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Berni M, Erani P, Lopomo NF, Baleani M. Optimization of In Situ Indentation Protocol to Map the Mechanical Properties of Articular Cartilage. MATERIALS (BASEL, SWITZERLAND) 2022; 15:6425. [PMID: 36143736 PMCID: PMC9505484 DOI: 10.3390/ma15186425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/29/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
Tissue engineering aims at developing complex composite scaffolds for articular cartilage repair. These scaffolds must exhibit a mechanical behavior similar to the whole osteochondral unit. In situ spherical indentation allows us to map the mechanical behavior of articular cartilage, avoiding removal of the underlying bone tissue. Little is known about the impact of grid spacing, indenter diameter, and induced deformation on the cartilage response to indentation. We investigated the impact of grid spacing (range: a to 3a, where a is the radius of the contact area between cartilage and indenter), indenter diameter (range: 1 to 8 mm), and deformation induced by indentation (constant indentation depth versus constant nominal deformation) on cartilage response. The bias induced by indentations performed in adjacent grid points was minimized with a 3a grid spacing. The cartilage response was indenter-dependent for diameters ranging between 1 and 6 mm with a nominal deformation of 15%. No significant differences were found using 6 mm and 8 mm indenters. Six mm and 8 mm indenters were used to map human articular cartilage with a grid spacing equal to 3a. Instantaneous elastic modulus E0 was calculated for constant indentation depth and constant nominal deformation. E0 value distribution did not change significantly by switching the two indenters, while dispersion decreased by 5-6% when a constant nominal deformation was applied. Such an approach was able to discriminate changes in tissue response due to doubling the indentation rate. The proposed procedure seems to reduce data dispersion and properly determine cartilage mechanical properties to be compared with those of complex composite scaffolds.
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Affiliation(s)
- Matteo Berni
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Paolo Erani
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | | | - Massimiliano Baleani
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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Kitta Y, Kiriyama Y, Harato K, Kobayashi S, Niki Y, Matsumoto M, Nakamura M, Nagura T. Application of an indentation sensor for the arthroscopic measurement of articular cartilage stiffness. Proc Inst Mech Eng H 2022; 236:9544119221082432. [PMID: 35176938 DOI: 10.1177/09544119221082432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Direct measurement of cartilage stiffness provides useful clinical information and enables us to develop treatment strategies for patients. We applied an indentation sensor to evaluate cartilage stiffness under arthroscopic control. The purpose of this study was to validate the arthroscopic indentation sensor using cadaver knees and to measure cartilage stiffness in clinical cases. The stiffness of a material with known properties was measured at thicknesses from 2 mm to 10 mm with a 2-mm interval. This was repeated three times at each thickness to evaluate repeatability. The articular cartilage stiffness of the medial and lateral femoral condyles of five human cadaveric knees was measured. The sensor was inclined from 0° to 20° with 1° intervals. The stiffness value at each degree of inclination was compared to evaluate the acceptable measuring angle. Additionally, articular cartilage stiffness was measured in 23 adolescent and 11 adult patients under arthroscopy. Young's moduli of the material were 1.15-1.24 (mean 1.20) MPa. Inter-class correlation coefficients in repeated measurements using the material were 0.83-0.99. There were no differences in the cartilage stiffness between the medial and lateral femoral condyles of the cadaver knees. All condyles showed a nonlinear relationship between force and displacement. The force decreased in all condyles when the tip of the sensor system was tilted. The range of error was < 97.1% within 5° inclination. There was a moderate negative correlation between age and cartilage stiffness in adolescent patients, and a moderate positive correlation in adult patients. Since the sensor system is manually held during measurement, the validity and repeatability to assess material properties of the cartilage may be inaccurate. This study has proven that the instrument can measure the stiffness of joint cartilage reliably and is a useful clinical tool under arthroscopic control.
