1
|
Zeitlin J, Fontana MA, Parides MK, Nawabi DH, Wickiewicz TL, Pearle AD, Beynnon BD, Imhauser CW. Key Thresholds and Relative Contributions of Knee Geometry, Anteroposterior Laxity, and Body Weight as Risk Factors for Noncontact ACL Injury. Orthop J Sports Med 2023; 11:23259671231163627. [PMID: 37197036 PMCID: PMC10184233 DOI: 10.1177/23259671231163627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/27/2023] [Indexed: 05/19/2023] Open
Abstract
Background Limited data exist regarding the association of tibiofemoral bony and soft tissue geometry and knee laxity with risk of first-time noncontact anterior cruciate ligament (ACL) rupture. Purpose To determine associations of tibiofemoral geometry and anteroposterior (AP) knee laxity with risk of first-time noncontact ACL injury in high school and collegiate athletes. Study Design Cohort study; Level of evidence, 2. Methods Over a 4-year period, noncontact ACL injury events were identified as they occurred in 86 high school and collegiate athletes (59 female, 27 male). Sex- and age-matched control participants were selected from the same team. AP laxity of the uninjured knee was measured using a KT-2000 arthrometer. Magnetic resonance imaging was taken on ipsilateral and contralateral knees, and articular geometries were measured. Sex-specific general additive models were implemented to investigate associations between injury risk and 6 features: ACL volume, meniscus-bone wedge angle in the lateral compartment of the tibia, articular cartilage slope at the middle region of the lateral compartment of the tibia, femoral notch width at the anterior outlet, body weight, and AP displacement of the tibia relative to the femur. Importance scores (in percentages) were calculated to rank the relative contribution of each variable. Results In the female cohort, the 2 features with the highest importance scores were tibial cartilage slope (8.6%) and notch width (8.1%). In the male cohort, the 2 top-ranked features were AP laxity (5.6%) and tibial cartilage slope (4.8%). In female patients, injury risk increased by 25.5% with lateral middle cartilage slope becoming more posteroinferior from -6.2° to -2.0° and by 17.5% with lateral meniscus-bone wedge angle increasing from 27.3° to 28.2°. In males, an increase in AP displacement from 12.5 to 14.4 mm in response to a 133-N anterior-directed load was associated with a 16.7% increase in risk. Conclusion Of the 6 variables studied, there was no single dominant geometric or laxity risk factor for ACL injury in either the female or male cohort. In males, AP laxity >13 to 14 mm was associated with sharply increased risk of noncontact ACL injury. In females, lateral meniscus-bone wedge angle >28° was associated with a sharply decreased risk of noncontact ACL injury.
Collapse
Affiliation(s)
- Jacob Zeitlin
- Weill Cornell Medical College, New York, New York, USA
- Department of Biomechanics Research, Hospital for Special Surgery, New York, New York, USA
- Jacob Zeitlin, BA, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA ()
| | - Mark A. Fontana
- Weill Cornell Medical College, New York, New York, USA
- Center for Analytics, Modeling, and Performance, Hospital for Special Surgery, New York, New York, USA
| | - Michael K. Parides
- Biostatistics and Bioinformatics Program, Hospital for Special Surgery, New York, New York, USA
| | - Danyal H. Nawabi
- Department of Biomechanics Research, Hospital for Special Surgery, New York, New York, USA
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Thomas L. Wickiewicz
- Department of Biomechanics Research, Hospital for Special Surgery, New York, New York, USA
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Andrew D. Pearle
- Department of Biomechanics Research, Hospital for Special Surgery, New York, New York, USA
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Bruce D. Beynnon
- Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Carl W. Imhauser
- Department of Biomechanics Research, Hospital for Special Surgery, New York, New York, USA
| |
Collapse
|
2
|
Gong H, Wang H, Zhang X, Fu L, Chen L. Diagnostic value of the lateral femoral notch sign and kissing contusion in patients with anterior cruciate ligament injuries: a case-control study. Arch Orthop Trauma Surg 2023; 143:927-934. [PMID: 35230503 DOI: 10.1007/s00402-022-04366-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 01/19/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION The lateral femoral notch sign (LFNS) and the kissing contusion (KC) are two indirect signs of anterior cruciate ligament (ACL) injuries. They can be used to diagnose ACL injuries. MATERIALS AND METHODS A total of 1000 patients were enrolled in this study, including 500 patients with ACL injuries who assigned to experimental group and 500 patients with meniscal tear (MT) who allocated to control group. All the patients underwent magnetic resonance imaging (MRI) preoperatively, and the diagnosis was confirmed with the aid of arthroscopy. The depth of LFNS and the presence of KC were determined on MRI findings. The relationship and characteristics between these two indicators was explored. RESULTS The notch depth of lateral femoral condyle in the experimental group (0.99 ± 0.56 mm) was significantly greater than that in the control group (0.49 ± 0.28 mm) (P < 0.05). The positive rate of KC in the experimental group (183/500) was markedly higher than that in the control group (3/500) (P < 0.05). The values of notch depth in patients who had ACL rupture concomitant lateral MT injuries and medial collateral ligament (MCL) injuries were 1.12 ± 0.64 and 1.23 ± 0.74 mm, respectively, which were significantly higher than those in patients with only ACL injury (0.89 ± 0.49 mm) (P < 0.05). It also was revealed that when the optimal cut-off point of LFNS was 0.72 mm (area under the curve (AUC) = 81%), the values of specificity and sensitivity were 67% and 84%, respectively. For KC, the corresponding values were 36.6% and 99.4%, respectively. The diagnostic outcome of LFNS was not in agreement with that of KC, as there was a poor coincidence according to the Kappa coefficient (Kappa = 0.155 < 0.4, P = 0.035). CONCLUSION The LFNS and KC have strong clinical significance in the diagnosis of ACL injuries. A deeper notch often indicates a more complex knee injury. Notch depth equal to 0.72 mm can be basically considered as the optimal cut-off point for LFNS in statistics.
