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Cook JL, Rucinski K, Wissman R, Crecelius C, DeFroda S, Crist BD. Outcomes following open acetabular labrum reconstruction: Comparing fresh-frozen tendon with fresh meniscus allograft transplantation. J Orthop 2024; 53:13-19. [PMID: 38450061 PMCID: PMC10912234 DOI: 10.1016/j.jor.2024.02.024] [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: 02/12/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024] Open
Abstract
Background Symptomatic acetabular labral insufficiency in young, active patients is often treated with labral repair or reconstruction using fresh-frozen allografts. However, fresh-frozen tendon allografts do not have tissue or material properties that closely mimic acetabular labral fibrocartilage. Recent studies suggest meniscal allografts may be a better biomechanical, geometric, and material alternative for acetabular labrum reconstruction (ALR). Hypothesis Patients undergoing open ALR using fresh meniscus allograft transplants (MAT) will have better outcomes than those using fresh-frozen tendon allografts transplants (TAT) when comparing initial treatment success, diagnostic imaging assessments, and patient-reported pain and function scores. Study design Cohort Study. Methods With IRB approval, patients undergoing ALR with either TAT or MAT were included when initial (>1-year) outcomes data related to treatment success, pain, and function were available. In addition, a subcohort of patients underwent magnetic resonance imaging at least 6-months after surgery to evaluate allograft healing. Results Initial success rate, defined as no need for ALR revision or conversion to total hip arthroplasty (THA), was 88.9% for the entire group (n = 27, TAT = 5, MAT = 22) with 1 (20%) patient in the TAT cohort and 2 patients (9.9%) in the MAT cohort undergoing THA. In the MAT cohort, significant improvements were documented for physical function and pain scores at 1 year and final follow-up (FFU)(mean 26.8 months). Improvements in pain and function were noted at 1-year, but not at FFU (mean 59.6 months) in the TAT group. MRIs completed at least 6 months after labrum reconstruction showed improved allograft integrity and integration in the MAT cohort over the TAT cohort. Conclusion For acetabular labrum reconstructions, MAT was associated with a higher initial success rate, superior patient reported outcomes, and subjectively better MRI findings when compared to TAT.
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Affiliation(s)
- James L. Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| | - Kylee Rucinski
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| | - Robert Wissman
- Department of Radiology, University of Missouri, Columbia, MO, USA
| | - Cory Crecelius
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Steven DeFroda
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| | - Brett D. Crist
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
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Rajankunte Mahadeshwara M, Al-Jawad M, Hall RM, Pandit H, El-Gendy R, Bryant M. How Do Cartilage Lubrication Mechanisms Fail in Osteoarthritis? A Comprehensive Review. Bioengineering (Basel) 2024; 11:541. [PMID: 38927777 PMCID: PMC11200606 DOI: 10.3390/bioengineering11060541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/02/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024] Open
Abstract
Cartilage degeneration is a characteristic of osteoarthritis (OA), which is often observed in aging populations. This degeneration is due to the breakdown of articular cartilage (AC) mechanical and tribological properties primarily attributed to lubrication failure. Understanding the reasons behind these failures and identifying potential solutions could have significant economic and societal implications, ultimately enhancing quality of life. This review provides an overview of developments in the field of AC, focusing on its mechanical and tribological properties. The emphasis is on the role of lubrication in degraded AC, offering insights into its structure and function relationship. Further, it explores the fundamental connection between AC mechano-tribological properties and the advancement of its degradation and puts forth recommendations for strategies to boost its lubrication efficiency.
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Affiliation(s)
- Manoj Rajankunte Mahadeshwara
- Institute of Functional Surfaces, Mechanical Engineering, University of Leeds, Leeds LS2 9JT, UK
- Department of Oral Biology, Faculty of Dentistry, University of Leeds, Leeds LS2 9JT, UK; (M.A.-J.); (R.E.-G.)
| | - Maisoon Al-Jawad
- Department of Oral Biology, Faculty of Dentistry, University of Leeds, Leeds LS2 9JT, UK; (M.A.-J.); (R.E.-G.)
| | - Richard M. Hall
- School of Engineering, College of Engineering and Physical Sciences, University of Birmingham, Birmingham B15 2TT, UK;
| | - Hemant Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Chapel Allerton Hospital, Leeds LS7 4SA, UK;
| | - Reem El-Gendy
- Department of Oral Biology, Faculty of Dentistry, University of Leeds, Leeds LS2 9JT, UK; (M.A.-J.); (R.E.-G.)
- Department of Oral Pathology, Faculty of Dentistry, Suez Canal University, Ismailia 3, Ismailia Governorate 8366004, Egypt
| | - Michael Bryant
- Institute of Functional Surfaces, Mechanical Engineering, University of Leeds, Leeds LS2 9JT, UK
- School of Engineering, College of Engineering and Physical Sciences, University of Birmingham, Birmingham B15 2TT, UK;
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Maimaitimin M, Yang F, Huang H, Ao Y, Wang J. Can the Acetabular Labrum Be Reconstructed With a Meniscal Allograft? An In Vivo Pig Model. Clin Orthop Relat Res 2024; 482:386-398. [PMID: 37732715 PMCID: PMC10776144 DOI: 10.1097/corr.0000000000002860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/17/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND No single graft type has been shown to have a benefit in acetabular labral reconstruction. The native labrum and lateral meniscus share many similarities, suggesting that the meniscus may be a promising source of graft material in labral reconstruction. QUESTIONS/PURPOSES Using a pig model, we sought to evaluate the healing process of fresh-frozen meniscus allograft for acetabular reconstruction by assessing (1) MRI and macroscopic observations of the meniscus allograft; (2) histologic appearance and immunohistologic evaluation of the meniscus allograft, native meniscus, and labrum; (3) microscopic assessment of the native labrum and meniscus via scanning electron microscopy; and (4) biomechanical assessment of tensile properties. METHODS Twelve skeletally mature male miniature Bama pigs (24 hips) were randomly divided into two groups: labral defect group (control) and lateral meniscus allograft group. The selection of Bama pig specimens was based on the similarity of their acetabular labrum to that of the human acetabular labrum, characterized by the presence of fibrocartilage-like tissue lacking blood vessels. The pigs underwent bilateral hip surgery. Briefly, a 1.5-cm-long section was resected in the anterior dorsal labrum, which was left untreated or reconstructed using an allogeneic lateral meniscus. The pigs were euthanized at 12 and 24 weeks postoperatively, and then evaluated by macroscopic observations and MRI measurement to assess the extent of coverage of the labral defect. We also performed a histologic analysis and immunohistologic evaluation to assess the composition and structure of meniscus allograft, native labrum, and meniscus, as well as scanning electron microscopy assessment of the microstructure of the native labrum and meniscus and biomechanical assessment of tensile properties. RESULTS Imaging measurement and macroscopic observations revealed that the resected area of the labrum was fully filled in the lateral meniscus allograft group, whereas in the control group, the labral defect remained at 24 weeks. The macroscopic scores of the meniscus allograft group (8.2 ± 0.8) were higher than those of the control groups (4.8 ± 1.0) (mean difference 3.3 [95% CI 1.6 to 5.0]; p < 0.001). Moreover, in the meniscus allograft group, histologic assessment identified fibrocartilage-like cell cluster formation at the interface between the graft and acetabulum; cells and fibers arranged perpendicularly to the acetabulum and tideline structure that were similar to those of native labrum could be observed at 24 weeks. Immunohistochemical results showed that the average optical density value of Type II collagen at the graft-acetabulum interface was increased in the meniscus allograft group at 24 weeks compared with at 12 weeks (0.259 ± 0.031 versus 0.228 ± 0.023, mean difference 0.032 [95% CI 0.003 to 0.061]; p = 0.013). Furthermore, the tensile modulus of the lateral meniscus allograft was near that of the native labrum at 24 weeks (54.7 ± 9.9 MPa versus 63.2 ± 11.3 MPa, mean difference -8.4 MPa [95% CI -38.3 to 21.4]; p = 0.212). CONCLUSION In a pig model, lateral meniscus allografts fully filled labral defects in labral reconstruction. Regeneration of a fibrocartilage transition zone at the graft-acetabulum interface was observed at 24 weeks. CLINICAL RELEVANCE The use of an autograft meniscus for labral reconstruction may be a viable option when labral tears are deemed irreparable. Before its clinical implementation, it is imperative to conduct a comparative study involving tendon grafts, which are extensively used in current clinical practice.
