The investigation of fluid flow in cartilage contact gap

Performance parity in cartilage repair: SPMK-g-PEEK versus cartilage-cartilage interfaces

Effective fluid exudation and rehydration are essential for the low-friction function of healthy articular cartilage, facilitating interstitial fluid pressurisation, solute transport, and aqueous lubrication. However, current metallic biomaterials used in focal cartilage repair or hemiarthroplasty compromise this fluid-pressure dependent load support, leading to the erosion of the interfacing cartilage. This study investigates bioinspired hydrophilic 3-sulfopropyl methacrylate potassium salt (SPMK) polymer grafted onto a PEEK substrate (SPMK-g-PEEK) as a potential solution. SPMK-g-PEEK aims to mimic the natural tribology of cartilage by providing an aqueous low friction interface and polyelectrolyte-enhanced tribological rehydration (PETR), supporting fluid recovery and interstitial fluid pressurisation during cartilage sliding. We compare the tribological characteristics of physiological cartilage-cartilage interfaces, which rely on osmotic swelling and hydrodynamic tribological rehydration, with PETR enabled by SPMK-g-PEEK interfaces. This study introduces a bespoke Fuzzy-PI controlled biotribometer. Employing a dual-phase testing method, static compression followed by sliding, allows simultaneous measurement of friction and cartilage strain recovery, indicative of interstitial fluid recovery following compressive exudation. Cartilage condyle, unfunctionalised PEEK, and SPMK-g-PEEK surfaces were investigated against flat cartilage plugs, which provide no hydrodynamic entrainment zone for tribological rehydration, and convex cartilage plugs, which create a convergent hydrodynamic zone for tribological rehydration. Matched cartilage-cartilage contacts exhibited low friction coefficients of ∼ 0.04 and strain recovery of up to ∼ 14% during the sliding phase. SPMK-g-PEEK surfaces sliding against convex cartilage plugs demonstrated similar strain recovery of ∼ 13% and reduced friction coefficients of ∼ 0.01, due to the combined effects of PETR and hydrodynamic tribological rehydration. In contrast, unfunctionalised PEEK surfaces, similar to current hard biomaterials employed in cartilage resurfacing, showed significantly higher friction and inhibited rehydration. SPMK-g-PEEK effectively mimics the physiological rehydration of connatural articular cartilage surfaces, highlighting its potential as a biomimetic material for cartilage resurfacing.

Cartilage-targeted drug nanocarriers for osteoarthritis therapy

Osteoarthritis (OA) is a joint disease common worldwide. Currently, no disease-modifying osteoarthritis drugs (DMOADs) have successfully passed clinical trials, often due to a lack of cartilage penetration. Thus, targeting the extracellular matrix (ECM) is a major priority. The design of cartilage-targeting drug delivery systems (DDSs) for intra-articular administration requires consideration of the physicochemical properties of articular cartilage, such as its porosity and negative fixed charge. Various positively charged biomaterials such as polyaminoacids, proteins, polymers, and lipids can be used as DDSs to enhance cartilage penetration. Cationic nanocarriers interact electrostatically with anionic glycosaminoglycans of the ECM, ensuring passive cartilage-targeting penetration and prolonged retention. Active targeting strategies involve DDSs surface decoration using antibodies or peptides with a strong affinity for collagen II and chondrocytes in the cartilage. This review presents all the relevant bio-physicochemical properties of healthy and OA cartilages, as well as state-of-the-art intra-articular cartilage-targeted DDSs, intending to better understand the recent advances in the application of cartilage-targeting delivery systems for OA therapy.

Adhesion-Lubrication Paradox of Articular Cartilage

The friction of solids is primarily understood through the adhesive interactions between the surfaces. As a result, slick materials tend to be nonstick (e.g., Teflon), and sticky materials tend to produce high friction (e.g., tires and tape). Paradoxically, cartilage, the slippery bearing material of human joints, is also among the stickiest of known materials. This study aims to elucidate this apparent paradox. Cartilage is a biphasic material, and the most cited explanation is that both friction and adhesion increase as load transfers from the pressurized interstitial fluid to the solid matrix over time. In other words, cartilage is slippery and sticky under different times and conditions. This study challenges this explanation, demonstrating the strong adhesion of cartilage under high and low interstitial hydration conditions. Additionally, we find that cartilage clings to itself (a porous material) and Teflon (a nonstick material), as well as other surfaces. We conclude that the unusually strong interfacial tension produced by cartilage reflects suction (like a clingfish) rather than adhesion (like a gecko). This finding is surprising given its unusually large roughness, which typically allows for easy interfacial flow and defeats suction. The results provide compelling evidence that cartilage, like a clingfish, conforms to opposing surfaces and effectively seals submerged contacts. Further, we argue that interfacial sealing is itself a critical function, enabling cartilage to retain hydration, load support, and lubrication across long periods of inactivity.

