In vivo articular cartilage deformation: noninvasive quantification of intratissue strain during joint contact in the human knee

Exogenous Collagen Crosslinking is Highly Detrimental to Articular Cartilage Lubrication

Healthy articular cartilage is a remarkable bearing material optimized for near-frictionless joint articulation. Because its limited self-repair capacity renders it susceptible to osteoarthritis (OA), approaches to reinforce or rebuild degenerative cartilage are of significant interest. While exogenous collagen crosslinking (CXL) treatments improve cartilage's mechanical properties and increase its resistance to enzymatic degradation, their effects on cartilage lubrication remain less clear. Here, we examined how the collagen crosslinking agents genipin (GP) and glutaraldehyde (GTA) impact cartilage lubrication using the convergent stationary contact area (cSCA) configuration. Unlike classical configurations, the cSCA sustains biofidelic kinetic friction coefficients (μk) via superposition of interstitial and hydrodynamic pressurization (i.e., tribological rehydration). As expected, glutaraldehyde- and genipin-mediated CXL increased cartilage's tensile and compressive moduli. Although net tribological rehydration was retained after CXL, GP or GTA treatment drastically elevated μk. Both healthy and "OA-like" cartilage (generated via enzymatic digestion) sustained remarkably low μk in saline- (≤0.02) and synovial fluid-lubricated contacts (≤0.006). After CXL, μk increased up to 30-fold, reaching values associated with marked chondrocyte death in vitro. These results demonstrate that mechanical properties (i.e., stiffness) are necessary, but not sufficient, metrics of cartilage function. Furthermore, the marked impairment in lubrication suggests that CXL-mediated stiffening is ill-suited to cartilage preservation or joint resurfacing.

Brushing Up on Cartilage Lubrication: Polyelectrolyte-Enhanced Tribological Rehydration

This study presents new insights into the potential role of polyelectrolyte interfaces in regulating low friction and interstitial fluid pressurization of cartilage. Polymer brushes composed of hydrophilic 3-sulfopropyl methacrylate potassium salt (SPMK) tethered to a PEEK substrate (SPMK-g-PEEK) are a compelling biomimetic solution for interfacing with cartilage, inspired by the natural lubricating biopolyelectrolyte constituents of synovial fluid. These SPMK-g-PEEK surfaces exhibit a hydrated compliant layer approximately 5 μm thick, demonstrating the ability to maintain low friction coefficients (μ ∼ 0.01) across a wide speed range (0.1-200 mm/s) under physiological loads (0.75-1.2 MPa). A novel polyelectrolyte-enhanced tribological rehydration mechanism is elucidated, capable of recovering up to ∼12% cartilage strain and subsequently facilitating cartilage interstitial fluid recovery, under loads ranging from 0.25 to 2.21 MPa. This is attributed to the combined effects of fluid confinement within the contact gap and the enhanced elastohydrodynamic behavior of polymer brushes. Contrary to conventional theories that emphasize interstitial fluid pressurization in regulating cartilage lubrication, this work demonstrates that SPMK-g-PEEK's frictional behavior with cartilage is independent of these factors and provides unabating aqueous lubrication. Polyelectrolyte-enhanced tribological rehydration can occur within a static contact area and operates independently of known mechanisms of cartilage interstitial fluid recovery established for converging or migrating cartilage contacts. These findings challenge existing paradigms, proposing a novel polyelectrolyte-cartilage tribological mechanism not exclusively reliant on interstitial fluid pressurization or cartilage contact geometry. The implications of this research extend to a broader understanding of synovial joint lubrication, offering insights into the development of joint replacement materials that more accurately replicate the natural functionality of cartilage.

