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Bleakley C, Netterström-Wedin F. Does mechanical loading restore ligament biomechanics after injury? A systematic review of studies using animal models. BMC Musculoskelet Disord 2023; 24:511. [PMID: 37349749 DOI: 10.1186/s12891-023-06653-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 06/19/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Mechanical loading is purported to restore ligament biomechanics post-injury. But this is difficult to corroborate in clinical research when key ligament tissue properties (e.g. strength, stiffness), cannot be accurately measured. We reviewed experimental animal models, to evaluate if post-injury loading restores tissue biomechanics more favourably than immobilisation or unloading. Our second objective was to explore if outcomes are moderated by loading parameters (e.g. nature, magnitude, duration, frequency of loading). METHODS Electronic and supplemental searches were performed in April 2021 and updated in May 2023. We included controlled trials using injured animal ligament models, where at least one group was subjected to a mechanical loading intervention postinjury. There were no restrictions on the dose, time of initiation, intensity, or nature of the load. Animals with concomitant fractures or tendon injuries were excluded. Prespecified primary and secondary outcomes were force/stress at ligament failure, stiffness, laxity/deformation. The Systematic Review Center for Laboratory animal Experimentation tool was used to assess the risk of bias. RESULTS There were seven eligible studies; all had a high risk of bias. All studies used surgically induced injury to the medial collateral ligament of the rat or rabbit knee. Three studies recorded large effects in favour of ad libitum loading postinjury (vs. unloading), for force at failure and stiffness at 12-week follow up. However, loaded ligaments had greater laxity at initial recruitment (vs. unloaded) at 6 and 12 weeks postinjury. There were trends from two studies that adding structured exercise intervention (short bouts of daily swimming) to ad libitum activity further enhances ligament behaviour under high loads (force at failure, stiffness). Only one study compared different loading parameters (e.g. type, frequency); reporting that an increase in loading duration (from 5 to 15 min/day) had minimal effect on biomechanical outcomes. CONCLUSION There is preliminary evidence that post-injury loading results in stronger, stiffer ligament tissue, but has a negative effect on low load extensibility. Findings are preliminary due to high risk of bias in animal models, and the optimal loading dose for healing ligaments remains unclear.
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Affiliation(s)
- Chris Bleakley
- School of Health Sciences, Faculty of Life and Health Sciences, Ulster University, Jordanstown campus, Newtownabbey, UK
| | - Fredh Netterström-Wedin
- Division of Public Health Science, School of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
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2
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Holuba K, Vermeijden HD, Yang XA, O'Brien R, van der List JP, DiFelice GS. Treating Combined Anterior Cruciate Ligament and Medial Collateral Ligament Injuries Operatively in the Acute Setting Is Potentially Advantageous. Arthroscopy 2023; 39:1099-1107. [PMID: 35817377 DOI: 10.1016/j.arthro.2022.06.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/20/2022] [Accepted: 06/20/2022] [Indexed: 02/02/2023]
Abstract
Combined injury of the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) remains among the most common knee injury patterns in orthopaedics. Optimal treatment of grade III MCL injuries is still debated, especially when combined with ACL injury. Most patients with these severe injuries are treated conservatively for at least 6 weeks to allow for MCL healing, followed by delayed ACL reconstruction. Although acute treatment of the MCL was common in the 1970s, postoperative stiffness was frequently reported. Moreover, studies of such treatment failed to show clinical benefits of surgical over conservative treatment, and the MCL exhibited intrinsic healing capacity, leading to the consensus that all MCL injuries are treated conservatively. The current delayed treatment algorithm for ACL-MCL injuries has several disadvantages. First, MCL healing may be incomplete, resulting in residual valgus laxity that places the ACL graft at greater risk of failure. Second, delayed treatment lengthens the overall rehabilitation period, thereby prolonging the presence of atrophy and delaying return to preinjury activity levels. Third, the initial healing period leaves the knee unstable for longer and risks further intra-articular damage. Acute simultaneous surgical treatment of both ligaments has the potential to avoid these shortcomings. This article will review the evolution of treatment of ACL-MCL injuries and explain how it shifted toward the current treatment algorithm. We will (1) discuss why the consensus shifted, (2) discuss the shortcomings of the current treatment plan, (3) discuss the potential advantages of acute simultaneous treatment, and (4) present an overview of the available literature.
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Affiliation(s)
- Kurt Holuba
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Harmen D Vermeijden
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A.; Department of Orthopaedic Surgery, Amsterdam UMC Location, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Movement Sciences-Sports, Amsterdam, the Netherlands
| | - Xiuyi A Yang
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Robert O'Brien
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Jelle P van der List
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A.; Department of Orthopaedic Surgery, Amsterdam UMC Location, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Movement Sciences-Sports, Amsterdam, the Netherlands
| | - Gregory S DiFelice
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A..
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3
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Arant LR, Roth JD. Development and evaluation of ligament phantoms targeted for shear wave tensiometry. J Mech Behav Biomed Mater 2022; 126:104984. [PMID: 34857491 PMCID: PMC8792233 DOI: 10.1016/j.jmbbm.2021.104984] [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: 09/03/2021] [Revised: 11/03/2021] [Accepted: 11/17/2021] [Indexed: 02/03/2023]
Abstract
Developing a shear wave tensiometer capable of non-invasively measuring ligament tension holds promise for enhancing research and clinical assessments of ligament function. Such development would benefit from tunable test specimens fabricated from well-characterized and consistent materials. Although previous work found that yarn can replicate the mechanical behavior of collateral ligaments, it is not obvious whether yarn-based phantoms would be suitable for development of a shear wave tensiometer for measuring ligament tension. Accordingly, the primary objective of this study was to characterize the mechanical properties and shear wave speed - stress relationships of ligament phantoms fabricated from yarn and silicone, and compare these results to published data from biological ligaments. We measured the mechanical properties and shear wave speeds during axial loading in nine phantoms with systematically varied material properties. We performed a simple linear regression between shear wave speed squared and axial stress to determine the shear wave speed - stress relationship for each phantom. We found comparable elastic moduli, hysteresis, and shear wave speed squared - stress regression parameters between the phantoms and collateral ligaments. For example, the ranges of the coefficients of determination (R2) and slopes across the nine phantoms were 0.84-0.95, and 0.78-1.27 kPa/m2/s2, respectively, which overlapped with the ranges found in a prior study in porcine collateral ligaments (0.84-0.996 and 0.34-1.18 kPa/m2/s2, respectively). Additionally, the shear wave speed squared - stress regression parameters varied predictably with the density of the phantom and the shear modulus of the silicone. In summary, we found that yarn-based phantoms serve as mechanical analogs for ligaments (i.e., are ligament mimicking), and thus, should prove beneficial for investigations into ligament structure-function relationships and in the development of a shear wave tensiometer for measuring ligament tension.
