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Xu J, Lian Y, Sun S, Yang Z, Chen H. Diagnostic Performance of Multi-Direction Adjusted Multi-Planar Reconstruction with Helical CT for Evaluating Continuity of the Anterior Cruciate Ligament. Acad Radiol 2022; 29:e240-e247. [PMID: 35246375 DOI: 10.1016/j.acra.2021.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/30/2021] [Accepted: 12/30/2021] [Indexed: 11/23/2022]
Abstract
RATIONALE AND OBJECTIVES To analyze the diagnostic performance of MDA-MPR with CT for evaluating ACL structural continuity. METHODS A total of 145 patients with highly suspected ACL injury admitted to our hospital between January 2016 and May 2021 were retrospectively enrolled. All patients had undergone examination with MRI, CT, and arthroscopy. Taking arthroscopy results as the gold standard, the diagnostic accuracy for identifying ACL rupture by MRI and MDA-MPR with CT were compared. RESULTS The receiver operator characteristic curves demonstrated that both MRI and MDA-MPR with CT performed well in the diagnosis of ACL tears. The sensitivities of MRI and MDA-MPR with CT for diagnosing complete ACL tears were 95.16% (59/62) and 90.32% (56/62), respectively. Their specificities in this regard were 77.11% (64/83) and 84.34% (70/83), respectively. MRI had a higher sensitivity but MDA-MPR with CT had a higher specificity for detecting complete ACL tears, and the differences were statistically significant (p <.05). The sensitivities of diagnosing partial ACL tears using MRI and MDA-MPR with CT were 78.79% (26/33) and 75.76% (25/33), respectively, while the specificities were 86.61% (97/112) and 90.18% (101/112), respectively. These differences were non-significant (p >.05). CONCLUSION MDA-MPR with CT has high diagnostic efficiency for ACL injuries, especially in the diagnosis of complete ACL tears.
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Affiliation(s)
- Jun Xu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Jiangsu Road, Qingdao City, 266003, Shandong Province, China
| | - Yuanyuan Lian
- Department of Radiology, The Affiliated Hospital of Qingdao University, Jiangsu Road, Qingdao City, 266003, Shandong Province, China
| | - Shiqing Sun
- Department of Radiology, The Affiliated Hospital of Qingdao University, Jiangsu Road, Qingdao City, 266003, Shandong Province, China
| | - Zhitao Yang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Jiangsu Road, Qingdao City, 266003, Shandong Province, China
| | - Haisong Chen
- Department of Radiology, The Affiliated Hospital of Qingdao University, Jiangsu Road, Qingdao City, 266003, Shandong Province, China.
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Ancillao A. The helical axis of anatomical joints: calculation methods, literature review, and software implementation. Med Biol Eng Comput 2022; 60:1815-1825. [DOI: 10.1007/s11517-022-02576-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 04/19/2022] [Indexed: 11/29/2022]
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Hart DA, Martin CR, Scott M, Shrive NG. The instrumented sheep knee to elucidate insights into osteoarthritis development and progression: A sensitive and reproducible platform for integrated research efforts. Clin Biomech (Bristol, Avon) 2021; 87:105404. [PMID: 34171651 DOI: 10.1016/j.clinbiomech.2021.105404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/12/2021] [Accepted: 06/01/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Osteoarthritis of the knee is a very common condition that has been difficult to treat. The majority of cases are considered idiopathic. Much research effort remains focused on biology rather than the biomechanics of such joints. Some new methods were developed and validated to better appreciate the subtleties of the biomechanical integrity of joints, and how changes in biomechanics can contribute to osteoarthritis. METHODS Over the past 15 years our lab has enhanced the sensitivity of the assessment of knee biomechanics of an instrumented, trained large animal model (sheep) of osteoarthritis and integrated the findings with biological and histological assessments. These new methods include gait analysis before and after injury followed by robotic validation post-sacrifice, and more recently using Fibre Bragg Grating sensors to detect alterations in cartilage stresses. RESULTS A review of the findings obtained with this model are presented. The findings indicate that sheep, like humans, exhibit individual characteristics. They also indicate that joint kinetics, rather than kinematics may better define the alterations induced by injury. With the addition of Fibre Bragg Grating sensors, it has been possible to measure with good accuracy, alterations to cartilage stresses following a controlled knee injury. INTERPRETATION Using this model as Proof of Concept, this sheep system can now be viewed as a sensitive platform to address many questions related to risk for development of idiopathic osteoarthritis of the human knee, the efficacy of potential interventions to correct biomechanical disruptions, and how joint biomechanics and biology are integrated during aging.
