RESULTS Midway distraction, the distracted OA joint showed an upregulation of proteolytic genes, for example, ADAMTS5, MMP9, MMP13, compared to OA alone and the healthy joints, which correlated with an increased OARSI score. Additionally, genes of the transforming growth factor (TGF)-β and Notch pathway, and markers associated with progenitor cells were increased. CONCLUSIONS Joint distraction initiates both catabolic and anabolic transcriptional responses. The enhanced turnover, and thereby renewal of the matrix, could be the key to the cartilage repair observed in the months after joint distraction.
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Affiliation(s)
- Michelle Teunissen
- Department of Clinical Sciences,
Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Alberto Miranda Bedate
- Department of Clinical Sciences,
Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Katja Coeleveld
- Rheumatology & Clinical Immunology,
UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frank M. Riemers
- Department of Clinical Sciences,
Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Björn P. Meij
- Department of Clinical Sciences,
Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Floris P. J. G. Lafeber
- Rheumatology & Clinical Immunology,
UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marianna A. Tryfonidou
- Department of Clinical Sciences,
Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Simon C. Mastbergen
- Rheumatology & Clinical Immunology,
UMC Utrecht, Utrecht University, Utrecht, The Netherlands,Simon C. Mastbergen, Rheumatology &
Clinical Immunology, UMC Utrecht, Utrecht University, G02.228, PO Box 85500, GA,
Utrecht 3508, The Netherlands.
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10
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Wang XJ, Tian W, Xu WW, Lu X, Zhang YM, Li LJ, Chang F. Loss of Autophagy Causes Increased Apoptosis of Tibial Plateau Chondrocytes in Guinea Pigs with Spontaneous Osteoarthritis. Cartilage 2021; 13:796S-807S. [PMID: 34493119 PMCID: PMC8804872 DOI: 10.1177/19476035211044820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The goal of the present study was to observe the effect of autophagy in tibial plateau chondrocytes on apoptosis in spontaneous knee osteoarthritis (OA) in guinea pigs. DESIGN Fifty 2-month-old female Hartley guinea pigs were divided into a normal group (10 animals, all euthanized after 7 months) and an OA group (40 animals, 10 of which were euthanized after 10 months). Immunohistochemistry, RT-qPCR and Western blotting were used to evaluate autophagy levels, intracellular glycogen accumulation and apoptosis in tibial plateau chondrocytes in vivo and in vitro. The remaining 30 guinea pigs in the OA group were divided into 3 groups: a rapamycin group, a normal saline group, and a 3-methyladenine (3-MA) group. Intracellular glycogen accumulation and chondrocyte apoptosis were assessed by altering the level of autophagy in chondrocytes in vivo. RESULTS When spontaneous OA occurred in guinea pigs, autophagy levels in tibial plateau chondrocytes decreased, while intracellular glycogen accumulation and the rate of chondrocyte apoptosis increased. After enhancing the level of autophagy in tibial plateau chondrocytes in guinea pigs with OA, intracellular glycogen accumulation and the rate of chondrocyte apoptosis decreased, while inhibiting autophagy had the opposite effects. CONCLUSION The results indicate that the function of autophagy in chondrocytes may at least partly involve the catabolism of glycogen. In guinea pigs with OA, the level of autophagy in tibial plateau chondrocytes decreased, and chondrocytes were unable to degrade intracellular glycogen into glucose, leading to less energy for chondrocytes and increased apoptosis.
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Affiliation(s)
- Xiao-jian Wang
- Department of Orthopaedic
Surgery, Shanxi Provincial People’s Hospital, Taiyuan, China,Xiao-jian Wang, Department of
Orthopaedic Surgery, Shanxi Provincial People’s Hospital, Shuangtasi
Street 29, Taiyuan, Shanxi 030012, China.
| | - Wei Tian
- Department of Orthopaedic
Surgery, Shanxi Provincial People’s Hospital, Taiyuan, China
| | - Wei-wei Xu
- Shanxi Key Laboratory of Kidney
Disease, Taiyuan, China
| | - Xiao Lu
- Shanxi Key Laboratory of Kidney
Disease, Taiyuan, China
| | - Yu-ming Zhang
- Department of Orthopaedic
Surgery, Shanxi Provincial People’s Hospital, Taiyuan, China
| | - Li-jun Li
- Department of Orthopaedic
Surgery, Shanxi Provincial People’s Hospital, Taiyuan, China
| | - Feng Chang
- Department of Orthopaedic
Surgery, Shanxi Provincial People’s Hospital, Taiyuan, China
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11
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Bin Abd Razak HR, Campos JP, Khakha RS, Wilson AJ, van Heerwaarden RJ. Role of joint distraction in osteoarthritis of the knee: Basic science, principles and outcomes. J Clin Orthop Trauma 2021; 24:101723. [PMID: 34938647 PMCID: PMC8654974 DOI: 10.1016/j.jcot.2021.101723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 12/25/2022] Open
Abstract
The burden of knee osteoarthritis (OA) is increasing worldwide. Advanced tibiofemoral joint OA in young patients is particularly a problem with inferior results seen with total knee arthroplasty in this patient population. Knee joint distraction (KJD) has been evaluated recently as a joint preserving procedure for young patients with advanced tibiofemoral osteoarthritis, to delay the need for a primary total knee arthroplasty (TKA). This will decrease the risk for revision TKA later in life. KJD temporarily unloads the knee joint and keeps the tibia and femur separated over a course of 6 weeks. Outcomes of KJD appear promising. Through this article, the authors hope to share from their collective experience as well as the available literature on the basic science, principles of surgery and outcomes of KJD.
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Affiliation(s)
- Hamid Rahmatullah Bin Abd Razak
- London Knee Osteotomy Centre, Orthopaedic Specialists, Harley Street Specialist Hospital, 18-22 Queen Anne St, London, W1G 8HU, United Kingdom,Department of Orthopaedic Surgery, Sengkang General Hospital, 110 Sengkang East Way, 544886, Singapore,Corresponding author. Department of Orthopaedic Surgery, Sengkang General Hospital, 110 Sengkang East Way, 544886, Singapore.
| | - João Pedro Campos
- London Knee Osteotomy Centre, Orthopaedic Specialists, Harley Street Specialist Hospital, 18-22 Queen Anne St, London, W1G 8HU, United Kingdom,Serviço de Ortopedia e Traumatologia, Hospital Pedro Hispano, Rua Dr. Eduardo Torres, Matosinhos, Portugal
| | - Raghbir S. Khakha
- London Knee Osteotomy Centre, Orthopaedic Specialists, Harley Street Specialist Hospital, 18-22 Queen Anne St, London, W1G 8HU, United Kingdom,Department of Orthopaedics, Guys & St Thomas's Hospital, Great Maze Pond, SE1 9RT, United Kingdom
| | - Adrian J. Wilson
- London Knee Osteotomy Centre, Orthopaedic Specialists, Harley Street Specialist Hospital, 18-22 Queen Anne St, London, W1G 8HU, United Kingdom,Department of Sports and Exercise, University of Winchester, Sparkford Road, Winchester, SO22 4NR, United Kingdom
| | - Ronald J. van Heerwaarden
- London Knee Osteotomy Centre, Orthopaedic Specialists, Harley Street Specialist Hospital, 18-22 Queen Anne St, London, W1G 8HU, United Kingdom,Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, the Netherlands
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12
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Jansen MP, Boymans TA, Custers RJ, Van Geenen RC, Van Heerwaarden RJ, Huizinga MR, Nellensteijn JM, Sollie R, Spruijt S, Mastbergen SC. Knee Joint Distraction as Treatment for Osteoarthritis Results in Clinical and Structural Benefit: A Systematic Review and Meta-Analysis of the Limited Number of Studies and Patients Available. Cartilage 2021; 13:1113S-1123S. [PMID: 32698704 PMCID: PMC8808886 DOI: 10.1177/1947603520942945] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Knee joint distraction (KJD) is a joint-preserving osteoarthritis treatment that may postpone a total knee arthroplasty (TKA) in younger patients. This systematic review and meta-analysis evaluates short- and long-term clinical benefit and tissue structure changes after KJD. DESIGN MEDLINE, EMBASE, and Web of Science were searched for eligible clinical studies evaluating at least one of the primary parameters: WOMAC, VAS-pain, KOOS, EQ5D, radiographic joint space width or MRI cartilage thickness after KJD. Random effects models were applied on all outcome parameters and outcomes were compared with control groups found in the included studies. RESULTS Eleven articles reporting on 7 different KJD cohorts with in total 127 patients and 5 control groups with multiple follow-up moments were included, of which 2 were randomized controlled trials. Significant improvements in all primary parameters were found and benefit lasted up to at least 9 years. Overall, outcomes were comparable with control groups, including high tibial osteotomy, although TKA showed better clinical response. CONCLUSIONS Current, still limited, evidence shows KJD causes clear benefit in clinical and structural parameters, both short- and long-term. Longer follow-up with more patients is necessary, to validate outcome and to potentially improve patient selection for this intensive treatment. Thus far, for younger knee osteoarthritis patients, KJD may be an option to consider.