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Affiliation(s)
- Lesley R. Arant
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Joshua D. Roth
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA,Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA
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Lui H, Vaquette C, Denbeigh JM, Bindra R, Kakar S, van Wijnen AJ. Multiphasic scaffold for scapholunate interosseous ligament reconstruction: A study in the rabbit knee. J Orthop Res 2021; 39:1811-1824. [PMID: 32579261 PMCID: PMC7758190 DOI: 10.1002/jor.24785] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 06/06/2020] [Accepted: 06/12/2020] [Indexed: 02/04/2023]
Abstract
Scapholunate interosseous ligament tears are a common wrist injury in young and active patients that can lead to suboptimal outcomes after repair. This research aims to assess a multiphasic scaffold using 3D-printing for reconstruction of the dorsal scapholunate interosseous ligament. The scaffold was surgically implanted in vivo in the position of the native rabbit medial collateral ligament. Two branches of treatment were implemented in the study. In the first group, the rabbits (n = 8) had the knee joint fixed in flexion for 4 weeks using 1.4 mm K-wires prior to sample harvesting. The second group (n = 8) had the rabbit knee joint immobilized for 4 weeks prior to K-wire removal and mobilization for an additional 4 weeks prior to sample harvesting. Overall, samples were harvested at 4 weeks post-surgery (immobilized group) and eight weeks post-surgery (mobilized group). Mechanical tensile testing (n = 5/group) and histology (n = 3/group) of the constructs were conducted. Tissue integration and maturation were observed resulting in increased mechanical strength of the operated joint at 8 weeks (P < .05). Bone and ligament tissues were regenerated in their respective compartments with structural and mechanical properties approaching those reported for the human dorsal SLIL ligament. Clinical Significance: This proof of concept study has demonstrated that the synthetic multiphasic scaffold was capable of regenerating both bone and ligament while also withstanding the physiological load once implanted in the rabbit knee. The artificial scaffold may provide an alternative to current techniques for reconstruction of scapholunate instability or other ligament injuries in the hand and wrist.
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Affiliation(s)
- Hayman Lui
- Griffith University, School of Medicine, Gold Coast, Queensland, Australia
| | - Cedryck Vaquette
- The University of Queensland, School of Dentistry, Brisbane, Queensland, Australia
| | - Janet M. Denbeigh
- Mayo Clinic, Department of Orthopedic Surgery, Rochester, Minnesota, United States of America
| | - Randip Bindra
- Griffith University, School of Medicine, Gold Coast, Queensland, Australia,Gold Coast University Hospital, Department of Orthopaedic Surgery, Gold Coast, Queensland, Australia
| | - Sanjeev Kakar
- Mayo Clinic, Department of Orthopedic Surgery, Rochester, Minnesota, United States of America,Corresponding AuthorsProf Andre van Wijnen, Department of Orthopedic Surgery and Biochemistry & Molecular Biology, Mayo Clinic, Rochester, Minnesota, USA, +1-507-293-2105, , Dr Sanjeev Kakar, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA,
| | - Andre J. van Wijnen
- Mayo Clinic, Department of Orthopedic Surgery, Rochester, Minnesota, United States of America,Corresponding AuthorsProf Andre van Wijnen, Department of Orthopedic Surgery and Biochemistry & Molecular Biology, Mayo Clinic, Rochester, Minnesota, USA, +1-507-293-2105, , Dr Sanjeev Kakar, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA,
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5
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Jobmann S, Buckup J, Colcuc C, Roessler PP, Zimmermann E, Schüttler KF, Hoffmann R, Welsch F, Stein T. Anatomic ligament consolidation of the superior acromioclavicular ligament and the coracoclavicular ligament complex after acute arthroscopically assisted double coracoclavicular bundle stabilization. Knee Surg Sports Traumatol Arthrosc 2019; 27:3168-3179. [PMID: 28924949 DOI: 10.1007/s00167-017-4717-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 09/13/2017] [Indexed: 01/26/2023]
Abstract
PURPOSE The consolidation of the acromioclavicular (AC) and coracoclavicular (CC) ligament complex after arthroscopically assisted stabilization of acute acromioclavicular joint (ACJ) separation is still under consideration. METHODS Fifty-five consecutive patients after arthroscopically assisted double-CC-bundle stabilization within 14 days after acute high-grade ACJ separation were studied prospectively. All patients were clinically analysed preoperatively (FU0) and post-operatively (FU1 = 6 months; FU2 = 12 months). The structural MRI assessments were performed at FU0 (injured ACJ) and at FU2 bilateral (radiologic control group) and assessed separately the ligament thickness and length at defined regions for the conoid, trapezoid and the superior AC ligament. RESULTS Thirty-seven patients were assessed after 6.5 months and after 16.0 months. The 16-month MRI analysis revealed for all patients continuous ligament healing for the CC-complex and the superior AC ligament with in the average hypertrophic consolidation compared to the control side. Separate conoid and trapezoid strands (double-strand configuration) were detected in 27 of 37 (73%) patients, and a single-strand configuration was detected in 10 of 37 (27%) patients; both configurations showed similar CCD data. The ligament healing was not influenced by the point of surgery, age at surgery and heterotopic ossification. The clinical outcome was increased (FU0-FU2): Rowe, 47.7-97.0 pts.; TAFT, 3.9-10.6 pts.; NAS pain, 8.9-1.4 pts. (all P < 0.05). CONCLUSION The arthroscopically assisted double-CC-bundle stabilization within 14 days after acute high-grade ACJ separation showed 16 months after surgery sufficient consolidations of the AC and double-CC ligament complex in 73%. LEVEL OF EVIDENCE III, Case series.