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Affiliation(s)
- Maihemuti Maimaitimin
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, PR China
- Beijing Key Laboratory of Sports Injuries, Beijing, PR China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, PR China
| | - Fan Yang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, PR China
- Beijing Key Laboratory of Sports Injuries, Beijing, PR China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, PR China
| | - Hongjie Huang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, PR China
- Beijing Key Laboratory of Sports Injuries, Beijing, PR China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, PR China
| | - Yingfang Ao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, PR China
- Beijing Key Laboratory of Sports Injuries, Beijing, PR China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, PR China
| | - Jianquan Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, PR China
- Beijing Key Laboratory of Sports Injuries, Beijing, PR China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, PR China
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DeFroda SF, Crist B, Cook JL. Arthroscopic Hip Labral Reconstruction With Fresh Meniscal Allograft. Arthrosc Tech 2023; 12:e813-e821. [PMID: 37424660 PMCID: PMC10323673 DOI: 10.1016/j.eats.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/11/2023] [Indexed: 07/11/2023] Open
Abstract
The acetabular labrum is essential to maintaining the functional health of the hip joint through contributions to joint congruity, stability, and the negative pressure suction seal. Injury, overuse, long-standing developmental disorders, or failed primary labral repair can eventually lead to functional labral insufficiency requiring management via labral reconstruction. While numerous graft options exist for hip labral reconstruction, there is no current gold standard. The optimal graft should best mimic the native labrum with regard to geometry, structure, mechanical properties, and durability. This has led to the development of an arthroscopic technique for labral reconstruction with fresh meniscal allograft tissue.
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Affiliation(s)
- Steven F. DeFroda
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, U.S.A
| | - Brett Crist
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, U.S.A
| | - James L. Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, U.S.A
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Rasheed B, Ayyalasomayajula V, Schaarschmidt U, Vagstad T, Schaathun HG. Region- and layer-specific investigations of the human menisci using SHG imaging and biaxial testing. Front Bioeng Biotechnol 2023; 11:1167427. [PMID: 37143602 PMCID: PMC10151675 DOI: 10.3389/fbioe.2023.1167427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/04/2023] [Indexed: 05/06/2023] Open
Abstract
In this paper, we examine the region- and layer-specific collagen fiber morphology via second harmonic generation (SHG) in combination with planar biaxial tension testing to suggest a structure-based constitutive model for the human meniscal tissue. Five lateral and four medial menisci were utilized, with samples excised across the thickness from the anterior, mid-body, and posterior regions of each meniscus. An optical clearing protocol enhanced the scan depth. SHG imaging revealed that the top samples consisted of randomly oriented fibers with a mean fiber orientation of 43.3 o . The bottom samples were dominated by circumferentially organized fibers, with a mean orientation of 9.5 o . Biaxial testing revealed a clear anisotropic response, with the circumferential direction being stiffer than the radial direction. The bottom samples from the anterior region of the medial menisci exhibited higher circumferential elastic modulus with a mean value of 21 MPa. The data from the two testing protocols were combined to characterize the tissue with an anisotropic hyperelastic material model based on the generalized structure tensor approach. The model showed good agreement in representing the material anisotropy with a mean r 2 = 0.92.
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Affiliation(s)
- Bismi Rasheed
- Cyber-Physical Systems Laboratory, Department of ICT and Natural Sciences, Norwegian University of Science and Technology (NTNU), Ålesund, Norway
- Ålesund Biomechanics Lab, Ålesund General Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
- *Correspondence: Bismi Rasheed,
| | - Venkat Ayyalasomayajula
- Division of Biomechanics, Department of Structural Engineering, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Ute Schaarschmidt
- Cyber-Physical Systems Laboratory, Department of ICT and Natural Sciences, Norwegian University of Science and Technology (NTNU), Ålesund, Norway
| | - Terje Vagstad
- Cyber-Physical Systems Laboratory, Department of ICT and Natural Sciences, Norwegian University of Science and Technology (NTNU), Ålesund, Norway
- Ålesund Biomechanics Lab, Ålesund General Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Department of Orthopaedic Surgery, Medi3, Ålesund, Norway
| | - Hans Georg Schaathun
- Cyber-Physical Systems Laboratory, Department of ICT and Natural Sciences, Norwegian University of Science and Technology (NTNU), Ålesund, Norway
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De Rosa M, Filippone G, Best TM, Jackson AR, Travascio F. Mechanical properties of meniscal circumferential fibers using an inverse finite element analysis approach. J Mech Behav Biomed Mater 2022; 126:105073. [PMID: 34999488 PMCID: PMC9162054 DOI: 10.1016/j.jmbbm.2022.105073] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/20/2021] [Accepted: 01/02/2022] [Indexed: 02/03/2023]
Abstract
The extracellular matrix (ECM) of the meniscus is a gel-like water solution of proteoglycans embedding bundles of collagen fibers mainly oriented circumferentially. Collagen fibers significantly contribute to meniscal mechanics, however little is known about their mechanical properties. The objective of this study was to propose a constitutive model for collagen fibers embedded in the ECM of the meniscus and to characterize the tissue's pertinent mechanical properties. It was hypothesized that a linear fiber reinforced viscoelastic constitutive model is suitable to describe meniscal mechanical behavior in shear. It was further hypothesized that the mechanical properties governing the model depend on the tissue's composition. Frequency sweep tests were conducted on eight porcine meniscal specimens. A first cohort of experimental data resulted from tissue specimens where collagen fibers oriented parallel with respect to the shear plane were used. This was done to eliminate the contribution of collagen fibers from the mechanical response and characterize the mechanical properties of the ECM. A second cohort with fibers orthogonally oriented with respect to the shear plane that were used to determine the elastic properties of the collagen fibers via inverse finite element analysis. Our testing protocol revealed that tissue ECM mechanical behavior could be described by a generalized Maxwell model with 3 relaxation times. The inverse finite element analysis suggested that collagen fibers can be modeled as linear elastic elements having an average elastic modulus of 287.5 ± 62.6 MPa. Magnitudes of the mechanical parameters governing the ECM and fibers were negatively related to tissue water content.