Collapse
Affiliation(s)
- Heng Gong
- School of Clinical Medicine, Tsinghua University, Beijing, China.,Beijing Tsinghua Changgung Hospital Affiliated To Tsinghua University, Beijing, China
| | - Haijun Wang
- Peking University Third Hospital, Beijing, China
| | - Xiaofei Zhang
- Beijing Tsinghua Changgung Hospital Affiliated To Tsinghua University, Beijing, China
| | - Ligong Fu
- Beijing Tsinghua Changgung Hospital Affiliated To Tsinghua University, Beijing, China
| | - Lianxu Chen
- School of Clinical Medicine, Tsinghua University, Beijing, China. .,Beijing Tsinghua Changgung Hospital Affiliated To Tsinghua University, Beijing, China.
| |
Collapse
|
3
|
Yick HTV, Chan PK, Wen C, Fung WC, Yan CH, Chiu KY. Artificial intelligence reshapes current understanding and management of osteoarthritis: A narrative review. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2022. [DOI: 10.1177/22104917221082315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Current practice of osteoarthritis has its insufficiencies which researchers are tackling with artificial intelligence (AI). This article discusses three kinds of AI models, namely diagnostic models, prediction models and morphological models. Diagnostic models enhance efficiency in diagnosis by providing an automated algorithm in knee images processing. Prediction models utilize behavioral and radiological data to assess the risk of osteoarthritis before symptom onset and needs to perform surgery. Morphological models detect biomechanical changes to facilitate understanding of pathophysiology and provide personalized intervention. Through reviewing present evidence, we demonstrate that AI could assist doctors in diagnosis, predict osteoarthritis and guide future research.
Collapse
Affiliation(s)
- Hin Ting Victor Yick
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Ping Keung Chan
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Chunyi Wen
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR
| | - Wing Chiu Fung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Chun Hoi Yan
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Kwong Yuen Chiu
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, University of Hong Kong, Hong Kong, Hong Kong SAR
| |
Collapse
|
4
|
Flowers DW, Brewer W, Mitchell K, Ellison J. Why are we neglecting the core muscles in patients with knee osteoarthritis? A narrative review of the literature. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.1907947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Daniel W. Flowers
- Program in Physical Therapy, LSU Health-Shreveport, Shreveport, Louisiana, USA
| | - Wayne Brewer
- School of Physical Therapy, Texas Woman’s University, Houston, Texas, USA
| | - Katy Mitchell
- School of Physical Therapy, Texas Woman’s University, Houston, Texas, USA
| | - Jennifer Ellison
- School of Physical Therapy, Texas Woman’s University, Houston, Texas, USA
| |
Collapse
|
5
|
Burge AJ, Jawetz ST. Advanced Magnetic Resonance Imaging in Osteoarthritis. Semin Musculoskelet Radiol 2020; 24:355-366. [PMID: 32992364 DOI: 10.1055/s-0040-1708822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Osteoarthritis (OA) is one of the most common causes of disability throughout the world. Current therapeutic strategies are aimed at preventing the development and delaying the progression of OA, as well as repairing or replacing worn articular surfaces, because the regeneration of lost hyaline articular cartilage is not currently a clinically feasible option. Imaging is useful in formulating treatment strategies in patients at risk for OA, allowing assessment of risk factors, the degree of preexisting tissue damage, and posttreatment monitoring. Magnetic resonance imaging (MRI), in particular, provides in-depth evaluation of these patients, with optimal clinical sequencing allowing sensitive assessment of chondral signal and morphology, and the addition of advanced MRI techniques facilitating comprehensive evaluation of joint health, with increased sensitivity for changes in articular cartilage and surrounding joint tissues.