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Affiliation(s)
- S Jobmann
- Department of Sporttraumatology - Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany
| | - J Buckup
- Department of Sporttraumatology - Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany
| | - C Colcuc
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - P P Roessler
- Department of Orthopaedics and Rheumatology, University Hospital Marburg, Marburg, Germany
| | - E Zimmermann
- Department of Sports medicine, University of Bielefeld, Bielefeld, Germany
| | - K F Schüttler
- Department of Orthopaedics and Rheumatology, University Hospital Marburg, Marburg, Germany
| | - R Hoffmann
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - F Welsch
- Department of Sporttraumatology - Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany
| | - T Stein
- Department of Sporttraumatology - Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany. .,Department of Sports medicine, University of Bielefeld, Bielefeld, Germany.
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6
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Park TS, Park HB. A Modified Weaver-Dunn Procedure with or without Chip Bone Graft for the Treatment of Acromioclavicular Joint Separation. Indian J Orthop 2019; 53:111-116. [PMID: 30905990 PMCID: PMC6394188 DOI: 10.4103/ortho.ijortho_394_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND In spite of frequent injuries to the acromioclavicular (AC) joint, there is no consensus regarding optimal technique to be used. This cohort study evaluated the clinical results of a modified Weaver-Dunn procedure with or without chip bone graft for the treatment of AC joint separation retrospectively. MATERIALS AND METHODS 60 consecutive patients with AC joint separation, between the age of 19-76 years (mean age 43 years), were enrolled between January 2005 and September 2011. Forty patients (35 men, 5 women) were treated with a modified Weaver-Dunn procedure, and did not receive bone graft during the procedure (Group 1), whereas twenty patients (19 men, 1 woman) received autogenous chip bone graft (Group 2). Stability of the AC joint was evaluated clinically and radiographically, and the clinical results were assessed by the Imatani evaluation system. RESULTS The mean duration of followup was 2 years and 2 months. The results were excellent in all patients except one. At final followup, roentgenographic measurement revealed that the mean coracoclavicular interval was 8.2 mm on the affected side, and 8.9 mm on the unaffected side in Group 1, and 9.5 mm on the affected side and 10.1 mm on the unaffected side in Group 2. For Group 1, there were significant differences between augmentation of the grafted coracoacromial (CA) ligament antero-posteriorly and laterally (Option B) and repair of the torn AC ligament with augmentation of the grafted CA ligament antero-inferiorly (option A; P = 0.0351). CONCLUSIONS The modified Weaver-Dunn procedure (Group 1 and 2) provides a stable and strong reconstruction for the treatment of AC joint separation. In addition, this modified Weaver-Dunn procedure with chip bone graft (Group 2) may lead to same or more secure healing of the grafted CA ligament-bone than the same procedure without chip bone graft (P = 0.9737).
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Affiliation(s)
- Tae-Soo Park
- Department of Orthopaedic Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Hyung Bin Park
- Department of Orthopaedic Surgery, School of Medicine, Gyeongsang National University, Jinju, Korea,Address for correspondence: Prof. Hyung Bin Park, Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro Seongsan-gu, Changwon, Korea. E-mail:
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7
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Sevick JL, Heard BJ, Lo IKY, Randle JA, Frank CB, Shrive NG, Thornton GM. Are re-injured ligaments equivalent mechanically to injured ligaments: The role of re-injury severity? Proc Inst Mech Eng H 2018; 232:665-672. [DOI: 10.1177/0954411918784088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The consequences of ligament re-injury have received limited attention. Although the mechanical properties of injured ligaments improve over time, these properties are never fully recaptured, rendering these injured ligaments susceptible to re-injury. Previous injury is a significant risk factor for recurrent injury, and this re-injury can result in longer absence from activity than the initial injury. A rabbit medial collateral ligament model was used to compare mechanically re-injured right medial collateral ligaments to injured left medial collateral ligaments. Two groups of different re-injury severity were investigated: ‘minor’ re-injury comparing transection re-injured right medial collateral ligaments to transection injured left medial collateral ligaments; ‘major’ re-injury comparing gap re-injured right medial collateral ligaments to transection injured left medial collateral ligaments. Initial injuries for both groups were right medial collateral ligament transections 1 week before re-injury. After 5–6 weeks of healing, mechanical testing was performed to determine (dimensionally) cross-sectional area; (structurally) medial collateral ligament laxity, failure load, and stiffness; and (materially) cyclic creep strain and failure stress. Because we wanted to evaluate whether the mechanical properties of re-injured ligaments were equivalent or, at least, no worse than injured ligaments, we used equivalence/noninferiority testing. This approach evaluates a research hypothesis of equivalence, rather than difference, and determines whether comparisons are ‘statistically equivalent’, ‘noninferior’, or ‘potentially inferior’. Transection re-injured and gap re-injured ligaments were ‘statistically equivalent’ structurally to transection injured ligaments. Transection re-injured ligaments were ‘noninferior’ both materially and dimensionally to transection injured ligaments. Gap re-injured ligaments were ‘potentially inferior’ both materially and dimensionally to transection injured ligaments. Two differences between the re-injuries, which affect healing, may explain the mechanical outcomes: the presence or lack of healing products and the proximity of ligament ends at the time of re-injury. Our findings suggest that (in the short term) there is a severity of re-injury below which there is no additional disadvantage to the healing process, mechanical behaviour, and resulting potential for re-injury.
