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Koyanagi M, Matsuo T, Nakae N, Okimoto R, Nobekawa S, Tsukuda H, Ogasawara I, Shino K. Leaf spring exercise: A safe quadriceps strengthening exercise after anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2024; 113:106213. [PMID: 38458001 DOI: 10.1016/j.clinbiomech.2024.106213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Leg extensions should be avoided in the early stages after anterior cruciate ligament reconstruction because the force exerted by the quadriceps muscle leads to anterior tibial displacement. To allow for safe quadriceps training in the knee extension range during this period, we devised the leaf spring exercise, which involves placing subjects in the prone position with their knee slightly flexed and instructing them to perform maximum isometric quadriceps contractions while supporting the proximal region of the lower leg's anterior surface and immobilizing the femur's posterior surface to prevent lifting. The current study aimed to examine the safety of Leaf spring exercise by determining the femur-tibia relationship using ultrasound imaging. METHODS This controlled laboratory study included patients with unilateral anterior cruciate ligament-deficient knees (8 men and 8 women; age, 24.2 ± 8.3 years) who were instructed to perform Leaf spring exercise of both lower limbs. We measured the femur-tibia-step-off, which indicates the distance between the last point of the medial and lateral condyles of the femur and posterior margin of the tibial plateau, as a parameter to evaluate anterior tibial displacement via ultrasound diagnostic device. Further, peak torque of the quadriceps muscle was calculated using force measurement device. FINDINGS No difference in anterior tibial displacement and peak torque was observed between the uninjured and injured sides during Leaf spring exercise. INTERPRETATION Leaf spring exercise may add some strain on the reconstructed anterior cruciate ligament; hence, it can be considered a safe quadriceps exercise in the knee extension range.
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Affiliation(s)
- Maki Koyanagi
- Faculty of Medical Science and Health-Promotion, Osaka Electro-communication University, 1130-70 Kiyotaki, Shijonawate, Osaka 575-0063, Japan.
| | - Takayuki Matsuo
- Osaka Yukioka College of Health Science, 1 Chome, 1-41 Sojiji, Ibaraki, Osaka 567-0801, Japan
| | - Naruhiko Nakae
- Department of Rehabilitation, Kansai Medical Hospital, 1 Chome-1-7-2 Shinsenri Nishimachi, Toyonaka, Osaka 560-0083, Japan
| | - Ryo Okimoto
- Department of Rehabilitation, Yokoi Health Care Sports Clinic, 1 Chome-1-31 Nishimidorigaoka, Toyonaka, Osaka 560-0005, Japan
| | - Shota Nobekawa
- Department of Rehabilitation, Yukioka Hospital, 2 Chome-2-3 Ukida, Kita Ward, Osaka 530-0021, Japan
| | - Hideki Tsukuda
- Department of Rehabilitation, Yukioka Hospital, 2 Chome-2-3 Ukida, Kita Ward, Osaka 530-0021, Japan
| | - Issei Ogasawara
- Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, 2 Chome-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Konsei Shino
- Sports Orthopaedic Surgery Center, Yukioka Hospital, 2 Chome-2-3 Ukida, Kita Ward, Osaka 530-0021, Japan
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Coburn SL, Crossley KM, Kemp JL, Warden SJ, West TJ, Bruder AM, Mentiplay BF, Culvenor AG. Immediate and Delayed Effects of Joint Loading Activities on Knee and Hip Cartilage: A Systematic Review and Meta-analysis. SPORTS MEDICINE - OPEN 2023; 9:56. [PMID: 37450202 PMCID: PMC10348990 DOI: 10.1186/s40798-023-00602-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 06/19/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The impact of activity-related joint loading on cartilage is not clear. Abnormal loading is considered to be a mechanical driver of osteoarthritis (OA), yet moderate amounts of physical activity and rehabilitation exercise can have positive effects on articular cartilage. Our aim was to investigate the immediate effects of joint loading activities on knee and hip cartilage in healthy adults, as assessed using magnetic resonance imaging. We also investigated delayed effects of activities on healthy cartilage and the effects of activities on cartilage in adults with, or at risk of, OA. We explored the association of sex, age and loading duration with cartilage changes. METHODS A systematic review of six databases identified studies assessing change in adult hip and knee cartilage using MRI within 48 h before and after application of a joint loading intervention/activity. Studies included adults with healthy cartilage or those with, or at risk of, OA. Joint loading activities included walking, hopping, cycling, weightbearing knee bends and simulated standing within the scanner. Risk of bias was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analysis estimated the percentage change in compartment-specific cartilage thickness or volume and composition (T2 relaxation time) outcomes. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system evaluated certainty of evidence. RESULTS Forty studies of 653 participants were included after screening 5159 retrieved studies. Knee cartilage thickness or volume decreased immediately following all loading activities investigating healthy adults; however, GRADE assessment indicated very low certainty evidence. Patellar cartilage thickness and volume reduced 5.0% (95% CI 3.5, 6.4, I2 = 89.3%) after body weight knee bends, and tibial cartilage composition (T2 relaxation time) decreased 5.1% (95% CI 3.7, 6.5, I2 = 0.0%) after simulated standing within the scanner. Hip cartilage data were insufficient for pooling. Secondary outcomes synthesised narratively suggest knee cartilage recovers within 30 min of walking and 90 min of 100 knee bends. We found contrasting effects of simulated standing and walking in adults with, or at risk of, OA. An increase of 10 knee bend repetitions was associated with 2% greater reduction in patellar thickness or volume. CONCLUSION There is very low certainty evidence that minimal knee cartilage thickness and volume and composition (T2 relaxation time) reductions (0-5%) occur after weightbearing knee bends, simulated standing, walking, hopping/jumping and cycling, and the impact of knee bends may be dose dependent. Our findings provide a framework of cartilage responses to loading in healthy adults which may have utility for clinicians when designing and prescribing rehabilitation programs and providing exercise advice.