Collapse
Affiliation(s)
- Alissa J Burge
- Department of Radiology and Imaging (MRI), MRI Laboratory, Hospital for Special Surgery, New York
| | - Shari T Jawetz
- Department of Radiology and Imaging, Hospital for Special Surgery, New York
| |
Collapse
|
6
|
Wang LJ, Zeng N, Yan ZP, Li JT, Ni GX. Post-traumatic osteoarthritis following ACL injury. Arthritis Res Ther 2020; 22:57. [PMID: 32209130 PMCID: PMC7092615 DOI: 10.1186/s13075-020-02156-5] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/16/2020] [Indexed: 02/08/2023] Open
Abstract
Post-traumatic osteoarthritis (PTOA) develops after joint injury. Specifically, patients with anterior cruciate ligament (ACL) injury have a high risk of developing PTOA. In this review, we outline the incidence of ACL injury that progresses to PTOA, analyze the role of ACL reconstruction in preventing PTOA, suggest possible mechanisms thought to be responsible for PTOA, evaluate current diagnostic methods for detecting early OA, and discuss potential interventions to combat PTOA. We also identify important directions for future research. Although much work has been done, the incidence of PTOA among patients with a history of ACL injury remains high due to the complexity of ACL injury progression to PTOA, the lack of sensitive and easily accessible diagnostic methods to detect OA development, and the limitations of current treatments. A number of factors are thought to be involved in the underlying mechanism, including structural factors, biological factors, mechanical factors, and neuromuscular factor. Since there is a clear "start point" for PTOA, early detection and intervention is of great importance. Currently, imaging modalities and specific biomarkers allow early detection of PTOA. However, none of them is both sensitive and easily accessible. After ACL injury, many patients undergo surgical reconstruction of ACL to restore joint stability and prevent excessive loading. However, convincing evidence is still lacking for the superiority of ACL-R to conservative management in term of the incidence of PTOA. As for non-surgical treatment such as anti-cytokine and chemokine interventions, most of them are investigated in animal studies and have not been applied to humans. A complete understanding of mechanisms to stratify the patients into different subgroups on the basis of risk factors is critical. And the improvement of standardized and quantitative assessment techniques is necessary to guide intervention. Moreover, treatments targeted toward different pathogenic pathways may be crucial to the management of PTOA in the future.
Collapse
Affiliation(s)
- Li-Juan Wang
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Ni Zeng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhi-Peng Yan
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jie-Ting Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Guo-Xin Ni
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China.
| |
Collapse
|
7
|
Dexamethasone causes calcium deposition and degeneration in human anterior cruciate ligament cells through endoplasmic reticulum stress. Biochem Pharmacol 2020; 175:113918. [PMID: 32194056 DOI: 10.1016/j.bcp.2020.113918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 03/13/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Dexamethasone is widely used in the treatment of joint diseases due to its anti-inflammatory properties. However, it can cause serious adverse effects. The anterior cruciate ligament (ACL) is an important stabilizer of the knee joint. However, the effect of dexamethasone treatment on the ACL is unclear. OBJECTIVE This study aims to explore the effects of dexamethasone on ACL tissues and cells through in vitro and in vivo experiments. RESULTS In vitro, we found that after treatment with dexamethasone, human ACL cell apoptosis was increased, type I collagen (COL1A1) content was decreased, mineralization related genes (ENPP1 and ANKH) and calcified nodules were increased, and endoplasmic reticulum stress (ERS) was enhanced. However, ERS inhibitors could significantly inhibit the increase in calcification and the decrease in COL1A1 induced by dexamethasone. In vivo, Wistar rats received the infra-articular injection with dexamethasone (0.5 mg/kg) for 8 weeks. We found that dexamethasone treatment decreased the COL1A1 content and increased the COL2A1 content in the ACL tissues of rats and that chondroid differentiation and mineralization occurred. Meanwhile, the expression of ERS-related proteins was increased. CONCLUSION Dexamethasone increased the calcification of ACL cells and caused ACL degeneration through ERS, suggesting that long-term treatment with dexamethasone may cause adverse effects on ACL tissue and increase the risk of long-term rupture.
Collapse
|
8
|
Chahla J, Nelson T, Dallo I, Yalamanchili D, Eberlein S, Limpisvasti O, Mandelbaum B, Metzger MF. Anterior cruciate ligament repair versus reconstruction: A kinematic analysis. Knee 2020; 27:334-340. [PMID: 31813701 DOI: 10.1016/j.knee.2019.10.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/10/2019] [Accepted: 10/24/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to compare the biomechanical properties of an anterior cruciate ligament (ACL) anatomic repair of a true femoral avulsion to an anatomic ACL reconstruction. It was hypothesized that the ACL repair and ACL reconstruction would have comparable biomechanical behavior when compared to the native knee. METHODS Ten paired fresh-frozen cadaveric knees (n = 20) were used to investigate knee kinematics when an anterior drawer force, varus, valgus, internal, and external rotational moment were applied at 0, 15, 30, 45, 60, and 90 degrees of flexion. Displacement and rotation were recorded in the following conditions: ACL-intact, ACL-deficient, and ACL-repaired vs reconstructed. RESULTS Sectioning of the ACL significantly increased anterior tibial translation (0°, 15°, 30° and 45°) compared to the intact state. The mean anterior displacement difference from intact was lower in the ACL-repaired knees compared to reconstructed knees at 30° and 90°. There were no significant differences between conditions in varus, valgus, internal, or external rotations. CONCLUSION ACL repair and ACL reconstruction procedures restored knee anterior tibial translation in matched paired specimens. There were no differences in valgus, varus, internal, or external rotation. Although, ACL-repaired knees (avulsion model) demonstrated less anterior tibial translation when compared to ACL-reconstructed knees, this difference was less than one millimeter. Based on the findings of this study, repair and reconstruction procedures both restored anterior tibial translation in matched-pair specimens. This suggests that the initial functionality of both techniques is similar and that further clinical studies are needed to compare the long-term stability.