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Affiliation(s)
- Johnathan L Sevick
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Bryan J Heard
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Ian KY Lo
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - John A Randle
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Cyril B Frank
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Nigel G Shrive
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Gail M Thornton
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
- Department of Orthopaedics, The University of British Columbia, Vancouver, BC, Canada
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8
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LaMothe JM, Baxter JR, Murphy C, Gilbert S, DeSandis B, Drakos MC. Three-Dimensional Analysis of Fibular Motion After Fixation of Syndesmotic Injuries With a Screw or Suture-Button Construct. Foot Ankle Int 2016; 37:1350-1356. [PMID: 27654046 DOI: 10.1177/1071100716666865] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Suture-button constructs are an alternative to screw fixation for syndesmotic injuries, and proponents advocate that suture-button constructs may allow physiological motion of the syndesmosis. Recent biomechanical data suggest that fibular instability with syndesmotic injuries is greatest in the sagittal plane, but the design of a suture-button construct, being a rope and 2 retention washers, is most effective along the axis of the rope (in the coronal plane). Some studies report that suture-button constructs are able to constrain fibular motion in the coronal plane, but the ability of a tightrope to constrain sagittal fibular motion is unknown. The purpose of this study was to assess fibular motion in response to an external rotation stress test in a syndesmotic injury model after fixation with a screw or suture-button constructs. METHODS Eleven fresh-frozen cadaver whole legs with intact tibia-fibula articulations were secured to a custom fixture. Fibular motion (coronal, sagittal, and rotational planes) in response to a 6.5-Nm external rotation moment applied to the foot was recorded with fluoroscopy and a high-resolution motion capture system. Measures were taken for the following syndesmotic conditions: intact, complete lateral injury, complete lateral and deltoid injury, repair with a tetracortical 4.0-mm screw, and repair with a suture button construct (Tightrope; Arthrex, Naples, FL) aimed from the lateral fibula to the anterior medial malleolus. RESULTS The suture-button construct allowed significantly more sagittal plane motion than the syndesmotic screw. Measurements acquired with mortise imaging did not detect differences between the intact, lateral injury, and 2 repair conditions. External rotation of the fibula was significantly increased in both injury conditions and was not restored to intact levels with the screw or the suture-button construct. CONCLUSION A single suture-button placed from the lateral fibula to the anterior medial malleolus was unable to replicate the motion observed in the intact specimen when subjected to an external rotation stress test and allowed significantly more posterior motion of the fibula than when fixed with a screw in simulated highly unstable injuries. CLINICAL RELEVANCE Fixation of a syndesmotic injury with a single suture-button construct did not restore physiological fibular motion, which may have implications for postoperative care and clinical outcomes.
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Affiliation(s)
- Jeremy M LaMothe
- University of Calgary, Section of Orthopaedic Surgery, Health Sciences Centre, Calgary, AB, Canada
| | - Josh R Baxter
- Human Motion Lab, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Conor Murphy
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Susannah Gilbert
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | | | - Mark C Drakos
- Department of Orthopedic Surgery, Foot and Ankle, Hospital for Special Surgery, New York, NY, USA
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9
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Bloomfield SA, Martinez DA, Boudreaux RD, Mantri AV. Microgravity Stress: Bone and Connective Tissue. Compr Physiol 2016; 6:645-86. [PMID: 27065165 DOI: 10.1002/cphy.c130027] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The major alterations in bone and the dense connective tissues in humans and animals exposed to microgravity illustrate the dependency of these tissues' function on normal gravitational loading. Whether these alterations depend solely on the reduced mechanical loading of zero g or are compounded by fluid shifts, altered tissue blood flow, radiation exposure, and altered nutritional status is not yet well defined. Changes in the dense connective tissues and intervertebral disks are generally smaller in magnitude but occur more rapidly than those in mineralized bone with transitions to 0 g and during recovery once back to the loading provided by 1 g conditions. However, joint injuries are projected to occur much more often than the more catastrophic bone fracture during exploration class missions, so protecting the integrity of both tissues is important. This review focuses on the research performed over the last 20 years in humans and animals exposed to actual spaceflight, as well as on knowledge gained from pertinent ground-based models such as bed rest in humans and hindlimb unloading in rodents. Significant progress has been made in our understanding of the mechanisms for alterations in bone and connective tissues with exposure to microgravity, but intriguing questions remain to be solved, particularly with reference to biomedical risks associated with prolonged exploration missions.
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Affiliation(s)
- Susan A Bloomfield
- Department of Health & Kinesiology, Texas A&M University, College Station, Texas, USA
| | - Daniel A Martinez
- Department of Mechanical Engineering, University of Houston, Houston, Texas, USA
| | - Ramon D Boudreaux
- Biomedical Engineering, Texas A&M University, College Station, Texas, USA
| | - Anita V Mantri
- Department of Health & Kinesiology, Texas A&M University, College Station, Texas, USA.,Health Science Center School of Medicine, Texas A&M University, College Station, Texas, USA
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10
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Thornton GM, Reno CR, Achari Y, Morck DW, Hart DA. Surgical menopause initiates molecular changes that do not result in mechanical changes in normal and healing ligaments. Bone Joint Res 2015; 4:38-44. [PMID: 25761872 PMCID: PMC4381691 DOI: 10.1302/2046-3758.43.2000339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives Ligaments which heal spontaneously have a healing process that
is similar to skin wound healing. Menopause impairs skin wound healing
and may likewise impair ligament healing. Our purpose in this study
was to investigate the effect of surgical menopause on ligament
healing in a rabbit medial collateral ligament model. Methods Surgical menopause was induced with ovariohysterectomy surgery
in adult female rabbits. Ligament injury was created by making a
surgical gap in the midsubstance of the medial collateral ligament.
Ligaments were allowed to heal for six or 14 weeks in the presence
or absence of oestrogen before being compared with uninjured ligaments. Molecular
assessment examined the messenger ribonucleic acid levels for collagens,
proteoglycans, proteinases, hormone receptors, growth factors and
inflammatory mediators. Mechanical assessments examined ligament
laxity, total creep strain and failure stress. Results Surgical menopause in normal medial collateral ligaments initiated
molecular changes in all the categories evaluated. In early healing
medial collateral ligaments, surgical menopause resulted in downregulation
of specific collagens, proteinases and inflammatory mediators at
6 weeks of healing, and proteoglycans, growth factors and hormone receptors
at 14 weeks of healing. Surgical menopause did not produce mechanical
changes in normal or early healing medial collateral ligaments.