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Affiliation(s)
- Sally L. Coburn
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
| | - Kay M. Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
| | - Joanne L. Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
| | - Stuart J. Warden
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
- Department of Physical Therapy, School of Health & Human Sciences, Indiana University, Indianapolis, IN USA
| | - Tom J. West
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
| | - Andrea M. Bruder
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
| | - Benjamin F. Mentiplay
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
| | - Adam G. Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
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Fleischer MM, Hartner SE, Newton MD, Baker KC, Maerz T. Early patellofemoral cartilage and bone pathology in a rat model of noninvasive anterior cruciate ligament rupture. Connect Tissue Res 2023; 64:175-185. [PMID: 36318110 DOI: 10.1080/03008207.2022.2136571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Anterior cruciate ligament rupture (ACLR) is a risk factor for the development of post-traumatic osteoarthritis (PTOA). While PTOA in the tibiofemoral joint compartment is well-characterized, very little is known about pathology in the patellofemoral compartment after ACL injury. Here, we evaluated the extent to which ACLR induces early patellofemoral joint damage in a rat model. METHODS Adult female Lewis rats were randomized to noninvasive ACLR or Sham. Two weeks post-injury, contrast-enhanced micro-computed tomography (µCT) of femoral and patellar cartilage was performed using 20% v/v ioxaglate. Morphometric parameters of femoral trochlear and patellar cartilage, subchondral bone, and trabecular bone were derived from µCT. Sagittal Safranin-O/Fast-Green-stained histologic sections were graded using the OARSI score in a blinded fashion. RESULTS Cartilage and bone remodelling consistent with an early PTOA phenotype were observed in both femoral trochleas and patellae. ACLR caused osteophyte formation of the patella and pathology in the superficial zone of articular cartilage, including surface fibrillation, fissures, increased cellularity, and abnormal chondrocyte clustering. There were significant increases in thickness of patellar and trochlear cartilage. Loss of subchondral bone thickness, bone volume fraction, and tissue mineral density, as well as changes to patellar and trochlear trabecular microarchitecture, were indicative of catabolic bone remodelling. Several injury-induced changes, including increased cartilage thickness and trabecular spacing and decreased trabecular number were more severe in the patella compared to the trochlea. CONCLUSION The patellofemoral joint develops mild but evident pathology in the early period following ACL rupture, extending the utility of this model to the study of patellofemoral PTOA.
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Affiliation(s)
| | | | - Michael D Newton
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI, USA
| | - Kevin C Baker
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI, USA
- Bone & Joint Center, Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Tristan Maerz
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
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Design and validation of a semi-automatic bone segmentation algorithm from MRI to improve research efficiency. Sci Rep 2022; 12:7825. [PMID: 35551485 PMCID: PMC9098419 DOI: 10.1038/s41598-022-11785-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/22/2022] [Indexed: 11/24/2022] Open
Abstract
Segmentation of medical images into different tissue types is essential for many advancements in orthopaedic research; however, manual segmentation techniques can be time- and cost-prohibitive. The purpose of this work was to develop a semi-automatic segmentation algorithm that leverages gradients in spatial intensity to isolate the patella bone from magnetic resonance (MR) images of the knee that does not require a training set. The developed algorithm was validated in a sample of four human participants (in vivo) and three porcine stifle joints (ex vivo) using both magnetic resonance imaging (MRI) and computed tomography (CT). We assessed the repeatability (expressed as mean ± standard deviation) of the semi-automatic segmentation technique on: (1) the same MRI scan twice (Dice similarity coefficient = 0.988 ± 0.002; surface distance = − 0.01 ± 0.001 mm), (2) the scan/re-scan repeatability of the segmentation technique (surface distance = − 0.02 ± 0.03 mm), (3) how the semi-automatic segmentation technique compared to manual MRI segmentation (surface distance = − 0.02 ± 0.08 mm), and (4) how the semi-automatic segmentation technique compared when applied to both MRI and CT images of the same specimens (surface distance = − 0.02 ± 0.06 mm). Mean surface distances perpendicular to the cartilage surface were computed between pairs of patellar bone models. Critically, the semi-automatic segmentation algorithm developed in this work reduced segmentation time by approximately 75%. This method is promising for improving research throughput and potentially for use in generating training data for deep learning algorithms.
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Pimenta L, Garcia NM, Zdravevski E, Chorbev I, Trajkovik V, Lameski P, Albuquerque C, Pires IM. Can the Eight Hop Test Be Measured with Sensors? A Systematic Review. SENSORS 2022; 22:s22093582. [PMID: 35591272 PMCID: PMC9105795 DOI: 10.3390/s22093582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 02/01/2023]
Abstract
Rehabilitation aims to increase the independence and physical function after injury, surgery, or other trauma, so that patients can recover to their previous ability as much as possible. To be able to measure the degree of recovery and impact of the treatment, various functional performance tests are used. The Eight Hop Test is a hop exercise that is directly linked to the rehabilitation of people suffering from tendon and ligament injuries on the lower limb. This paper presents a systematic review on the use of sensors for measuring functional movements during the execution of the Eight Hop Test, focusing primarily on the use of sensors, related diseases, and different methods implemented. Firstly, an automated search was performed on the publication databases: PubMed, Springer, ACM, IEEE Xplore, MDPI, and Elsevier. Secondly, the publications related to the Eight-Hop Test and sensors were filtered according to several search criteria and 15 papers were finally selected to be analyzed in detail. Our analysis found that the Eight Hop Test measurements can be performed with motion, force, and imaging sensors.