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Affiliation(s)
- Massimiliano De Rosa
- Department of Mechanical and Aerospace Engineering, University of Miami, Coral Gables, FL
| | - Giovanni Filippone
- Department of Materials Engineering, University of Naples Federico II, Naples, Italy
| | - Thomas M. Best
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL,UHealth Sports Medicine Institute, Coral Gables, FL,Department of Orthopaedic Surgery, University of Miami, Miami, FL
| | - Alicia R. Jackson
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL,Corresponding authors: Dr. Francesco Travascio, Associate Professor, College of Engineering, University of Miami, 1251 Memorial Drive, MEB 276, Coral Gables, FL 33146, USA, Telephone: +1-(305)-284-2371, , Dr. Alicia R. Jackson, Associate Professor, College of Engineering, University of Miami, 1251 Memorial Drive, MEA 219, Coral Gables, FL 33146, USA, Telephone: +1-(305)-284-2135,
| | - Francesco Travascio
- Department of Mechanical and Aerospace Engineering, University of Miami, Coral Gables, FL,Department of Orthopaedic Surgery, University of Miami, Miami, FL,Max Biedermann Institute for Biomechanics at Mount Sinai Medical Center, Miami Beach, FL,Corresponding authors: Dr. Francesco Travascio, Associate Professor, College of Engineering, University of Miami, 1251 Memorial Drive, MEB 276, Coral Gables, FL 33146, USA, Telephone: +1-(305)-284-2371, , Dr. Alicia R. Jackson, Associate Professor, College of Engineering, University of Miami, 1251 Memorial Drive, MEA 219, Coral Gables, FL 33146, USA, Telephone: +1-(305)-284-2135,
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Wen C, Lin L, Zou R, Lin F, Liu Y. Mesenchymal stem cell-derived exosome mediated long non-coding RNA KLF3-AS1 represses autophagy and apoptosis of chondrocytes in osteoarthritis. Cell Cycle 2022; 21:289-303. [PMID: 34964696 PMCID: PMC8855872 DOI: 10.1080/15384101.2021.2019411] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Osteoarthritis is a degenerative joint disease and a leading cause of adult disability. Our previous study has reported that mesenchymal stem cell-derived exosomes (MSC-Exo) mediated long non-coding RNA KLF3-AS1 improves osteoarthritis. This study aims to investigate the molecular mechanism of KLF3-AS1 in osteoarthritis. Chondrocytes were treated with IL-1β to induce chondrocyte injury, followed by MSC-Exo treatment. We found that MSC-Exo enhanced KLF3-AS1 expression in IL-1β-treated chondrocytes. IL-1β treatment reduced cell viability and enhanced apoptosis in chondrocytes. MSC-Exo-mediated KLF3-AS1 promoted cell viability and repressed apoptosis of IL-1β-treated chondrocytes. Rapamycin (autophagy activator) promoted cell viability and suppressed apoptosis of chondrocytes by activating autophagy. Moreover, KLF3-AS1 interacted with YBX1 in chondrocytes. MSC-Exo-mediated KLF3-AS1 activated PI3K/Akt/mTOR signaling pathway, which was abrogated by YBX1 silencing. MSC-Exo-mediated KLF3-AS1 repressed autophagy and apoptosis of chondrocytes by activating PI3K/Akt/mTOR signaling pathway. In conclusion, our data demonstrate that MSC-Exo-mediated KLF3-AS1 inhibits autophagy and apoptosis of IL-1β-treated chondrocyte through PI3K/Akt/mTOR signaling pathway. KLF3-AS1 activates PI3K/Akt/mTOR signaling pathway by targeting YBX1 to improve the progression of osteoarthritis. Thus, this work suggests that MSC-Exo-mediated KLF3-AS1 may be a potential therapeutic target for osteoarthritis.
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Affiliation(s)
- Chuanyang Wen
- Department of Orthopaedics, Luhe People’s Hospital of Nanjing, Nanjing, Jiangsu, China
| | - Lupan Lin
- Department of Orthopaedics, Luhe People’s Hospital of Nanjing, Nanjing, Jiangsu, China
| | - Rui Zou
- Department of Orthopaedics, Luhe People’s Hospital of Nanjing, Nanjing, Jiangsu, China
| | - Fuqing Lin
- Department of Orthopaedics, Luhe People’s Hospital of Nanjing, Nanjing, Jiangsu, China
| | - Yubao Liu
- Department of Orthopaedics, Luhe People’s Hospital of Nanjing, Nanjing, Jiangsu, China,CONTACT Yubao Liu Luhe People’s Hospital of Nanjing, Nanjing, Jiangsu, China
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Numerical Modeling of Shockwave Treatment of Knee Joint. MATERIALS 2021; 14:ma14247678. [PMID: 34947273 PMCID: PMC8707368 DOI: 10.3390/ma14247678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/03/2021] [Accepted: 12/09/2021] [Indexed: 12/20/2022]
Abstract
Arthritis is a degenerative disease that primarily affects the cartilage and meniscus of the knee joint. External acoustic stimulation is used to treat this disease. This article presents a numerical model of the knee joint aimed at the computer-aided study of the regenerative effects of shockwave treatment. The presented model was verified and validated. A numerical analysis of the conditions for the regeneration of the tissues of the knee joint under shockwave action was conducted. The results allow us to conclude that to obtain the conditions required for the regeneration of cartilage tissues and meniscus (compressive stresses above the threshold value of 0.15 MPa to start the process of chondrogenesis; distortional strains above the threshold value of 0.05% characterized by the beginning of the differentiation of the tissues in large volumes; fluid pressure corresponding to the optimal level of 68 kPa to transfer tissue cells in large volumes), the energy flux density of therapeutic shockwave loading should exceed 0.3 mJ/mm2.