With or without surgical menopause, healing ligaments exhibited
increased total creep strain and decreased failure stress compared
with uninjured ligaments. Conclusions Surgical menopause did not affect the mechanical properties of
normal or early healing medial collateral ligaments in a rabbit
model. The results in this preclinical model suggest that menopause
may result in no further impairment to the ligament healing process. Cite this article: Bone Joint Res 2015;4:38–44
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Affiliation(s)
- G M Thornton
- University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
| | - C R Reno
- University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
| | - Y Achari
- University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
| | - D W Morck
- University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - D A Hart
- University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
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11
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Lin CY, Shau YW, Wang CL, Kang JH. Modeling and Analysis of the Viscoelastic Response of the Ankle Ligament Complex in Inversion Ankle Sprain. Ann Biomed Eng 2015; 43:2047-55. [DOI: 10.1007/s10439-014-1240-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 12/27/2014] [Indexed: 12/26/2022]
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12
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Thornton GM, Bailey SJ. Healing ligaments have shorter lifetime and greater strain rate during fatigue than creep at functional stresses. J Biomech Eng 2014; 135:91004. [PMID: 23775365 DOI: 10.1115/1.4024754] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 06/05/2013] [Indexed: 11/08/2022]
Abstract
Healing ligaments have compromised strength, which makes them susceptible to damage during daily activities at normal functional stresses. Daily activities expose ligaments to cyclic (fatigue) and static (creep) loading. A gap injury was created in the midsubstance of both hindlimb medial collateral ligaments of 40 female 1-year-old New Zealand White rabbits. After a 14-week healing interval, medial collateral ligament gap scars were exposed to long-term fatigue and creep loading over a range of functional force/stress levels. Lifetime and strain behavior were compared during fatigue and creep. The contribution of time-dependent mechanisms to fatigue lifetime was modeled using creep data. Fatigue-loaded healing ligaments had shorter lifetime, greater steady-state strain rate and greater increase in strain at 0.8 h than creep-loaded healing ligaments. The actual fatigue lifetime was less than the predicted fatigue lifetime which was derived from time-dependent damage alone, indicating an important role for cycle-dependent damage mechanisms in healing ligaments during fatigue loading. Cyclic loading decreased lifetime and increased strain rate and strain prior to rupture compared to static loading in healing ligaments. These findings suggest that, after a ligament injury, more care should be taken when exercises result in cyclic loading rather than static loading of the healing ligament even at functional stresses.
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Affiliation(s)
- Gail M Thornton
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB T2N 4Z6, Canada.
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Thornton GM, Bailey SJ. Repetitive loading damages healing ligaments more than sustained loading demonstrated by reduction in modulus and residual strength. J Biomech 2012; 45:2589-94. [DOI: 10.1016/j.jbiomech.2012.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 07/20/2012] [Accepted: 08/01/2012] [Indexed: 10/27/2022]
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14
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Irie T, Takahata M, Majima T, Abe Y, Komatsu M, Iwasaki N, Minami A. Effect of selective estrogen receptor modulator/raloxifene analogue on proliferation and collagen metabolism of tendon fibroblast. Connect Tissue Res 2010; 51:179-87. [PMID: 20073985 DOI: 10.3109/03008200903204669] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The selective estrogen receptor modulator raloxifene is therapeutically beneficial for postmenopausal connective tissue degradation, such as osteoporosis, vascular sclerosis, and dermal degradation; however, the effects of raloxifene on postmenopausal tendon metabolism have not been clarified. In this study, we investigated the effects of raloxifene analogue (LY117018) on cell proliferation and collagen metabolism using cultured rat Achilles tendon fibroblasts. 17beta-Estradiol (E(2); 10(-11)-10(-9) M) and LY117018 (10(-9)-10(-7) M) had no significant effects on tendon fibroblast proliferation, based on a BrdU (5-bromo-2'-deoxyuridine) incorporation assay (24 hr) and a WST-8 colorimetric assay (2 or 6 days). Neither E(2) nor LY117018 significantly altered the expression of type I collagen, which is a main component of the tendon extracellular matrix (ECM), whereas both E(2) and LY117018 significantly increased the expression of matrix metalloproteinase (MMP)-13, which is responsible for tendon collagen degradation in rat. Also, both E(2) and LY117018 increased the expression of type III collagen and elastin, which are minor components of tendon ECM, but are considered to govern the elastic properties of tendons. These changes in collagen and MMP induced by either E(2) or LY117018 were attenuated by the estrogen receptor alpha blocker ICI 182,780. The results of this study suggest that postmenopausal estrogen deficiency might downregulate tendon collagen turnover and decrease tendon elasticity. Further, raloxifene treatment might restore these changes to premenopausal levels.
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Affiliation(s)
- Toru Irie
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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15
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Fung DT, Wang VM, Andarawis-Puri N, Basta-Pljakic J, Li Y, Laudier DM, Sun HB, Jepsen KJ, Schaffler MB, Flatow EL. Early response to tendon fatigue damage accumulation in a novel in vivo model. J Biomech 2009; 43:274-9. [PMID: 19939387 DOI: 10.1016/j.jbiomech.2009.08.039] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Revised: 08/24/2009] [Accepted: 08/25/2009] [Indexed: 01/25/2023]
Abstract
This study describes the development and application of a novel rat patellar tendon model of mechanical fatigue for investigating the early in vivo response to tendon subfailure injury. Patellar tendons of adult female Sprague-Dawley rats were fatigue loaded between 1-35N using a custom-designed loading apparatus. Patellar tendons were subjected to Low-, Moderate- or High-level fatigue damage, defined by grip-to-grip strain measurement. Molecular response was compared with that of a laceration-repair injury. Histological analyses showed that progression of tendon fatigue involves formation of localized kinked fiber deformations at Low damage, which increased in density with presence of fiber delaminations at Moderate damage, and fiber angulation and discontinuities at High damage levels. RT-PCR analysis performed at 1- and 3-day post-fatigue showed variable changes in type I, III and V collagen mRNA expression at Low and Moderate damage levels, consistent with clinical findings of tendon pathology and were modest compared with those observed at High damage levels, in which expression of all collagens evaluated were increased markedly. In contrast, only type I collagen expression was elevated at the same time points post-laceration. Findings suggest that cumulative fatigue in tendon invokes a different molecular response than laceration. Further, structural repair may not be initiated until reaching end-stage fatigue life, where the repair response may unable to restore the damaged tendon to its pre-fatigue architecture.