Collapse
Affiliation(s)
- Jorge Chahla
- Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, CA, United States of America
| | - Trevor Nelson
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Ignacio Dallo
- Unit of Regenerative Therapy and Arthroscopy Surgery, Sanatorio Garay, Santa Fe, Argentina
| | - Dheeraj Yalamanchili
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America.
| | - Sam Eberlein
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Orr Limpisvasti
- Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, CA, United States of America
| | - Bert Mandelbaum
- Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, CA, United States of America
| | - Melodie F Metzger
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| |
Collapse
|
9
|
Comparison of Diagnostic Accuracy of Physical Examination and MRI in the Most Common Knee Injuries. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9194102] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: This study evaluated the diagnostic accuracy of physical examination and magnetic resonance imaging (MRI) in knee injuries. Methods: Ninety-six patients at a regional hospital were included in the study. Each participant underwent a physical examination in which menisci and ACL were evaluated. Knee joint MRI was collected from each patient. Physical examination and MRI scans were then compared with knee arthroscopy findings as a golden standard for meniscal and ligamentous lesions. The data were analyzed and specificity and sensitivity were calculated and correlated on receiver operating characteristics (ROC) curves. Results: Knee arthroscopy diagnosed 32 total ACL ruptures, 45 medial meniscus and 17 lateral meniscus lesions. Three patients were diagnosed with bilateral meniscal lesions. The highest sensitivities were the McMurray test (87.5%) for medial meniscus (MM) and the Thessaly test (70%) for lateral meniscus (LM). The most sensitive ACL test was Lachman (84.5%), whereas, the pivot shift and Lelli tests were the most specific (98.5%). MRI was highly sensitive for MM (96%) with specificity of 52%. MRI showed lower sensitivity (70%) and higher specificity (85.5%) for LM. The specificity of MRI for ACL rupture was 92%, with sensitivity only 75%. Conclusion: McMurray and Apley tests for meniscal lesions seem the most appropriate in daily practice. A combination of lever signs, pivot shifts (PSs) and Lachman tests showed the best sensitivity and specificity in detecting ACL deficiency, and was superior to MRI.
Collapse
|
10
|
Wang Y, Yu C, Zhang H. Lipopolysaccharides-mediated injury to chondrogenic ATDC5 cells can be relieved by Sinomenine via downregulating microRNA-192. Phytother Res 2019; 33:1827-1836. [PMID: 31094031 DOI: 10.1002/ptr.6372] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 03/05/2019] [Accepted: 03/30/2019] [Indexed: 12/15/2022]
Abstract
Sinomenine (SIN) is an isoquinoline derived from Caulis Sinomenii that has been used to treat rheumatoid arthritis and osteoarthritis for several decades in China. This study aims to reveal the effects of SIN on mouse chondrogenic ATDC5 cells growth and inflammation. SIN was used to treat ATDC5 cells injured by lipopolysaccharides (LPS). The following parameters were determined for evaluating the treatment effects of SIN: cell viability, apoptosis, reactive oxygen species generation, and pro-inflammatory cytokines release. Besides, the expression of LPS-sensitive miRNA (miR-192) and the activation of NF-κB and MAPK signaling were studied to explain SIN's function. SIN with concentration of 30 μM significantly attenuated LPS-induced cell damage via increasing cell viability, inhibiting apoptosis and reactive oxygen species generation, and declining IL-6 and TNF-α release. miR-192 was downregulated by SIN treatment. Restoration of miR-192 expression by miRNA transfection could significantly impede SIN's protective action. Besides, the inhibitory effects of SIN on the activation of NF-κB and MAPK signaling were attenuated by miR-192 overexpression. Furthermore, GDF11 was found to be a target gene of miR-192. LPS-mediated injury to chondrogenic ATDC5 cells can be relieved by SIN via downregulating miR-192 and subsequently repressing the activation of NF-κB and MAPK signaling.
Collapse
Affiliation(s)
- Yang Wang
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Chuandong Yu
- Department of Orthopaedics, Heze Municipal Hospital, Heze, China
| | - Hanyang Zhang
- Department of Orthopaedics, The Second Hospital of Jilin University, Changchun, China
| |
Collapse
|
11
|
Cinque ME, Dornan GJ, Chahla J, Moatshe G, LaPrade RF. High Rates of Osteoarthritis Develop After Anterior Cruciate Ligament Surgery: An Analysis of 4108 Patients. Am J Sports Med 2018; 46:2011-2019. [PMID: 28982255 DOI: 10.1177/0363546517730072] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Posttraumatic osteoarthritis (PTOA) after anterior cruciate ligament (ACL) reconstruction ultimately translates into a large economic effect on the health care system owing to the young ages of this population. Purpose/Hypothesis: The purposes were to perform a meta-analysis to determine the prevalence of osteoarthritis after an ACL reconstruction, examining the effects of length of time after surgery, preoperative time interval from injury to surgery, and patient age at the time of surgery. It was hypothesized that the prevalence of PTOA increased with time from surgery and that increased time from injury to surgery and age were also risk factors for the development of PTOA. STUDY DESIGN Meta-analysis. METHODS A meta-analysis of the prevalence of radiographic PTOA after ACL reconstruction was performed of studies with a minimum of 5 years' follow-up, with a level of evidence of 1, 2, or 3. The presence of osteoarthritis was defined according to knee radiographs evaluated with classification based on Kellgren and Lawrence, Ahlbäck, International Knee Documentation Committee, or the Osteoarthritis Research Society International. Metaregression models quantified the relationship between radiographic PTOA prevalence and the mean time from injury to surgery, mean patient age at time of surgery, and mean postoperative follow-up time. RESULTS Thirty-eight studies (4108 patients) were included. Longer postsurgical follow-up time was significantly positively associated with a higher proportion of PTOA development. The model-estimated proportion of PTOA (95% CI) at 5, 10, and 20 years after surgery was 11.3% (6.4%-19.1%), 20.6% (14.9%-27.7%), and 51.6% (29.1%-73.5%), respectively. Increased chronicity of the ACL tear before surgery and increased patient age were also associated with a higher likelihood of PTOA development. CONCLUSION The prevalence of osteoarthritis after an ACL reconstruction significantly increased with time. Longer chronicity of ACL tear and older age at the time of surgery were significantly positively correlated with the development of osteoarthritis. A timely referral and treatment of symptomatic patients are vital to diminish the occurrence of PTOA.