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Acetabular labral reconstruction with medial meniscal allograft: preliminary results of a new surgical technique. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:515-521. [PMID: 34028622 DOI: 10.1007/s00590-021-02986-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Reconstruction of the acetabular labrum during femoroacetabular impingement (FAI) surgery is accepted when the labrum is deficient and irreparable. Here we describe a novel technique using fresh-frozen medial meniscal allograft for labral reconstruction during surgical hip dislocation for correction of pincer FAI due to acetabular overcoverage. METHODS The results from seven hips (six patients) that underwent this procedure with 1 year minimum follow-up, and radiographs are presented. RESULTS Six of the seven hips had improvements in pain, hip flexion, hip abduction, and Merle d'Aubigné-Postel scores. Only one patient with pre-existing osteoarthritis underwent reoperation with conversion to total hip arthroplasty. All digastric trochanteric osteotomies healed, and there were no cases of femoral head osteonecrosis or progression of Tönnis grades. CONCLUSIONS The medial meniscus is a morphologically and clinically suitable option for labral reconstruction and effectively restores the hip fluid seal.
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Constitutive modeling of menisci tissue: a critical review of analytical and numerical approaches. Biomech Model Mechanobiol 2020; 19:1979-1996. [PMID: 32572727 DOI: 10.1007/s10237-020-01352-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/28/2020] [Indexed: 02/07/2023]
Abstract
Menisci are fibrocartilaginous disks consisting of soft tissue with a complex biomechanical structure. They are critical determinants of the kinematics as well as the stability of the knee joint. Several studies have been carried out to formulate tissue mechanical behavior, leading to the development of a wide spectrum of constitutive laws. In addition to developing analytical tools, extensive numerical studies have been conducted on menisci modeling. This study reviews the developments of the most widely used continuum models of the meniscus mechanical properties in conjunction with emerging analytical and numerical models used to study the meniscus. The review presents relevant approaches and assumptions used to develop the models and includes discussions regarding strengths, weaknesses, and discrepancies involved in the presented models. The study presents a comprehensive coverage of relevant publications included in Compendex, EMBASE, MEDLINE, PubMed, ScienceDirect, Springer, and Scopus databases. This review aims at opening novel avenues for improving menisci modeling within the framework of constitutive modeling through highlighting the needs for further research directed toward determining key factors in gaining insight into the biomechanics of menisci which is crucial for the elaborate design of meniscal replacements.
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Hip chondrolabral mechanics during activities of daily living: Role of the labrum and interstitial fluid pressurization. J Biomech 2018; 69:113-120. [PMID: 29366559 DOI: 10.1016/j.jbiomech.2018.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 12/29/2017] [Accepted: 01/08/2018] [Indexed: 11/21/2022]
Abstract
Osteoarthritis of the hip can result from mechanical factors, which can be studied using finite element (FE) analysis. FE studies of the hip often assume there is no significant loss of fluid pressurization in the articular cartilage during simulated activities and approximate the material as incompressible and elastic. This study examined the conditions under which interstitial fluid load support remains sustained during physiological motions, as well as the role of the labrum in maintaining fluid load support and the effect of its presence on the solid phase of the surrounding cartilage. We found that dynamic motions of gait and squatting maintained consistent fluid load support between cycles, while static single-leg stance experienced slight fluid depressurization with significant reduction of solid phase stress and strain. Presence of the labrum did not significantly influence fluid load support within the articular cartilage, but prevented deformation at the cartilage edge, leading to lower stress and strain conditions in the cartilage. A morphologically accurate representation of collagen fibril orientation through the thickness of the articular cartilage was not necessary to predict fluid load support. However, comparison with simplified fibril reinforcement underscored the physiological importance. The results of this study demonstrate that an elastic incompressible material approximation is reasonable for modeling a limited number of cyclic motions of gait and squatting without significant loss of accuracy, but is not appropriate for static motions or numerous repeated motions. Additionally, effects seen from removal of the labrum motivate evaluation of labral reattachment strategies in the context of labral repair.
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Levillain A, Magoariec H, Boulocher C, Decambron A, Viateau V, Hoc T. Viscoelastic properties of rabbit osteoarthritic menisci: A correlation with matrix alterations. J Mech Behav Biomed Mater 2016; 65:1-10. [PMID: 27543842 DOI: 10.1016/j.jmbbm.2016.08.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 07/23/2016] [Accepted: 08/05/2016] [Indexed: 01/11/2023]
Abstract
The aim of this study was to evaluate the effect of early osteoarthritis (OA) on the viscoelastic properties of rabbit menisci and to correlate the mechanical alterations with the microstructural changes. Anterior Cruciate Ligament Transection (ACLT) was performed in six male New-Zealand White rabbits on the right knee joint. Six healthy rabbits served as controls. Menisci were removed six weeks after ACLT and were graded macroscopically. Indentation-relaxation tests were performed in the anterior and posterior regions of the medial menisci. The collagen fibre organization and glycosaminoglycan (GAG) content were assessed by biphotonic confocal microscopy and histology, respectively. OA menisci displayed severe macroscopic lesions compared with healthy menisci (p=0.009). Moreover, the instantaneous and equilibrium moduli, which were 2.9±1.0MPa and 0.60±0.18MPa in the anterior region of healthy menisci, respectively, decreased significantly (p=0.03 and p=0.004, respectively) in OA menisci by 55% and 57%, respectively, indicating a global decrease in meniscal stiffness in this region. The equilibrium modulus alone decreased significantly (p=0.04) in the posterior region, going from 0.60±0.18MPa to 0.26±012MPa. This induced a loss of tissue elasticity. These mechanical changes were associated in the posterior region with a structural disruption of the superficial layers, from which the tie fibres emanate, and with a decrease in the GAG content in the anterior region. Consequently, the circumferential collagen fibres of the deep zone were dissociated and the collagen bundles were less compact. Our results demonstrate the strong meniscal modifications induced by ACLT at an early stage of OA and highlight the relationship between structural and chemical matrix alterations and mechanical properties.