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Affiliation(s)
- David T Fung
- Leni and Peter W May Department of Orthopaedics, Mount Sinai School of Medicine, 5 East 98th Street, 9th Floor, NY 10029, USA
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16
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Corr DT, Gallant-Behm CL, Shrive NG, Hart DA. Biomechanical behavior of scar tissue and uninjured skin in a porcine model. Wound Repair Regen 2009; 17:250-9. [PMID: 19320894 DOI: 10.1111/j.1524-475x.2009.00463.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A new method to test axial and transverse tensile properties of skin was developed to improve our understanding of skin mechanical behavior, and how it changes following injury and formation of a scar. Skin tissue was evaluated at 70 days following full-thickness wounding in juvenile female pigs (N=14). Samples were taken in the axial (cranial-caudal) and transverse (dorsal-ventral) directions, for both scar tissue and uninjured skin, and were evaluated mechanically in vitro using a protocol of stress relaxation followed by tensile failure. Uninjured skin was more compliant, with a larger toe-in region, and faster load relaxation, in the axial direction than the transverse. Such directional differences were not present in high-load responses, such as linear stiffness or failure properties. When compared with uninjured skin, scars displayed a similar linear stiffness, with considerably reduced failure properties, and reduced low-load compliance. Scars showed no directional differences in low-load behavior, viscous response, or failure properties. These findings suggest morphological changes that may occur with injury that are consistent with the viscoelastic and directional changes observed experimentally. This improved understanding of how injury affects skin biomechanical function provides valuable information necessary for the design of successful grafting procedures and tissue-engineered skin replacements.
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Affiliation(s)
- David T Corr
- Biomedical Engineering Department, Rensselaer Polytechnic Institute, Troy, New York, USA.
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17
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Fleming BC, Brady MF, Bradley MP, Banerjee R, Hulstyn MJ, Fadale PD. Tibiofemoral compression force differences using laxity- and force-based initial graft tensioning techniques in the anterior cruciate ligament-reconstructed cadaveric knee. Arthroscopy 2008; 24:1052-60. [PMID: 18760214 PMCID: PMC2638055 DOI: 10.1016/j.arthro.2008.05.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Revised: 04/02/2008] [Accepted: 05/05/2008] [Indexed: 02/02/2023]
Abstract
PURPOSE Our purpose was to document the tibiofemoral (TF) compression forces produced during clinical initial graft tension protocols. METHODS An image analysis system was used to track the position of the tibia relative to the femur in 11 cadaveric knees. TF compression forces were quantified by use of thin-film pressure sensors. Before anterior cruciate ligament (ACL) reconstructions were performed with patellar tendon grafts, measurements of TF compression force were obtained from the ACL-intact knee with knee flexion. ACL reconstructions were then performed by use of "force-based" and "laxity-based" graft tension approaches. Within each approach, high- and low-tension conditions were compared with the ACL-intact condition over the range of knee flexion angles. RESULTS The TF compression forces for all initial graft tension conditions were significantly greater than those of the normal knee when the knee was in full extension (0 degrees ). The TF compression forces produced with the laxity-based approach were greater than those produced with the force-based approach. However, the laxity-based approach was necessary to restore normal laxity at the time of surgery. CONCLUSIONS The results of this study show that initial graft tension conditions influence TF compressive forces at the time of surgery and that clinically relevant initial graft tension conditions produce different TF compressive forces. CLINICAL RELEVANCE This study showed that the TF compression forces were greater in the ACL-reconstructed knee for all of the initial graft tension conditions when compared with the ACL-intact knee and that clinically relevant initial graft tension conditions produce different TF compressive forces.
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Affiliation(s)
- Braden C. Fleming
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI,Bioengineering Laboratories, Warren Alpert Medical School of Brown University, Providence, RI,Division of Engineering, Brown University, Providence, RI
| | - Mark F. Brady
- Bioengineering Laboratories, Warren Alpert Medical School of Brown University, Providence, RI
| | - Michael P. Bradley
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI
| | - Rahul Banerjee
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI
| | - Michael J. Hulstyn
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI
| | - Paul D. Fadale
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI
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18
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Li NYK, Verdolini K, Clermont G, Mi Q, Rubinstein EN, Hebda PA, Vodovotz Y. A patient-specific in silico model of inflammation and healing tested in acute vocal fold injury. PLoS One 2008; 3:e2789. [PMID: 18665229 PMCID: PMC2481293 DOI: 10.1371/journal.pone.0002789] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Accepted: 05/12/2008] [Indexed: 12/26/2022] Open
Abstract
The development of personalized medicine is a primary objective of the medical community and increasingly also of funding and registration agencies. Modeling is generally perceived as a key enabling tool to target this goal. Agent-Based Models (ABMs) have previously been used to simulate inflammation at various scales up to the whole-organism level. We extended this approach to the case of a novel, patient-specific ABM that we generated for vocal fold inflammation, with the ultimate goal of identifying individually optimized treatments. ABM simulations reproduced trajectories of inflammatory mediators in laryngeal secretions of individuals subjected to experimental phonotrauma up to 4 hrs post-injury, and predicted the levels of inflammatory mediators 24 hrs post-injury. Subject-specific simulations also predicted different outcomes from behavioral treatment regimens to which subjects had not been exposed. We propose that this translational application of computational modeling could be used to design patient-specific therapies for the larynx, and will serve as a paradigm for future extension to other clinical domains.
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Affiliation(s)
- Nicole Y. K. Li
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Katherine Verdolini
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- University of Pittsburgh Voice Center, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Center for Inflammation and Regenerative Modeling, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Gilles Clermont
- Center for Inflammation and Regenerative Modeling, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Qi Mi
- Center for Inflammation and Regenerative Modeling, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Elaine N. Rubinstein
- Office of Measurement and Evaluation of Teaching, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Patricia A. Hebda
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Otolaryngology Wound Healing Laboratory, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Yoram Vodovotz
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Center for Inflammation and Regenerative Modeling, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
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19
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Beye JA, Hart DA, Bray RC, McDougall JJ, Salo PT. Injury-induced changes in mRNA levels differ widely between anterior cruciate ligament and medial collateral ligament. Am J Sports Med 2008; 36:1337-46. [PMID: 18448582 DOI: 10.1177/0363546508316283] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The drastic difference in healing capacity between the anterior cruciate ligament and the medial collateral ligament is still largely unexplained. Few studies have compared the profiles of messenger ribonucleic acid expression for healing-associated molecules in ligaments during the course of healing. HYPOTHESIS Injury responses of the injured anterior cruciate ligament and medial collateral ligament are characterized by very different profiles of angiogenesis-promoting and repair-associated gene expression during the healing process. STUDY DESIGN Controlled laboratory study. METHODS Reverse-transcriptase polymerase chain reaction was used to assay expression of messenger ribonucleic acid for 11 healing- and angiogenesis-associated molecules at 3 days and 2, 6, and 16 weeks after anterior cruciate ligament or medial collateral ligament injury in adult female New Zealand White rabbits. RESULTS Marked differences were found in the postinjury changes in messenger ribonucleic acid levels in the anterior cruciate ligament compared to the medial collateral ligament. Notably, messenger ribonucleic acid levels for the important repair-associated growth factor transforming growth factor-beta1 did not increase in injured anterior cruciate ligament at any time point. Similarly, unlike the injured medial collateral ligament, no statistically significant increases in messenger ribonucleic acid levels for the important scar matrix protein collagen III were detected in injured anterior cruciate ligament. In contrast, matrix metalloproteinase messenger ribonucleic acid levels were markedly elevated in injured anterior cruciate ligament but only modestly increased in medial collateral ligament. CONCLUSION The results suggest that injury leads to an antifibrotic, catabolic response in the rabbit anterior cruciate ligament, possibly to prevent fibrosis and diminish the risk for loss of joint motion. CLINICAL RELEVANCE The development of effective biologically based treatments for anterior cruciate ligament injuries will need to incorporate strategies to deal with the significant differences in the molecular responses to injury of these tissues.