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Affiliation(s)
- David A Hart
- McCaig Institute for Bone & Joint Health, University of Calgary, Calgary, AB, Canada; Department of Surgery, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; Bone & Joint Health Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada.
| | - C Ryan Martin
- McCaig Institute for Bone & Joint Health, University of Calgary, Calgary, AB, Canada; Section of Orthopedics, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Michael Scott
- Department of Veterinary Clinical & Diagnostic Sciences, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Nigel G Shrive
- McCaig Institute for Bone & Joint Health, University of Calgary, Calgary, AB, Canada; Department of Surgery, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; Department of Civil Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
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Motherwell JM, Hendershot BD, Goldman SM, Dearth CL. Gait biomechanics: A clinically relevant outcome measure for preclinical research of musculoskeletal trauma. J Orthop Res 2021; 39:1139-1151. [PMID: 33458856 DOI: 10.1002/jor.24990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/01/2020] [Accepted: 01/11/2021] [Indexed: 02/04/2023]
Abstract
Traumatic injuries to the musculoskeletal system are the most prevalent of those suffered by United States Military Service members and accounts for two-thirds of initial hospital costs to the Department of Defense. These combat-related wounds often leave survivors with life-long disability and represent a significant impediment to the readiness of the fighting force. There are immense opportunities for the field of tissue engineering and regenerative medicine (TE/RM) to address these musculoskeletal injuries through regeneration of damaged tissues as a means to restore limb functionality and improve quality of life for affected individuals. Indeed, investigators have made promising advancements in the treatment for these injuries by utilizing small and large preclinical animal models to validate therapeutic efficacy of next-generation TE/RM-based technologies. Importantly, utilization of a comprehensive suite of functional outcome measures, particularly those designed to mimic data collected within the clinical setting, is critical for successful translation and implementation of these therapeutics. To that end, the objective of this review is to emphasize the clinical relevance and application of gait biomechanics as a functional outcome measure for preclinical research studies evaluating the efficacy of TE/RM therapies to treat traumatic musculoskeletal injuries. Specifically, common musculoskeletal injuries sustained by service members-including volumetric muscle loss, post-traumatic osteoarthritis, and composite tissue injuries-are examined as case examples to highlight the use of gait biomechanics as an outcome measure using small and large preclinical animal models.