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Affiliation(s)
- Luís Pimenta
- Escola de Ciências e Tecnologia, University of Trás-os-Montes e Alto Douro, Quinta de Prados, 5001-801 Vila Real, Portugal;
| | - Nuno M. Garcia
- Instituto de Telecomunicações, Universidade da Beira Interior, 6200-001 Covilhã, Portugal;
| | - Eftim Zdravevski
- Faculty of Computer Science and Engineering, University Ss Cyril and Methodius, 1000 Skopje, North Macedonia; (E.Z.); (I.C.); (V.T.); (P.L.)
| | - Ivan Chorbev
- Faculty of Computer Science and Engineering, University Ss Cyril and Methodius, 1000 Skopje, North Macedonia; (E.Z.); (I.C.); (V.T.); (P.L.)
| | - Vladimir Trajkovik
- Faculty of Computer Science and Engineering, University Ss Cyril and Methodius, 1000 Skopje, North Macedonia; (E.Z.); (I.C.); (V.T.); (P.L.)
| | - Petre Lameski
- Faculty of Computer Science and Engineering, University Ss Cyril and Methodius, 1000 Skopje, North Macedonia; (E.Z.); (I.C.); (V.T.); (P.L.)
| | - Carlos Albuquerque
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3046-851 Coimbra, Portugal;
- Higher School of Health, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal
- Child Studies Research Center (CIEC), University of Minho, 4710-057 Braga, Portugal
| | - Ivan Miguel Pires
- Escola de Ciências e Tecnologia, University of Trás-os-Montes e Alto Douro, Quinta de Prados, 5001-801 Vila Real, Portugal;
- Instituto de Telecomunicações, Universidade da Beira Interior, 6200-001 Covilhã, Portugal;
- Correspondence: ; Tel.: +351-966-379-785
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Tamayo KS, Heckelman LN, Spritzer CE, DeFrate LE, Collins AT. Obesity impacts the mechanical response and biochemical composition of patellofemoral cartilage: An in vivo, MRI-based investigation. J Biomech 2022; 134:110991. [PMID: 35176590 PMCID: PMC11103252 DOI: 10.1016/j.jbiomech.2022.110991] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/26/2022] [Accepted: 02/03/2022] [Indexed: 12/15/2022]
Abstract
Obesity is a primary risk factor for osteoarthritis. While previous work has addressed relationships between in vivo cartilage mechanics, composition, and obesity in the tibiofemoral joint, there is limited information on these relationships in the patellofemoral joint. The purpose of this study was to compare the patellofemoral cartilage mechanical response to walking in participants with normal and obese body mass indices (BMIs). Additionally, patellar cartilage T1rho relaxation times were measured before exercise to characterize the biochemical composition of the tissue. Fifteen participants (eight with normal BMI and seven with obese BMI) underwent baseline magnetic resonance imaging (MRI) of their right knee. They then walked on a treadmill for 20 min at a speed normalized to their leg length before a second MRI scan. Subsequently, three-dimensional models of the bones and articular surfaces of the patellofemoral joint were created via manual segmentation of the pre- and post-exercise MR images to compute cartilage thickness and strain. Strain was defined as the change in patellofemoral cartilage thickness normalized to the baseline thickness. Results showed that participants with an obese BMI exhibited significantly increased patellofemoral cartilage strain compared to those with a normal BMI (5.4 ± 4% vs. 1.7 ± 3%, respectively; p = 0.003). Furthermore, patellar cartilage T1rho values were significantly higher in participants with obese versus normal BMIs (95 ms vs. 83 ms, respectively; p = 0.049), indicative of decreased proteoglycan content in those with an obese BMI. In summary, the altered patellofemoral cartilage strain and composition observed in those with an obese BMI may be indicative of cartilage degeneration.
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Affiliation(s)
- K S Tamayo
- Department of Orthopaedic Surgery, Duke University, Durham, NC, United States
| | - L N Heckelman
- Department of Orthopaedic Surgery, Duke University, Durham, NC, United States; Department of Biomedical Engineering, Duke University, Durham, NC, United States
| | - C E Spritzer
- Department of Radiology, Duke University, Durham, NC, United States
| | - L E DeFrate
- Department of Orthopaedic Surgery, Duke University, Durham, NC, United States; Department of Biomedical Engineering, Duke University, Durham, NC, United States; Department of Mechanical Engineering & Materials Science, Duke University, Durham, NC, United States.
| | - A T Collins
- Department of Orthopaedic Surgery, Duke University, Durham, NC, United States
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Hip-Knee Joint Coordination Patterns are Associated With Patellofemoral Joint Cartilage Composition in Patients With Anterior Cruciate Ligament Reconstruction. J Appl Biomech 2022; 38:20-28. [PMID: 35042183 DOI: 10.1123/jab.2021-0111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 10/27/2021] [Accepted: 11/29/2021] [Indexed: 11/18/2022]
Abstract
Joint coordination variability during walking that is associated with patellofemoral joint cartilage degeneration after anterior cruciate ligament reconstruction are not well understood. The purpose of this study was to assess between-limb differences in joint coordination variability and to determine the relationship of coordination variability with postoperative patellofemoral joint cartilage composition. Thirty-five patients underwent bilateral gait analysis and a magnetic resonance exam of the reconstructed knee joint at 6 months post anterior cruciate ligament reconstruction. Vector coding was used to assess coordination variability during the early (1%-33%), mid (34%-66%), and late (67%-100%) stance phase. The T1ρ/T2 mapping was used to evaluate the glycosaminoglycan-collagen matrix of the patellar and femoral trochlear cartilage. Compared with the uninjured limb, the reconstructed limb exhibited higher hip sagittal/knee sagittal plane coordination variability during midstance as well as higher knee sagittal/ankle sagittal plane coordination variability during both mid and late stance. The hip sagittal/knee sagittal plane coordination variability during midstance predicted 14.6% of the variance in patellar cartilage T1ρ values within the reconstructed limb. In addition, sex of participants was able to predict 32.4% and 13.7% of the variance in femoral trochlea T1ρ and T2 values, respectively. The study results demonstrate that a multijoint mechanism may be associated with early patellofemoral joint cartilage degeneration at 6 months after anterior cruciate ligament reconstruction.