Enzymatic digestion does not compromise sliding-mediated cartilage lubrication

Articular cartilage's remarkable low-friction properties are essential to joint function. In osteoarthritis (OA), cartilage degeneration (e.g., proteoglycan loss and collagen damage) decreases tissue modulus and increases permeability. Although these changes impair lubrication in fully depressurized and slowly slid cartilage, new evidence suggests such relationships may not hold under biofidelic sliding conditions more representative of those encountered in vivo. Our recent studies using the convergent stationary contact area (cSCA) configuration demonstrate that articulation (i.e., sliding) generates interfacial hydrodynamic pressures capable of replenishing cartilage interstitial fluid/pressure lost to compressive loading through a mechanism termed tribological rehydration. This fluid recovery sustains in vivo-like kinetic friction coefficients (µk<0.02 in PBS and <0.005 in synovial fluid) with little sensitivity to mechanical properties in healthy tissue. However, the tribomechanical function of compromised cartilage under biofidelic sliding conditions remains unknown. Here, we investigated the effects of OA-like changes in cartilage mechanical properties, modeled via enzymatic digestion of mature bovine cartilage, on its tribomechanical function during cSCA sliding. We found no differences in sliding-driven tribological rehydration behaviors or µk between naïve and digested cSCA cartilage (in PBS or synovial fluid). This suggests that OA-like cartilage retains sufficient functional properties to support naïve-like fluid recovery and lubrication under biofidelic sliding conditions. However, OA-like cartilage accumulated greater total tissue strains due to elevated strain accrual during initial load application. Together, these results suggest that elevated total tissue strains-as opposed to activity-mediated strains or friction-driven wear-might be the key biomechanical mediator of OA pathology in cartilage. STATEMENT OF SIGNIFICANCE: Osteoarthritis (OA) decreases cartilage's modulus and increases its permeability. While these changes compromise frictional performance in benchtop testing under low fluid load support (FLS) conditions, whether such observations hold under sliding conditions that better represent the joints' dynamic FLS conditions in vivo is unclear. Here, we leveraged biofidelic benchtop sliding experiments-that is, those mimicking joints' native sliding environment-to examine how OA-like changes in mechanical properties effect cartilage's natural lubrication. We found no differences in sliding-mediated fluid recovery or kinetic friction behaviors between naïve and OA-like cartilage. However, OA-like cartilage experienced greater strain accumulation during load application, suggesting that elevated tissue strains (not friction-driven wear) may be the primary biomechanical mediator of OA pathology.

The effect of trapeziometacarpal joint passive stiffness on mechanical loadings of cartilages

Hypermobility of the trapeziometacarpal joint is commonly considered to be a potential risk factor for osteoarthritis. Nevertheless, the results remain controversial due to a lack of quantitative validation. The objective of this study was to evaluate the effect of joint laxity on the mechanical loadings of cartilage. A patient-specific finite element model of trapeziometacarpal joint passive stiffness was developed. The joint passive stiffness was modeled by creating linear springs all around the joint. The linear spring stiffness was determined by using an optimization process to fit force-displacement data measured during laxity tests performed on eight healthy volunteers. The estimated passive stiffness parameters were then included in a full thumb finite element simulation of a pinch grip task driven by muscle forces to evaluate the effect on trapeziometacarpal loading. The correlation between stiffness and the loading of cartilage in terms of joint contact pressure and maximum shear strain was analyzed. A significant negative correlation was found between the trapeziometacarpal joint passive stiffness and the contact pressure on trapezium cartilage during the simulated pinch grip task. These results therefore suggest that the hypermobility of the trapeziometacarpal joint could affect the contact pressure on trapezium cartilage and support the existence of an increased risk associated with hypermobility.

Age and gender differences in lumbar intervertebral disk strain using mechanical loading magnetic resonance imaging

The objective of the current study was to investigate age- and gender-related differences in lumbar intervertebral disk (IVD) strain with the use of static mechanical loading and continuous three-dimensional (3D) golden-angle radial sparse parallel (GRASP) MRI. A continuous 3D-GRASP stack-of-stars trajectory of the lumbar spine was performed on a 3-T scanner with static mechanical loading. Compressed sensing reconstruction, motion deformation maps, and Lagrangian strain maps during loading and recovery in the X-, Y-, and Z-directions were calculated for segmented IVD segments from L1/L2 to L5/S1. Mean IVD height was measured at rest. Spearman coefficients were used to evaluate the associations between age and global IVD height and global IVD strain. Mann-Whitney tests were used to compare global IVD height and global IVD strain in males and females. The prospective study enrolled 20 healthy human volunteers (10 males, 10 females; age 34.6 ± 11.4 [mean ± SD], range 22-56 years). Significant increases in compressive strain were observed with age, as evidenced by negative correlations between age and global IVD strain during loading (ρ = -0.76, p = 0.0046) and recovery (ρ = -0.68, p = 0.0251) in the loading X-direction. There was no significant correlation between age and global IVD height, global IVD strain during loading and recovery in the Y-direction, and global IVD strain during loading and recovery in the Z-direction. There were no significant differences between males and females in global IVD height and global IVD strain during loading and recovery in the X-, Y-, and Z-directions. It was concluded that our study demonstrated the significant role aging plays in internal dynamic strains in the lumbar IVD during loading and recovery. Older healthy individuals have reduced IVD stiffness and greater IVD compression during static mechanical loading of the lumbar spine. The GRASP-MRI technique demonstrates the feasibility to identify changes in IVD mechanical properties with early IVD degeneration due to aging.