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Affiliation(s)
- Jessica M Motherwell
- DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, Maryland, USA.,Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Brad D Hendershot
- DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, Maryland, USA.,Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Stephen M Goldman
- DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, Maryland, USA.,Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Christopher L Dearth
- DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, Maryland, USA.,Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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Barton KI, Heard BJ, Kroker A, Sevick JL, Raymond DA, Chung M, Achari Y, Martin CR, Frank CB, Boyd SK, Shrive NG, Hart DA. Structural Consequences of a Partial Anterior Cruciate Ligament Injury on Remaining Joint Integrity: Evidence for Ligament and Bone Changes Over Time in an Ovine Model. Am J Sports Med 2021; 49:637-648. [PMID: 33523721 DOI: 10.1177/0363546520985279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Severe injury to the knee joint often results in accelerated posttraumatic osteoarthritis (PTOA). In an ovine knee injury model, altered kinematics and degradation of the cartilage have been observed at 20 and 40 weeks after partial anterior cruciate ligament (ACL) transection (p-ACL Tx) surgery. However, changes to the integrity of the remaining intact intra-articular ligaments (posterolateral [PL] band and posterior cruciate ligament [PCL]) as well as the subchondral bone after anteromedial (AM) band Tx remain to be characterized. PURPOSE (1) To investigate histological alterations to the remaining intact intra-articular ligaments, the synovium, and the infrapatellar fat pad (IPFP) and (2) to quantify subchondral bone changes at the contact surfaces of the proximal tibia at 20 and 40 weeks after AM band Tx. STUDY DESIGN Descriptive laboratory study. METHODS Mature female Suffolk cross sheep were allocated into 3 groups: nonoperative controls (n = 6), 20 weeks after partial ACL transection (p-ACL Tx; n = 5), and 40 weeks after p-ACL Tx (n = 6). Ligament, synovium, and IPFP sections were stained and graded. Tibial subchondral bone microarchitecture was assessed using high-resolution peripheral quantitative computed tomography. RESULTS p-ACL Tx of the AM band led to significant change in histological scores of the PL band and the PCL at 20 weeks after p-ACL Tx (P = .031 and P = .033, respectively) and 40 weeks after p-ACL Tx (P = .011 and P = .029) as compared with nonoperative controls. Alterations in inflammatory cells and collagen fiber orientation contributed to the greatest extent of the combined histological score in the PL band and PCL. p-ACL Tx did not lead to chronic activation of the synovium or IPFP. Trabecular bone mineral density was strongly inversely correlated with combined gross morphological damage in the top and middle layers of the subchondral bone in the lateral tibial plateau for animals at 40 weeks after p-ACL Tx. CONCLUSION p-ACL Tx influences the integrity (biology and structure) of remaining intact intra-articular ligaments and bone microarchitecture in a partial knee injury ovine model. CLINICAL RELEVANCE p-ACL Tx leads to alterations in structural integrity of the remaining intact ligaments and degenerative changes in the trabecular bone mineral density, which may be detrimental to the injured athlete's knee joint in the long term.
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Affiliation(s)
- Kristen I Barton
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Bryan J Heard
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Andres Kroker
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Schulich School of Engineering, University of Calgary, Calgary, Canada
| | - Johnathan L Sevick
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Schulich School of Engineering, University of Calgary, Calgary, Canada
| | - Duncan A Raymond
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - May Chung
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Yamini Achari
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - C Ryan Martin
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Section of Orthopaedics, Foothills Hospital, Calgary, Canada
| | | | - Steven K Boyd
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Schulich School of Engineering, University of Calgary, Calgary, Canada
| | - Nigel G Shrive
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Schulich School of Engineering, University of Calgary, Calgary, Canada
| | - David A Hart
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Faculty of Kinesiology, University of Calgary, Calgary, Canada.,Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Edmonton, Canada
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6
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Vakiel P, Shekarforoush M, Dennison CR, Achari Y, Muench G, Scott M, Hart DA, Shrive NG. Correlation of damage score in PTOA with changes in stress on cartilage in an ovine model. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 2:100109. [DOI: 10.1016/j.ocarto.2020.100109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/06/2020] [Indexed: 11/26/2022] Open
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Chakrabarti S, Ai M, Henson FM, Smith ESJ. Peripheral mechanisms of arthritic pain: A proposal to leverage large animals for in vitro studies. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2020; 8:100051. [PMID: 32817908 PMCID: PMC7426561 DOI: 10.1016/j.ynpai.2020.100051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/22/2020] [Accepted: 07/22/2020] [Indexed: 04/14/2023]
Abstract
Pain arising from musculoskeletal disorders such as arthritis is one of the leading causes of disability. Whereas the past 20-years has seen an increase in targeted therapies for rheumatoid arthritis (RA), other arthritis conditions, especially osteoarthritis, remain poorly treated. Although modulation of central pain pathways occurs in chronic arthritis, multiple lines of evidence indicate that peripherally driven pain is important in arthritic pain. To understand the peripheral mechanisms of arthritic pain, various in vitro and in vivo models have been developed, largely in rodents. Although rodent models provide numerous advantages for studying arthritis pathogenesis and treatment, the anatomy and biomechanics of rodent joints differ considerably to those of humans. By contrast, the anatomy and biomechanics of joints in larger animals, such as dogs, show greater similarity to human joints and thus studying them can provide novel insight for arthritis research. The purpose of this article is firstly to review models of arthritis and behavioral outcomes commonly used in large animals. Secondly, we review the existing in vitro models and assays used to study arthritic pain, primarily in rodents, and discuss the potential for adopting these strategies, as well as likely limitations, in large animals. We believe that exploring peripheral mechanisms of arthritic pain in vitro in large animals has the potential to reduce the veterinary burden of arthritis in commonly afflicted species like dogs, as well as to improve translatability of pain research into the clinic.