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Hwang JW, Chawla D, Han G, Eriten M, Henak CR. Effects of solvent osmolarity and viscosity on cartilage energy dissipation under high-frequency loading. J Mech Behav Biomed Mater 2021; 126:105014. [PMID: 34871958 DOI: 10.1016/j.jmbbm.2021.105014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/29/2021] [Accepted: 11/27/2021] [Indexed: 01/16/2023]
Abstract
Articular cartilage is a spatially heterogeneous, dissipative biological hydrogel with a high fluid volume fraction. Although energy dissipation is important in the context of delaying cartilage damage, the dynamic behavior of articular cartilage equilibrated in media of varied osmolarity and viscosity is not widely understood. This study investigated the mechanical behaviors of cartilage when equilibrated to media of varying osmolarity and viscosity. Dynamic moduli and phase shift were measured at both low (1 Hz) and high (75-300 Hz) frequency, with cartilage samples compressed to varied offset strain levels. Increasing solution osmolarity and viscosity both independently resulted in larger energy dissipation and decreased dynamic modulus of cartilage at both low and high frequency. Mechanical property alterations induced by varying osmolarity are likely due to the change in permeability and fluid volume fraction within the tissue. The effects of solution viscosity are likely due to frictional interactions at the solid-fluid interface, affecting energy dissipation. These findings highlight the significance of interstitial fluid on the energy dissipation capabilities of the tissue, which can influence the onset of cartilage damage.
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Affiliation(s)
- Jin Wook Hwang
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Dipul Chawla
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Guebum Han
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Melih Eriten
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Corinne R Henak
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA; Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA; Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA.
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Yue D, Du L, Zhang B, Wu H, Yang Q, Wang M, Pan J. Time-dependently Appeared Microenvironmental Changes and Mechanism after Cartilage or Joint Damage and the Influences on Cartilage Regeneration. Organogenesis 2021; 17:85-99. [PMID: 34806543 DOI: 10.1080/15476278.2021.1991199] [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] [Indexed: 12/15/2022] Open
Abstract
Cartilage and joint damage easily degenerates cartilage and turns into osteoarthritis (OA), which seriously affects human life and work, and has no cure currently. The temporal and spatial changes of multiple microenvironments upon the damage of cartilage and joint are noticed, including the emergences of inflammation, bone remodeling, blood vessels, and nerves, as well as alterations of extracellular and pericellular matrix, oxygen tension, biomechanics, underneath articular cartilage tissues, and pH value. This review summarizes the existing literatures on microenvironmental changes, mechanisms, and their negative effects on cartilage regeneration following cartilage and joint damage. We conclude that time-dependently rebuilding the multiple normal microenvironments of damaged cartilage is the key for cartilage regeneration after systematic studies for the timing and correlations of various microenvironment changes.
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Affiliation(s)
- Danyang Yue
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, Bioengineering College, Chongqing University, Chongqing, PR China
| | - Lin Du
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, Bioengineering College, Chongqing University, Chongqing, PR China
| | - Bingbing Zhang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, Bioengineering College, Chongqing University, Chongqing, PR China
| | - Huan Wu
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, Bioengineering College, Chongqing University, Chongqing, PR China
| | - Qiong Yang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, Bioengineering College, Chongqing University, Chongqing, PR China
| | - Min Wang
- Orthopedic Department, Xinqiao Hospital, Army Medical University, Chongqing, PR China
| | - Jun Pan
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, Bioengineering College, Chongqing University, Chongqing, PR China
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Rooks NB, Schneider MTY, Erdemir A, Halloran JP, Laz PJ, Shelburne KB, Hume DR, Imhauser CW, Zaylor W, Elmasry S, Schwartz A, Chokhandre SK, Abdollahi Nohouji N, Besier TF. A Method to Compare Heterogeneous Types of Bone and Cartilage Meshes. J Biomech Eng 2021; 143:111002. [PMID: 34041519 PMCID: PMC8299816 DOI: 10.1115/1.4051281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/16/2021] [Indexed: 01/29/2023]
Abstract
Accurately capturing the bone and cartilage morphology and generating a mesh remains a critical step in the workflow of computational knee joint modeling. Currently, there is no standardized method to compare meshes of different element types and nodal densities, making comparisons across research teams a significant challenge. The aim of this paper is to describe a method to quantify differences in knee joint bone and cartilages meshes, independent of bone and cartilage mesh topology. Bone mesh-to-mesh distances, subchondral bone boundaries, and cartilage thicknesses from meshes of any type of mesh are obtained using a series of steps involving registration, resampling, and radial basis function fitting after which the comparisons are performed. Subchondral bone boundaries and cartilage thicknesses are calculated and visualized in a common frame of reference for comparison. The established method is applied to models developed by five modeling teams. Our approach to obtain bone mesh-to-mesh distances decreased the divergence seen in selecting a reference mesh (i.e., comparing mesh A-to-B versus mesh B-to-A). In general, the bone morphology was similar across teams. The cartilage thicknesses for all models were calculated and the mean absolute cartilage thickness difference was presented, the articulating areas had the best agreement across teams. The teams showed disagreement on the subchondral bone boundaries. The method presented in this paper allows for objective comparisons of bone and cartilage geometry that is agnostic to mesh type and nodal density.