Intervertebral Disc Elastography to Relate Shear Modulus and Relaxometry in Compression and Bending

Intervertebral disc degeneration is the most recognized cause of low back pain, characterized by the decline of tissue structure and mechanics. Image-based mechanical parameters (e.g., strain, stiffness) may provide an ideal assessment of disc function that is lost with degeneration but unfortunately remains underdeveloped. Moreover, it is unknown whether strain or stiffness of the disc may be predicted by MRI relaxometry (e.g. T1 or T2), an increasingly accepted quantitative measure of disc structure. In this study, we quantified T1 and T2 relaxation times and in-plane strains using displacement-encoded MRI within the disc under physiological levels of compression and bending. We then estimated shear modulus in orthogonal image planes and compared these values to relaxation times and strains within regions of the disc. Intratissue strain depended on the loading mode, and shear modulus in the nucleus pulposus was typically an order of magnitude lower than the annulus fibrosis, except in bending, where the apparent stiffness depended on the loading. Relative shear moduli estimated from strain data derived under compression generally did not correspond with those from bending experiments, with no correlations in the sagittal plane and only 4 of 15 regions correlated in the coronal plane, suggesting that future inverse models should incorporate multiple loading conditions. Strain imaging and strain-based estimation of material properties may serve as imaging biomarkers to distinguish healthy and diseased discs. Additionally, image-based elastography and relaxometry may be viewed as complementary measures of disc structure and function to assess degeneration in longitudinal studies.

Multi-frame biomechanical and relaxometry analysis during in vivo loading of the human knee by spiral dualMRI and compressed sensing

PURPOSE

Knee cartilage experiences repetitive loading during physical activities, which is altered during the pathogenesis of diseases like osteoarthritis. Analyzing the biomechanics during motion provides a clear understanding of the dynamics of cartilage deformation and may establish essential imaging biomarkers of early-stage disease. However, in vivo biomechanical analysis of cartilage during rapid motion is not well established.

METHODS

We used spiral displacement encoding with stimulated echoes (DENSE) MRI on in vivo human tibiofemoral cartilage during cyclic varus loading (0.5 Hz) and used compressed sensing on the k-space data. The applied compressive load was set for each participant at 0.5 times body weight on the medial condyle. Relaxometry methods were measured on the cartilage before (T1ρ , T2 ) and after (T1ρ ) varus load.

RESULTS

Displacement and strain maps showed a gradual shift of displacement and strain in time. Compressive strain was observed in the medial condyle cartilage and shear strain was roughly half of the compressive strain. Male participants had more displacement in the loading direction compared to females, and T1ρ values did not change after cyclic varus load. Compressed sensing reduced the scanning time up to 25% to 40% when comparing the displacement maps and substantially lowered the noise levels.

CONCLUSION

These results demonstrated the ease of which spiral DENSE MRI could be applied to clinical studies because of the shortened imaging time, while quantifying realistic cartilage deformations that occur through daily activities and that could serve as biomarkers of early osteoarthritis.

GelMA-glycol chitosan hydrogels for cartilage regeneration: The role of uniaxial mechanical stimulation in enhancing mechanical, adhesive, and biochemical properties

Untreated osteochondral defects are a leading cause of osteoarthritis, a condition that places a heavy burden on both patients and orthopedic surgeons. Although tissue engineering has shown promise for creating mechanically similar cartilage-like constructs, their integration with cartilage remains elusive. Therefore, a formulation of biodegradable, biocompatible biomaterial with sufficient mechanical and adhesive properties for cartilage repair is required. To accomplish this, we prepared biocompatible, photo-curable, mechanically robust, and highly adhesive GelMA-glycol chitosan (GelMA-GC) hydrogels. GelMA-GC hydrogels had a modulus of 283 kPa and provided a biocompatible environment (>70% viability of embedded chondrocytes) in long-term culture within a bovine cartilage ring. The adhesive strength of bovine chondrocyte-laden GelMA-GC hydrogel to bovine cartilage increased from 38 to 52 kPa over four weeks of culture. Moreover, intermittent uniaxial mechanical stimulation enhanced the adhesive strength to ∼60 kPa, indicating that the cartilage-hydrogel integration could remain secure and functional under dynamic loading conditions. Furthermore, gene expression data and immunofluorescence staining revealed the capacity of chondrocytes in GelMA-GC hydrogel to synthesize chondrogenic markers (COL2A1 and ACAN), suggesting the potential for tissue regeneration. The promising in vitro results of this work motivate further exploration of the potential of photo-curable GelMA-GC bioadhesive hydrogels for cartilage repair and regeneration.

Complex deformation of cartilage micropellets following mechanical stimulation promotes chondrocyte gene expression

BACKGROUND

Articular cartilage (AC)'s main function is to resist to a stressful mechanical environment, and chondrocytes are responding to mechanical stress for the development and homeostasis of this tissue. However, current knowledge on processes involved in response to mechanical stimulation is still limited. These mechanisms are commonly investigated in engineered cartilage models where the chondrocytes are included in an exogeneous biomaterial different from their natural extracellular matrix. The aim of the present study is to better understand the impact of mechanical stimulation on mesenchymal stromal cells (MSCs)-derived chondrocytes generated in their own extracellular matrix.