Collapse
Affiliation(s)
- Mark E Cinque
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Grant J Dornan
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Jorge Chahla
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Gilbert Moatshe
- Steadman Philippon Research Institute, Vail, Colorado, USA.,Oslo University Hospital, Oslo, Norway
| | - Robert F LaPrade
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| |
Collapse
|
12
|
Maerz T, Sherman E, Newton M, Yilmaz A, Kumar P, Graham SF, Baker KC. Metabolomic serum profiling after ACL injury in rats: A pilot study implicating inflammation and immune dysregulation in post-traumatic osteoarthritis. J Orthop Res 2018; 36:1969-1979. [PMID: 29315787 DOI: 10.1002/jor.23854] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 12/24/2017] [Indexed: 02/04/2023]
Abstract
ACL rupture is a major risk factor for post-traumatic osteoarthritis (PTOA) development. Little information exists on acute systemic metabolic indicators of disease development. Thirty-six female Lewis rats were randomized to Control or noninvasive anterior cruciate ligament rupture (ACLR) and to three post-injury time points: 72 h, 4 weeks, 10 weeks (n = 6). Serum was collected and analyzed by 1 H nuclear magnetic resonance (NMR) spectroscopy and combined direct injection and liquid chromatography (LC)-mass spectrometry (MS)/MS (DI-MS). Univariate and multivariate statistics were used to analyze metabolomic data, and predictive biomarker models were analyzed by receiver operating characteristic (ROC) analysis. Topological pathway analysis was used to identify perturbed pathways. Two hundred twenty-two metabolites were identified by 1 H NMR and DI-MS. Differences in the serum metabolome between ACLR and Control were dominated by medium- and long-chain acylcarnitine species. Further, decreases in several tryptophan metabolites were either found to be significantly different in univariate analysis or to play important contributory roles to multivariate model separation. In addition to acylcarnitines and tryptophan metabolites, glycine, carnosine, and D-mannose were found to differentiate ACLR from Control. Glycine, 9-hexadecenoylcarnitine, trans-2-Dodecenoylcarnitine, linoelaidyl carnitine, hydroxypropionylcarnitine, and D-Mannose were identified as biomarkers with high area under ROC curve values and high predictive accuracies. Our analysis provides new information regarding the potential contribution of inflammatory processes and immune dysregulation to the onset and progression of PTOA following ACL injury. As these processes have most commonly been associated with inflammatory arthropathies, larger-scale studies elucidating their involvement in PTOA development and progression are necessary. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1969-1979, 2018.
Collapse
Affiliation(s)
- Tristan Maerz
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan.,Beaumont Research Institute, Orthopaedic Research Laboratories, Royal Oak, Michigan
| | - Eric Sherman
- Beaumont Research Institute, Metabolomics Division, OB/GYN, Royal Oak, Michigan
| | - Michael Newton
- Beaumont Research Institute, Orthopaedic Research Laboratories, Royal Oak, Michigan
| | - Ali Yilmaz
- Beaumont Research Institute, Metabolomics Division, OB/GYN, Royal Oak, Michigan
| | - Praveen Kumar
- Beaumont Research Institute, Metabolomics Division, OB/GYN, Royal Oak, Michigan
| | - Stewart F Graham
- Beaumont Research Institute, Metabolomics Division, OB/GYN, Royal Oak, Michigan
| | - Kevin C Baker
- Beaumont Research Institute, Orthopaedic Research Laboratories, Royal Oak, Michigan
| |
Collapse
|
13
|
Maerz T, Fleischer M, Newton MD, Davidson A, Salisbury M, Altman P, Kurdziel MD, Anderson K, Bedi A, Baker KC. Acute mobilization and migration of bone marrow-derived stem cells following anterior cruciate ligament rupture. Osteoarthritis Cartilage 2017; 25:1335-1344. [PMID: 28284998 DOI: 10.1016/j.joca.2017.03.004] [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: 10/24/2016] [Revised: 02/21/2017] [Accepted: 03/01/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Little is known regarding acute local and systemic processes following anterior cruciate ligament (ACL) rupture. No study has elucidated whether bone marrow-derived mesenchymal stem cells (MSCs) are mobilized into circulation and recruited to the injured joint. METHODS In Part 1, Lewis rats were randomized to noninvasive ACL rupture (Rupture) or non-injured (Control) (n = 6/group). After 72 h, whole blood MSC concentration was assessed using flow cytometry. Synovial fluid and serum were assayed for stromal cell-derived factor (SDF)-1α and cartilage degeneration biomarkers, respectively. In Part 2, 12 additional rats were randomized and intravenously-injected with fluorescently-labeled allogenic MSCs. Cell tracking was performed using longitudinal, in vivo and ex vivo near-infrared (NIR) imaging and histology. Synovium SDF-1α and interleukin (IL)-17A immunostaining was performed. Serum was assayed for SDF-1α and 29 other cytokines. RESULTS In Part 1, there was a significant increase in MSC concentration and synovial fluid SDF-1α in Rupture. No differences in cartilage biomarkers were observed. In Part 2, Rupture had significantly higher NIR signal at 24, 48, and 72 h, indicating active recruitment of MSCs to the injured joint. Ex vivo cell tracking demonstrated MSC localization in the synovium and myotendinous junction (MTJ) of the quadriceps. Injured synovia exhibited increased synovitis grade and higher degree of IL-17A and SDF-1α immunostaining. CONCLUSION ACL rupture induced peripheral blood mobilization of MSCs and migration of intravenously-injected allogenic MSCs to the injured joint, where they localized in the synovium and quadriceps MTJ.