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Affiliation(s)
- Sampurna Chakrabarti
- Department of Neuroscience, Max-Delbrück-Centrum für Molekulare Medizin (MDC), Berlin, Germany
- Department of Pharmacology, University of Cambridge, UK
| | - Minji Ai
- Department of Veterinary Medicine, University of Cambridge, UK
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Cone SG, Lambeth EP, Piedrahita JA, Spang JT, Fisher MB. Joint laxity varies in response to partial and complete anterior cruciate ligament injuries throughout skeletal growth. J Biomech 2020; 101:109636. [PMID: 32005549 DOI: 10.1016/j.jbiomech.2020.109636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 01/13/2020] [Accepted: 01/13/2020] [Indexed: 01/01/2023]
Abstract
Anterior cruciate ligament (ACL) injuries are increasingly common in the skeletally immature population. As such there is a need to increase our understanding of the biomechanical function of the joint following partial and complete ACL injury during skeletal growth. In this work, we aimed to assess changes in knee kinematics and loading of the remaining soft tissues following both partial and complete ACL injury in a porcine model. To do so, we applied anterior-posterior tibial loads and varus-valgus moments to stifle joints of female pigs ranging from early juvenile to late adolescent ages and assessed both kinematics and in-situ loads carried in the bundles of the ACL and other soft tissues including the collateral ligaments and the menisci. Partial ACL injury led to increased anterior tibial translation only in late adolescence and small increases in varus-valgus rotation at all ages. Complete ACL injury led to substantial increases in translation and rotation at all ages. At all ages, the medial collateral ligament and the medial meniscus combined to resist the majority of applied anterior tibial load following complete ACL transection. Across all ages and flexion angles, the contribution of the MCL ranged from 45 to 90% of the anterior load and the contribution of the medial meniscus ranged from 14 to 35% of the anterior load. These findings add to our current understanding of age-specific functional properties of both healthy and injured knees during skeletal growth.
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Affiliation(s)
- Stephanie G Cone
- Joint Department of Biomedical Engineering, North Carolina State University and the University of North Carolina - Chapel Hill, Raleigh, NC 27695, United States; Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27695, United States
| | - Emily P Lambeth
- Joint Department of Biomedical Engineering, North Carolina State University and the University of North Carolina - Chapel Hill, Raleigh, NC 27695, United States
| | - Jorge A Piedrahita
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27695, United States
| | - Jeffrey T Spang
- Department of Orthopaedics, University of North Carolina - Chapel Hill, Chapel Hill, NC 27599, United States
| | - Matthew B Fisher
- Joint Department of Biomedical Engineering, North Carolina State University and the University of North Carolina - Chapel Hill, Raleigh, NC 27695, United States; Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27695, United States; Department of Orthopaedics, University of North Carolina - Chapel Hill, Chapel Hill, NC 27599, United States.
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