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Affiliation(s)
- Mylène P. Jansen
- Department of Rheumatology &
Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands,Mylène P. Jansen, Department of Rheumatology
& Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100
(G02.228), Utrecht, 3584CX, The Netherlands.
| | - Tim A.E.J. Boymans
- Department of Orthopaedic Surgery,
Maastricht UMC, Maastricht, Netherlands
| | - Roel J.H. Custers
- Department of Orthopaedic Surgery,
University Medical Center Utrecht, Utrecht, Netherlands
| | | | | | | | - Jorm M. Nellensteijn
- Department of Orthopaedic Surgery,
Medisch Spectrum Twente, Enschede, Netherlands
| | - Rob Sollie
- Department of Orthopaedic Surgery,
Annatommie mc, Amstelveen/Utrecht, Netherlands
| | - Sander Spruijt
- Department of Orthopaedic Surgery,
HagaZiekenhuis, The Hague, Netherlands
| | - Simon C. Mastbergen
- Department of Rheumatology &
Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands
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13
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Chowdhury JM, Lineham B, Pallett M, Pandit HG, Stewart TD, Harwood PJ. Comparison of Mechanical Performance between Circular Frames and Biplanar Distraction Devices for Knee Joint Distraction. Strategies Trauma Limb Reconstr 2021; 16:71-77. [PMID: 34804222 PMCID: PMC8578248 DOI: 10.5005/jp-journals-10080-1530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim and objective This study was designed to test and compare the mechanical performance of the biplanar ArthroSave KneeReviver and a circular frame construct with the intended use of providing a mechanically favourable environment for cartilage regeneration across a knee joint. Materials and methods Three similar constructs of the two devices were applied to biomechanical testing sawbones, with the knee distracted by 8 mm. The constructs were vertically loaded to 800 N in an Instron testing machine at 20 mm/minute. Tests were conducted in neutral hip flexion and at 12° of hip flexion and extension, to mimic leg position in gait. Displacement measurements were taken from the Instron machine, and three-dimensional joint motion was recorded using an Optotrak Certus motion capture system. Results Overall axial rigidity was similar between the two devices (circular frame, 81.6 N/mm ± 5.9; and KneeReviver, 79.5 N/mm ± 25.1 with hip neutral) and similar in different hip positions. At the point of joint contact, the overall rigidity of the circular frame increased significantly more than the KneeReviver (491 N/mm ± 27 and 93 N/mm ± 32, respectively, p <0.001). There was more variability between models in the KneeReviver. There was more off-axis motion in the KneeReviver, mainly due to increasing knee flexion on loading. This was exacerbated with the hip in flexion and extension but remained small, with the maximal off-axis displacement being 7 mm/3°. Conclusion The circular frame provides a similar mechanical environment to the novel KneeReviver device, for which most clinical data are available. These findings suggest that both devices appear a viable option for knee joint distraction (KJD). Further clinical data will help inform mode of application. Clinical significance KJD is a relatively novel technique for use in osteoarthritis (OA), and it remains unclear which distraction devices provide appropriate mechanics. Our testing gives evidence to support either option for further use. How to cite this article Chowdhury JMY, Lineham B, Pallett M, et al. Comparison of Mechanical Performance between Circular Frames and Biplanar Distraction Devices for Knee Joint Distraction. Strategies Trauma Limb Reconstr 2021;16(2):71–77.
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Affiliation(s)
- James My Chowdhury
- Department of Trauma and Orthopaedics, Leeds General Infirmary, Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom
| | - Beth Lineham
- Department of Trauma and Orthopaedics, Leeds General Infirmary, Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom
| | - Matthew Pallett
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
| | - Hemant G Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), Chapel Allerton Hospital, Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom
| | - Todd D Stewart
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
| | - Paul J Harwood
- Department of Trauma and Orthopaedics, Leeds General Infirmary, Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom
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14
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Jansen MP, Besselink NJ, van Heerwaarden RJ, Custers RJH, Emans PJ, Spruijt S, Mastbergen SC, Lafeber FPJG. Knee Joint Distraction Compared with High Tibial Osteotomy and Total Knee Arthroplasty: Two-Year Clinical, Radiographic, and Biochemical Marker Outcomes of Two Randomized Controlled Trials. Cartilage 2021; 12:181-191. [PMID: 30758214 PMCID: PMC7970375 DOI: 10.1177/1947603519828432] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Both, knee joint distraction (KJD) and high tibial osteotomy (HTO) are joint-preserving surgeries that postpone total knee arthroplasty (TKA) in younger osteoarthritis (OA) patients. Here we evaluate the 2-year follow-up of KJD versus TKA and KJD versus HTO in 2 noninferiority studies. DESIGN Knee OA patients indicated for TKA were randomized to KJD (n = 20; KJDTKA) or TKA (n = 40). Medial compartmental knee OA patients considered for HTO were randomized to KJD (n = 23; KJDHTO) or HTO (n = 46). Patient-reported outcome measures were assessed over 2 years of follow-up. The radiographic joint space width (JSW) was measured yearly. In the KJD groups, serum-PIIANP and urinary-CTXII levels were measured as collagen type-II synthesis and breakdown markers. It was hypothesized that there was no clinically important difference in the primary outcome, the total WOMAC, when comparing KJD with HTO and with TKA. RESULTS Both trials were completed, with 114 patients (19 KJDTKA; 34 TKA; 20 KJDHTO; 41 HTO) available for 2-year analyses. At 2 years, the total WOMAC score (KJDTKA: +30.4 [95% CI 23.0-37.9] points; TKA: +42.4 [95% CI 38.1-46.8]; KJDHTO: +21.6 [95% CI 13.8-29.4]; HTO: +29.2 [95% CI 23.6-34.8]; all: P < 0.05) and radiographic minimum JSW (KJDTKA: +0.9 [95% CI 0.2-1.6] mm; KJDHTO: +0.9 [95% CI 0.5-1.4]; HTO: +0.6 [95% CI 0.3-0.9]; all: P < 0.05) were still increased for all groups. The net collagen type-II synthesis 2 years after KJD was increased (P < 0.05). Half of KJD patients experienced pin tract infections, successfully treated with oral antibiotics. CONCLUSIONS Sustained improvement of clinical benefit and (hyaline) cartilage thickness increase after KJD is demonstrated. KJD was clinically noninferior to HTO and TKA in the primary outcome.
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Affiliation(s)
- Mylène P. Jansen
- Rheumatology & Clinical Immunology,
University Medical Center Utrecht, Utrecht, The Netherlands,Mylène P. Jansen, Rheumatology &
Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100
(G02.228), Utrecht, 3584CX, The Netherlands
| | - Nick J. Besselink
- Rheumatology & Clinical Immunology,
University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ronald J. van Heerwaarden
- Centre for Deformity Correction and
Joint Preserving Surgery, Kliniek ViaSana, Mill, The Netherlands
| | - Roel J. H. Custers
- Department of Orthopedic Surgery,
University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pieter J. Emans
- Department of Orthopedics, Maastricht
University Medical Center, Maastricht, The Netherlands
| | - Sander Spruijt
- Department of Orthopedics,
HagaZiekenhuis, The Hague, The Netherlands
| | - Simon C. Mastbergen
- Rheumatology & Clinical Immunology,
University Medical Center Utrecht, Utrecht, The Netherlands
| | - Floris P. J. G. Lafeber
- Rheumatology & Clinical Immunology,
University Medical Center Utrecht, Utrecht, The Netherlands
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15
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Alves JCA, Santos AMMPD, Jorge PIF, Lavrador CFTVB, Carreira LMA. Management of Osteoarthritis Using 1 Intra-articular Platelet Concentrate Administration in a Canine Osteoarthritis Model. Am J Sports Med 2021; 49:599-608. [PMID: 33428459 DOI: 10.1177/0363546520981558] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteoarthritis (OA) represents a significant burden to societies, as it affects quality of life and performance and implies a large cost in terms of health care. Autologous platelets are a regenerative treatment modality for OA that are thought to be a potential stimulation of the natural healing cascade. PURPOSE To describe the effect of the platelet concentrate V-PET in the management of OA in a naturally occurring canine model, using several outcome assessment modalities. STUDY DESIGN Controlled laboratory study. METHODS A total of 40 joints of active working police dogs with hip OA were randomly assigned to a control group (CG) and a platelet concentrate group (PCG; treatment) and evaluated. At treatment day (T0) and 8, 15, 30, 90, and 180 days after treatment, weight distribution, joint range of motion at flexion and extension, thigh girth, digital thermography, radiographic signs, 4 clinical metrology instruments, and synovial fluid interleukin 1 and C-reactive protein levels were recorded. Results were compared using repeated-measures analysis of variance with a Huynh-Feldt correction, paired-samples t test, or Wilcoxon signed rank test, with P < .05. RESULTS Dogs were 6.5 ± 2.4 years old (mean ± SD) and had a body weight of 26.7 ± 5.2 kg. At T0, 32 (80%) joints were graded as having mild OA, 6 (15%) as moderate, and 2 (5%) as severe. No differences were found between groups at T0. Between the PCG and CG, the symmetry index showed significant improvements in the PCG from 8 days (P = .01) to 180 days (P = .01). Joint flexion also improved in the PCG up to 90 days (P < .05) and extension improved up to 180 days (P < .01). Several clinical metrology instrument scores also improved up to 90 to 180 days after treatment. In the CG, radiographic signs progressed, while the PCG showed some improved signs. In both groups, increasing body weight and age corresponded with worse clinical and laboratory findings. CONCLUSION A single injection of platelet concentrate had a positive effect, lasting up to 6 months, on several clinical, imaging, and laboratory signs in a naturally occurring canine OA model. CLINICAL RELEVANCE We characterized the effects of this platelet concentrate in dogs, considered the gold standard of the study of OA, with a group of working animals with similar high demands as athletes.