Tibial and femoral articular cartilage exhibit opposite outcomes for T1ρ and T2* relaxation times in response to acute compressive loading in healthy knees

Abnormal loading is thought to play a key role in the disease progression of cartilage, but our understanding of how cartilage compositional measurements respond to acute compressive loading in-vivo is limited. Ten healthy subjects were scanned at two timepoints (7 ± 3 days apart) with a 3 T magnetic resonance imaging (MRI) scanner. Scanning sessions included T1ρ and T2* acquisitions of each knee in two conditions: unloaded (traditional MRI setup) and loaded in compression at 40 % bodyweight as applied by an MRI-compatible loading device. T1ρ and T2* parameters were quantified for contacting cartilage (tibial and femoral) and non-contacting cartilage (posterior femoral condyle) regions. Significant effects of load were found in contacting regions for both T1ρ and T2*. The effect of load (loaded minus unloaded) in femoral contacting regions ranged from 4.1 to 6.9 ms for T1ρ, and 3.5 to 13.7 ms for T2*, whereas tibial contacting regions ranged from -5.6 to -1.7 ms for T1ρ, and -2.1 to 0.7 ms for T2*. Notably, the responses to load in the femoral and tibial cartilage revealed opposite effects. No significant differences were found in response to load between the two visits. This is the first study that analyzed the effects of acute loading on T1ρ and T2* measurements in human femoral and tibial cartilage separately. The results suggest the effect of acute compressive loading on T1ρ and T2* was: 1) opposite in the femoral and tibial cartilage; 2) larger in contacting regions than in non-contacting regions of the femoral cartilage; and 3) not different visit-to-visit.

Elbow dimensions in quadrupedal mammals driven by lubrication regime

Synovial joints, such as the elbow, experience different lubrication regimes, ranging from fluid film to boundary lubrication, depending on locomotion conditions. We explore the relationship between the elbow lubrication regime and the size of quadrupedal mammals. We use allometry to analyze the dimensions, contact stress, and sliding speed of the elbow in 110 quadrupedal mammals. Our results reveal that the average diameter and width of the distal humerus are scaled [Formula: see text], which allowed us to estimate a consistent contact pressure and sliding speed across mammals. This consistency likely promotes fluid film lubrication regardless of body mass. Further, the ratio between the diameter and width is about 0.5 for all analyzed taxa, which is a good compromise between loading capacity and size. Our study deepens our understanding of synovial joints and their adaptations, with implications for the development of treatments, prostheses, and bioinspired joint designs.

Ion-Induced Swelling Behavior of Articular Cartilage due to Non-Newtonian Flow and Its Effects on Fluid Pressure and Solid Displacement

In this study, we examine the behavior of articular cartilage equilibrated in a salt (NaCl) solution during non-Newtonian fluid flow that follows an Ostwald-de Waele model. A linearly elastic and isotropic rectangular strip of cartilage is considered for analysis. A continuum theory of mixtures has been employed to develop a coupled system of partial differential equations for the solid displacement and the fluid pressure by considering the important factor of the ion concentration by assuming the cartilage as a deformable porous media. The coupled system of partial differential equations is solved using the numerical method named method of lines. In most cases, shear-thinning fluid is compared to the shear-thickening fluid to magnify the difference. Graphical results show that shear-thickening fluids bring more solid deformation and shows less fluid pressure in comparison to the shear-thinning fluids.