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Affiliation(s)
- Nynke B. Rooks
- Auckland Bioengineering Institute, University of Auckland, Level 6/70 Symonds Street, Auckland, Grafton 1010, New Zealand
| | - Marco T. Y. Schneider
- Auckland Bioengineering Institute, University of Auckland, Level 6/70 Symonds Street, Auckland, Grafton 1010, New Zealand
| | - Ahmet Erdemir
- Department of Biomedical Engineering & Computational Biomodeling (CoBi) Core, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue (ND20), Cleveland, OH 44195
| | - Jason P. Halloran
- Applied Sciences Laboratory, Institute for Shock Physics, Washington State University, 1455 East College Avenue, Spokane, Pullman, WA 99164
| | - Peter J. Laz
- Department of Mechanical and Materials Engineering, University of Denver, 2155 East Wesley Avenue, Denver, CO 80210; Center for Orthopaedic Biomechanics, University of Denver, 2155 East Wesley Avenue, Denver, CO 80210
| | - Kevin B. Shelburne
- Department of Mechanical and Materials Engineering, University of Denver, 2155 East Wesley Avenue, Denver, CO 80210; Center for Orthopaedic Biomechanics, University of Denver, 2155 East Wesley Avenue, Denver, CO 80210
| | - Donald R. Hume
- Department of Mechanical and Materials Engineering, University of Denver, 2155 East Wesley Avenue, Denver, CO 80210; Center for Orthopaedic Biomechanics, University of Denver, 2155 East Wesley Avenue, Denver, CO 80210
| | - Carl W. Imhauser
- Department of Biomechanics, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | - William Zaylor
- Department of Mechanical Engineering, Cleveland State University, 1960 East 24th Street, Cleveland, OH 44115; Center for Human Machine Systems, Cleveland State University, 1960 East 24th Street, Cleveland, OH 44115
| | - Shady Elmasry
- Department of Biomechanics, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | - Ariel Schwartz
- Department of Biomedical Engineering & Computational Biomodeling (CoBi) Core, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue (ND20), Cleveland, OH 44195
| | - Snehal K. Chokhandre
- Department of Biomedical Engineering & Computational Biomodeling (CoBi) Core, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue (ND20), Cleveland, OH 44195
| | - Neda Abdollahi Nohouji
- Department of Mechanical Engineering, Cleveland State University, 1960 East 24th Street, Cleveland, OH 44115; Center for Human Machine Systems, Cleveland State University, 1960 East 24th Street, Cleveland, OH 44115; Department of Biomedical Engineering & Computational Biomodeling (CoBi) Core, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue (ND20), Cleveland, OH 44195
| | - Thor F. Besier
- Auckland Bioengineering Institute, University of Auckland, Level 6/70 Symonds Street, Grafton, Auckland 1010, New Zealand; Department of Engineering Science, Faculty of Engineering, University of Auckland, Level 6/70 Symonds Street, Grafton, Auckland 1010, New Zealand
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Englander ZA, Lau BC, Wittstein JR, Goode AP, DeFrate LE. Patellar Tendon Orientation and Strain Are Predictors of ACL Strain In Vivo During a Single-Leg Jump. Orthop J Sports Med 2021; 9:2325967121991054. [PMID: 33796591 PMCID: PMC7983247 DOI: 10.1177/2325967121991054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/23/2020] [Indexed: 11/25/2022] Open
Abstract
Background: There is little in vivo data that describe the relationships between patellar
tendon orientation, patellar tendon strain, and anterior cruciate ligament
(ACL) strain during dynamic activities. Quantifying how the quadriceps load
the ACL via the patellar tendon is important for understanding ACL injury
mechanisms. Hypothesis: We hypothesized that flexion angle, patellar tendon orientation, and patellar
tendon strain influence ACL strain during a single-leg jump. Specifically,
we hypothesized that patellar tendon and ACL strains would increase
concurrently when the knee is positioned near extension during the jump. Study Design: Descriptive laboratory study. Methods: Models of the femur, tibia, ACL, patellar tendon, and quadriceps tendon
attachment sites of 8 male participants were generated from magnetic
resonance imaging (MRI). High-speed biplanar radiographs during a single-leg
jump were obtained. The bone models were registered to the radiographs,
thereby reproducing the in vivo positions of the bones, ligament, and tendon
attachment sites. Flexion angle, patellar tendon orientation, patellar
tendon strain, and ACL strain were measured from the registered models. ACL
and patellar tendon strains were approximated by normalizing their length at
each knee position to their length at the time of MRI. Two separate
bivariate linear regression models were used to assess relationships between
flexion angle and patellar tendon orientation and between ACL strain and
patellar tendon strain. A multivariate linear regression model was used to
assess whether flexion angle and patellar tendon strain were significant
predictors of ACL strain during the inflight and landing portions of the
jump. Results: Both flexion angle and patellar tendon strain were significant predictors
(P < .05) of ACL strain. These results indicate that
elevated ACL and patellar tendon strains were observed concurrently when the
knee was positioned near extension. Conclusion: Concurrent increases in patellar tendon and ACL strains indicate that the
quadriceps load the ACL via the patellar tendon when the knee is positioned
near extension. Clinical Relevance: Increased ACL strain when the knee is positioned near extension before
landing may be due to quadriceps contraction. Thus, landing with
unanticipated timing on an extended knee may increase vulnerability to ACL
injury as a taut ligament is more likely to fail.
