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Boretti G, Amirfallah A, Edmunds KJ, Hamzehpour H, Sigurjónsson ÓE. Advancing Cartilage Tissue Engineering: A Review of 3D Bioprinting Approaches and Bioink Properties. TISSUE ENGINEERING. PART B, REVIEWS 2024. [PMID: 39381849 DOI: 10.1089/ten.teb.2024.0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2024]
Abstract
Articular cartilage is crucial in human physiology, and its degeneration poses a significant public health challenge. While recent advancements in 3D bioprinting and tissue engineering show promise for cartilage regeneration, there remains a gap between research findings and clinical application. This review critically examines the mechanical and biological properties of hyaline cartilage, along with current 3D manufacturing methods and analysis techniques. Moreover, we provide a quantitative synthesis of bioink properties used in cartilage tissue engineering. After screening 181 initial works, 33 studies using extrusion bioprinting were analyzed and synthesized, presenting results that indicate the main materials, cells, and methods utilized for mechanical and biological evaluation. Altogether, this review motivates the standardization of mechanical analyses and biomaterial assessments of 3D bioprinted constructs to clarify their chondrogenic potential.
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Affiliation(s)
- Gabriele Boretti
- School of Science and Engineering, Reykjavík University, Reykjavík, Iceland
| | - Arsalan Amirfallah
- The Blood Bank, Landspitali, The National University Hospital of Iceland, Reykjavík, Iceland
| | - Kyle J Edmunds
- School of Science and Engineering, Reykjavík University, Reykjavík, Iceland
| | - Helena Hamzehpour
- Faculty of Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland
| | - Ólafur E Sigurjónsson
- School of Science and Engineering, Reykjavík University, Reykjavík, Iceland
- The Blood Bank, Landspitali, The National University Hospital of Iceland, Reykjavík, Iceland
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Sundar S, Koopman A, Manzoni TJ, Xie W, Bhatti QUA, Lo CY, Damani VS, Yang AN, Pochan D, Parreno J, Engiles JB, Kayser LV, Dhong C. Kinetics and Retention of Polystyrenesulfonate for Proteoglycan Replacement in Cartilage. Biomacromolecules 2024; 25:5819-5833. [PMID: 39142342 PMCID: PMC11389691 DOI: 10.1021/acs.biomac.4c00479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Tissue hydration provides articular cartilage with dynamic viscoelastic properties. Early stage osteoarthritis (OA) is marked by loss of proteoglycans and glycosaminoglycans (GAG), lowering fixed charge density, and impairing tissue osmotic function. The most common GAG replacement, chondroitin sulfate (CS), has failed to show effectiveness. Here, we investigated a synthetic polyelectrolyte, poly(styrenesulfonate) (PSS), both as a model compound to investigate polyelectrolyte transport in cartilage, and as a potential candidate to restore bulk fixed charge density in cartilage with GAG loss. Through bovine explants and histology, we determined zonal-based effective diffusion coefficients for three different molecular weights of PSS. Compared to CS, PSS was retained longer in GAG-depleted cartilage in static and compression-based desorption experiments. We explained enhanced solute performance of PSS by its more compact morphology and higher charge density by small-angle X-ray scattering. This study may improve design of GAG mimetic molecules for repairing osmotic function in OA cartilage.
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Affiliation(s)
- Shalini Sundar
- Department of Biomedical Engineering, University of Delaware, Newark 19716, Delaware, United States
| | - Allison Koopman
- Department of Materials Science and Engineering, University of Delaware, Newark 19716, Delaware, United States
| | - Thomas J Manzoni
- Department of Biological Sciences, University of Delaware, Newark 19716, Delaware, United States
| | - Weiran Xie
- Department of Materials Science and Engineering, University of Delaware, Newark 19716, Delaware, United States
| | - Qurat-Ul-Ain Bhatti
- Department of Materials Science and Engineering, University of Delaware, Newark 19716, Delaware, United States
| | - Chun-Yuan Lo
- Department of Chemistry and Biochemistry, University of Delaware, Newark 19716, Delaware, United States
| | - Vidhika S Damani
- Department of Materials Science and Engineering, University of Delaware, Newark 19716, Delaware, United States
| | - Ai Nin Yang
- Department of Chemistry and Biochemistry, University of Delaware, Newark 19716, Delaware, United States
| | - Darrin Pochan
- Department of Materials Science and Engineering, University of Delaware, Newark 19716, Delaware, United States
| | - Justin Parreno
- Department of Biomedical Engineering, University of Delaware, Newark 19716, Delaware, United States
- Department of Biological Sciences, University of Delaware, Newark 19716, Delaware, United States
| | - Julie B Engiles
- Department of Clinical Studies, University of Pennsylvania School of Veterinary Medicine, Kennett Square 19348, Pennsylvania, United States
- Department of Pathobiology, University of Pennsylvania School of Veterinary Medicine, Kennett Square, Pennsylvania 19348, United States
| | - Laure V Kayser
- Department of Materials Science and Engineering, University of Delaware, Newark 19716, Delaware, United States
- Department of Chemistry and Biochemistry, University of Delaware, Newark 19716, Delaware, United States
| | - Charles Dhong
- Department of Biomedical Engineering, University of Delaware, Newark 19716, Delaware, United States
- Department of Materials Science and Engineering, University of Delaware, Newark 19716, Delaware, United States
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Whiteley JP, Brown CP, Gaffney EA. Sensitivity of cartilage mechanical behaviour to spatial variations in material properties. J Mech Behav Biomed Mater 2024; 156:106575. [PMID: 38824865 DOI: 10.1016/j.jmbbm.2024.106575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/28/2024] [Accepted: 05/08/2024] [Indexed: 06/04/2024]
Abstract
Articular cartilage tissue exhibits a spatial dependence in material properties that govern mechanical behaviour. A mathematical model of cartilage tissue under one dimensional confined compression testing is developed for normal tissue that takes account of these variations in material properties. Modifications to the model representative of a selection of mechanisms driving osteoarthritic cartilage are proposed, allowing application of the model to both physiological and pathophysiological, osteoarthritic tissue. Incorporating spatial variations into the model requires the specification of more parameters than are required in the absence of these variations. A global sensitivity analysis of these parameters is implemented to identify the dominant mechanisms of mechanical response, in normal and osteoarthritic cartilage tissue, to both static and dynamic loading. The most sensitive parameters differ between dynamic and static mechanics of the cartilage, and also differ between physiological and osteoarthritic pathophysiological cartilage. As a consequence changes in cartilage mechanics in response to alterations in cartilage structure are predicted to be contingent on the nature of loading and the health, or otherwise, of the cartilage. In particular the mechanical response of cartilage, especially deformation, is predicted to be much more sensitive to cartilage stiffness in the superficial zone given the onset of osteoarthritic changes to material properties, such as superficial zone increases in permeability and reductions in fixed charge. In turn this indicates that any degenerative changes in the stiffness associated with the superficial cartilage collagen mesh are amplified if other elements of osteoarthritic disease are present, which provides a suggested mechanism-based explanation for observations that the range of mechanical parameters representative of normal and osteoarthritic tissue can overlap substantially.
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Affiliation(s)
- Jonathan P Whiteley
- Department of Computer Science, University of Oxford, Parks Road, OX1 3QD, Oxford, United Kingdom.
| | - Cameron P Brown
- MMPE, MERF, Faculty of Engineering, Queensland University of Technology, QLD 4000, Brisbane, Australia.
| | - Eamonn A Gaffney
- Mathematical Institute, University of Oxford, Andrew Wiles Building, Woodstock Road, OX2 6GG, Oxford, United Kingdom.
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Mutsuzaki H, Nakajima H. Histological differences in cartilage layer growth at various tendon and ligament insertions in rabbits. J Rural Med 2024; 19:181-185. [PMID: 38975044 PMCID: PMC11222623 DOI: 10.2185/jrm.2024-009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/30/2024] [Indexed: 07/09/2024] Open
Abstract
Objectives: Histological differences in cartilage layer growth in Achilles tendon (AT), quadriceps tendon (QT), patellar tendon (PT), and anterior cruciate ligament (ACL) insertion are unclear. Therefore, this study aimed to investigate the differences in cartilage layer growth in AT, QT, PT, and ACL insertions. Materials and Methods: Forty-eight male Japanese white rabbits were used. Six animals were euthanized at different stages (day 1 and 1, 2, 4, 6, 8, 12, and 24 weeks). Safranin O-stained glycosaminoglycan (GAG) production area, chondrocyte count, and insertion width were investigated. Results: A two-way analysis of variance (ANOVA) revealed a significant difference in the main effects of time and insertion for all parameters. In addition, the time × insertion interaction was significant. Multiple comparisons showed a significant difference between the ACL insertion and all other variables; however, the GAG production area was not significantly different for the QT, PT, and AT insertions. AT insertions were significantly different from all other groups; however, the number of chondrocytes and insertion width were not significantly different for ACL, QT, and PT insertions. Conclusion: Cartilage layer growth differed between the AT, QT, PT, and ACL insertions. The differences between the insertions may also be due to the differences in their structures, locations, and mechanical environments.
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Affiliation(s)
- Hirotaka Mutsuzaki
- Center for Medical Science, Ibaraki Prefectural University of Health Sciences, Japan
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Japan
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Berni M, Marchiori G, Baleani M, Giavaresi G, Lopomo NF. Biomechanics of the Human Osteochondral Unit: A Systematic Review. MATERIALS (BASEL, SWITZERLAND) 2024; 17:1698. [PMID: 38612211 PMCID: PMC11012636 DOI: 10.3390/ma17071698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/17/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024]
Abstract
The damping system ensured by the osteochondral (OC) unit is essential to deploy the forces generated within load-bearing joints during locomotion, allowing furthermore low-friction sliding motion between bone segments. The OC unit is a multi-layer structure including articular cartilage, as well as subchondral and trabecular bone. The interplay between the OC tissues is essential in maintaining the joint functionality; altered loading patterns can trigger biological processes that could lead to degenerative joint diseases like osteoarthritis. Currently, no effective treatments are available to avoid degeneration beyond tissues' recovery capabilities. A thorough comprehension on the mechanical behaviour of the OC unit is essential to (i) soundly elucidate its overall response to intra-articular loads for developing diagnostic tools capable of detecting non-physiological strain levels, (ii) properly evaluate the efficacy of innovative treatments in restoring physiological strain levels, and (iii) optimize regenerative medicine approaches as potential and less-invasive alternatives to arthroplasty when irreversible damage has occurred. Therefore, the leading aim of this review was to provide an overview of the state-of-the-art-up to 2022-about the mechanical behaviour of the OC unit. A systematic search is performed, according to PRISMA standards, by focusing on studies that experimentally assess the human lower-limb joints' OC tissues. A multi-criteria decision-making method is proposed to quantitatively evaluate eligible studies, in order to highlight only the insights retrieved through sound and robust approaches. This review revealed that studies on human lower limbs are focusing on the knee and articular cartilage, while hip and trabecular bone studies are declining, and the ankle and subchondral bone are poorly investigated. Compression and indentation are the most common experimental techniques studying the mechanical behaviour of the OC tissues, with indentation also being able to provide information at the micro- and nanoscales. While a certain comparability among studies was highlighted, none of the identified testing protocols are currently recognised as standard for any of the OC tissues. The fibril-network-reinforced poro-viscoelastic constitutive model has become common for describing the response of the articular cartilage, while the models describing the mechanical behaviour of mineralised tissues are usually simpler (i.e., linear elastic, elasto-plastic). Most advanced studies have tested and modelled multiple tissues of the same OC unit but have done so individually rather than through integrated approaches. Therefore, efforts should be made in simultaneously evaluating the comprehensive response of the OC unit to intra-articular loads and the interplay between the OC tissues. In this regard, a multidisciplinary approach combining complementary techniques, e.g., full-field imaging, mechanical testing, and computational approaches, should be implemented and validated. Furthermore, the next challenge entails transferring this assessment to a non-invasive approach, allowing its application in vivo, in order to increase its diagnostic and prognostic potential.