Collapse
Affiliation(s)
- T Maerz
- Orthopaedic Research Laboratory, Beaumont Health, Royal Oak, MI, USA; Department of Orthopaedic Surgery, Oakland University - William Beaumont School of Medicine, Rochester, MI, USA
| | - M Fleischer
- Orthopaedic Research Laboratory, Beaumont Health, Royal Oak, MI, USA
| | - M D Newton
- Orthopaedic Research Laboratory, Beaumont Health, Royal Oak, MI, USA
| | - A Davidson
- Orthopaedic Research Laboratory, Beaumont Health, Royal Oak, MI, USA
| | - M Salisbury
- Orthopaedic Research Laboratory, Beaumont Health, Royal Oak, MI, USA
| | - P Altman
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI, USA
| | - M D Kurdziel
- Orthopaedic Research Laboratory, Beaumont Health, Royal Oak, MI, USA; Department of Orthopaedic Surgery, Oakland University - William Beaumont School of Medicine, Rochester, MI, USA
| | - K Anderson
- Department of Orthopaedic Surgery, Oakland University - William Beaumont School of Medicine, Rochester, MI, USA; Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI, USA
| | - A Bedi
- MedSport and Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - K C Baker
- Orthopaedic Research Laboratory, Beaumont Health, Royal Oak, MI, USA; Department of Orthopaedic Surgery, Oakland University - William Beaumont School of Medicine, Rochester, MI, USA.
| |
Collapse
|
14
|
Li B, Bai L, Shen P, Sun Y, Chen Z, Wen Y. Identification of differentially expressed microRNAs in knee anterior cruciate ligament tissues surgically removed from patients with osteoarthritis. Int J Mol Med 2017; 40:1105-1113. [PMID: 28765881 PMCID: PMC5593459 DOI: 10.3892/ijmm.2017.3086] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 07/17/2017] [Indexed: 01/12/2023] Open
Abstract
The degradation of cruciate ligaments is frequently observed in degenerative joint diseases, such as osteoarthritis (OA). The present study aimed to identify the differentially expressed microRNAs (miRNAs or miRs) in knee anterior cruciate ligament (ACL) tissues derived from patients with OA and in health subjects (non-OA). By using Affymetrix miRNA 4.0 microarrays, a total of 22 miRNAs (including let-7f-5p, miR-26b-5p and miR-146a-5p) were found to be upregulated, while 17 (including miR-18a-3p, miR-138-5p and miR-485-3p) were downregulated in the osteoarthritic ACL tissues (fold change ≥2, P-value <0.05). The expression levels of 12 miRNAs were validated by quantitative PCR, and the corresponding results revealed an excellent correlation with the microarray data (R2=0.889). Genes (such as a disintegrin and metalloproteinase domain with thrombospondin type-1 motifs, bone morphogenetic protein-2, runt related transcription factor-2, collagen-1A1 and 2, interleukin-6 and transforming growth factor-β) involved in cartilage development and remodeling, collagen biosynthesis and degradation, inflammatory response and extracellular matrix homeostasis were predicted as potential targets of the dysregulated miRNAs. Moreover, a large set of putative genes were enriched in OA pathogenesis-associated pathways (such as mitogen-activated protein kinase and vascular endothelial growth factor signaling pathway). Collectively, the data from our study provides novel insight into the ligament injury-related miRNA dysregulation in patients with OA.