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Affiliation(s)
- A Levillain
- LTDS, UMR CNRS 5513, Université de Lyon, Ecole centrale de Lyon, 36av Guy de Collongue, 69134 Ecully Cedex, France
| | - H Magoariec
- LTDS, UMR CNRS 5513, Université de Lyon, Ecole centrale de Lyon, 36av Guy de Collongue, 69134 Ecully Cedex, France
| | - C Boulocher
- Research unit ICE, UPSP 2011.03.101, Université de Lyon, veterinary campus of VetAgro Sup, 69 280 Marcy l'Etoile, France
| | - A Decambron
- B2OA, UMR 7052, ENVA, 7Avenue du Général de Gaulle, 94700 Maisons-Alfort, France
| | - V Viateau
- B2OA, UMR 7052, ENVA, 7Avenue du Général de Gaulle, 94700 Maisons-Alfort, France
| | - T Hoc
- LTDS, UMR CNRS 5513, Université de Lyon, Ecole centrale de Lyon, 36av Guy de Collongue, 69134 Ecully Cedex, France.
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13
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Abstract
The options for labral treatment are debridement, repair, and reconstruction. Debridement of labral tissue is indicated when there is peripheral tearing of the labrum that does not compromise the functionality of the labrum at its base or if the labrum is not playing an important role in the patient's pathology. Labral repair is performed when the base of the labrum is unstable at its attachment at the acetabular rim and the tissue is of otherwise good quality. Labral reconstruction is an option for labral tissue compromised beyond repair, segmental labral defect, or previous failed repair.
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Affiliation(s)
- Andrew B Wolff
- Department of Orthopedic Surgery, Washington Orthopaedics and Sports Medicine, 2021 K Street Northwest, Suite 516, Washington, DC 20006, USA.
| | - Jamie Grossman
- Department of Orthopaedic Surgery, Lenox Hill Hospital, 210 East 64th Street, New York, NY 10065, USA
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14
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Danso E, Mäkelä J, Tanska P, Mononen M, Honkanen J, Jurvelin J, Töyräs J, Julkunen P, Korhonen R. Characterization of site-specific biomechanical properties of human meniscus—Importance of collagen and fluid on mechanical nonlinearities. J Biomech 2015; 48:1499-507. [DOI: 10.1016/j.jbiomech.2015.01.048] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 01/29/2015] [Indexed: 10/24/2022]
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Wheatley BB, Fischenich KM, Button KD, Haut RC, Haut Donahue TL. An optimized transversely isotropic, hyper-poro-viscoelastic finite element model of the meniscus to evaluate mechanical degradation following traumatic loading. J Biomech 2015; 48:1454-60. [PMID: 25776872 DOI: 10.1016/j.jbiomech.2015.02.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 02/15/2015] [Indexed: 01/13/2023]
Abstract
Inverse finite element (FE) analysis is an effective method to predict material behavior, evaluate mechanical properties, and study differences in biological tissue function. The meniscus plays a key role in load distribution within the knee joint and meniscal degradation is commonly associated with the onset of osteoarthritis. In the current study, a novel transversely isotropic hyper-poro-viscoelastic constitutive formulation was incorporated in a FE model to evaluate changes in meniscal material properties following tibiofemoral joint impact. A non-linear optimization scheme was used to fit the model output to indentation relaxation experimental data. This study is the first to investigate rate of relaxation in healthy versus impacted menisci. Stiffness was found to be decreased (p=0.003), while the rate of tissue relaxation increased (p=0.010) at twelve weeks post impact. Total amount of relaxation, however, did not change in the impacted tissue (p=0.513).
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Affiliation(s)
- Benjamin B Wheatley
- 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
| | - Roger C Haut
- Orthopaedic Biomechanics Laboratories, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA; Department of Radiology, 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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16
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Short-term consolidation of articular cartilage in the long-term context of osteoarthritis. J Theor Biol 2015; 368:102-12. [DOI: 10.1016/j.jtbi.2015.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 12/04/2014] [Accepted: 01/04/2015] [Indexed: 01/18/2023]
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17
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Hellwig F, Tong J, Hussell J. Hip joint degeneration due to cam impingement: a finite element analysis. Comput Methods Biomech Biomed Engin 2015; 19:41-8. [DOI: 10.1080/10255842.2014.983490] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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18
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Matsuda DK, Bharam S, White BJ, Matsuda NA, Safran M. Anchor-induced chondral damage in the hip. J Hip Preserv Surg 2015; 2:56-64. [PMID: 27011815 PMCID: PMC4718472 DOI: 10.1093/jhps/hnv001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 12/24/2014] [Accepted: 01/01/2015] [Indexed: 01/02/2023] Open
Abstract
The purpose of this study is to investigate the outcomes from anchor-induced chondral damage of the hip, both with and without frank chondral penetration. A multicenter retrospective case series was performed of patients with chondral deformation or penetration during initial hip arthroscopic surgery. Intra-operative findings, post-surgical clinical courses, hip outcome scores and descriptions of arthroscopic treatment in cases requiring revision surgery and anchor removal are reported. Five patients (three females) of mean age 32 years (range, 16-41 years) had documented anchor-induced chondral damage with mean 3.5 years (range, 1.5-6.0 years) follow-up. The 1 o'clock position (four cases) and anterior and mid-anterior portals (two cases each) were most commonly implicated. Two cases of anchor-induced acetabular chondral deformation without frank penetration had successful clinical and radiographic outcomes, while one case progressed from deformation to chondral penetration with clinical worsening. Of the cases that underwent revision hip arthroscopy, all three had confirmed exposed hard anchors which were removed. Two patients have had clinical improvement and one patient underwent early total hip arthroplasty. Anchor-induced chondral deformation without frank chondral penetration may be treated with close clinical and radiographic monitoring with a low threshold for revision surgery and anchor removal. Chondral penetration should be treated with immediate removal of offending hard anchor implants. Preventative measures include distal-based portals, small diameter and short anchors, removable hard anchors, soft suture-based anchors, curved drill and anchor insertion instrumentation and attention to safe trajectories while visualizing the acetabular articular surface.