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Affiliation(s)
- Matteo Berni
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (M.B.); (M.B.)
| | - Gregorio Marchiori
- Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy;
| | - Massimiliano Baleani
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (M.B.); (M.B.)
| | - Gianluca Giavaresi
- Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy;
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Coefficient of Friction and Height Loss: Two Criteria Used to Determine the Mechanical Property and Stability of Regenerated Versus Natural Articular Cartilage. Biomedicines 2022; 10:biomedicines10112685. [DOI: 10.3390/biomedicines10112685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/28/2022] [Accepted: 10/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background: The coefficient of friction (CoF) serves as an indicator for the mechanical properties of natural and regenerated articular cartilage (AC). After tribological exposure, a height loss (HL) of the cartilage pair specimens can be measured. Our aim was to determine the CoF and HL of regenerated AC tissue and compare them with those of natural AC from non-operated joints and AC from joints where the regenerated tissues had been created after different treatments. Methods: In partial-thickness defects of the trochleae of the stifle joints of 60 Göttingen Minipigs, regenerated AC was created. In total, 40 animals received a Col I matrix, 20 laden with autologous chondrocytes, and 20 without. The defects of 20 animals were left empty. The healing periods were 24 and 48 weeks. A total of 10 not-operated animals, delivered the “external” control specimens. Osteochondral pins were harvested from defect and non-defect areas, the latter serving as “internal” controls. Using a pin-on-plate tribometer, we measured the CoF and the HL. Results: The CoF of the regenerated AC ranged from 0.0393 to 0.0688, and the HL, from 0.22 mm to 0.3 mm. The differences between the regenerated AC of the six groups and the “external” controls were significant. The comparison with the “internal” controls revealed four significant differences for the CoF and one for the HL in the operated groups. No differences were seen within the operated groups. Conclusions: The mechanical quality of the regenerated AC tissue showed inferior behavior with regard to the CoF and HL in comparison with natural AC. The comparison of regenerated AC tissue with AC from untreated joints was more promising than with AC from the treated joints.
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Post-traumatic Osteoarthritis in Rabbits Following Traumatic Injury and Surgical Reconstruction of the Knee. Ann Biomed Eng 2022; 50:169-182. [PMID: 35028785 DOI: 10.1007/s10439-022-02903-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/01/2022] [Indexed: 01/13/2023]
Abstract
Post-traumatic osteoarthritis (PTOA) of the knee is often attributed to anterior cruciate ligament (ACL) and meniscus injury. The development of PTOA, however, does not seem to depend on whether or not the damaged ACL is reconstructed. There has been a need to develop animal models to study the mechanisms of PTOA following reconstruction of a traumatized knee. Eighteen rabbits underwent closed-joint trauma to produce ACL rupture and meniscus damage. Then, for the first time, the traumatized knee was surgically repaired in this animal model. Upon euthanasia at 1-, 3- or 6-month post-trauma, joint stability, cartilage morphology and mechanical properties, as well as histology of the cartilage and subchondral bone were evaluated. Trauma-induced knee injury involved 72% mid-substance ACL rupture, 28% partial ACL tear and 56% concurrent medial meniscal damage. ACL reconstruction effectively restored joint stability by reducing joint laxity to a level similar to that in the contralateral intact knee. Compared to their contralateral controls, reconstructed limbs showed osteoarthritic changes to the cartilage and subchondral bone as early as 1-month post-trauma. The degeneration progressed over time up to 6-month. Overall, the medial compartments had more tissue damage than their corresponding lateral counterparts. Damage patterns to the ACL, the frequency of observed concurrent meniscal injury, and reductions in cartilage integrity and health were consistent with clinical observations of human patients who undergo ACL injury and reconstruction. Thus, we believe the combined closed-joint injury and surgical repair lapine model of PTOA, being first-ever and clinically relevant, shows promise to evaluate well-targeted therapeutics and other interventions for this chronic disease.
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Reversible changes in the 3D collagen fibril architecture during cyclic loading of healthy and degraded cartilage. Acta Biomater 2021; 136:314-326. [PMID: 34563724 PMCID: PMC8631461 DOI: 10.1016/j.actbio.2021.09.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/19/2021] [Accepted: 09/20/2021] [Indexed: 01/09/2023]
Abstract
Biomechanical changes to the collagen fibrillar architecture in articular cartilage are believed to play a crucial role in enabling normal joint function. However, experimentally there is little quantitative knowledge about the structural response of the Type II collagen fibrils in cartilage to cyclic loading in situ, and the mechanisms that drive the ability of cartilage to withstand long-term repetitive loading. Here we utilize synchrotron small-angle X-ray scattering (SAXS) combined with in-situ cyclic loading of bovine articular cartilage explants to measure the fibrillar response in deep zone articular cartilage, in terms of orientation, fibrillar strain and inter-fibrillar variability in healthy cartilage and cartilage degraded by exposure to the pro-inflammatory cytokine IL-1β. We demonstrate that under repeated cyclic loading the fibrils reversibly change the width of the fibrillar orientation distribution whilst maintaining a largely consistent average direction of orientation. Specifically, the effect on the fibrillar network is a 3-dimensional conical orientation broadening around the normal to the joint surface, inferred by 3D reconstruction of X-ray scattering peak intensity distributions from the 2D pattern. Further, at the intrafibrillar level, this effect is coupled with reversible reduction in fibrillar pre-strain under compression, alongside increase in the variability of fibrillar pre-strain. In IL-1β degraded cartilage, the collagen rearrangement under cyclic loading is disrupted and associated with reduced tissue stiffness. These finding have implications as to how changes in local collagen nanomechanics might drive disease progression or vice versa in conditions such as osteoarthritis and provides a pathway to a mechanistic understanding of such diseases. Statement of significance Structural deterioration in biomechanically loaded musculoskeletal organs, e.g., joint osteoarthritis and back pain, are linked to breakdown and changes in their collagen-rich cartilaginous tissue matrix. A critical component enabling cartilage biomechanics is the ultrastructural collagen fibrillar network in cartilage. However, experimental probes of the dynamic structural response of cartilage collagen to biomechanical loads are limited. Here, we use X-ray scattering during cyclic loading (as during walking) on joint tissue to show that cartilage fibrils resist loading by a reversible, three-dimensional orientation broadening and disordering mechanism at the molecular level, and that inflammation reduces this functionality. Our results will help understand how changes to small-scale tissue mechanisms are linked to ageing and osteoarthritic progression, and development of biomaterials for joint replacements.
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Lin W, Meng Q, Li J, Chen Z, Jin Z. The effect of highly inhomogeneous biphasic properties on mechanical behaviour of articular cartilage. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 206:106122. [PMID: 33979755 DOI: 10.1016/j.cmpb.2021.106122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/16/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Investigating the biomechanics of cartilage could help to understand the unique load-bearing property of the cartilage and optimize the scaffold design in tissue-engineering. It is important to model the cartilage as a highly inhomogeneous fibril-reinforced biphasic material to represent its complex composition and structure. The depth-dependent and strain-dependent properties of the cartilage would also play an important role in its mechanical behaviour. However, the differences in representing the cartilage as a highly inhomogeneous model or as simplified models still remain unclear. Hence, in this study, a highly inhomogeneous fibril-reinforced biphasic cartilage model considering both the depth-dependent and strain-dependent properties was constructed; the effect of highly inhomogeneous properties on the mechanical behaviour of articular cartilage was investigated. METHODS A finite element model of the cartilage was developed based on a flat-ended indentation test. Compressive forces were applied to four various inhomogeneous layered models through a porous indenter (Model 1: nine layers with strain-dependent permeability; Model 2: three layers with strain-dependent permeability; Model 3: single layer with strain-dependent permeability; Model 4: nine layers with constant permeability). RESULTS Models 1 and 2 provided similar results with less than 3% difference in the peak effective stress, contact pressure, fluid pressure as well as fluid support ratio. However, Model 1 to Model 3 differed in stress and strain distribution patterns along depth over prolonged loads, which may provide an important insight into the highly inhomogeneous depth-dependent properties of cartilage. In addition, Model 1 with strain-dependent permeability demonstrated an enhanced capability on fluid pressurisation as compared with Model 4 which had constant permeability. CONCLUSIONS A highly inhomogeneous fibril-reinforced biphasic model considering both depth-dependent and strain-dependent properties was developed in this study, in order to illustrate the effect of highly inhomogeneous properties on the mechanical behaviour of the articular cartilage. The number of layers in the models with depth-dependent properties should be selected according to the research questions and clinical demands. The model with strain-dependent permeability offers an enhanced capability on fluid pressurisation. In future studies, the proposed model could be adopted in cell-models to provide more in-depth information or in tissue-engineering to optimize the depth-dependent scaffold structure.
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Affiliation(s)
- Weijian Lin
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, 710054, Xi'an, Shaanxi, China.
| | - Qingen Meng
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, LS2 9JT, United Kingdom
| | - Junyan Li
- Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, 610031, Chengdu, Sichuan, China
| | - Zhenxian Chen
- Key Laboratory of Road Construction Technology and Equipment (Ministry of Education), Chang'an University, 710064, Xi'an, Shaanxi, China.
| | - Zhongmin Jin
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, 710054, Xi'an, Shaanxi, China; Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, LS2 9JT, United Kingdom; Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, 610031, Chengdu, Sichuan, China.
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Mostakhdemin M, Nand A, Ramezani M. Articular and Artificial Cartilage, Characteristics, Properties and Testing Approaches-A Review. Polymers (Basel) 2021; 13:2000. [PMID: 34207194 PMCID: PMC8234542 DOI: 10.3390/polym13122000] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 12/25/2022] Open
Abstract
The design and manufacture of artificial tissue for knee joints have been highlighted recently among researchers which necessitates an apt approach for its assessment. Even though most re-searches have focused on specific mechanical or tribological tests, other aspects have remained underexplored. In this review, elemental keys for design and testing artificial cartilage are dis-cussed and advanced methods addressed. Articular cartilage structure, its compositions in load-bearing and tribological properties of hydrogels, mechanical properties, test approaches and wear mechanisms are discussed. Bilayer hydrogels as a niche in tissue artificialization are presented, and recent gaps are assessed.
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Affiliation(s)
- Mohammad Mostakhdemin
- Department of Mechanical Engineering, Auckland University of Technology, Auckland 1142, New Zealand
| | - Ashveen Nand
- School of Environmental and Animal Sciences, Unitec Institute of Technology, Auckland 1025, New Zealand;
- School of Healthcare and Social Practice, Unitec Institute of Technology, Auckland 1025, New Zealand
| | - Maziar Ramezani
- Department of Mechanical Engineering, Auckland University of Technology, Auckland 1142, New Zealand
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Chu M, Wu P, Hong M, Zeng H, Wong CK, Feng Y, Cai Z, Lu WW. Lingzhi and San-Miao-San with hyaluronic acid gel mitigate cartilage degeneration in anterior cruciate ligament transection induced osteoarthritis. J Orthop Translat 2020; 26:132-140. [PMID: 33437632 PMCID: PMC7773973 DOI: 10.1016/j.jot.2020.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/27/2020] [Accepted: 07/31/2020] [Indexed: 12/20/2022] Open
Abstract
Objective To investigate the mitigate efficacy of Chinese medicine Lingzhi (LZ) and San-Miao-San (SMS) combined with hyaluronic acid (HA)-gel in attenuating cartilage degeneration in traumatic osteoarthritis (OA). Methods The standardized surgery of anterior cruciate ligament transection (ACLT) was made from the medial compartment of right hind limbs of 8-week-old female SD rats and resulted in a traumatic OA. Rats (n = 5/group) were treated once intra-articular injection of 50 μl HA-gel, 50 μl HA-gel+50 μg LZ-SMS, 50 μl of saline+50 μg LZ-SMS and null (ACLT group) respectively, except sham group. Limbs were harvested for μCT scan and histopathological staining 3-month post-treatment. Inflammatory cytokines from plasma and synovial fluid were detected using Immunology Multiplex Assay kit. The putative targets of active compounds in LZ-SMS and known therapeutic targets for OA were combined to construct protein–protein interaction network. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis was adopted to predict the potential targets and signaling pathway of LZ-SMS in OA through the tool of DAVID Bioinformatics. Results In vivo, HA-gel + LZ-SMS treatment resulted in a higher volume ratio of hyaline cartilage (HC)/calcified cartilage (CC) and HC/Sum (total volume of cartilage), compared to ACLT and HA-gel groups. In addition, histological results showed the elevated cartilage matrix, chondrogenic and osteoblastic signals in HA-gel + LZ-SMS treatment. Treatment also significantly altered subchondral bone (SCB) structure including an increase in BV/TV, Tb.Th, BMD, Conn.Dn, Tb.N, and DA, as well as a significant decrease in Tb.Sp and Po(tot), which implied a protective effect on maintaining the stabilization of tibial SCB microstructure. Furthermore, there was also a down-regulated inflammatory cytokines and upregulated anti-inflammatory cytokine IL-10 in HA+LZ-SMS group. Finally, 64 shared targets from 37 active compounds in LZ-SMS related to the core genes for the development of OA. LZ-SMS has a putative role in regulating inflammatory circumstance through influencing the MAPK signaling pathway. Conclusion Our study elucidated a protective effect of HA-gel + LZ-SMS in mitigating cartilage degradation and putative interaction with targets and signaling pathway for the development of traumatic OA. The translational potential of this article Our results provide a biological rationale for the use of LZ-SMS as a potential candidate for OA treatment.