METHODS

A fluidic custom-made device was used for the mechanical stimulation of cartilage micropellets obtained from human MSCs by culture in a chondrogenic medium for 21 days. Six micropellets were positioned into the conical wells of the device chamber and stimulated with different signals of positive pressure (amplitude, frequency and duration). A camera was used to record the sinking of each micropellet into their cone, and micropellet deformation was analyzed using a finite element model. Micropellets were harvested at different time points after stimulation for RT-qPCR and histology analysis.

RESULTS

Moderate micropellet deformation was observed during stimulation with square pressure signals as mean von Mises strains between 6.39 and 14.35% were estimated for amplitudes of 1.75-14 kPa superimposed on a base pressure of 50% of the amplitude. The compression, tension and shear observed during deformation did not alter micropellet microstructure as shown by histological staining. A rapid and transient increase in the expression of chondrocyte markers (SOX9, AGG and COL2B) was measured after a single 30-min stimulation with a square pressure signal of 3.5 kPa amplitude superimposed on a minimum pressure of 1.75 kPa, at 1 Hz. A small change of 1% of cyclical deformations when using a square pressure signal instead of a constant pressure signal induced a fold change of 2 to 3 of chondrogenic gene expression. Moreover, the expression of fibrocartilage (COL I) or hypertrophic cartilage (COL X, MMP13 and ADAMTS5) was not significantly regulated, except for COL X.

CONCLUSIONS

Our data demonstrate that the dynamic deformation of cartilage micropellets by fluidic-based compression modulates the expression of chondrocyte genes responsible for the production of a cartilage-like extracellular matrix. This lays the foundations for further investigating the chondrocyte mechanobiology and the cartilage growth under mechanical stimulation.

Spatial Gradients of Quantitative MRI as Biomarkers for Early Detection of Osteoarthritis: Data From Human Explants and the Osteoarthritis Initiative

BACKGROUND

Healthy articular cartilage presents structural gradients defined by distinct zonal patterns through the thickness, which may be disrupted in the pathogenesis of several disorders. Analysis of textural patterns using quantitative MRI data may identify structural gradients of healthy or degenerating tissue that correlate with early osteoarthritis (OA).

PURPOSE

To quantify spatial gradients and patterns in MRI data, and to probe new candidate biomarkers for early severity of OA.

STUDY TYPE

Retrospective study.

SUBJECTS

Fourteen volunteers receiving total knee replacement surgery (eight males/two females/four unknown, average age ± standard deviation: 68.1 ± 9.6 years) and 10 patients from the OA Initiative (OAI) with radiographic OA onset (two males/eight females, average age ± standard deviation: 57.7 ± 9.4 years; initial Kellgren-Lawrence [KL] grade: 0; final KL grade: 3 over the 10-year study).

FIELD STRENGTH/SEQUENCE

3.0-T and 14.1-T, biomechanics-based displacement-encoded imaging, fast spin echo, multi-slice multi-echo T2 mapping.

ASSESSMENT

We studied structure and strain in cartilage explants from volunteers receiving total knee replacement, or structure in cartilage of OAI patients with progressive OA. We calculated spatial gradients of quantitative MRI measures (eg, T2) normal to the cartilage surface to enhance zonal variations. We compared gradient values against histologically OA severity, conventional relaxometry, and/or KL grades.

STATISTICAL TESTS

Multiparametric linear regression for evaluation of the relationship between residuals of the mixed effects models and histologically determined OA severity scoring, with a significance threshold at α = 0.05.

RESULTS

Gradients of individual relaxometry and biomechanics measures significantly correlated with OA severity, outperforming conventional relaxometry and strain metrics. In human explants, analysis of spatial gradients provided the strongest relationship to OA severity (R2  = 0.627). Spatial gradients of T2 from OAI data identified variations in radiographic (KL Grade 2) OA severity in single subjects, while conventional T2 alone did not.

DATA CONCLUSION

Spatial gradients of quantitative MRI data may improve the predictive power of noninvasive imaging for early-stage degeneration.

EVIDENCE LEVEL

1 TECHNICAL EFFICACY: Stage 1.

In vivo evaluation of ankle kinematics and tibiotalar joint contact strains using digital volume correlation and 3 T clinical MRI

BACKGROUND

In vivo evaluation of ankle joint biomechanics is key to investigating the effect of injuries on the mechanics of the joint and evaluating the effectiveness of treatments. The objectives of this study were to 1) investigate the kinematics and contact strains of the ankle joint and 2) to investigate the correlation between the tibiotalar joint contact strains and the prevalence of osteochondral lesions of the talus distribution.