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Affiliation(s)
- João Carlos Agostinho Alves
- Divisão de Medicina Veterinária, Guarda Nacional Republicana, Lisbon, Portugal.,Mediterranean Institute for Agriculture, Environment and Development, Instituto de Investigação e Formação Avançada, Universidade de Évora, Évora, Portugal
| | | | | | | | - Luis Miguel Alves Carreira
- Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal.,Interdisciplinary Centre for Research in Animal Health, University of Lisbon, Lisbon, Portugal.,Anjos of Assis Veterinary Medicine Centre, Barreiro, Portugal
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16
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Alves J, Jorge P, Santos A. Comparison of Two Mesotherapy Protocols in the Management of Back Pain in Police Working Dogs: A Retrospective Study. Top Companion Anim Med 2021; 43:100519. [PMID: 33548549 DOI: 10.1016/j.tcam.2021.100519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 11/06/2020] [Accepted: 01/29/2021] [Indexed: 12/26/2022]
Abstract
This study aimed to compare 2 protocols for the management of back pain in police working dogs. Twenty animals were signaled based on history, trainer complaints, physical and radiographic examination consistent with back pain. In a retrospective study, 2 groups were considered: GM, treated with a solution comprising a combination of lidocaine, dexamethasone, and tiocolchicoseide; and GT, treated with the same solution, with the addition of Traumeel LT. Response to treatment, measured by the Canine Brief Pain Inventory (CBPI, divided into pain interference score - PIS, and pain severity score - PSS) and Hudson Visual Analogue Scale (HVAS), was evaluated before treatment (T0), after 15 (+15d) days and 1 (+30d), 2 (+60d), 3 (+90d), 4 (+120d), 5 (+150d) and 6 (+180d) months. Results were compared using an independent samples t-test or a Paired Samples t-test. Comparing results for each moment with T0 within each group, differences where observed only in GM at +15d (P < .01 for PIS and P < .01 for PSS), +30d (P = .04 for PIS and P < .01 for PSS), +60d (P = .03 for PIS and P = .02 for PSS) and +90d (P = .02 for PSS). Treatment was successful in reducing PSS (reduction of ≥1) in 8/10 animals of GM at +15d (80%), 8/10 at +30d (80%), 5/10 at +60d (50%), 4/10 at +90d (40%), 3/9 at +120d (33.3%) and 2/9 at +150d -+ 180d (22.2%). In GT, treatment was successful in 1/10 at +15d -+30d (10%), 2/10 at +60d (20%) and 1/10 at +90d (10%). No differences were observed with HVAS any time point for either intervention or when comparing groups in each moment. The protocol used in GM produced significant improvements, while the addition of Traumeel did not, rather reducing the effect of treatment in working dogs with back pain. Further studies are required.
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Affiliation(s)
- João Alves
- MED - Mediterranean Institute for Agriculture, Environment and Development, Instituto de Investigação e Formação Avançada, Universidade de Évora, Pólo da Mitra, Ap. 94, 7006-554; Divisão de Medicina Veterinária, Guarda Nacional Republicana, Lisbon, Portugal.
| | - Patrícia Jorge
- Divisão de Medicina Veterinária, Guarda Nacional Republicana, Lisbon, Portugal
| | - Ana Santos
- Divisão de Medicina Veterinária, Guarda Nacional Republicana, Lisbon, Portugal
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17
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Alves JC, Santos A, Jorge P, Lavrador C, Carreira LM. The intra-articular administration of triamcinolone hexacetonide in the treatment of osteoarthritis. Its effects in a naturally occurring canine osteoarthritis model. PLoS One 2021; 16:e0245553. [PMID: 33471857 PMCID: PMC7816979 DOI: 10.1371/journal.pone.0245553] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/03/2021] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To evaluate the effect of an intra-articular (IA) administration of triamcinolone hexacetonide, compared with saline. PATIENTS AND METHODS Forty (N = 40) hip joints were randomly assigned to a treatment group (THG, n = 20, receiving IA triamcinolone hexacetonide) and a control group (CG, n = 20, receiving IA saline). On treatment day (T0), and at 8, 15, 30, 90 and 180 days post-treatment, weight distribution, joint range of motion, thigh girth, digital thermography, radiographic signs, synovial fluid interleukin-1 and C-reactive protein levels were evaluated. Data from four Clinical Metrology Instruments was also gathered. Results were compared Repeated Measures ANOVA, with a Huynh-Feldt correction, Paired Samples T-Test or Wilcoxon Signed Ranks Test. A Kaplan-Meier test was performed to compare both groups, with p<0.05. RESULTS Joints were graded as mild (65%), moderate (20%) and severe (15%). Patients of both sexes, with a mean age of 6.5±2.4 years and bodyweight of 26.7±5.2kg, were included. No differences were found between groups at T0. Comparing THG to CG, weight distribution showed significant improvements in THG from 8 (p = 0.05) up to 90 days (p = 0.01). THG showed lower values during thermographic evaluation in the Lt view (p<0.01). Pain and function scores also improved from 30 to 180 days. Increasing body weight, age, and presence of caudolateral curvilinear osteophyte corresponded to worse response to treatment. Results of the Kaplan Meier test showed significant differences between groups, with THG performing better considering several evaluations and scores. CONCLUSION THG recorded significant improvements in weight-bearing and in with the considered CMIs, particularly pain scores. Lower thermographic values were registered in THG up to the last evaluation day. Age, sex, and radiographic findings did significantly influenced response to treatment.
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Affiliation(s)
- João C. Alves
- Divisão de Medicina Veterinária, Guarda Nacional Republicana (GNR), Lisbon, Portugal
- MED – Mediterranean Institute for Agriculture, Environment and Development, Instituto de Investigação e Formação Avançada, Universidade de Évora, Pólo da Mitra, Évora, Portugal
| | - Ana Santos
- Divisão de Medicina Veterinária, Guarda Nacional Republicana (GNR), Lisbon, Portugal
| | - Patrícia Jorge
- Divisão de Medicina Veterinária, Guarda Nacional Republicana (GNR), Lisbon, Portugal
| | - Catarina Lavrador
- MED – Mediterranean Institute for Agriculture, Environment and Development, Instituto de Investigação e Formação Avançada, Universidade de Évora, Pólo da Mitra, Évora, Portugal
| | - L. Miguel Carreira
- Faculty of Veterinary Medicine, University of Lisbon (FMV/ULisboa), Lisbon, Portugal
- Interdisciplinary Centre for Research in Animal Health (CIISA) – University of Lisbon, (FMV/ULisboa), Lisbon, Portugal
- Anjos of Assis Veterinary Medicine Centre (CMVAA), Barreiro, Portugal
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18
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Abstract
PURPOSE OF REVIEW Current thinking in the study of posttraumatic osteoarthritis (PTOA) is overviewed: the osteoarthritis which follows acute joint injury. The review particularly highlights important publications in the last 18 months, also reflecting on key older literature, in terms of what have we have we learned and have yet to learn from PTOA, which can advance the osteoarthritis field as a whole. RECENT FINDINGS PTOA is a mechanically driven disease, giving insight into mechanical drivers for osteoarthritis. A mechanosensitive molecular tissue injury response (which includes activation of pain, degradative and also repair pathways) is triggered by acute joint injury and seen in osteoarthritis. Imaging features of PTOA are highly similar to osteoarthritis, arguing against it being a different phenotype. The inflammatory pathways activated by injury contribute to early joint symptoms. However, later structural changes appear to be dissociated from traditional measures of synovial inflammation. SUMMARY PTOA remains an important niche in which to understand processes underlying osteoarthritis and seek interventional targets. Whether PTOA has true molecular or clinical differences to osteoarthritis as a whole remains to be understood. This knowledge is important for a field where animal modelling of the disease relies heavily on the link between injury and osteoarthritis.