Full Regional Creep Displacement Map of Articular Cartilage Based on Nanoindentation Array

The elucidation of the mechanisms underlying articular cartilage lesions poses a formidable challenge in the field of cartilage repair. Despite significant strides in cartilage mechanics research, the region-dependent creep properties of articular cartilage remain elusive. In this study, we employ depth-sensing indentation tests to experimentally determine the creep properties of four distinct regions of articular cartilage, thereby unveiling a region-dependent full map of creep parameters. The measured creep displacement-time response curves indicate that the creep properties of the articular cartilage exhibit a clear regional correlation. Accordingly, the full regional creep map of articular cartilage is experimentally constructed for the first time. The correlation between the microstructures and the creep properties of cartilage in different regions is revealed. A three-parameter model is established to describe the creep velocity-displacement response of cartilage. Raman spectra reveal that the proteoglycan content is positively correlated with creep properties. The Raman shift directly indicates diverse residual stresses in different microregions. The obtained data facilitate a deep understanding of the potential creep dependent damage mechanism of cartilage and the further development of artificial cartilage materials.

Osteochondral junction leakage and cartilage joint lubrication

BACKGROUND AND OBJECTIVES

Previous studies have shown that there is potentially interstitial fluid exchange between cartilage tissue and the subarticular spongiosa region in the case of injury or disease (e.g., osteoarthritis and osteoporosis). Interstitial flow is also required for cartilage lubrication under joint load. A key question then is how cartilage lubrication is modified by increased interstitial fluid leakage across the osteochondral junction. Thus, the purpose of this study is to develop a numerical model to investigate changes in cartilage lubrication with changes in osteochondral junction leakage.

METHODS

The multi-phase coupled model includes domains corresponding to the contact gap, cartilage tissue and subchondral bone plate region (ScBP). Each of these domains are treated as poroelastic systems, with their coupling implemented through mass and pressure continuity. The effects of osteochondral junction leakage on lubrication were investigated with a parametric study on the relative permeability between the ScBP and cartilage tissue.

RESULTS

Significant effects of ScBP permeability were predicted, especially during the early stage of the junction leakage development (early stage of the disease). There is a significant reduction in mixed-mode lubrication duration under the effect of increased junction leakage (the cartilage tissue mixed-mode lubrication duration is about 33% decrease for a relative permeability ratio of 0.1 between ScBP and cartilage tissue, and about 52% decrease under the osteoarthritis condition). In addition, the time for cartilage to reach steady-state consolidation is significantly reduced when ScBP permeability increases (the consolidation time reduces from roughly 2 h to 1.2 h when the relative permeability ratio increases from 0.001 to 0.1, and it reduces to 0.8 h for an advanced osteoarthritis condition). It is predicted that the initial friction coefficient could increase by over 60% when the ScBP permeability is consistent with an advanced osteoarthritis (OA) condition.

CONCLUSION

Increased osteochondral junction leakage induced by joint injury and disease could result in increased cartilage surface wear rates due to more rapid interstitial fluid depressurization within articular cartilage.

Computational Modelling for Managing Pathways to Cartilage Failure

Over several decades the perception and therefore description of articular cartilage changed substantially. It has transitioned from being described as a relatively inert tissue with limited repair capacity, to a tissue undergoing continuous maintenance and even adaption, through a range of complex regulatory processes. Even from the narrower lens of biomechanics, the engagement with articular cartilage has changed from it being an interesting, slippery material found in the hostile mechanical environment between opposing long bones, to an intriguing example of mechanobiology in action. The progress revealing this complexity, where physics, chemistry, material science and biology are merging, has been described with increasingly sophisticated computational models. Here we describe how these computational models of cartilage as an integrated system can be combined with the approach of structural reliability analysis. That is, causal, deterministic models placed in the framework of the probabilistic approach of structural reliability analysis could be used to understand, predict, and mitigate the risk of cartilage failure or pathology. At the heart of this approach is seeing cartilage overuse and disease processes as a 'material failure', resulting in failure to perform its function, which is largely mechanical. One can then describe pathways to failure, for example, how homeostatic repair processes can be overwhelmed leading to a compromised tissue. To illustrate this 'pathways to failure' approach, we use the interplay between cartilage consolidation and lubrication to analyse the increase in expected wear rates associated with cartilage defects or meniscectomy.