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Affiliation(s)
- Jasmine A Beye
- McCaig Institute for Bone and Joint Health, Calgary, Alberta, Canada
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20
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Treatment of Subacute Low Back Pain With a Novel Device For Continuous Passive Motion of the Spine: A Report of Three Cases. Am J Ther 2008; 15:176-9. [DOI: 10.1097/mjt.0b013e3181400451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Salo P, Bray R, Seerattan R, Reno C, McDougall J, Hart DA. Neuropeptides regulate expression of matrix molecule, growth factor and inflammatory mediator mRNA in explants of normal and healing medial collateral ligament. ACTA ACUST UNITED AC 2007; 142:1-6. [PMID: 17292490 DOI: 10.1016/j.regpep.2007.01.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2006] [Revised: 11/25/2006] [Accepted: 01/05/2007] [Indexed: 10/23/2022]
Abstract
Denervation degrades normal ligament properties and impairs ligament healing. This suggests that secreted neuromediators, such as neuropeptides, could be modulating cell metabolism in ligament and scar tissue. To test this hypothesis we investigated the effect of exogenous substance P (SP), neuropeptide Y (NPY) or calcitonin gene-related peptide (CGRP) on the mRNA levels for proteins associated with inflammation, angiogenesis, and matrix production in tissue-cultured specimens of normal and injured medial collateral ligament. SP and NPY induced increased mRNA levels for several inflammatory mediators in the 2-week post-injury specimens. All three neuropeptides induced decreases in mRNA levels for healing-associated growth factors and matrix molecules, including basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF) and collagen types I and III. The results indicate that neuropeptides strongly influence the metabolic activity of cells in healing ligament, particularly at early time points after injury.
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Affiliation(s)
- Paul Salo
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
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22
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Beye JA, Hart DA, Bray RC, Seerattan RA, McDougall JJ, Leonard CA, Reno CR, Salo PT. Denervation alters mRNA levels of repair-associated genes in a rabbit medial collateral ligament injury model. J Orthop Res 2006; 24:1842-53. [PMID: 16865716 DOI: 10.1002/jor.20219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Previous experiments revealed that denervation impairs healing of the MCL. This suggested the hypothesis that denervation would decrease repair-associated mRNA levels in the injured MCL when compared with normally innervated injured MCL. Adult, skeletally mature female rabbits were assigned to one of four groups: unoperated control, femoral nerve transection alone (denervated controls), MCL partial tear or denervated MCL partial tear. At three days, two weeks, six weeks or sixteen weeks post-surgery, cohorts of 6 rabbits from each experimental group were killed. Ligaments were harvested, RNA extracted and RT-PCR was performed using rabbitspecific primers. In the denervated injury group, mRNA levels for the angiogenesis-associated gene MMP-13, matrix components Collagen I and III, growth factor TGF-beta and angiogenesis inhibitors TIMP-3, and TSP-1 had all increased by two-weeks post-injury, in comparison to the non-denervated injury group (p < or = 0.01). An increased level of TSP-1 mRNA was also detected in the denervated injured group at sixteen weeks post injury (p < or = 0.01). Contrary to the initial hypothesis, denervation led to increased mRNA levels for many relevant molecules during the early stages of MCL healing. Thus, inappropriate timing of over-expression of some molecules may potentially contribute to the decreased quality of the scar tissue, particularly molecules such as TSP-1. Neuronal derived factors strongly influence the in vivo metabolic activity of ligament and scar fibroblasts in the initial phases of healing.
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Affiliation(s)
- Jasmine A Beye
- McCaig Centre for Joint Injury and Arthritis Research, Department of Surgery, University of Calgary, Alberta, Canada T2N 4N1
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23
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Chi SS, Rattner JB, Sciore P, Boorman R, Lo IKY. Gap junctions of the medial collateral ligament: structure, distribution, associations and function. J Anat 2005; 207:145-54. [PMID: 16050901 PMCID: PMC1571515 DOI: 10.1111/j.1469-7580.2005.00440.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Ligaments are composed of two major components: cells and extracellular matrix. The cells express gap junction proteins and are arranged into a series of rows that traverse the tissue, suggesting that all the cells of the tissue are functionally interconnected. The results of our study demonstrate that medial collateral ligament (MCL) cells do not have a uniform fusiform morphology or placement along a row of cells as previously suggested, but rather display a complex placement and form that weaves within the collagen matrix in a manner that is far more extensive and complex than previously appreciated. Within this morphological context, we find that MCL cells in vivo contain functional gap junctions (verified using fluorescence recovery after photobleaching) that are localized to sites of close cell-cell contact, and this pattern imparts or reflects a bipolarity inherent to each cell. When we studied ligament cells in conventional tissue culture we found that this bipolarity is lost, and the placement of gap junctions and their related proteins, as well as general cell morphology, is also altered. Finally, our study demonstrates, for the first time, that in addition to gap junctions, adherens junctions and desmosomes are also expressed by MCL cells both in vivo and in vitro and map to sites of cell-cell contact.