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Affiliation(s)
- Fiona E Watt
- Centre for Osteoarthritis Pathogenesis Versus Arthritis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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19
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Alves JC, Santos A, Jorge P, Lavrador C, Carreira LM. Clinical and diagnostic imaging findings in police working dogs referred for hip osteoarthritis. BMC Vet Res 2020; 16:425. [PMID: 33160336 PMCID: PMC7648415 DOI: 10.1186/s12917-020-02647-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/27/2020] [Indexed: 12/17/2022] Open
Abstract
Background Osteoarthritis (OA) is the most commonly diagnosed joint disease in veterinary medicine, with at least 80% of the cases of lameness and joint diseases in companion animals being classified as OA. Sporting and working animals are more predisposed to develop OA since they are exposed to chronic fatigue injuries, leading to bone and muscular tissue damage and failure, resulting in clinical signs. To characterize the clinical signs and diagnostic findings of Police working dogs presenting with bilateral hip OA at the time of diagnosis. Fifty animals were evaluated with a bodyweight ≥ 15 kg, be older than two years, and without any medication or nutritional supplements for ≥ 6 weeks. Results Weight distribution, joint range of motion at flexion and extension, thigh girth, digital thermography, and radiographic signs were collected. Data from different Clinical Metrology Instruments (CMI) were collected: Canine Brief Pain Inventory, Liverpool Osteoarthritis in Dogs, Canine Orthopedic Index, and the Hudson Visual Analogue Scale. Results were compared by breed, age, sex, and Orthopaedic Foundation for Animals hip grades with the Independent Samples T-Test, ANOVA followed by a Bonferroni post hoc test, and Pearson correlation coefficient, with p < 0.05. The sample included 30 males and 20 females, with a mean age of 6.5 ± 2.4 years and a bodyweight of 26.7 ± 5.2 kg. Animals with weight distribution below normal levels had significant variations of joint extension and function scores. This evaluation was the only not correlated with at least one breed. Animals with caudolateral curvilinear osteophyte showed a poorer clinical presentation and worse scores in all considered CMIs. Radiographic changes correlated with age and corresponded to worse CMIs scores and weight distribution. Dutch Shepherd Dogs showed better CMI scores than the other considered breeds. Conclusions Police working dogs presented with complaints related to hip OA at an early stage of the disease. Hip scores influenced clinical presentation, with moderate cases showing lower thigh girth and worse pain interference and severity, and function scores than mild cases. Patients with severe OA had lower thermographic evaluations than patients with moderate OA. Age was the primary variable influencing considered CMI scores.
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Affiliation(s)
- J C Alves
- Divisão de Medicina Veterinária, Guarda Nacional Republicana (GNR), Rua Presidente Arriaga, 9, 1200-771, Lisbon, Portugal. .,MED - Mediterranean Institute for Agriculture, Environment and Development, Instituto de Investigação e Formação Avançada, Universidade de Évora , Pólo da Mitra, Ap. 94, 7006-554, Évora, Portugal.
| | - A Santos
- Divisão de Medicina Veterinária, Guarda Nacional Republicana (GNR), Rua Presidente Arriaga, 9, 1200-771, Lisbon, Portugal
| | - P Jorge
- Divisão de Medicina Veterinária, Guarda Nacional Republicana (GNR), Rua Presidente Arriaga, 9, 1200-771, Lisbon, Portugal
| | - C Lavrador
- MED - Mediterranean Institute for Agriculture, Environment and Development, Instituto de Investigação e Formação Avançada, Universidade de Évora , Pólo da Mitra, Ap. 94, 7006-554, Évora, Portugal
| | - L Miguel Carreira
- Faculty of Veterinary Medicine, University of Lisbon (FMV/ULisboa), Lisbon, Portugal.,Interdisciplinary Centre for Research in Animal Health (CIISA), University of Lisbon, FMV/ULisboa, Lisbon, Portugal.,Anjos of Assis Veterinary Medicine Centre (CMVAA), Barreiro, Portugal
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20
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An update to the advances in understanding distraction histogenesis: From biological mechanisms to novel clinical applications. J Orthop Translat 2020. [DOI: 10.1016/j.jot.2020.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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21
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Sanjurjo-Rodriguez C, Altaie A, Mastbergen S, Baboolal T, Welting T, Lafeber F, Pandit H, McGonagle D, Jones E. Gene Expression Signatures of Synovial Fluid Multipotent Stromal Cells in Advanced Knee Osteoarthritis and Following Knee Joint Distraction. Front Bioeng Biotechnol 2020; 8:579751. [PMID: 33178674 PMCID: PMC7591809 DOI: 10.3389/fbioe.2020.579751] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/16/2020] [Indexed: 12/16/2022] Open
Abstract
Osteoarthritis (OA) is the most common musculoskeletal disorder. Although joint replacement remains the standard of care for knee OA patients, knee joint distraction (KJD), which works by temporarily off-loading the joint for 6–8 weeks, is becoming a novel joint-sparing alternative for younger OA sufferers. The biological mechanisms behind KJD structural improvements remain poorly understood but likely involve joint-resident regenerative cells including multipotent stromal cells (MSCs). In this study, we hypothesized that KJD leads to beneficial cartilage-anabolic and anti-catabolic changes in joint-resident MSCs and investigated gene expression profiles of synovial fluid (SF) MSCs following KJD as compared with baseline. To obtain further insights into the effects of local biomechanics on MSCs present in late OA joints, SF MSC gene expression was studied in a separate OA arthroplasty cohort and compared with subchondral bone (SB) MSCs from medial (more loaded) and lateral (less loaded) femoral condyles from the same joints. In OA arthroplasty cohort (n = 12 patients), SF MSCs expressed lower levels of ossification- and hypotrophy-related genes [bone sialoprotein (IBSP), parathyroid hormone 1 receptor (PTH1R), and runt-related transcription factor 2 (RUNX2)] than did SB MSCs. Interestingly, SF MSCs expressed 5- to 50-fold higher levels of transcripts for classical extracellular matrix turnover molecules matrix metalloproteinase 1 (MMP1), a disintegrin and metalloproteinase with thrombospondin motifs 5 (ADAMTS5), and tissue inhibitor of metalloproteinase-3 (TIMP3), all (p < 0.05) potentially indicating greater cartilage remodeling ability of OA SF MSCs, compared with SB MSCs. In KJD cohort (n = 9 patients), joint off-loading resulted in sustained, significant increase in SF MSC colonies’ sizes and densities and a notable transcript upregulation of key cartilage core protein aggrecan (ACAN) (weeks 3 and 6), as well as reduction in pro-inflammatory C–C motif chemokine ligand 2 (CCL2) expression (weeks 3 and 6). Additionally, early KJD changes (week 3) were marked by significant increases in MSC chondrogenic commitment markers gremlin 1 (GREM1) and growth differentiation factor 5 (GDF5). In combination, our results reveal distinct transcriptomes on joint-resident MSCs from different biomechanical environments and show that 6-week joint off-loading leads to transcriptional changes in SF MSCs that may be beneficial for cartilage regeneration. Biomechanical factors should be certainly considered in the development of novel MSC-based therapies for OA.
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Affiliation(s)
- Clara Sanjurjo-Rodriguez
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.,Physiotherapy, Medicine and Biomedical Sciences department, CIBER-BBN, Institute of Biomedical Research of A Coruña (INIBIC)-Centre of Advanced Scientific Researches (CICA), University of A Coruña, A Coruña, Spain
| | - Ala Altaie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Simon Mastbergen
- University Medical Center Utrecht, Rheumatology & Clinical Immunology, Regenerative Medicine Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Thomas Baboolal
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Tim Welting
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Floris Lafeber
- University Medical Center Utrecht, Rheumatology & Clinical Immunology, Regenerative Medicine Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Hemant Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.,NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds, United Kingdom
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.,NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds, United Kingdom
| | - Elena Jones
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
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22
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van Heerwaarden RJ, Verra W. Kniegelenkdistraktion bei der Behandlung schwerer Arthrose. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-020-00389-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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23
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Knee joint distraction in the treatment of severe osteoarthritis. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-020-00382-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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24
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Alves JC, Santos A, Jorge P, Lavrador C, Carreira LM. A report on the use of a single intra-articular administration of autologous platelet therapy in a naturally occurring canine osteoarthritis model - a preliminary study. BMC Musculoskelet Disord 2020; 21:127. [PMID: 32106842 PMCID: PMC7047415 DOI: 10.1186/s12891-020-3140-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 02/17/2020] [Indexed: 02/07/2023] Open
Abstract
Background Osteoarthritis (OA) represents a significant burden to societies, as it affects quality of life, performance and poses a large healthcare cost. We aimed to describe the use of a single intra-articular (IA) injection of an autologous platelet therapy in the management of osteoarthritis (OA) in a naturally occurring canine model. Methods Fifteen police working dogs with bilateral hip OA were treated with 3 ml of platelet concentrate per hip joint, produced with the V-PET kit. Response to treatment was measured by the Canine Brief Pain Inventory (CBPI, divided in pain interference score – PIS, and Pain Severity Score - PSS), Liverpool Osteoarthritis in Dogs (LOAD), Canine Orthopedic Index (COI, divided in four dimensions: function, gait, stiffness and quality of life - QOL) and the Hudson Visual Analogue Scale (HVAS). Seven different time points were considered: T0 (before treatment), T1 (after 15 days), T2, T3, T4, T5 and T6 (after 1, 2, 3, 4 and 5 months respectively). Results from each evaluation moment were compared with T0 with a Paired Samples T-Test, and a p < 0.05 was set. Results Significant differences were observed at T1 (p < 0.01 for HVAS, PSS, COI, Gait and QOL; p = 0.01 for PIS; p = 0.02 for Function; and p < 0.05 for Stiffness), T2 (p < 0.01 for PSS, PIS and Gait; p = 0.01 for COI; p = 0.02 for HVAS, Function and QOL; and p = 0.04 for Stiffness), T3 (p < 0.01 for HVAS, PSS, PIS, Function and Gait; p = 0.01 for COI; and p = 0.02 for QOL), T4 (p < 0.01 for PSS; p = 0.03 for PIS and Gait), T5 (p < 0.01 for COI, Function and Gait; p = 0.03 for PSS, PIS and Stiffness), T6 (p < 0.01 for PSS, Function and Gait; p = 0.04 for PIS; p < 0.05 for COI) and T7 (p < 0.01 for PSS, Function and Gait; p = 0.01 for COI; and p < 0.05 for PIS). Conclusions Autologous platelet therapy was used without apparent harm in the subjects. A single administration produced significant improvements, which lasted several months, and therefore warrants further study.