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Affiliation(s)
- Zoë A Englander
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.,Duke Sport Science Institute, Department of Orthopaedics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Brian C Lau
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.,Duke Sport Science Institute, Department of Orthopaedics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jocelyn R Wittstein
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.,Duke Sport Science Institute, Department of Orthopaedics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Adam P Goode
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.,Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Louis E DeFrate
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.,Duke Sport Science Institute, Department of Orthopaedics, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
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12
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Heckelman LN, Riofrio AD, Vinson EN, Collins AT, Gwynn OR, Utturkar GM, Goode AP, Spritzer CE, DeFrate LE. Dose and Recovery Response of Patellofemoral Cartilage Deformations to Running. Orthop J Sports Med 2020; 8:2325967120967512. [PMID: 33344670 PMCID: PMC7731713 DOI: 10.1177/2325967120967512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/18/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Running is a common recreational activity that provides many health benefits. However, it remains unclear how patellofemoral cartilage is affected by varied running distances and how long it takes the cartilage to recover to its baseline state after exercise. Hypothesis: We hypothesized that patellofemoral cartilage thickness would decrease immediately after exercise and return to its baseline thickness by the following morning in asymptomatic male runners. We further hypothesized that we would observe a significant distance-related dose response, with larger compressive strains (defined here as the mean change in cartilage thickness measured immediately after exercise, divided by the pre-exercise cartilage thickness) observed immediately after 10-mile runs compared with 3-mile runs. Study Design: Descriptive laboratory study. Methods: Eight asymptomatic male participants underwent magnetic resonance imaging of their dominant knee before, immediately after, and 24 hours after running 3 and 10 miles at a self-selected pace (on separate visits). Results: Mean patellar cartilage thicknesses measured before exercise and after the 24-hour recovery period were significantly greater than the thicknesses measured immediately after both the 3- and 10-mile runs (P < .001). This relationship was not observed in trochlear cartilage. Mean patellar cartilage compressive strains were significantly greater after 10-mile runs compared with 3-mile runs (8% vs 5%; P = .01). Conclusion: Patellar cartilage thickness decreased immediately after running and returned to its baseline thickness within 24 hours of running up to 10 miles. Furthermore, patellar cartilage compressive strains were dose-dependent immediately after exercise. Clinical Relevance: These findings provide critical baseline data for understanding patellofemoral cartilage biomechanics in asymptomatic male runners that may be used to optimize exercise protocols and investigations targeting those with running-induced patellofemoral pain.
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Affiliation(s)
- Lauren N Heckelman
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina, USA
| | - Alexie D Riofrio
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Emily N Vinson
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Amber T Collins
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Olivia R Gwynn
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina, USA
| | - Gangadhar M Utturkar
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Adam P Goode
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Charles E Spritzer
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Louis E DeFrate
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina, USA.,Department of Mechanical Engineering & Materials Science, Pratt School of Engineering, Duke University, Durham, North Carolina, USA
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13
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Sakamoto Y, Tsukada H, Sasaki S, Kimura Y, Yamamoto Y, Tsuda E, Ishibashi Y. Effects of the tibial tunnel position on knee joint stability and meniscal contact pressure after double-bundle anterior cruciate ligament reconstruction. J Orthop Sci 2020; 25:1040-1046. [PMID: 31937484 DOI: 10.1016/j.jos.2019.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/13/2019] [Accepted: 12/12/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND To investigate the effect of the tibial tunnel position on knee stability and the maximum contact area and peak contact pressure on the menisci after double-bundle anterior cruciate ligament (ACL) reconstruction. METHODS Ten human knee specimens (mean age: 74.1 ± 15.8 years) were used in this study. The anterior tibial loading test was conducted using a material testing machine at 30°, 60°, and 90° of knee flexion, with the anterior tibial translation (ATT) and the maximum contact area and peak contact pressure on the menisci measured. Outcome measures were compared between the following groups: 1) intact ACL (intact group); 2) anatomical tibial tunnel position (anatomical group) and 3) posterior tibial tunnel position (posterior group) with double-bundle reconstruction, and 4) ACL-deficient (deficient group). RESULTS In response to a 100 N anterior tibial load, the ATT was greater for the posterior and ACL-deficient groups compared to that in the intact group. The normalized maximum contact area of the medial meniscus significantly decreased for the posterior group compared to that in the intact group. The normalized peak contact pressure on the medial meniscus increased in all groups compared to that in the intact group, but with no between-group differences in pressure applied to the lateral meniscus. CONCLUSIONS ATT and contact pressure on the medial meniscus increased, concomitant with a decrease in contact area of the medial meniscus, as the position of the tibial tunnel position moved towards a posterior position.
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Affiliation(s)
- Yukiko Sakamoto
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - Harehiko Tsukada
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shizuka Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuka Kimura
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuji Yamamoto
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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14
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Owusu-Akyaw KA. Editorial Commentary: Advances in 3-Dimensional Imaging are the Key to Improving our Surgical Precision in Hip Arthroscopy and Beyond. Arthroscopy 2019; 35:2866-2867. [PMID: 31604506 DOI: 10.1016/j.arthro.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 02/02/2023]
Abstract
Advances in high-resolution magnetic resonance imaging have driven a wealth of knowledge in orthopaedic basic science. The application of these novel techniques to clinical practice is the next logical step for enhancing our understanding of intra-articular pathology and morphology. The specific diagnostic challenge presented by hip labral and chondral pathology is a particular point of interest, given the increasing popularity of hip arthroscopy. As our field continues to progress in complexity, the integration of new, higher-resolution imaging sequences such as multiple-echo recombined gradient echo and double-echo steady state provide the potential to enhance preoperative planning and ultimately the effectiveness of our arthroscopic techniques.