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Affiliation(s)
- Dean K. Matsuda
- 1. DISC Sports and Spine Center, 13160 Mindanao Way, Suite 300, Marina del Rey, CA 90292, USA
| | | | - Brian J. White
- 3. Western Orthopaedics, 1830 Franklin St #450, Denver, CO 80218, USA
| | - Nicole A. Matsuda
- 4. Westchester Enriched Science Magnet, 7400 West Manchester Avenue, Los Angeles, CA 90045, USA
| | - Marc Safran
- 5. Stanford Medical Clinics, 450 Broadway S, Pavilion A, Redwood City, CA 94063, USA
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19
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Li J, Hua X, Jin Z, Fisher J, Wilcox RK. Biphasic investigation of contact mechanics in natural human hips during activities. Proc Inst Mech Eng H 2014; 228:556-563. [PMID: 24898443 PMCID: PMC4361357 DOI: 10.1177/0954411914537617] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The aim of this study was to determine the cartilage contact mechanics and the associated fluid pressurisation of the hip joint under eight daily activities, using a three-dimensional finite element hip model with biphasic cartilage layers and generic geometries. Loads with spatial and temporal variations were applied over time and the time-dependent performance of the hip cartilage during walking was also evaluated. It was found that the fluid support ratio was over 90% during the majority of the cycles for all the eight activities. A reduced fluid support ratio was observed for the time at which the contact region slid towards the interior edge of the acetabular cartilage, but these occurred when the absolute level of the peak contact stress was minimal. Over 10 cycles of gait, the peak contact stress and peak fluid pressure remained constant, but a faster process of fluid exudation was observed for the interior edge region of the acetabular cartilage. The results demonstrate the excellent function of the hip cartilage within which the solid matrix is prevented from high levels of stress during activities owing to the load shared by fluid pressurisation. The findings are important in gaining a better understanding of the hip function during daily activities, as well as the pathology of hip degeneration and potential for future interventions. They provide a basis for future subject-specific biphasic investigations of hip performance during activities.
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Affiliation(s)
- Junyan Li
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Xijin Hua
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Zhongmin Jin
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - John Fisher
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Ruth K Wilcox
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
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20
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Halonen KS, Mononen ME, Jurvelin JS, Töyräs J, Salo J, Korhonen RK. Deformation of articular cartilage during static loading of a knee joint--experimental and finite element analysis. J Biomech 2014; 47:2467-74. [PMID: 24813824 DOI: 10.1016/j.jbiomech.2014.04.013] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 04/03/2014] [Accepted: 04/03/2014] [Indexed: 10/25/2022]
Abstract
Novel conical beam CT-scanners offer high resolution imaging of knee structures with i.a. contrast media, even under weight bearing. With this new technology, we aimed to determine cartilage strains and meniscal movement in a human knee at 0, 1, 5, and 30 min of standing and compare them to the subject-specific 3D finite element (FE) model. The FE model of the volunteer׳s knee, based on the geometry obtained from magnetic resonance images, was created to simulate the creep. The effects of collagen fibril network stiffness, nonfibrillar matrix modulus, permeability and fluid flow boundary conditions on the creep response in cartilage were investigated. In the experiment, 80% of the maximum strain in cartilage developed immediately, after which the cartilage continued to deform slowly until the 30 min time point. Cartilage strains and meniscus movement obtained from the FE model matched adequately with the experimentally measured values. Reducing the fibril network stiffness increased the mean strains substantially, while the creep rate was primarily influenced by an increase in the nonfibrillar matrix modulus. Changing the initial permeability and preventing fluid flow through noncontacting surfaces had a negligible effect on cartilage strains. The present results improve understanding of the mechanisms controlling articular cartilage strains and meniscal movements in a knee joint under physiological static loading. Ultimately a validated model could be used as a noninvasive diagnostic tool to locate cartilage areas at risk for degeneration.
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Affiliation(s)
- K S Halonen
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211 Kuopio, Finland.
| | - M E Mononen
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211 Kuopio, Finland; Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio, Finland
| | - J S Jurvelin
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211 Kuopio, Finland
| | - J Töyräs
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211 Kuopio, Finland; Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio, Finland
| | - J Salo
- Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio, Finland
| | - R K Korhonen
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211 Kuopio, Finland
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21
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Dwyer MK, Jones HL, Hogan MG, Field RE, McCarthy JC, Noble PC. The acetabular labrum regulates fluid circulation of the hip joint during functional activities. Am J Sports Med 2014; 42:812-9. [PMID: 24557859 DOI: 10.1177/0363546514522395] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND An assessment of the effect of surgical repair or reconstruction on the function of the hip labrum is critical to the advancement of hip preservation surgery; however, validated models of the hip that allow the quantification of labral function in functional joint positions have yet to be developed. PURPOSE To evaluate (1) whether intra-articular pressures within the hip are regulated by fluid transport between the labrum and femoral head and (2) whether the sealing capacity of the labrum varies with joint posture. STUDY DESIGN Descriptive laboratory study. METHODS The sealing ability of the hip labrum was measured during fluid infusion into the central compartments of 8 cadaveric specimens. Additionally, the pathway of fluid transfer from the central to the peripheral compartment was assessed via direct visualization in 3 specimens. The effect of joint posture on the sealing capacity of the labrum was determined by placing all 8 specimens in 10 functional postures. The relationship between pressure resistance and 3-dimensional motion of the femoral head within the acetabulum was quantified using motion analysis and computer modeling. RESULTS Resistance to fluid transport from the central compartment of the hip was directly controlled by the labrum during loading. Maximum pressure resistance was affected by joint posture (P = .001). Specifically, positions that increased external rotation of the joint (pivoting) provided an improved seal, while positions that increased flexion combined with internal rotation (stooping) augmented the ease of fluid transport from the central to the peripheral compartment. Maximum pressure resistance was associated with the distance between the labrum and femoral head during pivoting. CONCLUSION This study demonstrated that the transfer of fluid from the central compartment of the hip occurs at the junction of the labrum and femoral head. Joint position was shown to strongly affect the sealing function of the labrum and was attributable to the distance between the labrum and femoral head in certain positions. CLINICAL RELEVANCE Altering the relationship between the labrum and femoral head may disrupt the sealing ability of the labrum, potentially leaving the joint at risk for pathological changes with time.
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Affiliation(s)
- Maureen K Dwyer
- Philip C. Noble, Institute of Orthopedic Research and Education, 6550 Fannin Street, Suite 2512, Houston, TX 77030, USA.