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Key Words
- 3D, Three-dimensional
- AC, Articular cartilage
- ACLT, Anterior cruciate ligament transection
- Acan, Aggrecan
- Articular cartilage
- BMD, Bone mineral density
- BV/TV, Bone volume fraction
- CC, Calcified cartilage
- Conn.Dn, Connectivity density
- DA, Degree of anisotropy
- DL, Drug-likeness
- ECM, Extracellular matrix
- FDR, False discovery rate
- GO, Gene ontology
- HA, Hyaluronic acid
- HC, Hyaline cartilage
- Hyaluronic acid gel
- KEGG, Kyoto Encyclopedia of Genes and Genomes
- LZ-SMS, Lingzhi-San-Miao-San
- Lingzhi and San-Miao-San
- MZ, Middle zone area of articular cartilage
- NC, Negative control
- OA, Osteoarthritis
- OB, Oral bioavailability
- OMIM, Online Mendelian Inheritance in Man
- Osteoarthritis
- PPI, Protein–protein interaction
- Po(tot), Total porosity
- ROI, Region of Interest
- SC, Superficial cartilage
- SCB, Subchondral bone
- SZ, Superficial zone of articular cartilage
- Subchondral trabecular bone
- Sum, Whole cartilage
- TCM, Traditional Chinese medicine
- TCMSP, Traditional Chinese Medicine Systems Pharmacology Database
- Tb.N, Trabecular number
- Tb.Pf, Trabecular bone pattern factor
- Tb.Sp, Trabecular separation
- Tb.Th, Trabecular thickness
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Affiliation(s)
- Man Chu
- Faulty of Medical Technology, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Ping Wu
- Department of Allergy, Immunology and Rheumatology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Ming Hong
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, China.,Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Huasong Zeng
- Department of Allergy, Immunology and Rheumatology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Chun Kwok Wong
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Yu Feng
- Department of Traumatology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, China
| | - Zhe Cai
- Department of Allergy, Immunology and Rheumatology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China.,Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.,The Joint Center for Infection and Immunity, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou, China.,The Joint Center for Infection and Immunity, Institute Pasteur of Shanghai, Chinese Academy of Science, Shanghai, China
| | - William Weijia Lu
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.,Shenzhen Institutes of Advanced Technology, Chinese Academy of Science, Shenzhen, China
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12
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Salinas EY, Aryaei A, Paschos N, Berson E, Kwon H, Hu JC, Athanasiou KA. Shear stress induced by fluid flow produces improvements in tissue-engineered cartilage. Biofabrication 2020; 12:045010. [PMID: 32640430 DOI: 10.1088/1758-5090/aba412] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Tissue engineering aims to create implantable biomaterials for the repair and regeneration of damaged tissues. In vitro tissue engineering is generally based on static culture, which limits access to nutrients and lacks mechanical signaling. Using shear stress is controversial because in some cases it can lead to cell death while in others it promotes tissue regeneration. To understand how shear stress works and how it may be used to improve neotissue function, a series of studies were performed. First, a tunable device was designed to determine optimal levels of shear stress for neotissue formation. Then, computational fluid dynamics modeling showed the device applies fluid-induced shear (FIS) stress spanning three orders of magnitude on tissue-engineered cartilage (neocartilage). A beneficial window of FIS stress was subsequently identified, resulting in up to 3.6-fold improvements in mechanical properties of neocartilage in vitro. In vivo, neocartilage matured as evidenced by the doubling of collagen content toward native values. Translation of FIS stress to human derived neocartilage was then demonstrated, yielding analogous improvements in mechanical properties, such as 168% increase in tensile modulus. To gain an understanding of the beneficial roles of FIS stress, a mechanistic study was performed revealing a mechanically gated complex on the primary cilia of chondrocytes that is activated by FIS stress. This series of studies places FIS stress into the arena as a meaningful mechanical stimulation strategy for creating robust and translatable neotissues, and demonstrates the ease of incorporating FIS stress in tissue culture.
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Affiliation(s)
- E Y Salinas
- Department of Biomedical Engineering, University of California Irvine, 3131 Engineering Hall, Irvine, CA, 92697, United States of America. Authors contributed equally to this work
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13
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Cai Z, Hong M, Xu L, Yang K, Li C, Sun T, Feng Y, Zeng H, Lu WW, Chiu KY. Prevent action of magnoflorine with hyaluronic acid gel from cartilage degeneration in anterior cruciate ligament transection induced osteoarthritis. Biomed Pharmacother 2020; 126:109733. [PMID: 32113051 DOI: 10.1016/j.biopha.2019.109733] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/26/2019] [Accepted: 11/29/2019] [Indexed: 12/22/2022] Open
Abstract
According to the Chinese medicine, magnoflorine exerted significant anti-inflammatory effects and potentially promoted synthesis of proteoglycans in chondrocytes to reverse the progression of rheumatoid arthritis. However, the latent beneficial effect of magnoflorine for the treatment of traumatic osteoarthritis (OA) is still unknown. Therefore, we aim to demonstrate the efficacy of magnoflorine combined with HA-gel in attenuating cartilage degeneration in anterior cruciate ligament transection (ACLT) induced OA rat model. We found that the histological results showed the elevated cartilage matrix, chondrogenic signals and chondroprogenitor cells in HA-gel + magnoflorine treatment. HA-gel + magnoflorine treatment resulted in a decreased modified Mankin's score, and a higher volume ratio of hyaline cartilage (HC)/calcified cartilage (CC) and HC/Sum (whole cartilage), compared to ACLT and HA-gel groups. Furthermore, both the volume ratios of HC/Sum and HC/CC were negatively correlated with modified Mankin's scores. Finally, HA-gel + magnoflorine could significantly increase the BV/TV, Tb.Th, and decrease the Tb.Pf, Po(tot), Conn.Dn and Tb.Sp. In vitro, 50 μg/ml magnoflorine treatment could significantly increase the viability, S-phase, migration rate and chondrogenesis of chondroprogenitor cells. There were significant downregulations of MAPK/NF-κB signaling, and upregulations of chondrogenic signals in 50 μg/ml magnoflorine treatment. There were significant downregulations of proinflammatory cytokines and upregulation of IL-10 in HA-gel + magnoflorine treated group. Therefore, our study elucidated a protective effect of HA-gel + magnoflorine on attenuating cartilage degradation and maintaining SCB stabilization in ACLT induced OA.
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Affiliation(s)
- Zhe Cai
- The Joint Center for Infection and Immunity, 1. Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, China; 2. Institute Pasteur of Shanghai, Chinese Academy of Science, Shanghai, 200031, China; Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Department of Allergy, Immunology and Rheumatology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Ming Hong
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, China; Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, 510000, China
| | - Lei Xu
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Kedi Yang
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Chentian Li
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Tianhao Sun
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Yu Feng
- Department of Traumatology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, China.
| | - Huasong Zeng
- Department of Allergy, Immunology and Rheumatology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China.
| | - William Weijia Lu
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Shenzhen Institutes of Advanced Technology, Chinese Academy of Science, Shenzhen, China.
| | - Kwong-Yuen Chiu
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
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14
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Comparison of Cartilage Mechanical Properties Measured During Creep and Recovery. Sci Rep 2020; 10:1547. [PMID: 32005844 PMCID: PMC6994684 DOI: 10.1038/s41598-020-58220-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 01/02/2020] [Indexed: 12/23/2022] Open
Abstract
The diagnosis of osteoarthritis (OA) currently depends on the presence of pain and radiographic imaging findings, which generally do not present until later stages of the disease when the condition is difficult to treat. Therefore, earlier detection of OA pathology is needed for improved disease management. Ex vivo cartilage studies indicate that changes in the mechanical function of cartilage occur as degeneration progresses during OA. Thus, measurement of the in vivo cartilage mechanical response may serve as an earlier indicator of OA pathology. Though mechanical characterization is classically performed during loading, the unloading (recovery) response of cartilage may also enable determination of mechanical response. Therefore, the purpose of this study was to validate the use of the recovery response for mechanical characterization of cartilage in a controlled, ex vivo environment. To do so, confined compression creep and recovery tests were conducted on cartilage explants (N = 10), and the resulting mechanical properties from both the creep and recovery phases were compared. No statistically significant differences were found in the mechanical properties between the two phases, reinforcing the hypothesis that unloading (recovery) may be a good surrogate for loading.
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15
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Ferruzzi J, Zhang Y, Roblyer D, Zaman MH. Multi-scale Mechanics of Collagen Networks: Biomechanical Basis of Matrix Remodeling in Cancer. MULTI-SCALE EXTRACELLULAR MATRIX MECHANICS AND MECHANOBIOLOGY 2020. [DOI: 10.1007/978-3-030-20182-1_11] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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16
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Cipollaro L, Ciardulli MC, Della Porta G, Peretti GM, Maffulli N. Biomechanical issues of tissue-engineered constructs for articular cartilage regeneration: in vitro and in vivo approaches. Br Med Bull 2019; 132:53-80. [PMID: 31854445 DOI: 10.1093/bmb/ldz034] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Given the limited regenerative capacity of injured articular cartilage, the absence of suitable therapeutic options has encouraged tissue-engineering approaches for its regeneration or replacement. SOURCES OF DATA Published articles in any language identified in PubMed and Scopus electronic databases up to August 2019 about the in vitro and in vivo properties of cartilage engineered constructs. A total of 64 articles were included following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. AREAS OF AGREEMENT Regenerated cartilage lacks the biomechanical and biological properties of native articular cartilage. AREAS OF CONTROVERSY There are many different approaches about the development of the architecture and the composition of the scaffolds. GROWING POINTS Novel tissue engineering strategies focus on the development of cartilaginous biomimetic materials able to repair cartilage lesions in association to cell, trophic factors and gene therapies. AREAS TIMELY FOR DEVELOPING RESEARCH A multi-layer design and a zonal organization of the constructs may lead to achieve cartilage regeneration.
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Affiliation(s)
- Lucio Cipollaro
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Via San Leonardo 1, 84131 Salerno, Italy
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy
| | - Maria Camilla Ciardulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy
| | - Giovanna Della Porta
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy
| | - Giuseppe M Peretti
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, via Mangiagalli 31, 20133, Milan, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Via San Leonardo 1, 84131 Salerno, Italy
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, Queen Mary University of London, London, UK
- Institute of Science and Technology in Medicine, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, UK
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17
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Effect of structural distortions on articular cartilage permeability under large deformations. Biomech Model Mechanobiol 2019; 19:317-334. [DOI: 10.1007/s10237-019-01213-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 08/14/2019] [Indexed: 02/06/2023]
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18
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Fazaeli S, Ghazanfari S, Mirahmadi F, Everts V, Smit TH, Koolstra JH. The dynamic mechanical viscoelastic properties of the temporomandibular joint disc: The role of collagen and elastin fibers from a perspective of polymer dynamics. J Mech Behav Biomed Mater 2019; 100:103406. [PMID: 31473438 DOI: 10.1016/j.jmbbm.2019.103406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/27/2019] [Accepted: 08/24/2019] [Indexed: 10/26/2022]
Abstract
The temporomandibular joint disc is a structure, characterized as heterogeneous fibrocartilage, and is composed of macromolecular biopolymers. Despite a large body of characterization studies, the contribution of matrix biopolymers on the dynamic viscoelastic behavior of the disc is poorly understood. Given the high permeability and low concentration of glycosaminoglycans in the disc, it has been suggested that poro-elastic behavior can be neglected and that the intrinsic viscoelastic nature of solid matrix plays a dominant role in governing its time-dependent behavior. This study attempts to quantify the contribution of collagen and elastin fibers to the viscoelastic properties of the disc. Using collagenase and elastase, we perturbed the collagen and elastin fibrillar network in porcine temporomandibular joint discs and investigated the changes of dynamic viscoelastic properties in five different regions of the disc. Following both treatments, the storage and loss moduli of these regions were reduced dramatically up to the point that the tissue was no longer mechanically heterogeneous. However, the proportion of changes in storage and loss moduli were different for each treatment, reflected in the decrease and increase of the loss tangent for collagenase and elastase treated discs, respectively. The reduction of storage and loss moduli of the disc correlated with a decrease of biopolymer length. The present study indicates that the compositional and structural changes of collagen and elastin fibers alter the viscoelastic properties of the disc consistent with polymer dynamics.