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Affiliation(s)
- Simon S Chi
- The McCaig Center for Joint Injury and Arthritis Research, University of Calgary, Calgary, AB, Canada T2N 4N1
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24
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Jones BF, Wall ME, Carroll RL, Washburn S, Banes AJ. Ligament cells stretch-adapted on a microgrooved substrate increase intercellular communication in response to a mechanical stimulus. J Biomech 2005; 38:1653-64. [PMID: 15958223 DOI: 10.1016/j.jbiomech.2004.07.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2004] [Indexed: 01/26/2023]
Abstract
An in vitro model was used to investigate the effect of mechanical stimuli on adaptation to load and calcium signaling in aligned medial collateral ligament cells (MCL). This model used a patterned silicone membrane to align the cells parallel with the direction of the microgrooves. Alignment created an architecture that simulated a degree of cell orientation in native ligament tissue. It was hypothesized that aligned ligament cells would be more efficient at calcium wave propagation than cells that were randomly oriented. It was further hypothesized that calcium wave propagation would be greater among cells that were both aligned and subjected to mechanical stretch compared to cells that were aligned but not stretched. Rat MCL cells were loaded with Fura-2AM, a calcium-binding dye, and mechanically indented using a micropipette tip. A ratio-imaging fluorescence technique was used to quantitate the calcium (Ca2+) response. It was concluded that stretching ligament cells prior to stimulation increased their sensitivity to load and their ability to propagate a calcium wave. However, the ability of aligned cells to propagate this wave was not significantly different when compared to nonaligned cells. Treatment of cultures with inhibitors such as apyrase and suramin significantly reduced the number of cells recruited in the calcium response. Hence, it was concluded that ATP released from mechanically stimulated cells was a principal mediator responsible for the rise in intracellular calcium in ligament cells. Further, purinoceptor activation may amplify the signal to alert and recruit more cells in a response to mechanical stimulation.
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Affiliation(s)
- Bertina F Jones
- Curriculum in Applied and Material Sciences, University of North Carolina, Chapel Hill, NC 27599-7055, USA
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25
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26
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Bramono DS, Richmond JC, Weitzel PP, Chernoff H, Martin I, Volloch V, Jakuba CM, Diaz F, Gandhi JS, Kaplan DL, Altman GH. Characterization of transcript levels for matrix molecules and proteases in ruptured human anterior cruciate ligaments. Connect Tissue Res 2005; 46:53-65. [PMID: 16019414 DOI: 10.1080/03008200590935556] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
An improved understanding of cellular responses during normal anterior cruciate ligament (ACL) function or repair is essential for clinical assessments, understanding ligament biology, and the implementation of tissue engineering strategies. The present study utilized quantitative real-time RT-PCR combined with univariate and multivariate statistical analyses to establish a quantitative database of marker transcript expression that can provide a "blueprint" of ACL wound healing. Selected markers (collagen types I and III, biglycan, decorin, MMP-1, MMP-2, MMP-9, and TIMP-1) were assessed from 33 torn ACLs harvested during reconstructive surgery. Trends were observed between postinjury period and marker expressions. Significant correlations between marker expression existed and were most prominent between collagen types I and III. Canonical correlation analysis established a relationship between patient demographics and a combination of all marker expressions. The currently observed trends and correlations may assist in identifying appropriate tissue samples and provide a baseline information of marker expression level that can support in vitro optimization of environmental cues for ligament tissue engineering application.
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Affiliation(s)
- Diah S Bramono
- Department of Biomedical Engineering, Tufts University, School of Engineering, Medford, Massachusetts 02155, USA
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27
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Adeeb SM, Zec ML, Thornton GM, Frank CB, Shrive NG. A Novel Application of the Principles of Linear Elastic Fracture Mechanics (LEFM) to the Fatigue Behavior of Tendon Tissue. J Biomech Eng 2004; 126:641-50. [PMID: 15648817 DOI: 10.1115/1.1800556] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background: Experiments on the fatigue of tendons have shown that cyclic loading induces failure at stresses lower than the ultimate tensile strength (UTS) of the tendons. The number of cycles to failure Nf has been shown to be dependent upon the magnitude of the applied cyclic stress. Method of approach: Utilizing data collected by Schechtman (1995), we demonstrate that the principles of Linear Elastic Fracture Mechanics (LEFM) can be used to predict the fatigue behavior of tendons under cyclic loading for maximum stress levels that are higher than 10% of the ultimate tensile strength (UTS) of the tendon (the experimental results at 10% UTS did not fit with our equations). Conclusions: LEFM and other FM approaches may prove to be very valuable in advancing our understanding of damage accumulation in soft connective tissues.
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Affiliation(s)
- Samer M Adeeb
- McCaig Center for Joint Injury and Arthritis Research, University of Calgary, Calgary, Canada
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28
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Sbriccoli P, Solomonow M, Zhou BH, Baratta RV, Lu Y, Zhu MP, Burger EL. Static load magnitude is a risk factor in the development of cumulative low back disorder. Muscle Nerve 2004; 29:300-8. [PMID: 14755497 DOI: 10.1002/mus.10531] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Occupations requiring frequent periods of static lumbar flexion are known epidemiologically to be risk factors for the development of cumulative low back disorder. The impact of the load magnitude sustained during a series of short static lumbar flexions followed by an equally long rest period on the development of a cumulative low back disorder was addressed in an in vivo feline model. Static loads of 20, 40, and 60 N were applied over 10 min of flexion followed by 10-min rest sessions that were repeated six times (for a total of 2 h) while monitoring lumbar viscoelastic creep (laxity) and reflex electromyographic (EMG) activity from the multifidus muscles. Creep and EMG were also monitored over 7 h of rest following the six flexion-rest sessions. It was found that the creep developed in the 10-min flexion periods did not recover completely during the following 10 min of rest, giving rise to a large cumulative creep at the end of the work-rest session. Muscle activity demonstrated spasms during the static flexion periods as well as initial and delayed hyperexcitability during the 7-h rest period. Loads of 20 and 40 N did not result in delayed hyperexcitability, whereas loads of 60 N resulted in delayed hyperexcitability. Statistical analysis demonstrated that increased load significantly intensified the magnitude of the hyperexcitabilities (P < 0.05). Thus, repeated periods of static lumbar flexion were found to result in a transient neuromuscular disorder with an intensity directly related to the load magnitude, which should be considered a compounding risk factor.
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Affiliation(s)
- Paola Sbriccoli
- Occupational Medicine Research Center, Bioengineering Laboratory, Suite 400, Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, 2025 Gravier Street, New Orleans, Louisiana 70112, USA
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