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22
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Philippon MJ, Nepple JJ, Campbell KJ, Dornan GJ, Jansson KS, LaPrade RF, Wijdicks CA. The hip fluid seal--Part I: the effect of an acetabular labral tear, repair, resection, and reconstruction on hip fluid pressurization. Knee Surg Sports Traumatol Arthrosc 2014; 22:722-9. [PMID: 24519614 DOI: 10.1007/s00167-014-2874-z] [Citation(s) in RCA: 222] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 01/24/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE The acetabular labrum is theorized to be important to normal hip function by creating intra-articular fluid pressurization through the hip fluid seal. However, the effect of a labral tear or partial labral resection, and interventions including labral repair and labral reconstruction, on the hip fluid seal remains to be defined. The purpose of this study was to characterize intra-articular fluid pressurization in six labral conditions: intact, tear, repair (looped vs. through sutures), partial resection, reconstruction with iliotibial band, and complete resection. METHODS Eight cadaveric hips with a mean age of 47.8 years (SD 4.3, range 41-51) were included in the study. For each labral condition, the hip was compressed with a force of 2.7 times body weight (2,118 N) while intra-articular pressure was continuously measured with 1.0 × 0.3 mm pressure transducers. Peak intra-articular pressure measurements for each condition were normalized relative to the intact state. Statistical analyses were performed utilizing linear mixed-effects models with repeated measures analysis. RESULTS Intra-articular fluid pressurization of the intact state varied from 78 to 422 kPa (mean 188 kPa ± SD 120). Labral tear, partial resection, and complete resection resulted in average pressurization of 75 ± 33, 53 ± 37, and 24 ± 18 %, respectively compared with the intact state. Through type labral repair resulted in significantly greater increases in pressurization from the labral tear state, compared with the looped type repair (median increase; +46 vs. -12 %, p = 0.029). Labral reconstruction resulted in a mean pressurization of 110 ± 38 % relative to intact state, with a significant 56 ± 47 % improvement in pressurization compared with partial labral resection (p = 0.009). CONCLUSIONS Partial labral resection caused significant decreases in intra-articular fluid pressurization. Through type labral suture repair restored the fluid pressurization better than looped type repairs. Labral reconstruction significantly improved pressurization to levels similar to the intact state. This study demonstrated the effect of labral tears and partial resections on intra-articular fluid pressurization via the hip fluid seal, and it also demonstrated improvements in pressurization seen with through type labral repairs and labral reconstructions.
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Affiliation(s)
- Marc J Philippon
- Steadman Philippon Research Institute, 181 W. Meadow Drive, Suite 1000, Vail, CO, 81657, USA
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23
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Domb BG, El Bitar YF, Stake CE, Trenga AP, Jackson TJ, Lindner D. Arthroscopic labral reconstruction is superior to segmental resection for irreparable labral tears in the hip: a matched-pair controlled study with minimum 2-year follow-up. Am J Sports Med 2014; 42:122-30. [PMID: 24186974 DOI: 10.1177/0363546513508256] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The acetabular labrum is an important structure that plays a significant role in proper biomechanical function of the hip joint. When the labrum is significantly deficient, arthroscopic reconstruction could provide a potential solution for the nonfunctional labrum. PURPOSE To compare the clinical outcomes of arthroscopic labral reconstruction (RECON) with those of arthroscopic segmental labral resection (RESEC) in patients with femoroacetabular impingement (FAI) of the hip. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Between April 2010 and March 2011, all prospectively gathered data for patients with FAI who underwent arthroscopic acetabular labral reconstruction or segmental resection with a minimum 2-year follow-up were reviewed. Eleven cases in the RECON group were matched to 22 cases in the RESEC group according to the preoperative Non-Arthritic Hip Score (NAHS) and sex. The patient-reported outcome scores (PROs) used included the NAHS, the Hip Outcome Score (HOS), and the modified Harris Hip Score (mHHS). Statistical analyses were performed to compare the change in PROs in both groups. RESULTS There was no statistically significant difference between groups regarding the preoperative NAHS (P = .697), any of the other preoperative PROs, or demographic and radiographic data. The mean change in the NAHS was 24.8 ± 16.0 in the RECON group and 12.5 ± 16.0 in the RESEC group. The mean change in the HOS-activities of daily living (HOS-ADL) was 21.7 ± 16.5 in the RECON group and 9.5 ± 15.5 in the RESEC group. Comparison of the amount of change between groups showed greater improvement in the NAHS and HOS-ADL for the RECON group (P = .046 and .045, respectively). There was no statistically significant difference in the mean changes in the rest of the PROs, although there were trends in all in favor of the RECON group. All PROs in both groups showed a statistically significant improvement at follow-up compared with preoperative levels. CONCLUSION Arthroscopic labral reconstruction is an effective and safe procedure that provides good short-term clinical outcomes in hips with insufficient and nonfunctional labra in the setting of FAI.
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Affiliation(s)
- Benjamin G Domb
- Benjamin G. Domb, American Hip Institute, 1010 Executive Court, Suite 250, Westmont, IL 60559.
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24
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Meng Q, Jin Z, Fisher J, Wilcox R. Comparison between FEBio and Abaqus for biphasic contact problems. Proc Inst Mech Eng H 2013; 227:1009-19. [PMID: 23804955 PMCID: PMC3834732 DOI: 10.1177/0954411913483537] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Articular cartilage plays an important role in the function of diarthrodial joints. Computational methods have been used to study the biphasic mechanics of cartilage, and Abaqus has been one of the most widely used commercial software packages for this purpose. A newly developed open-source finite element solver, FEBio, has been developed specifically for biomechanical applications. The aim of this study was to undertake a direct comparison between FEBio and Abaqus for some practical contact problems involving cartilage. Three model types, representing a porous flat-ended indentation test, a spherical-ended indentation test, and a conceptual natural joint contact model, were compared. In addition, a parameter sensitivity study was also performed for the spherical-ended indentation test to investigate the effects of changes in the input material properties on the model outputs, using both FEBio and Abaqus. Excellent agreement was found between FEBio and Abaqus for all of the model types and across the range of material properties that were investigated.
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Affiliation(s)
- Qingen Meng
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK.
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25
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Li J, Stewart TD, Jin Z, Wilcox RK, Fisher J. The influence of size, clearance, cartilage properties, thickness and hemiarthroplasty on the contact mechanics of the hip joint with biphasic layers. J Biomech 2013; 46:1641-7. [PMID: 23664238 PMCID: PMC3688071 DOI: 10.1016/j.jbiomech.2013.04.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 04/12/2013] [Accepted: 04/14/2013] [Indexed: 11/18/2022]
Abstract
Computational models of the natural hip joint are needed to examine and optimise tissue sparing interventions where the natural cartilage remains part of the bearing surfaces. Although the importance of interstitial fluid pressurisation in the performance of cartilage has long been recognized, few studies have investigated the time dependent interstitial fluid pressurisation in a three dimensional natural hip joint model. The primary aim of this study was to develop a finite element model of the natural hip incorporating the biphasic cartilage layers that was capable of simulating the joint response over a prolonged physiological loading period. An initial set of sensitivity studies were also undertaken to investigate the influence of hip size, clearance, cartilage properties, thickness and hemiarthroplasty on the contact mechanics of the joint. The contact stress, contact area, fluid pressure and fluid support ratio were calculated and cross-compared between models with different parameters to evaluate their influence. It was found that the model predictions for the period soon after loading were sensitive to the hip size, clearance, cartilage aggregate modulus, thickness and hemiarthroplasty, while the time dependent behaviour over 3000 s was influenced by the hip clearance and cartilage aggregate modulus, permeability, thickness and hemiarthroplasty. The modelling methods developed in this study provide a basic platform for biphasic simulation of the whole hip joint onto which more sophisticated material models or other input parameters could be added in the future.