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Affiliation(s)
- Sepanta Fazaeli
- Department of Oral Cell Biology and Functional Anatomy, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Samaneh Ghazanfari
- Aachen-Maastricht Institute for Biobased Materials, Faculty of Science and Engineering, Maastricht University, Geleen, the Netherlands; Department of Biohybrid & Medical Textiles (Biotex), RWTH Aachen University, Aachen, Germany.
| | - Fereshteh Mirahmadi
- Department of Oral Cell Biology and Functional Anatomy, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Vincent Everts
- Department of Oral Cell Biology and Functional Anatomy, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Theodoor Henri Smit
- Department of Medical Biology - Academic Medical Center Amsterdam, Amsterdam, the Netherlands.
| | - Jan Harm Koolstra
- Department of Oral Cell Biology and Functional Anatomy, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
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19
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Pflieger I, Stolberg-Stolberg J, Foehr P, Kuntz L, Tübel J, Grosse CU, Burgkart R. Full biomechanical mapping of the ovine knee joint to determine creep-recovery, stiffness and thickness variation. Clin Biomech (Bristol, Avon) 2019; 67:1-7. [PMID: 31054436 DOI: 10.1016/j.clinbiomech.2019.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 03/21/2019] [Accepted: 04/23/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Clinical cartilage repair strategies can be tested using the sheep model as suggest by the European Medicines Agency. To characterize variation within the joint a full biomechanical mapping is necessary. The aim of this study is to establish a loading model, to map regional differences within the knee and determine reference areas for area specific replacement techniques. METHODS A porous indenter was selected to evaluate 22 defined test locations (femoral condyles, tibia plateau, patella, femoral groove) on ovine knees (n = 7). A high-dynamic force-controlled micro creep and creep-recovery indentation test system applied five loading (0.11 MPa) and unloading (5.6 kPa) cycles for 60 s each and recorded creep-recovery. Needle indentation was used to measure cartilage thickness and calculate total strain. FINDINGS Steady state behaviour was observed from the third cycle and further evaluated. Little variation of stiffness in N/mm was found within the patella (4.3SD0.5) and femoral groove (8.1SD0.7) compared to larger variations in the femur (7.9SD2.0) and tibia (7.5SD3.2). Creep indentation showed values of 14.5%(SD2.7%) for the patella and 17.4%(SD3%) for the femoral grove opposed to 13.4%(SD4.3%) for the femoral condyles and 21.8%(SD6.6%) for the tibia plateau. Similar trends were observed analysing creep-recovery. Values were normalized to cartilage thickness which ranged between 0.36 mm and 1.14 mm. INTERPRETATION Our setup allows a reliable evaluation of zonal differences. Homogenous biomechanical behaviour is found within the patella and femoral groove whereas significant biomechanical variation within the femoral condyles and tibia plateau indicates the need for site-specific cartilage repair products.
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Affiliation(s)
- Iris Pflieger
- Department of Orthopaedics and Sports Orthopaedics, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany; Department of Trauma Surgery, Trauma Center Murnau, Professor-Küntscher-Str. 8, 82418 Murnau, Germany
| | - Josef Stolberg-Stolberg
- Department of Orthopaedics and Sports Orthopaedics, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany; Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Muenster, Germany.
| | - Peter Foehr
- Department of Orthopaedics and Sports Orthopaedics, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany; Chair of Non-destructive Testing, Technical University of Munich, Baumbachstr. 7, 81245 Munich, Germany
| | - Lara Kuntz
- Department of Orthopaedics and Sports Orthopaedics, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
| | - Jutta Tübel
- Department of Orthopaedics and Sports Orthopaedics, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
| | - Christian U Grosse
- Chair of Non-destructive Testing, Technical University of Munich, Baumbachstr. 7, 81245 Munich, Germany
| | - Rainer Burgkart
- Department of Orthopaedics and Sports Orthopaedics, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
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20
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Paranjape CS, Cutcliffe HC, Grambow SC, Utturkar GM, Collins AT, Garrett WE, Spritzer CE, DeFrate LE. A New Stress Test for Knee Joint Cartilage. Sci Rep 2019; 9:2283. [PMID: 30783146 PMCID: PMC6381136 DOI: 10.1038/s41598-018-38104-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 12/12/2018] [Indexed: 12/12/2022] Open
Abstract
Cartilage metabolism—both the synthesis and breakdown of cartilage constituents and architecture—is influenced by its mechanical loading. Therefore, physical activity is often recommended to maintain cartilage health and to treat or slow the progression of osteoarthritis, a debilitating joint disease causing cartilage degeneration. However, the appropriate exercise frequency, intensity, and duration cannot be prescribed because direct in vivo evaluation of cartilage following exercise has not yet been performed. To address this gap in knowledge, we developed a cartilage stress test to measure the in vivo strain response of healthy human subjects’ tibial cartilage to walking exercise. We varied both walk duration and speed in a dose-dependent manner to quantify how these variables affect cartilage strain. We found a nonlinear relationship between walk duration and in vivo compressive strain, with compressive strain initially increasing with increasing duration, then leveling off with longer durations. This work provides innovative measurements of cartilage creep behavior (which has been well-documented in vitro but not in vivo) during walking. This study showed that compressive strain increased with increasing walking speed for the speeds tested in this study (0.9–2.0 m/s). Furthermore, our data provide novel measurements of the in vivo strain response of tibial cartilage to various doses of walking as a mechanical stimulus, with maximal strains of 5.0% observed after 60 minutes of walking. These data describe physiological benchmarks for healthy articular cartilage behavior during walking and provide a much-needed baseline for studies investigating the effect of exercise on cartilage health.
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Affiliation(s)
| | - Hattie C Cutcliffe
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.,Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Steven C Grambow
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | | | - Amber T Collins
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | | | | | - Louis E DeFrate
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA. .,Department of Biomedical Engineering, Duke University, Durham, NC, USA. .,Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA.
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21
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Shaktivesh, Malekipour F, Lee PVS. Shock absorbing ability in healthy and damaged cartilage-bone under high-rate compression. J Mech Behav Biomed Mater 2018; 90:388-394. [PMID: 30445365 DOI: 10.1016/j.jmbbm.2018.10.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 09/13/2018] [Accepted: 10/14/2018] [Indexed: 01/06/2023]
Abstract
Articular cartilage is a soft tissue that distributes the loads in joints and transfers the compressive load to the underlying bone. At high rate and magnitudes of mechanical loading, cartilage and subchondral bone together are susceptible to damage. In addition, any disruption to the cartilage's structure, caused by injury, trauma or disorder such as osteoarthritis (OA), can alter the mechanism of load transfer from the cartilage to the underlying bone. Changes in the cartilage structure can also alter the ability of cartilage-bone to absorb and dissipate the impact energy. To investigate the effects of cartilage degradation on cartilage-bone shock absorption ability, the top 50% of the cartilage thickness was removed (modified cartilage) to mimic the cartilage thickness reduction in Grade III cartilage lesion and the remaining cartilage-bone unit (modified cartilage-bone) was compressed at high-rate (4% strain at 5 Hz). High-speed camera and microscope were used to capture microscopic deformation, and digital image correlation technique (DIC) employed to quantify the deformation of cartilage and bone. The mechanical properties (i.e. stiffness, strain, absorbed and dissipated energies) of cartilage and bone were calculated before and after the removal of the top 50% of the cartilage thickness, consisting of both the superficial tangential zone (STZ) and part of the middle zone of the cartilage. The results showed a significant degradation in the mechanical properties of the cartilage-bone unit after the removal of the top 50% cartilage thickness. The stiffness of the modified cartilage reduced significantly (by ~39%) and energy absorption in underlying bone increased by 32%, which can make the bone more vulnerable to damage in the modified cartilage-bone unit. In addition, the energy dissipation in the modified cartilage-bone unit was also increased by approximately 14%. These changes in mechanical properties suggest a crucial role of the STZ and middle zone (within the top 50% cartilage thickness) in protecting the underlying bone from the severe compressive impact loading. Results also indicated that under physiological contact stress of 7 MPa, strain in damaged cartilage was increased by 3.22% without affecting the mechanical behaviour of the underlying bone.
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Affiliation(s)
- Shaktivesh
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Fatemeh Malekipour
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Peter V S Lee
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia.
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22
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Selective Enzymatic Digestion of Proteoglycans and Collagens Alters Cartilage T1rho and T2 Relaxation Times. Ann Biomed Eng 2018; 47:190-201. [PMID: 30288634 DOI: 10.1007/s10439-018-02143-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 09/26/2018] [Indexed: 12/21/2022]
Abstract
Our objective was to determine the relationship of T1rho and T2 relaxation mapping to the biochemical and biomechanical properties of articular cartilage through selective digestion of proteoglycans and collagens. Femoral condyles were harvested from porcine knee joints and treated with either chondroitinase ABC (cABC) followed by collagenase, or collagenase followed by cABC. Magnetic resonance images were acquired and cartilage explants were harvested for biochemical, biomechanical, and histological analyses before and after each digestion. Targeted enzymatic digestion of proteoglycans with cABC resulted in elevated T1rho relaxation times and decreased sulfated glycosaminoglycan content without affecting T2 relaxation times. In contrast, extractable collagen and T2 relaxation times were increased by collagenase digestion; however, neither was altered by cABC digestion. Aggregate modulus decreased with digestion of both components. Overall, we found that targeted digestion of proteoglycans and collagens had varying effects on biochemical, biomechanical, and imaging properties. T2 relaxation times were altered with changes in extractable collagen, but not changes in proteoglycan. However, T1rho relaxation times were altered with proteoglycan loss, which may also coincide with collagen disruption. Since it is unclear which matrix components are disrupted first in osteoarthritis, both markers may be important for tracking disease progression.
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23
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Salinas EY, Hu JC, Athanasiou K. A Guide for Using Mechanical Stimulation to Enhance Tissue-Engineered Articular Cartilage Properties. TISSUE ENGINEERING PART B-REVIEWS 2018; 24:345-358. [PMID: 29562835 DOI: 10.1089/ten.teb.2018.0006] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The use of tissue-engineered articular cartilage (TEAC) constructs has the potential to become a powerful treatment option for cartilage lesions resulting from trauma or early stages of pathology. Although fundamental tissue-engineering strategies based on the use of scaffolds, cells, and signals have been developed, techniques that lead to biomimetic AC constructs that can be translated to in vivo use are yet to be fully confirmed. Mechanical stimulation during tissue culture can be an effective strategy to enhance the mechanical, structural, and cellular properties of tissue-engineered constructs toward mimicking those of native AC. This review focuses on the use of mechanical stimulation to attain and enhance the properties of AC constructs needed to translate these implants to the clinic. In vivo, mechanical loading at maximal and supramaximal physiological levels has been shown to be detrimental to AC through the development of degenerative changes. In contrast, multiple studies have revealed that during culture, mechanical stimulation within narrow ranges of magnitude and duration can produce anisotropic, mechanically robust AC constructs with high cellular viability. Significant progress has been made in evaluating a variety of mechanical stimulation techniques on TEAC, either alone or in combination with other stimuli. These advancements include determining and optimizing efficacious loading parameters (e.g., duration and frequency) to yield improvements in construct design criteria, such as collagen II content, compressive stiffness, cell viability, and fiber organization. With the advancement of mechanical stimulation as a potent strategy in AC tissue engineering, a compendium detailing the results achievable by various stimulus regimens would be of great use for researchers in academia and industry. The objective is to list the qualitative and quantitative effects that can be attained when direct compression, hydrostatic pressure, shear, and tensile loading are used to tissue-engineer AC. Our goal is to provide a practical guide to their use and optimization of loading parameters. For each loading condition, we will also present and discuss benefits and limitations of bioreactor configurations that have been used. The intent is for this review to serve as a reference for including mechanical stimulation strategies as part of AC construct culture regimens.
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Affiliation(s)
- Evelia Y Salinas
- Biomedical Engineering Department, University of California , Irvine, California
| | - Jerry C Hu
- Biomedical Engineering Department, University of California , Irvine, California
| | - Kyriacos Athanasiou
- Biomedical Engineering Department, University of California , Irvine, California
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24
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Kleinhans KL, Jackson AR. Hydraulic permeability of meniscus fibrocartilage measured via direct permeation: Effects of tissue anisotropy, water volume content, and compressive strain. J Biomech 2018; 72:215-221. [PMID: 29605083 DOI: 10.1016/j.jbiomech.2018.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 02/27/2018] [Accepted: 03/06/2018] [Indexed: 11/30/2022]
Abstract
Hydraulic permeability is an important material property of cartilaginous tissues, governing the rate of fluid flow, which is crucial to tissue biomechanics and cellular nutrition. The effects of strain, anisotropy, and region on the hydraulic permeability in meniscus tissue have not been fully elucidated. Using a one-dimensional direct permeation test, we measured the hydraulic permeability within statically compressed porcine meniscus specimens, prepared such that the explants were in either the axial or circumferential direction of either the central or horn (axial direction only) region of the medial and lateral menisci. A constant flow was applied and the pressure difference was measured using pressure transducers. Specimens were tested under 10-20% compressive strain. Permeability values were in the range of 1.53-1.87 × 10-15 m4/Ns, which is comparable to values found in the literature. Permeability was significantly anisotropic, being higher in the circumferential direction than in the axial direction. Additionally, there was a significant negative correlation between strain level and permeability for all groups. Lastly, no statistically significant difference was found between permeability coefficients from different regional locations. This study provides important information regarding structure-function relationships in meniscal tissues that helps to elucidate biomechanics and transport in the tissue, and can aid in the understanding of the tissue's role in the function of the knee joint and onset of osteoarthritis.