Collapse
Affiliation(s)
- Bin Li
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Lunhao Bai
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Peng Shen
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Yue Sun
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Zhizuo Chen
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Yu Wen
- Department of Histology and Embryology, College of Basic Medical Sciences, China Medical University, Shenyang, Liaoning 110122, P.R. China
| |
Collapse
|
15
|
Murtha AS, Johnson AE, Buckwalter JA, Rivera JC. Total knee arthroplasty for posttraumatic osteoarthritis in military personnel under age 50. J Orthop Res 2017; 35:677-681. [PMID: 27177309 DOI: 10.1002/jor.23290] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/10/2016] [Indexed: 02/04/2023]
Abstract
United States military personnel frequently suffer knee injuries. The resulting progressive posttraumatic osteoarthritis (PTOA) causes significant disability in these young high-demand patients for which total knee arthroplasty (TKA) is the only effective treatment of their pain and impairment. Yet the use of this option for treatment of PTOA has not been studied. This retrospective review identified 74 knees in 64 U.S. military personnel who underwent TKA at ≤50 years of age during an 8-year period at a tertiary-care, academic, military medical center. Fifty-five knees (74.3%) experienced one or more prior ligamentous, meniscal, or chondral injuries prior to arthroplasty. Only one subject had a history of osteochondral intra-articular fracture. The average at injury was 29.2 years (95%CI of ±2.50) with an average age at arthroplasty of 44.3 years (±1.11). The most common injury was anterior cruciate ligament rupture (n = 19) with a mean time to TKA of 23.1 (±10.54) and 18.8 years (±7.01) when concomitant meniscal pathology was noted. Nineteen patients were noted to have radiographic and symptomatic end-stage osteoarthritis without a specified etiology at 41.4 years (±1.47) and underwent subsequent TKA. This is the first study to evaluate treatment of end-stage PT OA in young people treated with TKA, finding that the incidence of PTOA as an indication for arthroplasty is significantly higher than among civilians. In this otherwise healthy, high-demand patient population, the rate of OA progression following knee injury is accelerated and the long term implications can be career and life altering. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:677-681, 2017.
Collapse
Affiliation(s)
- Andrew S Murtha
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, JBSA Fort Sam Houston, Texas
| | - Anthony E Johnson
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, JBSA Fort Sam Houston, Texas
| | - Joseph A Buckwalter
- Department of Orthopaedic Surgery, University of Iowa Hospitals, Iowa City, Iowa
| | - Jessica C Rivera
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, JBSA Fort Sam Houston, Texas.,US Army Institute of Surgical Research and San Antonio Military Medical Center, 3698 Chambers Pass, JBSA Fort Sam Houston 78234, Texas
| |
Collapse
|
16
|
Lattermann C, Jacobs CA, Bunnell MP, Jochimsen KN, Abt JP, Reinke EK, Gammon LG, Huebner JL, Kraus VB, Spindler KP. Logistical challenges and design considerations for studies using acute anterior cruciate ligament injury as a potential model for early posttraumatic osteoarthritis. J Orthop Res 2017; 35:641-650. [PMID: 27279368 DOI: 10.1002/jor.23329] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 06/05/2016] [Indexed: 02/04/2023]
Abstract
Anterior cruciate ligament (ACL) injuries are common and lead to posttraumatic osteoarthritis (PTOA) in a high percentage of patients. Research has been ineffective in identifying successful treatment options for people suffering from symptomatic PTOA resulting in a shift of focus toward the young, ACL injured patients at risk of developing PTOA. Randomized clinical trials examining the very early phase after ACL injury are ideal to study this population; however, these trials face significant challenges regarding recruitment as well as reproducibility of patient-reported outcomes (PROs) and inflammatory and/or chondrodegenerative biomarkers associated with early PTOA. The aim of this work was to develop an approach to allow for early recruitment into an RCT for early treatment following ACL injury and to analyze the variability of commonly used measures and biomarkers at various time points after injury. This paper reports the study design and data related to the first month of treatment for the placebo group of an ongoing 2-year clinical trial to evaluate the effect of an early intra-articular intervention after ACL injury. The results of this study suggest that acute ACL injury results in early changes of both inflammatory and chondrodegenerative biomarkers. These results also provide vital information for researchers to consider when developing future protocols, both related to the logistics of early patient enrollment as well as the appropriate timing of biomarker and patient-reported outcome collection. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:641-650, 2017.