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Affiliation(s)
- Junyan Li
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, UK.
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26
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Matsuda DK, Burchette RJ. Arthroscopic hip labral reconstruction with a gracilis autograft versus labral refixation: 2-year minimum outcomes. Am J Sports Med 2013; 41:980-7. [PMID: 23548806 DOI: 10.1177/0363546513482884] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is high interest but very little evidence to support labral reconstruction of the hip. Purpose/ HYPOTHESIS The purpose of this study was to determine the clinical effectiveness of arthroscopic hip labral reconstruction using gracilis autograft in the multistep surgeries for femoroacetabular impingement (FAI). The hypothesis was that patients undergoing arthroscopic hip labral reconstruction with gracilis autograft would have improvement in symptoms and function attributable to this procedure. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A comparative retrospective review at a large medical facility was performed of patients who underwent labral reconstruction with a gracilis autograft (RECON group) and those who underwent labral refixation (REFIX group) between October 2008 and November 2009. Inclusion criteria were adult patients having undergone arthroscopic surgery for symptomatic cam-pincer FAI without advanced radiographic osteoarthritis, who had both acetabular and femoral osteoplasties with a minimum 2-year follow-up. Patient satisfaction and preoperative and postoperative nonarthritic hip scores (NAHS) were obtained. Predictive modeling, linear regression, and a nested case-control study were performed. RESULTS A total of 54 patients met the inclusion criteria. The RECON group (n = 8; mean age, 34.6 years; range, 18-58 years) with an average 30-month follow-up (range, 24-37 months) and 100% participation reported a high level of patient satisfaction (7 high, 1 moderate). The mean NAHS improved by 50.5 points (P = .008) in the RECON group and 22.5 points (P < .0001) in the REFIX group; however, the preoperative NAHS was lower (P < .05) in the RECON group than in the REFIX group. Only the surgery group (RECON vs REFIX) and the preoperative NAHS were significantly associated with the NAHS at follow-up. The predictive model and linear regression revealed a 15.0- and 14.6-point increase, respectively, in the postoperative NAHS in the RECON group compared with the REFIX group. There were no major complications, revision surgeries, or conversion arthroplasties after labral reconstruction. CONCLUSION Arthroscopic hip labral reconstruction with gracilis tendon autograft is a safe and effective procedure. Patients undergoing labral reconstruction may not necessarily have outcomes inferior to those of patients undergoing labral refixation despite more severe initial labral insufficiency.
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Affiliation(s)
- Dean K Matsuda
- Kaiser West Los Angeles Medical Center, 6041 Cadillac Avenue, Los Angeles, CA 90034, USA.
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Physeal cartilage exhibits rapid consolidation and recovery in intact knees that are physiologically loaded. J Biomech 2013; 46:1516-23. [DOI: 10.1016/j.jbiomech.2013.03.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 03/23/2013] [Accepted: 03/30/2013] [Indexed: 11/20/2022]
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Nagel T, Kelly DJ. The Composition of Engineered Cartilage at the Time of Implantation Determines the Likelihood of Regenerating Tissue with a Normal Collagen Architecture. Tissue Eng Part A 2013; 19:824-33. [DOI: 10.1089/ten.tea.2012.0363] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Thomas Nagel
- 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
- Department of Environmental Informatics, Helmholtz Centre for Environmental Research UFZ, Leipzig, Germany
| | - Daniel 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
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Henak CR, Anderson AE, Weiss JA. Subject-specific analysis of joint contact mechanics: application to the study of osteoarthritis and surgical planning. J Biomech Eng 2013; 135:021003. [PMID: 23445048 PMCID: PMC3705883 DOI: 10.1115/1.4023386] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 01/03/2013] [Accepted: 01/18/2013] [Indexed: 11/08/2022]
Abstract
Advances in computational mechanics, constitutive modeling, and techniques for subject-specific modeling have opened the door to patient-specific simulation of the relationships between joint mechanics and osteoarthritis (OA), as well as patient-specific preoperative planning. This article reviews the application of computational biomechanics to the simulation of joint contact mechanics as relevant to the study of OA. This review begins with background regarding OA and the mechanical causes of OA in the context of simulations of joint mechanics. The broad range of technical considerations in creating validated subject-specific whole joint models is discussed. The types of computational models available for the study of joint mechanics are reviewed. The types of constitutive models that are available for articular cartilage are reviewed, with special attention to choosing an appropriate constitutive model for the application at hand. Issues related to model generation are discussed, including acquisition of model geometry from volumetric image data and specific considerations for acquisition of computed tomography and magnetic resonance imaging data. Approaches to model validation are reviewed. The areas of parametric analysis, factorial design, and probabilistic analysis are reviewed in the context of simulations of joint contact mechanics. Following the review of technical considerations, the article details insights that have been obtained from computational models of joint mechanics for normal joints; patient populations; the study of specific aspects of joint mechanics relevant to OA, such as congruency and instability; and preoperative planning. Finally, future directions for research and application are summarized.
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Affiliation(s)
- Corinne R. Henak
- Department of Bioengineering,University of Utah,Salt Lake City, UT 84112;Scientific Computing and Imaging Institute,University of Utah,Salt Lake City, UT 84112
| | - Andrew E. Anderson
- Department of Bioengineering,University of Utah,Salt Lake City, UT;Scientific Computing and Imaging Institute,University of Utah,Salt Lake City, UT;Department of Orthopaedics,University of Utah,Salt Lake City, UT 84108;Department of Physical Therapy,University of Utah,Salt Lake City, UT 84108
| | - Jeffrey A. Weiss
- Department of Bioengineering,University of Utah,Salt Lake City, UT 84108;Scientific Computing and Imaging Institute,University of Utah,Salt Lake City, UT 84108;Department of Orthopaedics,University of Utah,Salt Lake City, UT 84108e-mail:
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