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Affiliation(s)
- Kelsey L Kleinhans
- Orthopaedic Biomechanics Laboratory, Department of Biomedical Engineering, University of Miami, Coral Gables, FL, USA
| | - Alicia R Jackson
- Orthopaedic Biomechanics Laboratory, Department of Biomedical Engineering, University of Miami, Coral Gables, FL, USA.
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25
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Ribitsch I, Peham C, Ade N, Dürr J, Handschuh S, Schramel JP, Vogl C, Walles H, Egerbacher M, Jenner F. Structure-Function relationships of equine menisci. PLoS One 2018. [PMID: 29522550 PMCID: PMC5844599 DOI: 10.1371/journal.pone.0194052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Meniscal pathologies are among the most common injuries of the femorotibial joint in both human and equine patients. Pathological forces and ensuing injuries of the cranial horn of the equine medial meniscus are considered analogous to those observed in the human posterior medial horn. Biomechanical properties of human menisci are site- and depth- specific. However, the influence of equine meniscus topography and composition on its biomechanical properties is yet unknown. A better understanding of equine meniscus composition and biomechanics could advance not only veterinary therapies for meniscus degeneration or injuries, but also further substantiate the horse as suitable translational animal model for (human) meniscus tissue engineering. Therefore, the aim of this study was to investigate the composition and structure of the equine knee meniscus in a site- and age-specific manner and their relationship with potential site-specific biomechanical properties. The meniscus architecture was investigated histologically. Biomechanical testing included evaluation of the shore hardness (SH), stiffness and energy loss of the menisci. The SH was found to be subjected to both age and site-specific changes, with an overall higher SH of the tibial meniscus surface and increase in SH with age. Stiffness and energy loss showed neither site nor age related significant differences. The macroscopic and histologic similarities between equine and human menisci described in this study, support continued research in this field.
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Affiliation(s)
- Iris Ribitsch
- Department for Companion Animals and Horses, Veterm, University Equine Hospital, Vetmeduni Vienna, Vienna, Vienna, Austria
- * E-mail:
| | - Christian Peham
- Department for Companion Animals and Horses, Veterm, University Equine Hospital, Vetmeduni Vienna, Vienna, Vienna, Austria
| | - Nicole Ade
- Department for Companion Animals and Horses, Veterm, University Equine Hospital, Vetmeduni Vienna, Vienna, Vienna, Austria
- Department of Health Sciences and Technology, Institute for Biomechanics, ETH Zurich, Zurich, Zurich, Switzerland
| | - Julia Dürr
- Department of Pathobiology, Unit of Histology and Embryology, Vetmeduni Vienna, Vienna, Vienna, Austria
| | - Stephan Handschuh
- Vetcore Facility for Research, Vetmeduni Vienna, Vienna, Vienna, Austria
| | - Johannes Peter Schramel
- Department for Companion Animals and Horses, Veterm, University Equine Hospital, Vetmeduni Vienna, Vienna, Vienna, Austria
| | - Claus Vogl
- Department of Biomedical Sciences, Unit of Molecular Genetics, Vetmeduni Vienna, Vienna, Vienna, Austria
| | - Heike Walles
- Department of Tissue Engineering and Regenerative Medicine (TERM), University Hospital Wuerzburg and Translational Center Wuerzburg, Wuerzburg, Baveria, Germany
| | - Monika Egerbacher
- Department of Pathobiology, Unit of Histology and Embryology, Vetmeduni Vienna, Vienna, Vienna, Austria
| | - Florien Jenner
- Department for Companion Animals and Horses, Veterm, University Equine Hospital, Vetmeduni Vienna, Vienna, Vienna, Austria
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26
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Inamdar SR, Knight DP, Terrill NJ, Karunaratne A, Cacho-Nerin F, Knight MM, Gupta HS. The Secret Life of Collagen: Temporal Changes in Nanoscale Fibrillar Pre-Strain and Molecular Organization during Physiological Loading of Cartilage. ACS NANO 2017; 11:9728-9737. [PMID: 28800220 DOI: 10.1021/acsnano.7b00563] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Articular cartilage is a natural biomaterial whose structure at the micro- and nanoscale is critical for healthy joint function and where degeneration is associated with widespread disorders such as osteoarthritis. At the nanoscale, cartilage mechanical functionality is dependent on the collagen fibrils and hydrated proteoglycans that form the extracellular matrix. The dynamic response of these ultrastructural building blocks at the nanoscale, however, remains unclear. Here we measure time-resolved changes in collagen fibril strain, using small-angle X-ray diffraction during compression of bovine and human cartilage explants. We demonstrate the existence of a collagen fibril tensile pre-strain, estimated from the D-period at approximately 1-2%, due to osmotic swelling pressure from the proteoglycan. We reveal a rapid reduction and recovery of this pre-strain which occurs during stress relaxation, approximately 60 s after the onset of peak load. Furthermore, we show that this reduction in pre-strain is linked to disordering in the intrafibrillar molecular packing, alongside changes in the axial overlapping of tropocollagen molecules within the fibril. Tissue degradation in the form of selective proteoglycan removal disrupts both the collagen fibril pre-strain and the transient response during stress relaxation. This study bridges a fundamental gap in the knowledge describing time-dependent changes in collagen pre-strain and molecular organization that occur during physiological loading of articular cartilage. The ultrastructural details of this transient response are likely to transform our understanding of the role of collagen fibril nanomechanics in the biomechanics of cartilage and other hydrated soft tissues.
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Affiliation(s)
- Sheetal R Inamdar
- Institute of Bioengineering, School of Engineering and Materials Science, Queen Mary University of London , London E1 4NS, United Kingdom
| | - David P Knight
- Orthox Ltd. , 66 Innovation Drive, Milton Park, Abingdon OX14 4RQ, United Kingdom
| | - Nicholas J Terrill
- Harwell Science and Innovation Campus, Diamond Light Source , Harwell, Didcot OX11 0DE, United Kingdom
| | - Angelo Karunaratne
- Department of Bioengineering, Imperial College London , London SW7 2AZ, United Kingdom
| | - Fernando Cacho-Nerin
- Harwell Science and Innovation Campus, Diamond Light Source , Harwell, Didcot OX11 0DE, United Kingdom
| | - Martin M Knight
- Institute of Bioengineering, School of Engineering and Materials Science, Queen Mary University of London , London E1 4NS, United Kingdom
| | - Himadri S Gupta
- Institute of Bioengineering, School of Engineering and Materials Science, Queen Mary University of London , London E1 4NS, United Kingdom
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27
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Han B, Nia HT, Wang C, Chandrasekaran P, Li Q, Chery DR, Li H, Grodzinsky AJ, Han L. AFM-Nanomechanical Test: An Interdisciplinary Tool That Links the Understanding of Cartilage and Meniscus Biomechanics, Osteoarthritis Degeneration, and Tissue Engineering. ACS Biomater Sci Eng 2017; 3:2033-2049. [PMID: 31423463 PMCID: PMC6697429 DOI: 10.1021/acsbiomaterials.7b00307] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Our objective is to provide an in-depth review of the recent technical advances of atomic force microscopy (AFM)-based nanomechanical tests and their contribution to a better understanding and diagnosis of osteoarthritis (OA), as well as the repair of tissues undergoing degeneration during OA progression. We first summarize a range of technical approaches for AFM-based nanoindentation, including considerations in both experimental design and data analysis. We then provide a more detailed description of two recently developed modes of AFM-nanoindentation, a high-bandwidth nanorheometer system for studying poroviscoelasticity and an immunofluorescence-guided nanomechanical mapping technique for delineating the pericellular matrix (PCM) and territorial/interterritorial matrix (T/IT-ECM) of surrounding cells in connective tissues. Next, we summarize recent applications of these approaches to three aspects of joint-related healthcare and disease: cartilage aging and OA, developmental biology and OA pathogenesis in murine models, and nanomechanics of the meniscus. These studies were performed over a hierarchy of length scales, from the molecular, cellular to the whole tissue level. The advances described here have contributed greatly to advancing the fundamental knowledge base for improved understanding, detection, and treatment of OA.
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Affiliation(s)
- Biao Han
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania 19104, United States
| | - Hadi T. Nia
- Department of Radiation Oncology, Massachusetts General Hospital Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Chao Wang
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania 19104, United States
| | - Prashant Chandrasekaran
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania 19104, United States
| | - Qing Li
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania 19104, United States
| | - Daphney R. Chery
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania 19104, United States
| | - Hao Li
- College of Architecture and the Built Environment, Philadelphia University, Philadelphia, Pennsylvania 19144, United States
| | - Alan J. Grodzinsky
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| | - Lin Han
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania 19104, United States
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28
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Gkousioudi A, Tzeranis DS, Kanakaris GP, Saloufas M, Alexopoulos LG. Quantifying Cartilage Biomechanical Properties Using a Linearized Frequency-Domain Method. Ann Biomed Eng 2017; 45:2061-2074. [PMID: 28573419 DOI: 10.1007/s10439-017-1861-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 05/24/2017] [Indexed: 11/28/2022]
Abstract
Articular cartilage function relies on its unique mechanical behavior. Cartilage mechanics have been described by several analytic models, whose parameters are usually estimated by fitting their constitutive equations to stress-relaxation data. This procedure can be long and is prone to experimental and fitting errors. Τhis study describes a novel methodology for estimating the biomechanical properties of cartilage samples based on their linearized frequency response, derived by applying a series of small-amplitude harmonic displacements superimposed to a bias strain. The proposed methodology, denoted as linearized frequency-domain method (LFM), was demonstrated by quantifying the effects of collagenase and hyaluronidase on cartilage, where it provided robust cartilage parameter estimates that overall agreed well with estimates obtained by stress-relaxation analysis. LFM was also applied to unveil the strain-dependent nature of porcine cartilage biomechanical parameters. Results showed that increasing the bias strain from 5% to 15% caused a significant decrease in cartilage permeability but did not have significant effect on the compression modulus and the Poisson's ratio. Apart from cartilage, LFM can potentially quantify the strain-dependent nature of tissues and biomaterials, thereby enhance tissue-level understanding on organ physiology and pathology, lead to better computational tissue models, and guide tissue engineering research.
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Affiliation(s)
- A Gkousioudi
- Department of Mechanical Engineering, National Technical University of Athens, 157 80, Zografou, Greece.,School of Medicine, University of Patras, 265 04, Rio Achaias, Greece
| | - D S Tzeranis
- Department of Mechanical Engineering, National Technical University of Athens, 157 80, Zografou, Greece.,Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology - Hellas, Heraklion, 70013, Greece
| | - G P Kanakaris
- Department of Mechanical Engineering, National Technical University of Athens, 157 80, Zografou, Greece
| | - M Saloufas
- Department of Mechanical Engineering, National Technical University of Athens, 157 80, Zografou, Greece
| | - L G Alexopoulos
- Department of Mechanical Engineering, National Technical University of Athens, 157 80, Zografou, Greece.