METHODS

Eight healthy human ankle joints were subjected to compressive load and 3 T MRIs were obtained before and after applying load. The MR images in combination with digital volume correlation enabled non-invasive measurement of ankle joint kinematics and tibiotalar joint contact strains in three dimensions.

FINDINGS

The total translation of the calcaneus was smaller (0.48 ± 0.15 mm, p < 0.05) than the distal tibia (0.93 ± 0.16 mm) and the talus (1.03 ± 0.26 mm). These movements can produce compressive and shear joint contact strains (approaching 9%), which can cause development of lesions on joints. 87.5% of peak tensile, compressive, and shear strains in the tibiotalar joint took place in the medial and lateral zones.

INTERPRETATION

The findings suggested that ankle bones translate independently from each other, and in some cases in opposite directions. These findings help explain the distribution of osteochondral lesions of the talus which have previously been observed to be in medial and lateral regions of the talar dome in 90% of cases. They also provide a reason for the central region of talar dome being less susceptible to developing osteochondral lesions.

Creep-recovery behaviors of articular cartilage under uniaxial and biaxial tensile loadings

Creep deformation in cartilage can be observed under physiological loads in daily activities such as standing, single-leg lunge, the stance phase of gait. If not fully recovered in time, it may induce irreversible damage in cartilage and further lead to early osteoarthritis. In this study, 36 cruciform-shape samples in total from 18 bulls were employed to conduct the uniaxial and biaxial creep-recovery tests by using a biaxial cyclic testing system. Effects of stress level (σ = .5, 1.0, 1.5 MPa) and biaxial stress ratio (B = 0, .3, .5, 1.0) on creep-recovery behaviors of cartilage were characterized. And then, a viscoelastic constitutive model was employed to predict its creep-recovery behaviors. The results showed that the creep strain and its three components, namely instantaneous elastic strain, delayed elastic strain and viscous flow strain, increase with the increasing stress level or with the decreasing biaxial stress ratio. Compared with uniaxial creep-recovery, biaxial creep-recovery exhibits a smaller creep strain, a faster recovery rate of creep strain and a smaller residual strain. Besides, the built viscoelastic model can be used to describe the uniaxial creep-recovery behaviors of cartilage as a good correlation between the fitted results and test results is achieved. The findings are expected to provide new insights into understanding normal joint function and cartilage pathology.

Hyperelastic characterization reveals proteoglycans drive the nanoscale strain-stiffening response in hyaline cartilage

Degenerative diseases such as osteoarthritis (OA) result in deterioration of cartilage extracellular matrix (ECM) components, significantly compromising tissue function. For measurement of mechanical properties at micron resolution, atomic force microscopy (AFM) is a leading technique in biomaterials research, including in the study of OA. It is common practice to determine material properties by applying classical Hertzian contact theory to AFM data. However, errors are consequential because the application of a linear elastic contact model to tissue ignores the fact that soft materials exhibit nonlinear properties even at small strains, influencing the biological conclusions of clinically-relevant studies. Additionally, nonlinear material properties are not well characterized, limiting physiological relevance of Young's modulus. Here, we probe the ECM of hyaline cartilage with AFM and explore the application of Hertzian theory in comparison to five hyperelastic models: NeoHookean, Mooney-Rivlin, Arruda-Boyce, Fung, and Ogden. The Fung and Ogden models achieved the best fits of the data, but the Fung model demonstrated robust sensitivity during model validation, demonstrating its ideal application to cartilage ECM and potentially other connective tissues. To develop a biological understanding of the Fung nonlinear parameter, we selectively degraded ECM components to target collagens (purified collagenase), hyaluronan (bacterial hyaluronidase), and glycosaminoglycans (chondroitinase ABC). We found significant differences in both Fung parameters in response to enzymatic treatment, indicating that proteoglycans drive the nonlinear response of cartilage ECM, and validating biological relevance of these phenomenological parameters. Our findings add value to the biomechanics community of using two-parameter material models for microindentation of soft biomaterials.

Deformation behaviors and mechanical impairments of tissue cracks in immature and mature cartilages

Degeneration of articular cartilage is often triggered by a small tissue crack. As cartilage structure and composition change with age, the mechanics of cracked cartilage may depend on the tissue age, but this relationship is poorly understood. Here, we investigated cartilage mechanics and crack deformation in immature and mature cartilage exposed to a full-thickness tissue crack using indentation testing and histology, respectively. When a cut was introduced, tissue cracks opened wider in the mature cartilage compared to the immature cartilage. However, the opposite occurred upon mechanical indentation over the cracked region. Functionally, the immature-cracked cartilages stress-relaxed faster, experienced increased tissue strain, and had reduced instantaneous stiffness, compared to the mature-cracked cartilages. Taken together, mature cartilage appears to withstand surface cracks and maintains its mechanical properties better than immature cartilage and these superior properties can be explained by the structure of their collagen fibrous network.