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Affiliation(s)
- Yuki Kitta
- Department of Orthopedic Surgery, Keio University, Tokyo, Japan
| | - Yoshimori Kiriyama
- Department of Mechanical Systems Engineering, Kogakuin University, Tokyo, Japan
| | - Kengo Harato
- Department of Orthopedic Surgery, Keio University, Tokyo, Japan
| | - Shu Kobayashi
- Department of Orthopedic Surgery, Keio University, Tokyo, Japan
| | - Yasuo Niki
- Department of Orthopedic Surgery, Keio University, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University, Tokyo, Japan
| | - Takeo Nagura
- Department of Clinical Biomechanics, Keio University, Tokyo, Japan
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Rapagna S, Roberts BC, Solomon LB, Reynolds KJ, Thewlis D, Perilli E. Tibial cartilage, subchondral bone plate and trabecular bone microarchitecture in varus- and valgus-osteoarthritis versus controls. J Orthop Res 2021; 39:1988-1999. [PMID: 33241575 DOI: 10.1002/jor.24914] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/26/2020] [Accepted: 11/08/2020] [Indexed: 02/04/2023]
Abstract
This preliminary study quantified tibia cartilage thickness (Cart.Th), subchondral bone plate thickness (SBPl.Th) and subchondral trabecular bone (STB) microarchitecture in subjects with varus- or valgus- malaligned knees diagnosed with end-stage knee osteoarthritis (OA) and compared them to controls (non-OA). Tibial plateaus from 25 subjects with knee-OA (undergoing knee arthroplasty) and 15 cadavers (controls) were micro-CT scanned (17 µm/voxel). Joint alignment was classified radiographically for OA subjects (varus-aligned n = 18, valgus-aligned n = 7). Cart.Th, SBPl.Th, STB bone volume fraction (BV/TV) and their medial-to-lateral ratios were analyzed in anteromedial, anterolateral, posteromedial and posterolateral subregions. Varus-OA and valgus-OA were compared to controls. Compared to controls (1.19-1.54 mm), Cart.Th in varus-OA was significantly lower anteromedially (0.58 mm, -59%) and higher laterally (2.19-2.47 mm, +60-63%); in valgus-OA, Cart.Th was significantly higher posteromedially (1.86 mm, +56%). Control medial-to-lateral Cart.Th ratios were around unity (0.8-1.1), in varus-OA significantly below (0.2-0.6) and in valgus-OA slightly above (1.0-1.3) controls. SBPl.Th and BV/TV were significantly higher medially in varus-OA (0.58-0.72 mm and 37-44%, respectively) and laterally in valgus-OA (0.60-0.61 mm and 32-37%), compared to controls (0.26-0.47 mm and 18-37%). In varus-OA, the medial-to-lateral SBPl.Th and BV/TV ratios were above unity (1.4-2.4) and controls (0.8-2.1); in valgus-OA they were closer to unity (0.8-1.1) and below controls. Varus- and valgus-OA tibia differ significantly from controls in Cart.Th, SBPl.Th and STB microarchitecture depending on joint alignment, suggesting structural changes in OA may reflect differences in medial-to-lateral load distribution upon the tibial plateau. Here we identified an inverse relationship between cartilage thickness and underlying subchondral bone, suggesting a whole-joint response in OA to daily stimuli.
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Affiliation(s)
- Sophie Rapagna
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Bryant C Roberts
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia.,Department of Oncology and Metabolism, Insigneo Institute for In Silico Medicine, The University of Sheffield, Sheffield, UK
| | - Lucian B Solomon
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Karen J Reynolds
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Dominic Thewlis
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Egon Perilli
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
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Ter Voert CEM, Kour RYN, van Teeffelen BCJ, Ansari N, Stok KS. Contrast-enhanced micro-computed tomography of articular cartilage morphology with ioversol and iomeprol. J Anat 2020; 237:1062-1071. [PMID: 32683740 DOI: 10.1111/joa.13271] [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: 07/17/2019] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 11/29/2022] Open
Abstract
Non-ionic, low-osmolar contrast agents (CAs) used for computed tomography, such as Optiray (ioversol) and Iomeron (iomeprol), are associated with the reduced risk of adverse reactions and toxicity in comparison with ionic CAs, such as Hexabrix. Hexabrix has previously been used for imaging articular cartilage but has been commercially discontinued. This study aimed to evaluate the efficacy of Optiray and Iomeron as alternatives for visualisation of articular cartilage in small animal joints using contrast-enhanced micro-computed tomography (CECT). For this purpose, mouse femora were immersed in different concentrations (20%-50%) of Optiray 350 or Iomeron 350 for periods of time starting at five minutes. The femoral condyles were scanned ex vivo using CECT, and regions of articular cartilage manually contoured to calculate mean attenuation at each time point and concentration. For both CAs, a 30% CA concentration produced a mean cartilage attenuation optimally distinct from both bone and background signal, whilst 5-min immersion times were sufficient for equilibration of CA absorption. Additionally, plugs of bovine articular cartilage were digested by chondroitinase ABC to produce a spectrum of glycosaminoglycan (GAG) content. These samples were immersed in CA and assessed for any correlation between mean attenuation and GAG content. No significant correlation was found between attenuation and cartilage GAG content for either CAs. In conclusion, Optiray and Iomeron enable high-resolution morphological assessment of articular cartilage in small animals using CECT; however, they are not indicative of GAG content.