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29
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Mutsuzaki H, Nakajima H, Nomura S, Sakane M. Differences in placement of calcium phosphate-hybridized tendon grafts within the femoral bone tunnel during ACL reconstruction do not influence tendon-to-bone healing. J Orthop Surg Res 2017; 12:80. [PMID: 28577573 PMCID: PMC5455123 DOI: 10.1186/s13018-017-0583-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 05/22/2017] [Indexed: 12/02/2022] Open
Abstract
Background Calcium phosphate (CaP)-hybridization of tendon grafts has been shown to improve tendon-to-bone healing. The purpose of this study was to clarify the influence of different tendon graft placement methods on tendon-to-bone healing using CaP-hybridized tendon grafts in anterior cruciate ligament (ACL) reconstructions in rabbits. Methods We compared two methods of tendon graft placement within the femoral bone tunnel: suspension of the tendon graft within the bone tunnel (suspension group) and implantation of the tendon graft coherent with the bone socket (coherence group). CaP-hybridized tendon grafts were used in both groups. Fifty-six male Japanese white rabbits were used for this study. The results of biomechanical tests (n = 9) and histological analyses (n = 5) were evaluated at 2 and 4 weeks after surgery. Results The ultimate failure load, stiffness, stress, soft tissue remaining in bone tunnel after biomechanical testing, and direct bonding area at tendon–bone interface did not differ significantly between the suspension and coherence groups at either 2 or 4 weeks after surgery (p > 0.05). In both groups, the ultimate failure load, stress, soft tissue remaining in the bone tunnel, and direct bonding area at interface at 4 weeks after surgery were significantly greater than those at 2 weeks after surgery (p < 0.05). Conclusions Tendon-to-bone healing in both groups progressed until the endpoint of 4 weeks. There was no influence of the CaP-hybridized tendon graft placement method on tendon-to-bone healing at 4 weeks after ACL reconstruction in rabbits. Thus, the CaP-hybridized tendon grafts were unaffected by differences in their placement within the bone tunnel and became equally anchored to the bone tunnel during the early postoperative period. The tendon graft placement method may not influence tendon-to-bone healing in ACL reconstruction when CaP-hybridized tendon grafts are used.
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Affiliation(s)
- Hirotaka Mutsuzaki
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Inashiki-gun, Ibaraki, 300-0394, Japan.
| | - Hiromi Nakajima
- Department of Agriculture, Ibaraki University, 3-21-1 Chuo, Ami, Ibaraki, 300-0393, Japan
| | - Shunsuke Nomura
- Department of Agriculture, Ibaraki University, 3-21-1 Chuo, Ami, Ibaraki, 300-0393, Japan
| | - Masataka Sakane
- Department of Orthopaedic Surgery, Tsukuba Gakuen Hospital, 2573-1 Kamiyokoba, Tsukuba, Ibaraki, 305-0854, Japan
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30
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Fischenich KM, Button KD, DeCamp C, Haut RC, Donahue TLH. Comparison of two models of post-traumatic osteoarthritis; temporal degradation of articular cartilage and menisci. J Orthop Res 2017; 35:486-495. [PMID: 27129040 DOI: 10.1002/jor.23275] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/22/2016] [Indexed: 02/04/2023]
Abstract
The objective of this study was to compare longitudinal results from two models of combined anterior cruciate ligament (ACL) and meniscal injury. A modified ACL transection (mACLT) model and a traumatic impact (ACLF) model were used to create an ACL rupture and acute meniscal damage in a Flemish Giant animal model. The animals were euthanized at time points of 4, 8, or 12 weeks. The menisci were assessed for equilibrium and instantaneous compressive modulus, as well as glycosaminoglycan (GAG) coverage. The articular cartilage was mechanically assessed for thickness, matrix modulus, fiber modulus, and permeability. Articular cartilage GAG coverage, fissuring, tidemark integrity, and subchondral bone thickness were measured. Both models resulted in damage indicative of osteoarthritis, including decreased meniscal mechanics and GAG coverage, increased permeability and fissuring of articular cartilage, and decreased GAG coverage. The mACLT model had an early and lasting effect on the menisci mechanics and GAG coverage, while cartilage damage was not significantly affected until 12 weeks. The ACLF model resulted in an earlier change of articular cartilage GAG coverage and fissuring in both the 8 and 12 week groups. The menisci were only significantly affected at the 12 week time point in the ACLF model. We concluded the progression of post traumatic osteoarthritis was dependent on injury modality: a point to be considered in future investigations. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:486-495, 2017.
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Affiliation(s)
- Kristine M Fischenich
- Department of Mechanical Engineering, Colorado State University, 1374 Campus Delivery, Fort Collins, 80523, Colorado.,School of Biomedical Engineering, Colorado State University, 1374 Campus Delivery, Fort Collins, 80523, Colorado
| | - Keith D Button
- Orthopaedic Biomechanics Laboratories, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Charlie DeCamp
- Small Animal Clinical Sciences, College of Veterinary, Michigan State University, East Lansing, Michigan
| | - Roger C Haut
- Orthopaedic Biomechanics Laboratories, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Tammy L Haut Donahue
- Department of Mechanical Engineering, Colorado State University, 1374 Campus Delivery, Fort Collins, 80523, Colorado.,School of Biomedical Engineering, Colorado State University, 1374 Campus Delivery, Fort Collins, 80523, Colorado
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31
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Influence of Knee Immobilization on Chondrocyte Apoptosis and Histological Features of the Anterior Cruciate Ligament Insertion and Articular Cartilage in Rabbits. Int J Mol Sci 2017; 18:ijms18020253. [PMID: 28134763 PMCID: PMC5343789 DOI: 10.3390/ijms18020253] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 01/18/2017] [Accepted: 01/20/2017] [Indexed: 11/30/2022] Open
Abstract
This study examined the influence of immobilization on chondrocyte apoptosis and histological features of the anterior cruciate ligament (ACL) insertion and knee articular cartilage in rabbits. Forty-eight male Japanese white rabbits were assigned to an immobilization (n = 24) or sham (n = 24) group. Rabbits in the immobilization group underwent complete unilateral surgical knee immobilization and rabbits in the sham group underwent a sham surgery. The average thickness of the glycosaminoglycan (GAG) stained red area by safranin O staining, the chondrocyte apoptosis rate and the chondrocyte proliferation rate in the cartilage layer in the ACL insertion and the articular cartilage of the medial tibial condyle were measured at one, two, four and eight weeks in six animals from each group. In the ACL insertion, the chondrocyte apoptosis rate was higher in the immobilization group than in the sham group at two and eight weeks after surgery (p < 0.05). The chondrocyte proliferation rate gradually decreased from two weeks to eight weeks in the immobilization group. The GAG layer was thinner in the immobilization group than in the sham group at two, four and eight weeks after surgery (p < 0.05). In the articular cartilage, the chondrocyte apoptosis rate in the immobilization group was higher than in the sham group at four and eight weeks after surgery (p < 0.05). The GAG layer was significantly thinner in the immobilization group than that in the sham group at four and eight weeks after surgery (p < 0.05). Knee immobilization significantly increased chondrocyte apoptosis at two and eight weeks after surgery in the ACL insertion and at four and eight weeks after surgery in the articular cartilage of the medial tibial condyle, and decreased GAG layer thickness from two to eight weeks after surgery in the ACL insertion and from four to eight weeks after surgery in the articular cartilage.
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32
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Wheatley BB, Odegard GM, Kaufman KR, Haut Donahue TL. A validated model of passive skeletal muscle to predict force and intramuscular pressure. Biomech Model Mechanobiol 2016; 16:1011-1022. [PMID: 28040867 DOI: 10.1007/s10237-016-0869-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 12/19/2016] [Indexed: 02/02/2023]
Abstract
The passive properties of skeletal muscle are often overlooked in muscle studies, yet they play a key role in tissue function in vivo. Studies analyzing and modeling muscle passive properties, while not uncommon, have never investigated the role of fluid content within the tissue. Additionally, intramuscular pressure (IMP) has been shown to correlate with muscle force in vivo and could be used to predict muscle force in the clinic. In this study, a novel model of skeletal muscle was developed and validated to predict both muscle stress and IMP under passive conditions for the New Zealand White Rabbit tibialis anterior. This model is the first to include fluid content within the tissue and uses whole muscle geometry. A nonlinear optimization scheme was highly effective at fitting model stress output to experimental stress data (normalized mean square error or NMSE fit value of 0.993) and validation showed very good agreement to experimental data (NMSE fit values of 0.955 and 0.860 for IMP and stress, respectively). While future work to include muscle activation would broaden the physiological application of this model, the passive implementation could be used to guide surgeries where passive muscle is stretched.
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Affiliation(s)
- Benjamin B Wheatley
- Department of Mechanical Engineering, Colorado State University, 1374 Campus Delivery, Fort Collins, CO, 80523, USA
| | - Gregory M Odegard
- Department of Mechanical Engineering - Engineering Mechanics, Michigan Technological University, 1400 Townsend Drive, Houghton, MI, 49931, USA
| | - Kenton R Kaufman
- Department of Orthopedic Surgery, Mayo Clinic, First Street SW, Rochester, MN, 55905, USA
| | - Tammy L Haut Donahue
- Department of Mechanical Engineering, School of Biomedical Engineering, Colorado State University, 1374 Campus Delivery, Fort Collins, CO, 80523, USA.
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Abstract
During mandibular movement, the geometric relationships of the articular surfaces in the temporomandibular joint (TMJ) change, so that the disc undergoes different stress concentrations with respect to time and position. In this study, we compared the intra-articular space variations of 13 clicking and 15 asymptomatic TMJs for jaw opening/closing. Magnetic resonance imaging and jaw tracking were combined to display the motion of the whole condyle within the fossa. In clicking TMJs, the mediolateral spread s of the stress-field trajectories was 2.4 ± 1.0 mm ( smax = 4.9 ± 2.1 mm) with an aspect ratio a/h of 2.5 ± 1.6, both significantly greater than in controls (p < 0.05). The stress-field trajectories of the controls coincided during opening/closing ( s = 0.9 ± 0.2 mm, smax = 1.8 ± 0.8 mm, a/h = 1.6 ± 0.3). Clicking TMJs showed much less coincident stress-field paths and much “flatter” stress-fields than controls during jaw opening/closing.
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Affiliation(s)
- D B Gössi
- Clinic for Masticatory Disorders and Complete Dentures, Center for Oral Medicine, Dental and Maxillo-Facial Surgery, University of Zürich, Plattenstrasse 11, CH-8028 Zürich, Switzerland
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Abstract
The pattern of a limb fracture can be determined by the material property of the bone and the characteristics of the deforming force. In this review we outline the composition and material properties of cortical and cancellous bone, and articular cartilage. We defi ne the biomechanics of fractures and describe the various fracture patterns that are seen clinically.
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Affiliation(s)
- AM McGee
- University of Birmingham NHS Trust, South Birmingham Trauma Unit, Birmingham, UK
| | - AA Qureshi
- University of Birmingham NHS Trust, South Birmingham Trauma Unit, Birmingham, UK
| | - KM Porter
- University of Birmingham NHS Trust, South Birmingham Trauma Unit, Birmingham, UK,
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35
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Quiroga JMP, Wilson W, Ito K, van Donkelaar CC. Relative contribution of articular cartilage's constitutive components to load support depending on strain rate. Biomech Model Mechanobiol 2016; 16:151-158. [PMID: 27416853 PMCID: PMC5285416 DOI: 10.1007/s10237-016-0807-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 06/28/2016] [Indexed: 11/29/2022]
Abstract
Cartilage is considered a biphasic material in which the solid is composed of proteoglycans and collagen. In biphasic tissue, the hydraulic pressure is believed to bear most of the load under higher strain rates and its dissipation due to fluid flow determines creep and relaxation behavior. In equilibrium, hydraulic pressure is zero and load bearing is transferred to the solid matrix. The viscoelasticity of the collagen network also contributes to its time-dependent behavior, and the osmotic pressure to load bearing in equilibrium. The aim of the present study was to determine the relative contributions of hydraulic pressure, viscoelastic collagen stress, solid matrix stiffness and osmotic pressure to load carriage in cartilage under transient and equilibrium conditions. Unconfined compression experiments were simulated using a fibril-reinforced poroviscoelastic model of articular cartilage, including water, fibrillar viscoelastic collagen and non-fibrillar charged glycosaminoglycans. The relative contributions of hydraulic and osmotic pressures and stresses in the fibrillar and non-fibrillar network were evaluated in the superficial, middle and deep zone of cartilage under five different strain rates and after relaxation. Initially upon loading, the hydraulic pressure carried most of the load in all three zones. The osmotic swelling pressure carried most of the equilibrium load. In the surface zone, where the fibers were loaded in tension, the collagen network carried 20 % of the load for all strain rates. The importance of these fibers was illustrated by artificially modifying the fiber architecture, which reduced the overall stiffness of cartilage in all conditions. In conclusion, although hydraulic pressure dominates the transient behavior during cartilage loading, due to its viscoelastic nature the superficial zone collagen fibers carry a substantial part of the load under transient conditions. This becomes increasingly important with higher strain rates. The interesting and striking new insight from this study suggests that under equilibrium conditions, the swelling pressure generated by the combination of proteoglycans and collagen reinforcement accounts cartilage stiffness for more than 90 % of the loads carried by articular cartilage. This finding is different from the common thought that load is transferred from fluid to solid and is carried by the aggregate modulus of the solid. Rather, it is transformed from hydraulic to osmotic swelling pressure. These results show the importance of considering both (viscoelastic) collagen fibers as well as swelling pressure in studies of the (transient) mechanical behavior of cartilage.