Effects of mechanical stimulation on metabolomic profiles of SW1353 chondrocytes: shear and compression

Mechanotransduction is a biological phenomenon where mechanical stimuli are converted to biochemical responses. A model system for studying mechanotransduction are the chondrocytes of articular cartilage. Breakdown of this tissue results in decreased mobility, increased pain, and reduced quality of life. Either disuse or overloading can disrupt cartilage homeostasis, but physiological cyclical loading promotes cartilage homeostasis. To model this, we exposed SW1353 cells to cyclical mechanical stimuli, shear and compression, for different durations of time (15 and 30 min). By utilizing liquid chromatography-mass spectroscopy (LC-MS), metabolomic profiles were generated detailing metabolite features and biological pathways that are altered in response to mechanical stimulation. In total, 1457 metabolite features were detected. Statistical analyses identified several pathways of interest. Taken together, differences between experimental groups were associated with inflammatory pathways, lipid metabolism, beta-oxidation, central energy metabolism, and amino acid production. These findings expand our understanding of chondrocyte mechanotransduction under varying loading conditions and time periods. This article has an associated First Person interview with the first author of the paper.

Comparative tribology II-Measurable biphasic tissue properties have predictable impacts on cartilage rehydration and lubricity

Healthy articular cartilage supports load bearing and frictional properties unmatched among biological tissues and man-made bearing materials. Balancing fluid exudation and recovery under loaded and articulated conditions is essential to the tissue's biological and mechanical longevity. Our prior tribological investigations, which leveraged the convergent stationary contact area (cSCA) configuration, revealed that sliding alone can modulate cartilage interstitial fluid pressurization and the recovery and maintenance of lubrication under load through a mechanism termed 'tribological rehydration.' Our recent comparative assessment of tribological rehydration revealed remarkably consistent sliding speed-dependent fluid recovery and lubrication behaviors across femoral condyle cartilage from five mammalian species (equine/horse, bovine/cow, porcine/pig, ovine/sheep, and caprine/goat). In the present study, we identified and characterized key predictive relationships among tissue properties, sliding-induced tribological rehydration, and the modulation/recovery of lubrication within healthy articular cartilage. Using correlational analysis, we linked observed speed-dependent tribological rehydration behaviors to cartilage's geometry and biphasic properties (tensile and compressive moduli, and permeability). Together, these findings demonstrate that easily measurable biphasic tissue characteristics (e.g., bulk tissue material properties, compressive strain magnitude, and strain rates) can be used to predict cartilage's rehydration and lubricating abilities, and ultimately its function in vivo. STATEMENT OF SIGNIFICANCE: In healthy cartilage, articulation recovers fluid lost to static loading thereby sustaining tissue lubricity. Osteoarthritis causes changes to cartilage composition, stiffness, and permeability associated with faster fluid exudation and presumably poorer frictional outcomes. Yet, the relationship between mechanical properties and fluid recovery during articulation/sliding remains unclear. Through innovative, high-speed benchtop sliding and indentation experiments, we found that cartilage's tissue properties regulate its exudation/hydration under slow sliding speeds but have minimal effect at high sliding speeds. In fact, cartilage rehydration appears insensitive to permeability and stiffness under high fluid load support conditions. This new understanding of the balance of cartilage exudation and rehydration during activity, based upon comparative tribology studies, may improve prevention and rehabilitation strategies for joint injuries and osteoarthritis.

High-performance bilayer composites for the replacement of osteochondral defects

Two novel bilayer constructs for the repair of osteochondral defects were developed from nanofibers and ceramic particles embedded into PVA matrices, exhibiting multiple promising properties similar to those of corresponding natural tissues.

Mechanical metrics may show improved ability to predict osteoarthritis compared to T1rho mapping

Changes in cartilage structure and composition are commonly observed during the progression of osteoarthritis (OA). Importantly, quantitative magnetic resonance imaging (MRI) methods, such as T1rho relaxation imaging, can noninvasively provide in vivo metrics that reflect changes in cartilage composition and therefore have the potential for use in early OA detection. Changes in cartilage mechanical properties are also hallmarks of OA cartilage; thus, measurement of cartilage mechanical properties may also be beneficial for earlier OA detection. However, the relative predictive ability of compositional versus mechanical properties in detecting OA has yet to be determined. Therefore, we developed logistic regression models predicting OA status in an ex vivo environment using several mechanical and compositional metrics to assess which metrics most effectively predict OA status. Specifically, in this study the compositional metric analyzed was the T1rho relaxation time, while the mechanical metrics analyzed were the stiffness and recovery (defined as a measure of how quickly cartilage returns to its original shape after loading) of the cartilage. Cartilage recovery had the best predictive ability of OA status both alone and in a multivariate model including the T1rho relaxation time. These findings highlight the potential of cartilage recovery as a non-invasive marker of in vivo cartilage health and motivate future investigation of this metric clinically.