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15
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DeFrate LE, Kim-Wang SY, Englander ZA, McNulty AL. Osteoarthritis year in review 2018: mechanics. Osteoarthritis Cartilage 2019; 27:392-400. [PMID: 30597275 PMCID: PMC6489451 DOI: 10.1016/j.joca.2018.12.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To review recent biomechanics literature focused on the interactions between biomechanics and articular cartilage health, particularly focused on macro-scale and human studies. DESIGN A literature search was conducted in PubMed using the search terms (biomechanics AND osteoarthritis) OR (biomechanics AND cartilage) OR (mechanics AND osteoarthritis) OR (mechanics AND cartilage) for publications from April 2017 to April 2018. RESULTS Abstracts from the 559 articles generated from the literature search were reviewed. Due to the wide range of topics, 62 full texts with a focus on in vivo biomechanical studies were included for further discussion. Several overarching themes in the recent literature were identified and are summarized, including 1) new methods to detect early osteoarthritis (OA) development, 2) studies describing healthy and OA cartilage and biomechanics, 3) ACL injury and OA development, 4) meniscus injury and OA development, and 5) OA prevention, treatment, and management. CONCLUSIONS Mechanical loading is a critical factor in the maintenance of joint health. Abnormal mechanical loading can lead to the onset and progression of OA. Thus, recent studies have utilized various biomechanical models to better describe the etiology of OA development and the subsequent effects of OA on the mechanics of joint tissues and whole body biomechanics.
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Affiliation(s)
- Louis E. DeFrate
- Department of Orthopaedic Surgery, Duke University School of Medicine, Duke University, Durham, North Carolina, USA,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA,Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Sophia Y. Kim-Wang
- Department of Orthopaedic Surgery, Duke University School of Medicine, Duke University, Durham, North Carolina, USA,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Zoë A. Englander
- Department of Orthopaedic Surgery, Duke University School of Medicine, Duke University, Durham, North Carolina, USA,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Amy L. McNulty
- Department of Orthopaedic Surgery, Duke University School of Medicine, Duke University, Durham, North Carolina, USA,Department of Pathology, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
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16
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Sutter EG, Liu B, Utturkar GM, Widmyer MR, Spritzer CE, Cutcliffe HC, Englander ZA, Goode AP, Garrett WE, DeFrate LE. Effects of Anterior Cruciate Ligament Deficiency on Tibiofemoral Cartilage Thickness and Strains in Response to Hopping. Am J Sports Med 2019; 47:96-103. [PMID: 30365903 PMCID: PMC6559720 DOI: 10.1177/0363546518802225] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Changes in knee kinematics after anterior cruciate ligament (ACL) injury may alter loading of the cartilage and thus affect its homeostasis, potentially leading to the development of posttraumatic osteoarthritis. However, there are limited in vivo data to characterize local changes in cartilage thickness and strain in response to dynamic activity among patients with ACL deficiency. PURPOSE/HYPOTHESIS The purpose was to compare in vivo tibiofemoral cartilage thickness and cartilage strain resulting from dynamic activity between ACL-deficient and intact contralateral knees. It was hypothesized that ACL-deficient knees would show localized reductions in cartilage thickness and elevated cartilage strains. STUDY DESIGN Controlled laboratory study. METHODS Magnetic resonance images were obtained before and after single-legged hopping on injured and uninjured knees among 8 patients with unilateral ACL rupture. Three-dimensional models of the bones and articular surfaces were created from the pre- and postactivity scans. The pre- and postactivity models were registered to each other, and cartilage strain (defined as the normalized difference in cartilage thickness pre- and postactivity) was calculated in regions across the tibial plateau, femoral condyles, and femoral cartilage adjacent to the medial intercondylar notch. These measurements were compared between ACL-deficient and intact knees. Differences in cartilage thickness and strain between knees were tested with multiple analysis of variance models with alpha set at P < .05. RESULTS Compressive strain in the intercondylar notch was elevated in the ACL-deficient knee relative to the uninjured knee. Furthermore, cartilage in the intercondylar notch and adjacent medial tibia was significantly thinner before activity in the ACL-deficient knee versus the intact knee. In these 2 regions, thinning was significantly influenced by time since injury, with patients with more chronic ACL deficiency (>1 year since injury) experiencing greater thinning. CONCLUSION Among patients with ACL deficiency, the medial femoral condyle adjacent to the intercondylar notch in the ACL-deficient knee exhibited elevated cartilage strain and loss of cartilage thickness, particularly with longer time from injury. It is hypothesized that these changes may be related to posttraumatic osteoarthritis development. CLINICAL RELEVANCE This study suggests that altered mechanical loading is related to localized cartilage thinning after ACL injury.