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Affiliation(s)
- J M Párraga Quiroga
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands
| | - W Wilson
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands
| | - K Ito
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands
| | - C C van Donkelaar
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands.
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36
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Lad NK, Liu B, Ganapathy PK, Utturkar GM, Sutter EG, Moorman CT, Garrett WE, Spritzer CE, DeFrate LE. Effect of normal gait on in vivo tibiofemoral cartilage strains. J Biomech 2016; 49:2870-2876. [PMID: 27421206 DOI: 10.1016/j.jbiomech.2016.06.025] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 06/10/2016] [Accepted: 06/23/2016] [Indexed: 11/17/2022]
Abstract
Altered cartilage loading is believed to be associated with osteoarthritis development. However, there are limited data regarding the influence of normal gait, an essential daily loading activity, on cartilage strains. In this study, 8 healthy subjects with no history of knee surgery or injury underwent magnetic resonance imaging of a single knee prior to and following a 20-min walking activity at approximately 1.1m/s. Bone and cartilage surfaces were segmented from these images and compiled into 3-dimensional models of the tibia, femur, and associated cartilage. Thickness changes were measured across a grid of evenly spaced points spanning the models of the articular surfaces. Averaged compartmental strains and local strains were then calculated. Overall compartmental strains after the walking activity were found to be significantly different from zero in all four tibiofemoral compartments, with tibial cartilage strain being significantly larger than femoral cartilage strain. These results provide baseline data regarding the normal tibiofemoral cartilage strain response to gait. Additionally, the technique employed in this study has potential to be used as a "stress test" to understand how factors including age, weight, and injury influence tibiofemoral cartilage strain response, essential information in the development of potential treatment strategies for the prevention of osteoarthritis.
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Affiliation(s)
- Nimit K Lad
- Duke Sports Medicine Center, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Betty Liu
- Duke Sports Medicine Center, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Pramodh K Ganapathy
- Duke Sports Medicine Center, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Gangadhar M Utturkar
- Duke Sports Medicine Center, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - E Grant Sutter
- Duke Sports Medicine Center, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Claude T Moorman
- Duke Sports Medicine Center, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - William E Garrett
- Duke Sports Medicine Center, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Charles E Spritzer
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Louis E DeFrate
- Duke Sports Medicine Center, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA.
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Hatami-Marbini H, Maulik R. A Biphasic Transversely Isotropic Poroviscoelastic Model for the Unconfined Compression of Hydrated Soft Tissue. J Biomech Eng 2016; 138:4032059. [DOI: 10.1115/1.4032059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Indexed: 11/08/2022]
Abstract
The unconfined compression experiments are commonly used for characterizing the mechanical behavior of hydrated soft tissues such as articular cartilage. Several analytical constitutive models have been proposed over the years to analyze the unconfined compression experimental data and subsequently estimate the material parameters. Nevertheless, new mathematical models are still required to obtain more accurate numerical estimates. The present study aims at developing a linear transversely isotropic poroviscoelastic theory by combining a viscoelastic material law with the transversely isotropic biphasic model. In particular, an integral type viscoelastic model is used to describe the intrinsic viscoelastic properties of a transversely isotropic solid matrix. The proposed constitutive theory incorporates viscoelastic contributions from both the fluid flow and the intrinsic viscoelasticity to the overall stress-relaxation behavior. Moreover, this new material model allows investigating the biomechanical properties of tissues whose extracellular matrix exhibits transverse isotropy. In the present work, a comprehensive parametric study was conducted to determine the influence of various material parameters on the stress–relaxation history. Furthermore, the efficacy of the proposed theory in representing the unconfined compression experiments was assessed by comparing its theoretical predictions with those obtained from other versions of the biphasic theory such as the isotropic, transversely isotropic, and viscoelastic models. The unconfined compression behavior of articular cartilage as well as corneal stroma was used for this purpose. It is concluded that while the proposed model is capable of accurately representing the viscoelastic behavior of any hydrated soft tissue in unconfined compression, it is particularly useful in modeling the behavior of those with a transversely isotropic skeleton.
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Affiliation(s)
- H. Hatami-Marbini
- Department of Mechanical and Industrial Engineering, University of Illinois at Chicago, Chicago, IL 60607 e-mail:
| | - R. Maulik
- School of Mechanical and Aerospace Engineering, Oklahoma State University, Stillwater, OK 74075
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Jia S, Zhang T, Xiong Z, Pan W, Liu J, Sun W. In Vivo Evaluation of a Novel Oriented Scaffold-BMSC Construct for Enhancing Full-Thickness Articular Cartilage Repair in a Rabbit Model. PLoS One 2015; 10:e0145667. [PMID: 26695629 PMCID: PMC4687859 DOI: 10.1371/journal.pone.0145667] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 12/07/2015] [Indexed: 01/15/2023] Open
Abstract
Tissue engineering (TE) has been proven usefulness in cartilage defect repair. For effective cartilage repair, the structural orientation of the cartilage scaffold should mimic that of native articular cartilage, as this orientation is closely linked to cartilage mechanical functions. Using thermal-induced phase separation (TIPS) technology, we have fabricated an oriented cartilage extracellular matrix (ECM)-derived scaffold with a Young's modulus value 3 times higher than that of a random scaffold. In this study, we test the effectiveness of bone mesenchymal stem cell (BMSC)-scaffold constructs (cell-oriented and random) in repairing full-thickness articular cartilage defects in rabbits. While histological and immunohistochemical analyses revealed efficient cartilage regeneration and cartilaginous matrix secretion at 6 and 12 weeks after transplantation in both groups, the biochemical properties (levels of DNA, GAG, and collagen) and biomechanical values in the oriented scaffold group were higher than that in random group at early time points after implantation. While these differences were not evident at 24 weeks, the biochemical and biomechanical properties of the regenerated cartilage in the oriented scaffold-BMSC construct group were similar to that of native cartilage. These results demonstrate that an oriented scaffold, in combination with differentiated BMSCs can successfully repair full-thickness articular cartilage defects in rabbits, and produce cartilage enhanced biomechanical properties.
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Affiliation(s)
- Shuaijun Jia
- Department of Mechanical Engineering, Biomanufacturing Engineering Research Institute, Tsinghua University, Beijing, China
- Department of Orthopaedics, Shannxi Hospital of Armed Police Force, Xi'an, Shannxi, China
| | - Ting Zhang
- Department of Mechanical Engineering, Biomanufacturing Engineering Research Institute, Tsinghua University, Beijing, China
| | - Zhuo Xiong
- Department of Mechanical Engineering, Biomanufacturing Engineering Research Institute, Tsinghua University, Beijing, China
| | - Weimin Pan
- Department of Human Movement Studies, Xi’an physical education university, Xi'an, Shannxi, China
| | - Jian Liu
- Institute of Orthopaedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shannxi, China
| | - Wei Sun
- Department of Mechanical Engineering, Biomanufacturing Engineering Research Institute, Tsinghua University, Beijing, China
- Department of Mechanical Engineering, Drexel University, Philadelphia, Pennsylvania, United States of America
- * E-mail:
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40
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Quantifying the lubricity of mechanically tough polyvinyl alcohol hydrogels for cartilage repair. Proc Inst Mech Eng H 2015; 229:845-52. [DOI: 10.1177/0954411915599016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Polyvinyl alcohol hydrogels are biocompatible and can be used as synthetic articular cartilage. Their mechanical characteristics can be tailored by various techniques such as annealing or blending with other hydrophilic polymers. In this study, we quantified the coefficient of friction of various candidate polyvinyl alcohol hydrogels against cobalt–chrome alloy or swine cartilage using a new rheometer-based method. We investigated the coefficient of friction of polyvinyl alcohol–only hydrogels and blends with polyethylene glycol, polyacrylic acid, and polyacrylamide against swine cartilage and polished cobalt–chrome surfaces. The addition of the functional groups to polyvinyl alcohol, such as acrylamide (semi-interpenetrating network) and acrylic acid (blend), significantly reduced the coefficient of friction. The coefficient of friction of the polyvinyl alcohol–only hydrogel was measured as 0.4 ± 0.03 against cobalt–chrome alloy, and 0.09 ± 0.004 against cartilage, while those measurements for the polyvinyl alcohol–polyacrylic acid blends and polyvinyl alcohol–polyacrylamide semi-interpenetrating network were 0.07 ± 0.01 and 0.1 ± 0.003 against cobalt–chrome alloy, and 0.03 ± 0.001 and 0.02 ± 0.001 against cartilage, respectively. There was no significant or minimal difference in the coefficient of friction between samples from different regions of the knee, or animals, or when the cartilage samples were frozen for 1 day or 2 days before testing. However, changing lubricant from deionized water to ionic media, for example, saline or simulated body fluid, increased the coefficient of friction significantly.
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41
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Tohfafarosh M, Baykal D, Kiel JW, Mansmann K, Kurtz SM. Effects of gamma and e-beam sterilization on the chemical, mechanical and tribological properties of a novel hydrogel. J Mech Behav Biomed Mater 2015; 53:250-256. [PMID: 26344857 DOI: 10.1016/j.jmbbm.2015.08.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 08/12/2015] [Accepted: 08/15/2015] [Indexed: 10/23/2022]
Abstract
Hydrogels are known to possess cartilage-like mechanical and lubrication properties; however, hydrogel sterilization is challenging. Cyborgel(™), a proprietary hydrogel, is intended for use as a cartilage replacement implant. This study evaluated the effect of 30-35 kGy e-beam and gamma radiation on the polymer swell ratio, and the mechanical, chemical and tribological behavior of this hydrogel. Three different formulations were mechanically tested, and material parameters were identified using finite element analysis. FTIR spectroscopy was used to investigate chemical changes. Wear test was carried out for 2 million cycles in bovine serum, followed by 2 million cycles in distilled water. No significant difference was found in the swell ratio, mechanical and tribological properties of control hydrogel samples and those exposed to e-beam or gamma radiation; however, chemical spectra of e-beam sterilized samples revealed minor changes, which were absent in unsterilized and gamma sterilized samples.
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Affiliation(s)
- Mariya Tohfafarosh
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 3401 Market St, Suite 345, Philadelphia, PA, USA.
| | - Doruk Baykal
- Exponent, Inc., 3440 Market St, Philadelphia, PA, USA
| | | | | | - Steven M Kurtz
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 3401 Market St, Suite 345, Philadelphia, PA, USA; Exponent, Inc., 3440 Market St, Philadelphia, PA, USA
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42
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Vikingsson L, Claessens B, Gómez-Tejedor J, Gallego Ferrer G, Gómez Ribelles J. Relationship between micro-porosity, water permeability and mechanical behavior in scaffolds for cartilage engineering. J Mech Behav Biomed Mater 2015; 48:60-69. [DOI: 10.1016/j.jmbbm.2015.03.021] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 03/18/2015] [Accepted: 03/24/2015] [Indexed: 01/04/2023]
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Gannon AR, Nagel T, Bell AP, Avery NC, Kelly DJ. The changing role of the superficial region in determining the dynamic compressive properties of articular cartilage during postnatal development. Osteoarthritis Cartilage 2015; 23:975-84. [PMID: 25680651 DOI: 10.1016/j.joca.2015.02.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 01/28/2015] [Accepted: 02/02/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To explore how changes to the superficial region (SR) of articular cartilage during skeletal development impact its functional properties. It was hypothesised that a functional superficial region is not present in skeletally immature articular cartilage, and removal of this zone of the tissue would only negatively impact the dynamic modulus of the tissue with the attainment of skeletal maturity. METHODS Porcine osteochondral cores were mechanically tested statically and dynamically with and without their respective superficial regions in confined and unconfined compression at different stages of postnatal development and maturation. A novel combination of histological, biochemical and imaging techniques were utilised to accurately describe changes to the superficial region during postnatal development. RESULTS Articular cartilage was found to become stiffer and less permeable with age. The confined and unconfined dynamic modulus significantly decreased after removal of the superficial region in skeletally mature cartilage, whilst no significant change was observed in the 4 week old tissue. Biochemical analysis revealed a significant decrease in overall sGAG content with age (as % dry weight), whilst collagen content significantly increased with age, although the composition of the superficial region relative to the remainder of the tissue did not significantly change with age. Helium ion microscopy (HIM) revealed dramatic changes to the organization of the superficial region with age. CONCLUSIONS The findings demonstrate that the superficial region of articular cartilage undergoes dramatic structural adaptation with age, which in turn plays a key role in determining the dynamic compressive properties of the tissue.