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Affiliation(s)
- J C Alves
- Divisão de Medicina Veterinária, Guarda Nacional Republicana (GNR), Rua Presidente Arriaga, 9, 1200-771, Lisbon, Portugal. .,MED - Mediterranean Institute for Agriculture, Environment and Development, Instituto de Investigação e Formação Avançada, Universidade de Évora, Pólo da Mitra, Ap. 94, 7006-554, Évora, Portugal.
| | - A Santos
- Divisão de Medicina Veterinária, Guarda Nacional Republicana (GNR), Rua Presidente Arriaga, 9, 1200-771, Lisbon, Portugal
| | - P Jorge
- Divisão de Medicina Veterinária, Guarda Nacional Republicana (GNR), Rua Presidente Arriaga, 9, 1200-771, Lisbon, Portugal
| | - C Lavrador
- MED - Mediterranean Institute for Agriculture, Environment and Development, Instituto de Investigação e Formação Avançada, Universidade de Évora, Pólo da Mitra, Ap. 94, 7006-554, Évora, Portugal
| | - L Miguel Carreira
- Faculty of Veterinary Medicine, University of Lisbon (FMV/ULisboa), Lisbon, Portugal.,Interdisciplinary Centre for Research in Animal Health (CIISA), University of Lisbon (FMV/ULisboa), Lisbon, Portugal.,Anjos of Assis Veterinary Medicine Centre (CMVAA), Barreiro, Portugal
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25
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Huang J, Chen C, Liang C, Luo P, Xia G, Zhang L, Wang X, Wen Z, Cao X, Wu S. Dysregulation of the Wnt Signaling Pathway and Synovial Stem Cell Dysfunction in Osteoarthritis Development. Stem Cells Dev 2020; 29:401-413. [PMID: 31964233 DOI: 10.1089/scd.2019.0260] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Stem cell dysfunction and failure have been found in joints afflicted by osteoarthritis (OA). However, the exact factors in the OA microenvironment that impair stem cell functions and the role of stem cell dysfunction in OA development have not been fully clarified. In this study, we evaluated the functional status of synovial mesenchymal stem cells (SMSCs) from OA patients and explored the influence of OA-SMSCs on cartilage degradation in a rat model. We then screened 138 Wnt signaling-related genes in the synovium of OA patients, focusing on the effects of five WNT ligands on SMSC functions. The OA synovium showed mild hyperplasia, and we found a large number of CD90+/CD105+ stem cells in synovial hyperplasia. The OA-SMSCs revealed a cellular senescence phenotype, with decreased proliferation and chondrogenic capacity, accompanied by enhanced migration, proinflammatory and matrix degradation activities. The intra-articular transplantation of these OA-SMSCs significantly aggravated the degradation and destruction of the articular cartilage. Of 138 Wnt signaling genes, the expression of 86 genes was consistently altered in the OA synovium, among which the increased expression of DVL2, WNT10A, and DKK3 was the most marked. In general, we found that canonical Wnt/β-catenin pathways were inhibited in the OA synovium, whereas noncanonical PCP and Wnt/Ca2+ pathways were activated. In vitro, WNT10A had an obvious antisenescence effect on SMSCs. WNT5B significantly inhibited the chondrogenic differentiation of SMSCs, and WNT10A and WNT5A increased the expression of inflammatory cytokines in SMSCs. In a rat model, WNT5A significantly aggravated joint degeneration, whereas WNT10A had a mild protective effect on cartilage integrity. In conclusion, stem cells in the OA synovium were functionally abnormal and promoted the development of OA, whereas dysregulation of the Wnt signaling pathway revealed a comprehensive influence on SMSC functions and cartilage degradation.
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Affiliation(s)
- Junjie Huang
- Department of Orthopaedics, The 3rd Xiangya Hospital, Central South University, Changsha, China
| | - Chuanshun Chen
- Department of Orthopaedics, The 3rd Xiangya Hospital, Central South University, Changsha, China
| | - Chi Liang
- Department of Orthopaedics, The 3rd Xiangya Hospital, Central South University, Changsha, China
| | - Pan Luo
- Department of Orthopaedics, The 3rd Xiangya Hospital, Central South University, Changsha, China
| | - Guang Xia
- Department of Orthopaedics, The 3rd Xiangya Hospital, Central South University, Changsha, China
| | - Lina Zhang
- Department of Orthopaedics, The 3rd Xiangya Hospital, Central South University, Changsha, China
| | - Xinxing Wang
- Department of Orthopaedics, The 3rd Xiangya Hospital, Central South University, Changsha, China
| | - Zi Wen
- Department of Orthopaedics, The 3rd Xiangya Hospital, Central South University, Changsha, China
| | - Xu Cao
- Department of Orthopaedics, The 3rd Xiangya Hospital, Central South University, Changsha, China
| | - Song Wu
- Department of Orthopaedics, The 3rd Xiangya Hospital, Central South University, Changsha, China
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26
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Goh EL, Lou WCN, Chidambaram S, Ma S. The role of joint distraction in the treatment of knee osteoarthritis: a systematic review and quantitative analysis. Orthop Res Rev 2019; 11:79-92. [PMID: 31496838 PMCID: PMC6689796 DOI: 10.2147/orr.s211060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/10/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction Knee osteoarthritis is a major cause of pain and disability for which joint distraction is a potential treatment to delay the need for knee arthroplasty. This systematic review aims to assess the short- and long-term clinical and structural outcomes following knee joint distraction (KJD). Methods MEDLINE, EMBASE, Scopus, and Web of Science databases were searched from the date of inception to 26th June 2019. Clinical studies investigating joint distraction for knee osteoarthritis with outcomes including ∆WOMAC index, ∆VAS pain score, and ∆joint space width were included. The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) – CRD42018087032. Results Nine studies comprising a total of 507 patients were included. There were four randomized controlled trials (RCTs), five open prospective cohort studies, and one case series. Overall, there were significant improvements in WOMAC index, VAS pain score and joint space width following KJD, which persisted up to 9 years. KJD also demonstrated comparable clinical outcomes with high tibial osteotomy and total knee arthroplasty. Conclusion There is moderate quality evidence supporting the beneficial outcomes of joint distraction for knee osteoarthritis. Larger RCTs with longer follow-up (>1 year) are necessary to establish the true effect size of this procedure.
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Affiliation(s)
- En Lin Goh
- Oxford University Clinical Academic Graduate School, Medical Sciences Division, University of Oxford , Oxford, UK
| | | | - Swathikan Chidambaram
- Oxford University Clinical Academic Graduate School, Medical Sciences Division, University of Oxford , Oxford, UK
| | - Shaocheng Ma
- City and Guilds Building, Imperial College London, London, UK
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27
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Walter SG, Ossendorff R, Schildberg FA. Articular cartilage regeneration and tissue engineering models: a systematic review. Arch Orthop Trauma Surg 2019; 139:305-316. [PMID: 30382366 DOI: 10.1007/s00402-018-3057-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Cartilage regeneration and restoration is a major topic in orthopedic research as cartilaginous degeneration and damage is associated with osteoarthritis and joint destruction. This systematic review aims to summarize current research strategies in cartilage regeneration research. MATERIALS AND METHODS A Pubmed search for models investigating single-site cartilage defects as well as chondrogenesis was conducted and articles were evaluated for content by title and abstract. Finally, only manuscripts were included, which report new models or approaches of cartilage regeneration. RESULTS The search resulted in 2217 studies, 200 of which were eligible for inclusion in this review. The identified manuscripts consisted of a large spectrum of research approaches spanning from cell culture to tissue engineering and transplantation as well as sophisticated computational modeling. CONCLUSIONS In the past three decades, knowledge about articular cartilage and its defects has multiplied in clinical and experimental settings and the respective body of research literature has grown significantly. However, current strategies for articular cartilage repair have not yet succeeded to replicate the structure and function of innate articular cartilage, which makes it even more important to understand the current strategies and their impact. Therefore, the purpose of this review was to globally summarize experimental strategies investigating cartilage regeneration in vitro as well as in vivo. This will allow for better referencing when designing new models or strategies and potentially improve research translation from bench to bedside.
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Affiliation(s)
- Sebastian G Walter
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Robert Ossendorff
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Frank A Schildberg
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.