Assessment of Native Human Articular Cartilage: A Biomechanical Protocol

OBJECTIVES

Recapitulating the mechanical properties of articular cartilage (AC) is vital to facilitate the clinical translation of cartilage tissue engineering. Prior to evaluation of tissue-engineered constructs, it is fundamental to investigate the biomechanical properties of native AC under sudden, prolonged, and cyclic loads in a practical manner. However, previous studies have typically reported only the response of native AC to one or other of these loading regimes. We therefore developed a streamlined testing protocol to characterize the elastic and viscoelastic properties of human knee AC, generating values for several important parameters from the same sample.

DESIGN

Human AC was harvested from macroscopically normal regions of distal femoral condyles of patients (n = 3) undergoing total knee arthroplasty. Indentation and unconfined compression tests were conducted under physiological conditions (temperature 37 °C and pH 7.4) and testing parameters (strain rates and loading frequency) to assess elastic and viscoelastic parameters.

RESULTS

The biomechanical properties obtained were as follows: Poisson ratio (0.4 ± 0.1), instantaneous modulus (52.14 ± 9.47 MPa) at a loading rate of 1 mm/s, Young's modulus (1.03 ± 0.48 MPa), equilibrium modulus (7.48 ± 4.42 MPa), compressive modulus (10.60 ± 3.62 MPa), dynamic modulus (7.71 ± 4.62 MPa) at 1 Hz and loss factor (0.11 ± 0.02).

CONCLUSIONS

The measurements fell within the range of reported values for human knee AC biomechanics. To the authors' knowledge this study is the first to report such a range of biomechanical properties for human distal femoral AC. This protocol may facilitate the assessment of tissue-engineered composites for their functionality and biomechanical similarity to native AC prior to clinical trials.

Detecting Articular Cartilage and Meniscus Deformation Effects Using Magnetization Transfer Ultrashort Echo Time (MT-UTE) Modeling during Mechanical Load Application: Ex Vivo Feasibility Study

OBJECTIVE

Ultrashort echo time (UTE) magnetic resonance imaging (MRI) sequences have improved imaging of short T2 musculoskeletal (MSK) tissues. UTE-MRI combined with magnetization transfer modeling (UTE-MT) has demonstrated robust assessment of MSK tissues. This study aimed to investigate the variation of UTE-MT measures under mechanical loading in tibiofemoral cartilage and meniscus of cadaveric knee joints.

DESIGN

Fourteen knee joints from young (n = 8, 42 ± 12 years old) and elderly (n = 6, 89 ± 4 years old) donors were scanned on a 3-T scanner under 3 loading conditions: load = 300 N (Load1), load = 500 N (Load2), and load = 0 N (Unload). UTE-MT sequences were performed at each loading condition. Macromolecular proton fraction (MMF) was calculated from UTE-MT modeling. Wilcoxon rank sum test was used to examine the MRI data differences between loading conditions.

RESULTS

For young donors, MMF increased in all grouped regions of interest (meniscus [M], femoral articular cartilage [FAC], tibial articular cartilage [TAC], articular cartilage regions covered by meniscus [AC-MC], and articular cartilage regions uncovered by meniscus [AC-UC]) when the load increased from 300 to 500 N. The increases in MMF were significant for M (13.3%, P < 0.01) and AC-MC (9.2%, P = 0.04). MMF decreased in all studied regions after unloading, which was significant only for AC-MC (-8.9%, P = 0.01). For elderly donors, MRI parameters did not show significant changes by loading or unloading.

CONCLUSION

This study highlights the potential of the UTE-MT modeling combined with knee loading in differentiating between normal and abnormal knees. Average tissue deformation effects were likely higher and more uniformly distributed in the joints of young donors compared with elderly donors.