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Affiliation(s)
- E. Grant Sutter
- Department of Orthopaedic Surgery, Duke University, Durham,
NC
| | - Betty Liu
- Department of Biomedical Engineering, Duke University,
Durham, NC
| | | | | | | | | | - Zoë A. Englander
- Department of Biomedical Engineering, Duke University,
Durham, NC
| | - Adam P. Goode
- Department of Orthopaedic Surgery, Duke University, Durham,
NC
| | | | - Louis E. DeFrate
- Department of Orthopaedic Surgery, Duke University, Durham,
NC,Department of Biomedical Engineering, Duke University,
Durham, NC,Department of Mechanical Engineering and Materials Science,
Duke University, Durham, NC
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17
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Activities of daily living influence tibial cartilage T1rho relaxation times. J Biomech 2018; 82:228-233. [PMID: 30455059 DOI: 10.1016/j.jbiomech.2018.10.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 09/06/2018] [Accepted: 10/23/2018] [Indexed: 12/20/2022]
Abstract
Quantitative T1rho magnetic resonance imaging (MRI) can potentially help identify early-stage osteoarthritis (OA) by non-invasively assessing proteoglycan concentration in articular cartilage. T1rho relaxation times are negatively correlated with proteoglycan concentration. Cartilage compresses in response to load, resulting in water exudation, a relative increase in proteoglycan concentration, and a decrease in the corresponding T1rho relaxation times. To date, there is limited information on changes in cartilage composition resulting from daily activity. Therefore, the objective of this study was to quantify changes in tibial cartilage T1rho relaxation times in healthy human subjects following activities of daily living. It was hypothesized that water exudation throughout the day would lead to decreased T1rho relaxation times. Subjects underwent MR imaging in the morning and afternoon on the same day and were free to go about their normal activities between scans. Our findings confirmed the hypothesis that tibial cartilage T1rho relaxation times significantly decreased (by 7%) over the course of the day with loading, which is indicative of a relative increase in proteoglycan concentration. Additionally, baseline T1rho values varied with position within the cartilage, supporting a need for site-specific measurements of T1rho relaxation times. Understanding how loading alters the proteoglycan concentration in healthy cartilage may hold clinical significance pertaining to cartilage homeostasis and potentially help to elucidate a mechanism for OA development. These results also indicate that future studies using T1rho relaxation times as an indicator of cartilage health should control the loading history prior to image acquisition to ensure the appropriate interpretation of the data.
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18
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Zhang H, Heckelman LN, Spritzer CE, Owusu-Akyaw KA, Martin JT, Taylor DC, Moorman C, Garrigues GE, DeFrate LE. In Vivo Assessment of Exercise-Induced Glenohumeral Cartilage Strain. Orthop J Sports Med 2018; 6:2325967118784518. [PMID: 30023404 PMCID: PMC6047251 DOI: 10.1177/2325967118784518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The human shoulder joint is the most mobile joint in the body. While in vivo shoulder kinematics under minimally loaded conditions have been studied, it is unclear how glenohumeral cartilage responds to high-demand loaded exercise. HYPOTHESIS A high-demand upper extremity exercise, push-ups, will induce compressive strain in the glenohumeral articular cartilage, which can be measured with validated magnetic resonance imaging (MRI)-based techniques. STUDY DESIGN Descriptive laboratory study. METHODS High-resolution MRI was used to measure in vivo glenohumeral cartilage thickness before and after exercise among 8 study participants with no history of upper extremity injury or disease. Manual MRI segmentation and 3-dimensional modeling techniques were used to generate pre- and postexercise thickness maps of the humeral head and glenoid cartilage. Strain was calculated as the difference between pre- and postexercise cartilage thickness, normalized to the pre-exercise cartilage thickness. RESULTS Significant compressive cartilage strains of 17% ± 6% and 15% ± 7% (mean ± 95% CI) were detected in the humeral head and glenoid cartilage, respectively. The anterior region of the glenoid cartilage experienced a significantly higher mean strain (19% ± 6%) than the posterior region of the glenoid cartilage (12% ± 8%). No significant regional differences in postexercise humeral head cartilage strain were observed. CONCLUSION Push-ups induce compressive strain on the glenohumeral joint articular cartilage, particularly at the anterior glenoid. This MRI-based methodology can be applied to further the understanding of chondral changes in the shoulder under high-demand loading conditions. CLINICAL RELEVANCE These results improve the understanding of healthy glenohumeral cartilage mechanics in response to loaded upper extremity exercise. In the future, these methods can be applied to identify which activities induce high glenohumeral cartilage strains and deviations from normal shoulder function.
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Affiliation(s)
- Hanci Zhang
- Department of Orthopaedic Surgery, James R. Urbaniak, MD, Sports Sciences Institute, Duke University, Durham, North Carolina, USA
| | - Lauren N. Heckelman
- Department of Orthopaedic Surgery, James R. Urbaniak, MD, Sports Sciences Institute, Duke University, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | | | - Kwadwo A. Owusu-Akyaw
- Department of Orthopaedic Surgery, James R. Urbaniak, MD, Sports Sciences Institute, Duke University, Durham, North Carolina, USA
| | - John T. Martin
- Department of Orthopaedic Surgery, James R. Urbaniak, MD, Sports Sciences Institute, Duke University, Durham, North Carolina, USA
| | - Dean C. Taylor
- Department of Orthopaedic Surgery, James R. Urbaniak, MD, Sports Sciences Institute, Duke University, Durham, North Carolina, USA
| | - C.T. Moorman
- Department of Orthopaedic Surgery, James R. Urbaniak, MD, Sports Sciences Institute, Duke University, Durham, North Carolina, USA
| | - Grant E. Garrigues
- Department of Orthopaedic Surgery, James R. Urbaniak, MD, Sports Sciences Institute, Duke University, Durham, North Carolina, USA
| | - Louis E. DeFrate
- Department of Orthopaedic Surgery, James R. Urbaniak, MD, Sports Sciences Institute, Duke University, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
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