Modelling articular cartilage: the relative motion of two adjacent poroviscoelastic layers

In skeletal joints two layers of adjacent cartilage are often in relative motion. The individual cartilage layers are often modelled as a poroviscoelastic material. To model the relative motion, noting the separation of scales between the pore level and the macroscale, a homogenization based on multiple scale asymptotic analysis has been used in this study to derive a macroscale model for the relative translation of two poroviscoelastic layers separated by a very thin layer of fluid. In particular the fluid layer thickness is essentially zero at the macroscale so that the two poroviscoelastic layers are effectively in contact and their interaction is captured in the derived model via a set of interfacial conditions, including a generalization of the Beavers-Joseph condition at the interface between a viscous fluid and a porous medium. In the simplifying context of a uniform geometry, constant fixed charge density, a Newtonian interstitial fluid and a viscoelastic scaffold, modelled via finite deformation theory, we present preliminary simulations that may be used to highlight predictions for how oscillatory relative movement of cartilage under load influences the peak force the cartilage experiences and the extent of the associated deformations. In addition to highlighting such cartilage mechanics, the systematic derivation of the macroscale models will enable the study of how nanoscale cartilage physics, such as the swelling pressure induced by fixed charges, manifests in cartilage mechanics at much higher lengthscales.

Influence of therapeutic grip exercises induced loading rates in distal radius fracture healing with volar locking plate fixation

BACKGROUND AND OBJECTIVE

Therapeutic exercises could potentially enhance the healing of distal radius fractures (DRFs) treated with volar locking plate (VLP). However, the healing outcomes are highly dependant on the patient-specific fracture geometries (e.g., gap size) and the loading conditions at the fracture site (e.g., loading frequency) resulted from different types of therapeutic exercises. The purpose of this study is to investigate the effects of different loading frequencies induced by therapeutic exercises on the biomechanical microenvironment of the fracture site and the transport of cells and growth factors within the fracture callus, ultimately the healing outcomes. This is achieved through numerical modelling and mechanical testing.

METHODS

Five radius sawbones specimens (Pacific Research Laboratories, Vashon, USA) fixed with VLP (VRP2.0+, Austofix) were mechanically tested using dynamic test instrument (INSTRON E3000, Norwood, MA). The loading protocol used in mechanical testing involved a series of cyclic axial compression tests representing hand and finger therapeutic exercises. The relationship between the dynamic loading rate (i.e., loading frequency) and dynamic stiffness of the construct was established and used as inputs to a developed numerical model for studying the dynamic loading induced cells and growth factors in fracture site and biomechanical stimuli required for healing.

RESULTS

There is a strong positive linear relationship between the loading rate and axial stiffness of the construct fixed with VLP. The loading rates induced by the moderate frequencies (i.e., 1-2 Hz) could promote endochondral ossification, whereas relatively high loading frequencies (i.e., over 3 Hz) may hinder the healing outcomes or lead to non-union. In addition, a dynamic loading frequency of 2 Hz in combination of a fracture gap size of 3 mm could produce a better healing outcome by enhancing the transport of cells and growth factors at the fracture site in comparison to free diffusion (i.e. without loading), and thereby produces a biomechanical microenvironment which is favourable for healing.

CONCLUSION

The experimentally validated numerical model presented in this study could potentially contribute to the design of effective patient-specific therapeutic exercises for better healing outcomes. Importantly, the model results demonstrate that therapeutic grip exercises induced dynamic loading could produce a better biomechanical microenvironment for healing without compromising the mechanical stability of the overall volar locking plate fixation construct.

The modes and competing rates of cartilage fluid loss and recovery

Cartilage loses, recovers, and maintains its thickness, hydration, and biomechanical functions based on competing rates of fluid loss and recovery under varying joint-use conditions. While the mechanics and implications of load-induced fluid loss have been studied extensively, those of fluid recovery have not. This study isolates, quantifies, and compares rates of cartilage recovery from three known modes: (1) passive swelling - fluid recovery within a static unloaded contact area; (2) free swelling - unrestricted fluid recovery by an exposed surface; (3) tribological rehydration - fluid recovery within a loaded contact area during sliding. Following static loading of adult bovine articular cartilage to between 100 and 500 μm of compression, passive swelling, free swelling, and tribological rehydration exhibited average rates of 0.11 ± 0.04, 0.71 ± 0.15, and 0.63 ± 0.22 μm/s, respectively, over the first 100 s of recovery; for comparison, the mean exudation rate just prior to sliding was 0.06 ± 0.04 μm/s. For this range of compressions, we detected no significant difference between free swelling and tribological rehydration rates. However, free swelling and tribological rehydration rates, those associated with joint articulation, were ∼7-fold faster than passive swelling rates. While previous studies show how joint articulation prevents fluid loss indefinitely, this study shows that joint articulation reverses fluid loss following static loading at >10-fold the preceding exudation rate. These competitive recovery rates suggest that joint space and function may be best maintained throughout an otherwise sedentary day using brief but regular physical activity. STATEMENT OF SIGNIFICANCE: Cartilage loses, recovers, and maintains its thickness, hydration, and biomechanical functions based on competing rates of fluid loss and recovery under varying joint-use conditions. While load-induced fluid loss is extremely well studied, this is the first to define the competing modes of fluid recovery and to quantify their rates. The results show that the fluid recovery modes associated with joint articulation are 10-fold faster than exudation during static loading and passive swelling during static unloading. The results suggest that joint space and function are best maintained throughout an otherwise sedentary day using brief but regular physical activities.