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28
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Sun ZB, Peng H. Experimental Study on the Prevention of Posttraumatic Osteoarthritis in the Rabbit Knee Using a Hinged External Fixator in Combination with Exercises. J INVEST SURG 2019; 32:552-559. [PMID: 30644773 DOI: 10.1080/08941939.2018.1543483] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Zhi-Bo Sun
- Department of Orthopedics, Renmin Hospital, Wuhan University, Wuhan, Hubei 430060, China
| | - Hao Peng
- Department of Orthopedics, Renmin Hospital, Wuhan University, Wuhan, Hubei 430060, China
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29
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McCulloch RS, Mente PL, O’Nan AT, Ashwell MS. Articular cartilage gene expression patterns in the tissue surrounding the impact site following applications of shear and axial loads. BMC Musculoskelet Disord 2018; 19:449. [PMID: 30579353 PMCID: PMC6303924 DOI: 10.1186/s12891-018-2374-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 12/06/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Osteoarthritis is a degradative joint disease found in humans and commercial swine which can develop from a number of factors, including prior joint trauma. An impact injury model was developed to deliver in vitro loads to disease-free porcine patellae in a model of OA. METHODS Axial impactions (2000 N normal) and shear impactions (500 N normal with induced shear forces) were delivered to 48 randomly assigned patellae. The patellae were then cultured for 0, 3, 7, or 14 days following the impact. Specimens in the tissue surrounding the loading site were harvested and expression of 18 OA related genes was studied via quantitative PCR. The selected genes were previously identified from published work and fell into four categories: cartilage matrix, degradative enzymes, inflammatory response, and apoptosis. RESULTS Type II collagen (Col2a1) showed significantly lower expression in shear vs. axial adjacent tissue at day 0 and 7 (fold changes of 0.40 & 0.19, respectively). In addition, higher expression of degradative enzymes and Fas, an apoptosis gene, was observed in the shear specimens. CONCLUSIONS The results suggest that a more physiologically valid shear load may induce more damage to surrounding articular cartilage than a normal load alone.
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Affiliation(s)
- R. S. McCulloch
- Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC, USA and University of North Carolina, Chapel Hill, North Carolina USA
- Department of Human Physiology, Gonzaga University, 502 E Boone Ave, Spokane, WA 99258 USA
| | - P. L. Mente
- Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC, USA and University of North Carolina, Chapel Hill, North Carolina USA
| | - A. T. O’Nan
- Department of Animal Science, North Carolina State University, 120 Broughton Dr, Raleigh, NC 27695 USA
| | - M. S. Ashwell
- Department of Animal Science, North Carolina State University, 120 Broughton Dr, Raleigh, NC 27695 USA
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30
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Evaluation of the Curative Effect of Umbilical Cord Mesenchymal Stem Cell Therapy for Knee Arthritis in Dogs Using Imaging Technology. Stem Cells Int 2018; 2018:1983025. [PMID: 29861739 PMCID: PMC5976915 DOI: 10.1155/2018/1983025] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/22/2018] [Accepted: 03/29/2018] [Indexed: 12/24/2022] Open
Abstract
Objective The aim of this study was to assess the efficacy of canine umbilical cord mesenchymal stem cells (UC-MSCs) on the treatment of knee osteoarthritis in dogs. Methods Eight dogs were evenly assigned to two groups. The canine model of knee osteoarthritis was established by surgical manipulation of knee articular cartilage on these eight dogs. UC-MSCs were isolated from umbilical cord Wharton's jelly by 0.1% type collagenase I and identified by immunofluorescence staining and adipogenic and osteogenic differentiation in vitro. A suspension of allogeneic UC-MSCs (1 × 106) and an equal amount of physiological saline was injected into the cavitas articularis in the treated and untreated control groups, respectively, on days 1 and 3 posttreatment. The structure of the canine knee joint was observed by magnetic resonance imaging (MRI), B-mode ultrasonography, and X-ray imaging at the 3rd, 7th, 14th, and 28th days after treatment. Concurrently, the levels of IL-6, IL-7, and TNF-α in the blood of the examined dogs were measured. Moreover, the recovery of cartilage and patella surface in the treated group and untreated group was compared using a scanning electron microscope (SEM) after a 35-day treatment. Results Results revealed that the isolated cells were UC-MSCs, because they were positive for CD44 and negative for CD34 surface markers, and the cells were differentiated into adipocytes and osteoblasts. Imaging technology showed that as treatment time increased, the high signal in the MRI T2-weighted images decreased, the echo-free space in B ultrasonography images disappeared basically, and the continuous linear hypoechoic region at the trochlear sulcus thickened. On X-ray images, the serrate defect at the ventral cortex of the patella improved, and the low-density gap of the ventral patella and trochlear crest gradually increased in the treated group. On the contrary, the high signal in the MRI T2-weighted images and the echo-free space in B ultrasonography images still increased after a 14-day treatment in the untreated control group, and the linear hypoechoic region was discontinuous. On the X-ray images, there was no improvement in the serrate defect of the ventral cortex of the patella. Results for inflammatory factors showed that the blood levels of IL-6, IL-7, and TNF-α of the untreated control group were significantly higher than those of the treated group (P < 0.05) 7-14 days posttreatment. The result of SEM showed that the cartilage neogenesis in the treated group had visible neonatal tissue and more irregular arrangement of new tissue fibers than that of the untreated control group. Furthermore, more vacuoles but without collagen fibers were observed in the cartilage of the untreated control group, and the thickness of the neogenetic cartilage in the treated group (65.13 ± 5.29, 65.30 ± 5.83) and the untreated control group (34.27 ± 5.42) showed a significant difference (P < 0.01). Conclusion Significantly higher improvement in cartilage neogenesis and recovery was observed in the treated group compared to the untreated control group. The joint fluid and the inflammatory response in the treated group decreased. Moreover, improved recovery in the neogenetic cartilage, damaged skin fascia, and muscle tissue around the joints was more significant in the treated group than in the untreated control group. In conclusion, canine UC-MSCs promote the repair of cartilage and patella injury in osteoarthritis, improve the healing of the surrounding tissues, and reduce the inflammatory response.
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31
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Nickien M, Heuijerjans A, Ito K, van Donkelaar CC. Comparison between in vitro and in vivo cartilage overloading studies based on a systematic literature review. J Orthop Res 2018; 36:2076-2086. [PMID: 29644716 PMCID: PMC6120482 DOI: 10.1002/jor.23910] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 03/27/2018] [Indexed: 02/04/2023]
Abstract
Methodological differences between in vitro and in vivo studies on cartilage overloading complicate the comparison of outcomes. The rationale of the current review was to (i) identify consistencies and inconsistencies between in vitro and in vivo studies on mechanically-induced structural damage in articular cartilage, such that variables worth interesting to further explore using either one of these approaches can be identified; and (ii) suggest how the methodologies of both approaches may be adjusted to facilitate easier comparison and therewith stimulate translation of results between in vivo and in vitro studies. This study is anticipated to enhance our understanding of the development of osteoarthritis, and to reduce the number of in vivo studies. Generally, results of in vitro and in vivo studies are not contradicting. Both show subchondral bone damage and intact cartilage above a threshold value of impact energy. At lower loading rates, excessive loads may cause cartilage fissuring, decreased cell viability, collagen network de-structuring, decreased GAG content, an overall damage increase over time, and low ability to recover. This encourages further improvement of in vitro systems, to replace, reduce, and/or refine in vivo studies. However, differences in experimental set up and analyses complicate comparison of results. Ways to bridge the gap include (i) bringing in vitro set-ups closer to in vivo, for example, by aligning loading protocols and overlapping experimental timeframes; (ii) synchronizing analytical methods; and (iii) using computational models to translate conclusions from in vitro results to the in vivo environment and vice versa. © 2018 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. J Orthop Res 9999:1-11, 2018.
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Affiliation(s)
- Mieke Nickien
- Department of Biomedical Engineering, Orthopaedic BiomechanicsEindhoven University of TechnologyP.O. Box 513, 5600MBEindhovenThe Netherlands
| | - Ashley Heuijerjans
- Department of Biomedical Engineering, Orthopaedic BiomechanicsEindhoven University of TechnologyP.O. Box 513, 5600MBEindhovenThe Netherlands
| | - Keita Ito
- Department of Biomedical Engineering, Orthopaedic BiomechanicsEindhoven University of TechnologyP.O. Box 513, 5600MBEindhovenThe Netherlands
| | - Corrinus C. van Donkelaar
- Department of Biomedical Engineering, Orthopaedic BiomechanicsEindhoven University of TechnologyP.O. Box 513, 5600MBEindhovenThe Netherlands
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32
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Dong P, Tang X, Wang J, Jiang Y, Yao W, Gui J. [Short-term effectiveness of joint distraction by Ilizarov combined with arthroscopic debridement in treatment of knee osteoarthritis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:794-798. [PMID: 29798521 PMCID: PMC8498158 DOI: 10.7507/1002-1892.201701099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 05/20/2017] [Indexed: 01/24/2023]
Abstract
Objective To investigate the short-term effectiveness of joint distraction by Ilizarov combined with arthroscopic debridement in the treatment of knee osteoarthritis (KOA). Methods Between January 2014 and January 2015, 15 patients (15 knees) with KOA were treated using arthroscopic debridement assisting with the Ilizarov distraction technology. There were 7 males and 8 females, aged from 45 to 64 years (mean, 55 years). The left knee and the right knee were involved in 6 and 9 cases respectively. The disease duration was 2.0-9.5 years (median, 6 years). They all had received conservative treatment for 6 months and got poor clinical improvement. The preoperative visual analogue scale (VAS) score, the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, the knee injury and osteoarthritis outcome score (KOOS), the range of motion (ROM) for knee, and the radiographic joint space width were 76.2±8.8, 59.3±5.7, 44.3±7.2, (75±21)°, and (2.5±0.4) mm respectively. According to Kellgren-Lawrence grade system, 11 cases were rated as grade III and 4 cases as grade IV. Results There was no poor incision healing, infection, and deep vein thrombosis. All the 15 patients were followed up 12-18 months (mean, 15.5 months). Patients achieved pain relief. The knee activity was obviously improved. The postoperative VAS score, WOMAC score, KOOS score, and ROM at 12 months were 20.9±7.8, 38.2±5.5, 92.1±6.9, and (118±14)° respectively, showing significant difference when compared with preoperative ones ( t=18.213, P=0.000; t=10.317, P=0.000; t=18.564, P=0.000; t=6.599, P=0.000). Postoperative X-ray film showed that joint space width at 12 months was (3.8±0.3) mm, showing significant difference when compared with preoperative one ( t=10.070, P=0.000). Conclusion Joint distraction by Ilizarov combined with arthroscopic debridement can effectively relieve pain, improve the function and quality of life. It was beneficial to cartilaginous tissue repair and delaying the degenerative process of KOA. The short-term effectiveness is satisfactory.