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Affiliation(s)
- Colet E M Ter Voert
- Department of Biomedical Engineering, The University of Melbourne, Parkville, Vic., Australia
| | - R Y Nigel Kour
- Department of Biomedical Engineering, The University of Melbourne, Parkville, Vic., Australia
| | - Bente C J van Teeffelen
- Department of Biomedical Engineering, The University of Melbourne, Parkville, Vic., Australia
| | - Niloufar Ansari
- Department of Biomedical Engineering, The University of Melbourne, Parkville, Vic., Australia
| | - Kathryn S Stok
- Department of Biomedical Engineering, The University of Melbourne, Parkville, Vic., Australia
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Freedman JD, Ellis DJ, Lusic H, Varma GV, Grant AK, Lakin BA, Snyder BD, Grinstaff MW. dGEMRIC and CECT Comparison of Cationic and Anionic Contrast Agents in Cadaveric Human Metacarpal Cartilage. J Orthop Res 2020; 38:719-725. [PMID: 31687789 PMCID: PMC7071952 DOI: 10.1002/jor.24511] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 10/31/2019] [Indexed: 02/04/2023]
Abstract
Magnetic resonance imaging (MRI) and computed tomography (CT) are widely used to image cartilage and their diagnostic capability is enhanced in the presence of contrast agents. The aim of the study is to directly compare the performance between commercial anionic MRI (Gd(DTPA), Gd2-) and CT (Ioxaglate, Iox1-) contrast agents with novel cationic MRI (Gd(DTPA)Lys2 , Gd4+) and CT (CA4+) contrast agents for assessment of cartilage mechanical and biochemical properties using the ex vivo human osteoarthritis metacarpal cartilage model. First, indentation testing was conducted to obtain the compressive modulus of the human fifth metacarpals. The samples were then immersed in the anionic and cationic contrast agents prior to delayed gadolinium-enhanced MRI of cartilage and CT scanning, respectively. The cartilage glycosaminoglycan (GAG) content and distribution were determined using the 1,9-dimethylmethylene blue assay and Safranin-O histology. Cationic agents significantly accumulate in cartilage compared with anionic agents. Significant positive correlations (p < 0.05) exist between imaging results of cationic agents and GAG content (Gd4+: R2 = 0.43; CA4+: R2 = 0.67) and indentation equilibrium modulus (Gd4+: R2 = 0.48; CA4+: R2 = 0.77). Significant negative correlations are observed between anionic MRI relaxation times, but not contrast-enhanced computed tomography attenuation and cartilage GAG content (Gd2-: R2 = 0.56, p < 0.05; Iox1-: R2 = 0.31, p > 0.05) and indentation equilibrium modulus (Gd2-: R2 = 0.38, p < 0.05; Iox1-: R2 = 0.17, p > 0.05). MRI or CT with cationic contrast agents provides greater sensitivity than their anionic analogs at assessing the biochemical and biomechanical properties of ex vivo human metacarpal cartilage. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:719-725, 2020.