A Probabilistic Failure Risk Approach to The Problem of Articular Cartilage Lubrication

BACKGROUND AND OBJECTIVE

The geometrical and mechanical properties that characterise the cartilage contact gap are uncertain and spatially varied. To date the effects of such uncertainties on cartilage lubrication have not been explored. Using a probabilistic approach, the purpose of this study is to numerically investigate the influence of surficial cartilage glycoaminoglycan (GAG) content on joint lubrication behaviour. Gap asperity stiffness and polymer brush border (PBB) thickness are affected by the uncertainty of surficial GAG concentration, and so their correlated effects in maintaining hydrodynamic joint lubrication are investigated.

METHODS

Correlated sampling data are first generated by Monte Carlo simulation. These data are used as inputs for the cartilage contact model, which includes three distinctive features of cartilage tissue (tension-compression nonlinearity, aggrecan dependent permeability and compressive modulus) and fluid flow resistance effects of PBB on cartilage surface. The degree of hydrodynamic lubrication after thirty minutes of constant loading is used as an indicator for assessing the lubrication performance at the contact interface.

RESULTS

The increase of PBB thickness with GAG concentration enhances the hydrodynamic lubrication component in the cartilage contact gap, whereas increasing the asperity stiffness with GAG concentration impairs hydrodynamic lubrication. GAG loss rate increases with the rise of GAG concentration. More aggrecan shedding through the surface could result in a thicker and denser PBB, and therefore enhance the lubrication performance in mixed-mode regime. On the other hand, higher GAG content makes the asperities stiffer, which may impede contact gap closure, and thus encourage gap fluid loss and impair the lubrication performance of cartilage.

CONCLUSION

The lubrication performance of cartilage varies with the physiological conditions of the joint. Since a range of variables are internally related, the outcomes on joint lubrication are difficult to predict. A probabilistic approach accounting for the uncertainties can potentially result in more accurate evaluations of joint lubrication performance.

Compressive stress relaxation behavior of articular cartilage and its effects on fluid pressure and solid displacement due to non-Newtonian flow

In this study, we investigate the effects of the power-law index and permeability parameter on the deformation of soft tissue (articular cartilage) which is bathed in the non-Newtonian fluid under stress-relaxation in compression. Ramp displacement is imposed on the surface of hydrated soft tissue. Deformation of the tissue and the fluid pressure is examined for the fast and slow rate of compression. We have employed a linear biphasic mixture theory to develop a mathematical model for compressive stress-relaxation behavior of articular cartilage for non-Newtonian flow. Numerical results indicate that shear-thinning fluids induce less solid deformation and exhibit more fluid pressure as compared to shear-thickening fluids for fast and slow rate of compression. The results also show that linear permeability induces more deformation as compared to strain-dependent nonlinear permeability due to viscoelastic nature of articular cartilage.

The status and challenges of replicating the mechanical properties of connective tissues using additive manufacturing

The ability to fabricate complex structures via precise and heterogeneous deposition of biomaterials makes additive manufacturing (AM) a leading technology in the creation of implants and tissue engineered scaffolds. Connective tissues (CTs) remain attractive targets for manufacturing due to their "simple" tissue compositions that, in theory, are replicable through choice of biomaterial(s) and implant microarchitecture. Nevertheless, characterisation of the mechanical and biological functions of 3D printed constructs with respect to their host tissues is often limited and remains a restriction towards their translation into clinical practice. This review aims to provide an update on the current status of AM to mimic the mechanical properties of CTs, with focus on arterial tissue, articular cartilage and bone, from the perspective of printing platforms, biomaterial properties, and topological design. Furthermore, the grand challenges associated with the AM of CT replacements and their subsequent regulatory requirements are discussed to aid further development of reliable and effective implants.