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Affiliation(s)
- Peilong Dong
- Department of Orthopedics, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing Jiangsu, 210006, P.R.China;Department of Orthopedics, Jianhu Hospital Affiliated to Nantong University, Yancheng Jiangsu, 224700, P.R.China
| | - Xiaobo Tang
- Department of Orthopedics, Jianhu Hospital Affiliated to Nantong University, Yancheng Jiangsu, 224700, P.R.China
| | - Jian Wang
- Department of Orthopedics, Jianhu Hospital Affiliated to Nantong University, Yancheng Jiangsu, 224700, P.R.China
| | - Yiqiu Jiang
- Department of Orthopedics, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing Jiangsu, 210006, P.R.China
| | - Wangxiang Yao
- Department of Orthopedics, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing Jiangsu, 210006, P.R.China
| | - Jianchao Gui
- Department of Orthopedics, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing Jiangsu, 210006,
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van der Woude JAD, Wiegant K, van Heerwaarden RJ, Spruijt S, van Roermund PM, Custers RJH, Mastbergen SC, Lafeber FPJG. Knee joint distraction compared with high tibial osteotomy: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2017; 25:876-886. [PMID: 27106926 PMCID: PMC5332499 DOI: 10.1007/s00167-016-4131-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 04/05/2016] [Indexed: 12/27/2022]
Abstract
PURPOSE Both, knee joint distraction as a relatively new approach and valgus-producing opening-wedge high tibial osteotomy (HTO), are knee-preserving treatments for knee osteoarthritis (OA). The efficacy of knee joint distraction compared to HTO has not been reported. METHODS Sixty-nine patients with medial knee joint OA with a varus axis deviation of <10° were randomized to either knee joint distraction (n = 23) or HTO (n = 46). Questionnaires were assessed at baseline and 3, 6, and 12 months. Joint space width (JSW) as a surrogate measure for cartilage thickness was determined on standardized semi-flexed radiographs at baseline and 1-year follow-up. RESULTS All patient-reported outcome measures (PROMS) improved significantly over 1 year (at 1 year p < 0.02) in both groups. At 1 year, the HTO group showed slightly greater improvement in 4 of the 16 PROMS (p < 0.05). The minimum medial compartment JSW increased 0.8 ± 1.0 mm in the knee joint distraction group (p = 0.001) and 0.4 ± 0.5 mm in the HTO group (p < 0.001), with minimum JSW improvement in favour of knee joint distraction (p = 0.05). The lateral compartment showed a small increase in the knee joint distraction group and a small decrease in the HTO group, leading to a significant increase in mean JSW for knee joint distraction only (p < 0.02). CONCLUSION Cartilaginous repair activity, as indicated by JSW, and clinical outcome improvement occurred with both, knee joint distraction and HTO. These findings suggest that knee joint distraction may be an alternative therapy for medial compartmental OA with a limited mechanical leg malalignment. LEVEL OF EVIDENCE Randomized controlled trial, Level I.
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Affiliation(s)
- J. A. D. van der Woude
- Limb and Knee Reconstruction Unit, Department of Orthopedic Surgery, Maartenskliniek Woerden, Woerden, The Netherlands ,0000000090126352grid.7692.aRheumatology and Clinical Immunology, University Medical Center Utrecht, F02.217, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - K. Wiegant
- 0000000090126352grid.7692.aRheumatology and Clinical Immunology, University Medical Center Utrecht, F02.217, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - R. J. van Heerwaarden
- Limb and Knee Reconstruction Unit, Department of Orthopedic Surgery, Maartenskliniek Woerden, Woerden, The Netherlands
| | - S. Spruijt
- Limb and Knee Reconstruction Unit, Department of Orthopedic Surgery, Maartenskliniek Woerden, Woerden, The Netherlands
| | - P. M. van Roermund
- 0000000090126352grid.7692.aDepartment of Orthopedics, UMC Utrecht, Utrecht, The Netherlands
| | - R. J. H. Custers
- 0000000090126352grid.7692.aDepartment of Orthopedics, UMC Utrecht, Utrecht, The Netherlands
| | - S. C. Mastbergen
- 0000000090126352grid.7692.aRheumatology and Clinical Immunology, University Medical Center Utrecht, F02.217, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - F. P. J. G. Lafeber
- 0000000090126352grid.7692.aRheumatology and Clinical Immunology, University Medical Center Utrecht, F02.217, PO Box 85500, 3508 GA Utrecht, The Netherlands
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van der Woude JAD, van Heerwaarden RJ, Spruijt S, Eckstein F, Maschek S, van Roermund PM, Custers RJH, van Spil WE, Mastbergen SC, Lafeber FPJG. Six weeks of continuous joint distraction appears sufficient for clinical benefit and cartilaginous tissue repair in the treatment of knee osteoarthritis. Knee 2016; 23:785-91. [PMID: 27238622 DOI: 10.1016/j.knee.2016.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 04/16/2016] [Accepted: 05/03/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Knee joint distraction (KJD) is a surgical joint-preserving treatment in which the knee joint is temporarily distracted by an external frame. It is associated with joint tissue repair and clinical improvement. Initially, patients were submitted to an eight-week distraction period, and currently patients are submitted to a six-week distraction period. This study evaluates whether a shorter distraction period influences the outcome. METHODS Both groups consisted of 20 patients. Clinical outcome was assessed by WOMAC questionnaires and VAS-pain. Cartilaginous tissue repair was assessed by radiographic joint space width (JSW) and MRI-observed cartilage thickness. RESULTS Baseline data between both groups were comparable. Both groups showed an increase in total WOMAC score; 24±4 in the six-week group and 32±5 in the eight-week group (both p<0.001). Mean JSW increased 0.9±0.3mm in the six-week group and 1.1±0.3mm in the eight-week group (p=0.729 between groups). The increase in mean cartilage thickness on MRI was 0.6±0.2mm in the eight-week group and 0.4±0.1mm in the six-week group (p=0.277). CONCLUSIONS A shorter distraction period does not influence short-term clinical and structural outcomes statistically significantly, although effect sizes tend to be smaller in six week KJD as compared to eight week KJD.
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Affiliation(s)
- J A D van der Woude
- Limb Deformity and Knee Reconstruction Unit, Dept of Orthopedic Surgery, Maartenskliniek Woerden, The Netherlands; Rheumatology & Clinical Immunology, UMC Utrecht, The Netherlands.
| | - R J van Heerwaarden
- Limb Deformity and Knee Reconstruction Unit, Dept of Orthopedic Surgery, Maartenskliniek Woerden, The Netherlands.
| | - S Spruijt
- Limb Deformity and Knee Reconstruction Unit, Dept of Orthopedic Surgery, Maartenskliniek Woerden, The Netherlands.
| | - F Eckstein
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; Chondrometrics Gmbh, Ainring, Germany.
| | - S Maschek
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; Chondrometrics Gmbh, Ainring, Germany.
| | | | | | - W E van Spil
- Rheumatology & Clinical Immunology, UMC Utrecht, The Netherlands.
| | - S C Mastbergen
- Rheumatology & Clinical Immunology, UMC Utrecht, The Netherlands.
| | - F P J G Lafeber
- Rheumatology & Clinical Immunology, UMC Utrecht, The Netherlands.
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Kosinska MK, Mastbergen SC, Liebisch G, Wilhelm J, Dettmeyer RB, Ishaque B, Rickert M, Schmitz G, Lafeber FP, Steinmeyer J. Comparative lipidomic analysis of synovial fluid in human and canine osteoarthritis. Osteoarthritis Cartilage 2016; 24:1470-8. [PMID: 27049029 DOI: 10.1016/j.joca.2016.03.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 02/17/2016] [Accepted: 03/25/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The lipid profile of synovial fluid (SF) is related to the health status of joints. The early stages of human osteoarthritis (OA) are poorly understood, which larger animals are expected to be able to model closely. This study examined whether the canine groove model of OA represents early OA in humans based on the changes in the lipid species profile in SF. Furthermore, the SF lipidomes of humans and dogs were compared to determine how closely canine lipid species profiles reflect the human lipidome. METHODS Lipids were extracted from cell- and cellular debris-free knee SF from nine donors with healthy joints, 17 patients with early and 13 patients with late osteoarthritic changes, and nine dogs with knee OA and healthy contralateral joints. Lipid species were quantified by electrospray ionization tandem mass spectrometry (ESI-MS/MS). RESULTS Compared with control canine SF most lipid species were elevated in canine OA SF. Moreover, the lipid species profiles in the canine OA model resembled early OA profiles in humans. The SF lipidomes between dog and human were generally similar, with differences in certain lipid species in the phosphatidylcholine (PC), lysophosphatidylcholine (LPC) and sphingomyelin (SM) classes. CONCLUSIONS Our lipidomic analysis demonstrates that SF in the canine OA model closely mimics the early osteoarthritic changes that occur in humans. Further, the canine SF lipidome often reflects normal human lipid metabolism.