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Affiliation(s)
- Jonathan D. Freedman
- Department of Pharmacology, Boston University, Boston, MA,Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Daniel J. Ellis
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Hrvoje Lusic
- Department of Chemistry, Boston University, Boston, MA
| | - Gopal V. Varma
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Aaron K. Grant
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Benjamin A. Lakin
- Department of Biomedical Engineering, Boston University, Boston, MA,Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Brian D. Snyder
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA,Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, MA.,Address correspondence and reprint requests to: Brian D. Snyder, M.D., Ph.D., Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 1 Overland Street, RN 115, Boston, MA 02215, , OR, Mark W. Grinstaff, Ph.D., Departments of Biomedical Engineering and Chemistry, Boston University, 590 Commonwealth Ave, Boston, MA 02215,
| | - Mark W. Grinstaff
- Department of Pharmacology, Boston University, Boston, MA,Department of Chemistry, Boston University, Boston, MA,Department of Biomedical Engineering, Boston University, Boston, MA,Address correspondence and reprint requests to: Brian D. Snyder, M.D., Ph.D., Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 1 Overland Street, RN 115, Boston, MA 02215, , OR, Mark W. Grinstaff, Ph.D., Departments of Biomedical Engineering and Chemistry, Boston University, 590 Commonwealth Ave, Boston, MA 02215,
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6
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Nelson BB, Mäkelä JTA, Lawson TB, Patwa AN, Barrett MF, McIlwraith CW, Hurtig MB, Snyder BD, Moorman VJ, Grinstaff MW, Goodrich LR, Kawcak CE. Evaluation of equine articular cartilage degeneration after mechanical impact injury using cationic contrast-enhanced computed tomography. Osteoarthritis Cartilage 2019; 27:1219-1228. [PMID: 31075424 DOI: 10.1016/j.joca.2019.04.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/13/2019] [Accepted: 04/16/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Cationic agent contrast-enhanced computed tomography (cationic CECT) characterizes articular cartilage ex vivo, however, its capacity to detect post-traumatic injury is unknown. The study objectives were to correlate cationic CECT attenuation with biochemical, mechanical and histological properties of cartilage and morphologic computed tomography (CT) measures of bone, and to determine the ability of cationic CECT to distinguish subtly damaged from normal cartilage in an in vivo equine model. DESIGN Mechanical impact injury was initiated in equine femoropatellar joints in vivo to establish subtle cartilage degeneration with site-matched controls. Cationic CECT was performed in vivo (clinical) and postmortem (microCT). Articular cartilage was characterized by glycosaminoglycan (GAG) content, biochemical moduli and histological scores. Bone was characterized by volume density (BV/TV) and trabecular number (Tb.N.), thickness (Tb.Th.) and spacing (Tb.Sp.). RESULTS Cationic CECT attenuation (microCT) of cartilage correlated with GAG (r = 0.74, P < 0.0001), compressive modulus (Eeq) (r = 0.79, P < 0.0001) and safranin-O histological score (r = -0.66, P < 0.0001) of cartilage, and correlated with BV/TV (r = 0.37, P = 0.0005), Tb.N. (r = 0.39, P = 0.0003), Tb.Th. (r = 0.28, P = 0.0095) and Tb.Sp. (r = -0.44, P < 0.0001) of bone. Mean [95% CI] cationic CECT attenuation at the impact site (2215 [1987, 2443] Hounsfield Units [HUs]) was lower than site-matched controls (2836 [2490, 3182] HUs, P = 0.036). Clinical cationic CECT attenuation correlated with GAG (r = 0.23, P = 0.049), Eeq (r = 0.26, P = 0.025) and safranin-O histology score (r = -0.32, P = 0.0046). CONCLUSIONS Cationic CECT (microCT) reflects articular cartilage properties enabling segregation of subtly degenerated from healthy tissue and also reflects bone morphometric properties on CT. Cationic CECT is capable of characterizing articular cartilage in clinical scanners.
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Affiliation(s)
- B B Nelson
- Equine Orthopaedic Research Center, Colorado State University, Fort Collins, CO, USA
| | - J T A Mäkelä
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; Department of Chemistry, Boston University, Boston, MA, USA
| | - T B Lawson
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; Department of Mechanical Engineering, Boston University, Boston, MA, USA
| | - A N Patwa
- Department of Chemistry, Boston University, Boston, MA, USA; SLSE (Chemistry), Navrachana University, Vadodara, Gujarat, India
| | - M F Barrett
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - C W McIlwraith
- Equine Orthopaedic Research Center, Colorado State University, Fort Collins, CO, USA
| | - M B Hurtig
- Department of Clinical Studies, University of Guelph, Ontario, Canada
| | - B D Snyder
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - V J Moorman
- Equine Orthopaedic Research Center, Colorado State University, Fort Collins, CO, USA
| | - M W Grinstaff
- Department of Chemistry, Boston University, Boston, MA, USA; Department of Mechanical Engineering, Boston University, Boston, MA, USA; Departments of Biomedical Engineering, and Medicine, Boston University, Boston, MA, USA
| | - L R Goodrich
- Equine Orthopaedic Research Center, Colorado State University, Fort Collins, CO, USA
| | - C E Kawcak
- Equine Orthopaedic Research Center, Colorado State University, Fort Collins, CO, USA.
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