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Affiliation(s)
- A R Gannon
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland; Department of Mechanical and Manufacturing Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland
| | - T Nagel
- Department of Environmental Informatics, Helmholtz Centre for Environmental Research GmbH - UFZ, Permoserstraße 15, 04318 Leipzig, Germany
| | - A P Bell
- CRANN Advanced Microscopy Laboratory, Trinity College Dublin, Ireland
| | - N C Avery
- Collagen Research Group, Division of Molecular and Cellular Biology, University of Bristol, Langford, Bristol, UK
| | - D J Kelly
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland; Department of Mechanical and Manufacturing Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland; Advanced Materials and Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland, Trinity College Dublin, Dublin, Ireland.
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Dabiri Y, Li L. Focal cartilage defect compromises fluid-pressure dependent load support in the knee joint. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2015; 31:e02713. [PMID: 25727068 DOI: 10.1002/cnm.2713] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 02/21/2015] [Accepted: 02/25/2015] [Indexed: 06/04/2023]
Abstract
A focal cartilage defect involves tissue loss or rupture. Altered mechanics in the affected joint may play an essential role in the onset and progression of osteoarthritis. The objective of the present study was to determine the compromised load support in the human knee joint during defect progression from the cartilage surface to the cartilage-bone interface. Ten normal and defect cases were simulated with a previously tested 3D finite element model of the knee. The focal defects were considered in both condyles within high load-bearing regions. Fluid pressurization, anisotropic fibril-reinforcement, and depth-dependent mechanical properties were considered for the articular cartilages and menisci. The results showed that a small cartilage defect could cause 25% reduction in the load support of the knee joint due to a reduced capacity of fluid pressurization in the defect cartilage. A partial-thickness defect could cause a fluid pressure decrease or increase in the remaining underlying cartilage depending on the defect depth. A cartilage defect also increased the shear strain at the cartilage-bone interface, which was more significant with a full-thickness defect. The effect of cartilage defect on the fluid pressurization also depended on the defect sites and contact conditions. In conclusion, a focal cartilage defect causes a fluid-pressure dependent load reallocation and a compromised load support in the joint, which depend on the defect depth, site, and contact condition.
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Affiliation(s)
- Yaghoub Dabiri
- Department of Mechanical and Manufacturing Engineering, University of Calgary, 2500 University Drive, N.W., Calgary, Alberta, T2N 1N4, Canada
| | - LePing Li
- Department of Mechanical and Manufacturing Engineering, University of Calgary, 2500 University Drive, N.W., Calgary, Alberta, T2N 1N4, Canada
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45
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Nguyen TD, Oloyede A, Singh S, Gu Y. Microscale consolidation analysis of relaxation behavior of single living chondrocytes subjected to varying strain-rates. J Mech Behav Biomed Mater 2015; 49:343-54. [PMID: 26093345 DOI: 10.1016/j.jmbbm.2015.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 05/01/2015] [Accepted: 05/06/2015] [Indexed: 11/19/2022]
Abstract
Besides the elastic stiffness, the relaxation behavior of single living cells is also of interest of various researchers when studying cell mechanics. It is hypothesized that the relaxation response of the cells is governed by both intrinsic viscoelasticity of the solid phase and fluid-solid interactions mechanisms. There are a number of mechanical models have been developed to investigate the relaxation behavior of single cells. However, there is lack of model enable to accurately capture both of the mechanisms. Therefore, in this study, the porohyperelastic (PHE) model, which is an extension of the consolidation theory, combined with inverse Finite Element Analysis (FEA) technique was used at the first time to investigate the relaxation response of living chondrocytes. This model was also utilized to study the dependence of relaxation behavior of the cells on strain-rates. The stress-relaxation experiments under the various strain-rates were conducted with the Atomic Force Microscopy (AFM). The results have demonstrated that the PHE model could effectively capture the stress-relaxation behavior of the living chondrocytes, especially at intermediate to high strain-rates. Although this model gave some errors at lower strain-rates, its performance was acceptable. Therefore, the PHE model is properly a promising model for single cell mechanics studies. Moreover, it has been found that the hydraulic permeability of living chondrocytes reduced with decreasing of strain-rates. It might be due to the intracellular fluid volume fraction and the fluid pore pressure gradients of chondrocytes were higher when higher strain-rates applied.
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Affiliation(s)
- Trung Dung Nguyen
- School of Chemistry, Physics and Mechanical Engineering, Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Adekunle Oloyede
- School of Chemistry, Physics and Mechanical Engineering, Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Sanjleena Singh
- School of Chemistry, Physics and Mechanical Engineering, Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia
| | - YuanTong Gu
- School of Chemistry, Physics and Mechanical Engineering, Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia.
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Sandino C, McErlain DD, Schipilow J, Boyd SK. The poro-viscoelastic properties of trabecular bone: a micro computed tomography-based finite element study. J Mech Behav Biomed Mater 2015; 44:1-9. [DOI: 10.1016/j.jmbbm.2014.12.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 12/15/2014] [Accepted: 12/18/2014] [Indexed: 11/29/2022]
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Determining equilibrium osmolarity in poly(ethylene glycol)/chondrotin sulfate gels mimicking articular cartilage. J Theor Biol 2015; 364:397-406. [PMID: 25300942 DOI: 10.1016/j.jtbi.2014.09.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 09/15/2014] [Accepted: 09/27/2014] [Indexed: 11/18/2022]
Abstract
We present an experimentally guided, multi-phase, multi-species polyelectrolyte gel model to make qualitative predictions on the equilibrium electro-chemical properties of articular cartilage. The mixture theory consists of two different types of polymers: poly(ethylene gylcol) (PEG), chondrotin sulfate (ChS), water (acting as solvent) and several different ions: H(+), Na(+), Cl(-). The polymer chains have covalent cross-links whose effect on the swelling kinetics is modeled via Doi rubber elasticity theory. Numerical studies on equilibrium polymer volume fraction and net osmolarity (difference in the solute concentration across the gel) show a complex interplay between ionic bath concentrations, pH, cross-link fraction and the average charge per monomer. Generally speaking, swelling is aided due to a higher average charge per monomer (or a higher particle fraction of ChS, the charged component of the polymer), low solute concentration in the bath, a high pH or a low cross-link fraction. A peculiar case arises at higher values of cross-link fraction, where it is observed that increasing the average charge per monomer leads to gel deswelling.
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Grenier S, Donnelly PE, Gittens J, Torzilli PA. Resurfacing damaged articular cartilage to restore compressive properties. J Biomech 2015; 48:122-9. [PMID: 25468298 PMCID: PMC4420241 DOI: 10.1016/j.jbiomech.2014.10.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 08/28/2014] [Accepted: 10/19/2014] [Indexed: 01/02/2023]
Abstract
Surface damage to articular cartilage is recognized as the initial underlying process causing the loss of mechanical function in early-stage osteoarthritis. In this study, we developed structure-modifying treatments to potentially prevent, stabilize or reverse the loss in mechanical function. Various polymers (chondroitin sulfate, carboxymethylcellulose, sodium hyaluronate) and photoinitiators (riboflavin, irgacure 2959) were applied to the surface of collagenase-degraded cartilage and crosslinked in situ using UV light irradiation. While matrix permeability and deformation significantly increased following collagenase-induced degradation of the superficial zone, resurfacing using tyramine-substituted sodium hyaluronate and riboflavin decreased both values to a level comparable to that of intact cartilage. Repetitive loading of resurfaced cartilage showed minimal variation in the mechanical response over a 7 day period. Cartilage resurfaced using a low concentration of riboflavin had viable cells in all zones while a higher concentration resulted in a thin layer of cell death in the uppermost superficial zone. Our approach to repair surface damage initiates a new therapeutic advance in the treatment of injured articular cartilage with potential benefits that include enhanced mechanical properties, reduced susceptibility to enzymatic degradation and reduced adhesion of macrophages.
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Affiliation(s)
- Stephanie Grenier
- Laboratory for Soft Tissue Research, Tissue Engineering, Regeneration and Repair Program, The Hospital for Special Surgery, New York, NY 10021, USA.
| | - Patrick E Donnelly
- Laboratory for Soft Tissue Research, Tissue Engineering, Regeneration and Repair Program, The Hospital for Special Surgery, New York, NY 10021, USA
| | - Jamila Gittens
- Laboratory for Soft Tissue Research, Tissue Engineering, Regeneration and Repair Program, The Hospital for Special Surgery, New York, NY 10021, USA
| | - Peter A Torzilli
- Laboratory for Soft Tissue Research, Tissue Engineering, Regeneration and Repair Program, The Hospital for Special Surgery, New York, NY 10021, USA
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Fischenich KM, Button KD, Coatney GA, Fajardo RS, Leikert KM, Haut RC, Haut Donahue TL. Chronic changes in the articular cartilage and meniscus following traumatic impact to the lapine knee. J Biomech 2014; 48:246-53. [PMID: 25523754 DOI: 10.1016/j.jbiomech.2014.11.038] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 11/23/2014] [Accepted: 11/24/2014] [Indexed: 01/13/2023]
Abstract
The objective of this study was to induce anterior cruciate ligament (ACL) and meniscal damage, via a single tibiofemoral compressive impact, in order to document articular cartilage and meniscal changes post-impact. Tibiofemoral joints of Flemish Giant rabbits were subjected to a single blunt impact that ruptured the ACL and produced acute meniscal damage. Animals were allowed unrestricted cage activity for 12 weeks before euthanasia. India ink analysis of the articular cartilage revealed higher degrees of surface damage on the impacted tibias (p=0.018) and femurs (p<0.0001) compared to controls. Chronic meniscal damage was most prevalent in the medial central and medial posterior regions. Mechanical tests revealed an overall 19.4% increase in tibial plateau cartilage thickness (p=0.026), 34.8% increase in tibial plateau permeability (p=0.054), 40.8% increase in femoral condyle permeability (p=0.029), and 20.1% decrease in femoral condyle matrix modulus (p=0.012) in impacted joints compared to controls. Both instantaneous and equilibrium moduli of the lateral and medial menisci were decreased compared to control (p<0.02). Histological analyses revealed significantly increased presence of fissures in the medial femur (p=0.036). In both meniscus and cartilage there was a significant decrease in GAG coverage for the impacted limbs. Based on these results it is clear that an unattended combined meniscal and ACL injury results in significant changes to the soft tissues in this experimental joint 12 weeks post-injury. Such changes are consistent with a clinical description of mid to late stage PTOA of the knee.
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Affiliation(s)
- Kristine M Fischenich
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Keith D Button
- Orthopaedic Biomechanics Laboratories, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Garrett A Coatney
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA; School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Ryan S Fajardo
- Department of Radiology, Michigan State University, East Lansing, MI, USA
| | - Kevin M Leikert
- Orthopaedic Biomechanics Laboratories, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Roger C Haut
- Department of Radiology, Michigan State University, East Lansing, MI, USA; Orthopaedic Biomechanics Laboratories, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Tammy L Haut Donahue
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA; School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA.
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50
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Guo H, Maher SA, Torzilli PA. A biphasic finite element study on the role of the articular cartilage superficial zone in confined compression. J Biomech 2014; 48:166-70. [PMID: 25465194 DOI: 10.1016/j.jbiomech.2014.11.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 11/02/2014] [Accepted: 11/06/2014] [Indexed: 11/26/2022]
Abstract
The aim of this study was to investigate the role of the superficial zone on the mechanical behavior of articular cartilage. Confined compression of articular cartilage was modeled using a biphasic finite element analysis to calculate the one-dimensional deformation of the extracellular matrix (ECM) and movement of the interstitial fluid through the ECM and articular surface. The articular cartilage was modeled as an inhomogeneous, nonlinear hyperelastic biphasic material with depth and strain-dependent material properties. Two loading conditions were simulated, one where the superficial zone was loaded with a porous platen (normal test) and the other where the deep zone was loaded with the porous platen (upside down test). Compressing the intact articular cartilage with 0.2 MPa stress reduced the surface permeability by 88%. Removing the superficial zone increased the rate of change for all mechanical parameters and decreased the fluid support ratio of the tissue, resulting in increased tissue deformation. Apparent permeability linearly increased after superficial removal in the normal test, yet it did not change in the upside down test. Orientation of the specimen affected the time-dependent biomechanical behavior of the articular cartilage, but not equilibrium behavior. The two tests with different specimen orientations resulted in very different apparent permeabilities, suggesting that in an experimental study which quantifies material properties of an inhomogeneous material, the specimen orientation should be stated along with the permeability result. The current study provides new insights into the role of the superficial zone on mechanical behavior of the articular cartilage.
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Affiliation(s)
- Hongqiang Guo
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
| | - Suzanne A Maher
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Peter A Torzilli
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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