Collapse
Affiliation(s)
- Christian Lattermann
- Department of Orthopaedics and Sports Medicine, University of Kentucky, Lexington, Kentucky
| | - Cale A Jacobs
- Department of Orthopaedics and Sports Medicine, University of Kentucky, Lexington, Kentucky
| | | | - Kate N Jochimsen
- Division of Athletic Training, College of Health Sciences, Sports Medicine Research Institute, University of Kentucky, Lexington, Kentucky
| | - John P Abt
- Division of Athletic Training, College of Health Sciences, Sports Medicine Research Institute, University of Kentucky, Lexington, Kentucky
| | - Emily K Reinke
- Department of Orthopaedic Surgery, Vanderbilt University, Nashville, Tennessee
| | - Lee G Gammon
- Department of Orthopaedics and Sports Medicine, University of Kentucky, Lexington, Kentucky
| | - Janet L Huebner
- Department of Medicine, Duke Molecular Physiology Institute and Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina
| | - Virginia B Kraus
- Department of Medicine, Duke Molecular Physiology Institute and Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina
| | - Kurt P Spindler
- Department of Orthopaedic Surgery, Vanderbilt University, Nashville, Tennessee.,Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| |
Collapse
|
17
|
Theisen D, Rada I, Brau A, Gette P, Seil R. Muscle Activity Onset Prior to Landing in Patients after Anterior Cruciate Ligament Injury: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0155277. [PMID: 27166929 PMCID: PMC4864320 DOI: 10.1371/journal.pone.0155277] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/26/2016] [Indexed: 01/13/2023] Open
Abstract
Muscle activation during landing is paramount to stabilise lower limb joints and avoid abnormal movement patterns. Delayed muscle activity onset measured by electromyography (EMG) has been suggested to be associated with anterior cruciate ligament (ACL) injury. Therefore, the aim of this systematic review and meta-analysis was to test the hypothesis if ACL-injured patients display different results for muscle onset timing during standard deceleration tasks compared to healthy control participants. PubMed, Embase, Scopus and ScienceDirect databases were systematically searched over the period from January 1980 to February 2015, yielding a total of 1461 citations. Six studies meeting inclusion criteria underwent quality assessment, data extraction and re-computing procedures for the meta-analysis. The quality was rated “moderate” for 2 studies and “poor” for 4. Patients included and procedures used were highly heterogeneous. The tasks investigated were single leg hopping, decelerating from running or walking, tested on a total of 102 ACL-injured participants and 86 controls. EMG analyses of the muscles vastus lateralis, vastus medialis, lateral and medial hamstrings revealed trivial and non-significant standardised mean differences (SMD<0.20; p>0.05) between patients and control participants. Furthermore, no differences were found between the contralateral leg of patients and controls for muscle activity onset of the medial and lateral gastrocnemius (SMD<0.20; p>0.05). Based on 3 studies, the involved legs of ACL-injured patients showed overall earlier muscle activity onset compared to control participants for the medial gastrocnemius (SMD = 0.5; p = 0.05). Similar results were found for the lateral gastrocnemius (SMD = 2.1; p<0.001), with a greater effect size but based only on a single study. We conclude that there are no differences between leg muscles of ACL-injured patients and healthy controls regarding the muscle activity onset during landing. However, current evidence is scarce and weak, which highlights the need for further research in this area.
Collapse
Affiliation(s)
- Daniel Theisen
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Strassen, Luxembourg, G.-D. of Luxembourg
| | - Isabel Rada
- Exercise Science Laboratory, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - Amélie Brau
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Strassen, Luxembourg, G.-D. of Luxembourg
| | - Paul Gette
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Strassen, Luxembourg, G.-D. of Luxembourg
| | - Romain Seil
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Strassen, Luxembourg, G.-D. of Luxembourg.,Department of Orthopedics, Centre Hospitalier de Luxembourg, Strassen, Luxembourg, G.-D. of Luxembourg
| |
Collapse
|
18
|
LEPLEY ADAMS, GRIBBLE PHILLIPA, THOMAS ABBEYC, TEVALD MICHAELA, SOHN DAVIDH, PIETROSIMONE BRIANG. Longitudinal Evaluation of Stair Walking Biomechanics in Patients with ACL Injury. Med Sci Sports Exerc 2016. [DOI: 10.1249/mss.0000000000000741] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
19
|
Zhang QS, Eaton GJ, Diallo C, Freeman TA. Stress-Induced Activation of Apoptosis Signal-Regulating Kinase 1 Promotes Osteoarthritis. J Cell Physiol 2015; 231:944-53. [PMID: 26405834 DOI: 10.1002/jcp.25186] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 09/03/2015] [Indexed: 12/11/2022]
Abstract
Apoptosis signal-regulated kinase 1 (ASK1) has been shown to affect a wide range of cellular processes including stress-related responses, cytokine and growth factor signaling, cell cycle and cell death. Recently, we reported that lack of ASK1 slowed chondrocyte hypertrophy, terminal differentiation and apoptosis resulting in an increase in trabecular bone formation. Herein, we investigated the role of ASK1 in the pathogenesis of osteoarthritis (OA). Immunohistochemistry performed on articular cartilage samples from patients with OA showed ASK1 expression increased with OA severity. In vitro analysis of chondrocyte hypertrophy, maturation and ASK1 signaling in embryonic fibroblasts from ASK1 knockout (KO) and wild type (WT) mice was examined. Western analysis demonstrated an increase in ASK1 signaling commensurate with chondrogenic maturation during differentiation or in response to stress by the cytokines, tumor necrosis factor alpha or interleukin 1 beta in WT, but not in ASK1 KO embryonic fibroblasts. Surgically induced moderate or severe OA or OA due to natural aging in WT and ASK1 KO mice was assessed by microCT of subchondral bone, immunohistochemistry, histology, and OARSI scoring. Immunohistochemistry, microCT and OARSI scoring all indicated that the lack of ASK1 protected against OA joint degeneration, both in surgically induced OA and in aging mice. We propose that the ASK1 MAP kinase signaling cascade is an important regulator of chondrocyte terminal differentiation and inhibitors of this pathway could be useful for slowing chondrocyte maturation and cell death observed with OA progression. J. Cell. Physiol. 231: 944-953, 2016. © 2015 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Qian-Shi Zhang
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.,Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, P. R. China
| | - Gregory J Eaton
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Carol Diallo
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Theresa A Freeman
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| |
Collapse
|