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Affiliation(s)
- M K Kosinska
- Laboratory for Experimental Orthopaedics, Department of Orthopaedics, Justus-Liebig-University Giessen, Germany.
| | - S C Mastbergen
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - G Liebisch
- Department of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Germany.
| | - J Wilhelm
- Medical Clinic II/IV, Justus-Liebig-University Giessen, Germany.
| | - R B Dettmeyer
- Institute of Forensic Medicine, Justus-Liebig-University Giessen, Germany.
| | - B Ishaque
- Laboratory for Experimental Orthopaedics, Department of Orthopaedics, Justus-Liebig-University Giessen, Germany.
| | - M Rickert
- Laboratory for Experimental Orthopaedics, Department of Orthopaedics, Justus-Liebig-University Giessen, Germany.
| | - G Schmitz
- Department of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Germany.
| | - F P Lafeber
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - J Steinmeyer
- Laboratory for Experimental Orthopaedics, Department of Orthopaedics, Justus-Liebig-University Giessen, Germany.
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Flouzat-Lachaniette CH, Roubineau F, Heyberger C, Bouthors C. Distraction to treat knee osteoarthritis. Joint Bone Spine 2016; 84:141-144. [PMID: 27178780 DOI: 10.1016/j.jbspin.2016.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2016] [Indexed: 01/27/2023]
Abstract
The objective of this article is to review data on joint distraction used to treat knee osteoarthritis. Joint distraction is a surgical procedure in which the two bony ends of the joint are gradually pulled apart then kept separated for 2 months in an external fixation frame. Weight bearing is continued to ensure variations in hydrostatic pressure within the joint. In published studies, joint distraction provided substantial clinical and structural improvements in patients with knee osteoarthritis, delaying joint replacement surgery for at least 2 years. Animal studies showed that joint distraction was associated with decrease in the secondary inflammatory response, cartilage breakdown, and subchondral bone remodeling. In vitro, the intermittent application of hydrostatic pressure stimulated the production of extracellular matrix, particularly in joints with osteoarthritis. Nevertheless, several considerations invite caution when considering the more widespread use of joint distraction. Published studies have short follow-ups and small sample sizes. In addition, the high frequency of pin tract infection is of concern, since most patients eventually require knee replacement surgery. These two considerations indicate a need for longer-term prospective studies of patient cohorts.
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Affiliation(s)
- Charles-Henri Flouzat-Lachaniette
- Service de chirurgie orthopédique et traumatologique, hôpital Henri-Mondor, AP-HP-UPEC, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France.
| | - François Roubineau
- Service de chirurgie orthopédique et traumatologique, hôpital Henri-Mondor, AP-HP-UPEC, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - Clémence Heyberger
- Service de chirurgie orthopédique et traumatologique, hôpital Henri-Mondor, AP-HP-UPEC, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - Charlie Bouthors
- Service de chirurgie orthopédique et traumatologique, hôpital Henri-Mondor, AP-HP-UPEC, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
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Chen Y, Sun Y, Pan X, Ho K, Li G. Joint distraction attenuates osteoarthritis by reducing secondary inflammation, cartilage degeneration and subchondral bone aberrant change. Osteoarthritis Cartilage 2015; 23:1728-35. [PMID: 26028135 DOI: 10.1016/j.joca.2015.05.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 05/15/2015] [Accepted: 05/21/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Osteoarthritis (OA) is a progressive joint disorder. To date, there is not effective medical therapy. Joint distraction has given us hope for slowing down the OA progression. In this study, we investigated the benefits of joint distraction in OA rat model and the probable underlying mechanisms. METHODS OA was induced in the right knee joint of rats through anterior cruciate ligament transaction (ACLT) plus medial meniscus resection. The animals were randomized into three groups: two groups were treated with an external fixator for a subsequent 3 weeks, one with and one without joint distraction; and one group without external fixator as OA control. Serum interleukin-1β level was evaluated by ELISA; cartilage quality was assessed by histology examinations (gross appearance, Safranin-O/Fast green stain) and immunohistochemistry examinations (MMP13, Col X); subchondral bone aberrant changes was analyzed by micro-CT and immunohistochemistry (Nestin, Osterix) examinations. RESULTS Characters of OA were present in the OA group, contrary to in general less severe damage after distraction treatment: firstly, IL-1β level was significantly decreased; secondly, cartilage degeneration was attenuated with lower histologic damage scores and the lower percentage of MMP13 or Col X positive chondrocytes; finally, subchondral bone abnormal change was attenuated, with reduced bone mineral density (BMD) and bone volume/total tissue volume (BV/TV) and the number of Nestin or Osterix positive cells in the subchondral bone. CONCLUSION In the present study, we demonstrated that joint distraction reduced the level of secondary inflammation, cartilage degeneration and subchondral bone aberrant change, joint distraction may be a strategy for slowing OA progression.
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Affiliation(s)
- Y Chen
- Department of Orthopaedics & Traumatology, Li Ka Shing Institute of Health Sciences and Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, PR China; The CUHK-ACC Space Medicine Centre on Health Maintenance of Musculoskeletal System, The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, PR China
| | - Y Sun
- Department of Orthopaedics & Traumatology, Li Ka Shing Institute of Health Sciences and Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, PR China; The CUHK-ACC Space Medicine Centre on Health Maintenance of Musculoskeletal System, The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, PR China
| | - X Pan
- Department of Orthopaedics and Traumatology, Bao-An District People's Hospital, Shenzhen, PR China
| | - K Ho
- Department of Orthopaedics & Traumatology, Li Ka Shing Institute of Health Sciences and Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, PR China; The CUHK-ACC Space Medicine Centre on Health Maintenance of Musculoskeletal System, The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, PR China.
| | - G Li
- Department of Orthopaedics & Traumatology, Li Ka Shing Institute of Health Sciences and Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, PR China; The CUHK-ACC Space Medicine Centre on Health Maintenance of Musculoskeletal System, The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, PR China; Key Laboratory for Regenerative Medicine, Ministry of Education, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, PR China.
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Baboolal TG, Mastbergen SC, Jones E, Calder SJ, Lafeber FPJG, McGonagle D. Synovial fluid hyaluronan mediates MSC attachment to cartilage, a potential novel mechanism contributing to cartilage repair in osteoarthritis using knee joint distraction. Ann Rheum Dis 2015; 75:908-15. [PMID: 25948596 PMCID: PMC4853581 DOI: 10.1136/annrheumdis-2014-206847] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 04/05/2015] [Indexed: 12/23/2022]
Abstract
Objectives Knee joint distraction (KJD) is a novel, but poorly understood, treatment for osteoarthritis (OA) associated with remarkable ‘spontaneous’ cartilage repair in which resident synovial fluid (SF) multipotential mesenchymal stromal cells (MSCs) may play a role. We hypothesised that SF hyaluronic acid (HA) inhibited the initial interaction between MSCs and cartilage, a key first step to integration, and postulate that KJD environment favoured MSC/cartilage interactions. Methods Attachment of dual-labelled SF-MSCs were assessed in a novel in vitro human cartilage model using OA and rheumatoid arthritic (RA) SF. SF was digested with hyaluronidase (hyase) and its effect on adhesion was observed using confocal microscopy. MRI and microscopy were used to image autologous dual-labelled MSCs in an in vivo canine model of KJD. SF-HA was investigated using gel electrophoresis and densitometry. Results Osteoarthritic-synovial fluid (OA-SF) and purified high molecular weight (MW) HA inhibited SF-MSC adhesion to plastic, while hyase treatment of OA-SF but not RA-SF significantly increased MSC adhesion to cartilage (3.7-fold, p<0.05) These differences were linked to the SF mediated HA-coat which was larger in OA-SF than in RA-SF. OA-SF contained >9 MDa HA and this correlated with increases in adhesion (r=0.880). In the canine KJD model, MSC adhesion to cartilage was evident and also dependent on HA MW. Conclusions These findings highlight an unappreciated role of SF-HA on MSC interactions and provide proof of concept that endogenous SF-MSCs are capable of adhering to cartilage in a favourable biochemical and biomechanical environment in OA distracted joints, offering novel one-stage strategies towards joint repair.
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Affiliation(s)
- Thomas G Baboolal
- Faculty of Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, West Yorkshire, UK
| | - Simon C Mastbergen
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Elena Jones
- Faculty of Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, West Yorkshire, UK NIHR-Leeds Musculoskeletal and Biomedical Research Unit, Chapel Allerton, Leeds Teaching Hospital Trust, Leeds, West Yorkshire, UK
| | - Stuart J Calder
- Department of Trauma and Orthopaedics, Chapel Allerton, Leeds Teaching Hospital Trust, Leeds, West Yorkshire, UK
| | - Floris P J G Lafeber
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dennis McGonagle
- Faculty of Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, West Yorkshire, UK NIHR-Leeds Musculoskeletal and Biomedical Research Unit, Chapel Allerton, Leeds Teaching Hospital Trust, Leeds, West Yorkshire, UK
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