Magnetic Resonance Imaging-based biomechanical simulation of cartilage: A systematic review

MRI-based mathematical and computational modeling studies can contribute to a better understanding of the mechanisms governing cartilage's mechanical performance and cartilage disease. In addition, distinct modeling of cartilage is needed to optimize artificial cartilage production. These studies have opened up the prospect of further deepening our understanding of cartilage function. Furthermore, these studies reveal the initiation of an engineering-level approach to how cartilage disease affects material properties and cartilage function. Aimed at researchers in the field of MRI-based cartilage simulation, research articles pertinent to MRI-based cartilage modeling were identified, reviewed, and summarized systematically. Various MRI applications for cartilage modeling are highlighted, and the limitations of different constitutive models used are addressed. In addition, the clinical application of simulations and studied diseases are discussed. The paper's quality, based on the developed questionnaire, was assessed, and out of 79 reviewed papers, 34 papers were determined as high-quality. Due to the lack of the best constitutive models for various clinical conditions, researchers may consider the effect of constitutive material models on the cartilage disease simulation. In the future, research groups may incorporate various aspects of machine learning into constitutive models and MRI data extraction to further refine the study methodology. Moreover, researchers should strive for further reproducibility and rigorous model validation and verification, such as gait analysis.

In-Situ Cartilage Functionality Assessment Based on Advanced MRI Techniques and Precise Compartmental Knee Joint Loading through Varus and Valgus Stress

Stress MRI brings together mechanical loading and MRI in the functional assessment of cartilage and meniscus, yet lacks basic scientific validation. This study assessed the response-to-loading patterns of cartilage and meniscus incurred by standardized compartmental varus and valgus loading of the human knee joint. Eight human cadaveric knee joints underwent imaging by morphologic (i.e., proton density-weighted fat-saturated and 3D water-selective) and quantitative (i.e., T1ρ and T2 mapping) sequences, both unloaded and loaded to 73.5 N, 147.1 N, and 220.6 N of compartmental pressurization. After manual segmentation of cartilage and meniscus, morphometric measures and T2 and T1ρ relaxation times were quantified. CT-based analysis of joint alignment and histologic and biomechanical tissue measures served as references. Under loading, we observed significant decreases in cartilage thickness (p < 0.001 (repeated measures ANOVA)) and T1ρ relaxation times (p = 0.001; medial meniscus, lateral tibia; (Friedman test)), significant increases in T2 relaxation times (p ≤ 0.004; medial femur, lateral tibia; (Friedman test)), and adaptive joint motion. In conclusion, varus and valgus stress MRI induces meaningful changes in cartilage and meniscus secondary to compartmental loading that may be assessed by cartilage morphometric measures as well as T2 and T1ρ mapping as imaging surrogates of tissue functionality.

Model for in-vivo estimation of stiffness of tibiofemoral joint using MR imaging and FEM analysis

BACKGROUND

Appropriate structural and material properties are essential for finite-element-modeling (FEM). In knee FEM, structural information could extract through 3D-imaging, but the individual subject's tissue material properties are inaccessible.

PURPOSE

The current study's purpose was to develop a methodology to estimate the subject-specific stiffness of the tibiofemoral joint using finite-element-analysis (FEA) and MRI data of knee joint with and without load.

METHODS

In this study, six Magnetic Resonance Imaging (MRI) datasets were acquired from 3 healthy volunteers with axially loaded and unloaded knee joint. The strain was computed from the tibiofemoral bone gap difference (ΔmBGFT) using the knee MR images with and without load. The knee FEM study was conducted using a subject-specific knee joint 3D-model and various soft-tissue stiffness values (1 to 50 MPa) to develop subject-specific stiffness versus strain models.

RESULTS

Less than 1.02% absolute convergence error was observed during the simulation. Subject-specific combined stiffness of weight-bearing tibiofemoral soft-tissue was estimated with mean values as 2.40 ± 0.17 MPa. Intra-subject variability has been observed during the repeat scan in 3 subjects as 0.27, 0.12, and 0.15 MPa, respectively. All subject-specific stiffness-strain relationship data was fitted well with power function (R² = 0.997).

CONCLUSION

The current study proposed a generalized mathematical model and a methodology to estimate subject-specific stiffness of the tibiofemoral joint for FEM analysis. Such a method might enhance the efficacy of FEM in implant design optimization and biomechanics for subject-specific studies. Trial registration The institutional ethics committee (IEC), Indian Institute of Technology, Delhi, India, approved the study on 20th September 2017, with reference number P-019; it was a pilot study, no clinical trail registration was recommended.

Ultrashort echo time adiabatic T1ρ (UTE-Adiab-T1ρ) is sensitive to human cadaveric knee joint deformation induced by mechanical loading and unloading

PURPOSE

The development of ultrashort echo time (UTE) MRI sequences has led to improved imaging of tissues with short T2 relaxation times, such as the deep layer cartilage and meniscus. UTE combined with adiabatic T1ρ preparation (UTE-Adiab-T1ρ) is an MRI measure with low sensitivity to the magic angle effect. This study aimed to investigate the sensitivity of UTE-Adiab-T1ρ to mechanical load-induced deformations in the tibiofemoral cartilage and meniscus of human cadaveric knee joints.

METHODS

Eight knee joints from young (42 ± 12 years at death) donors were evaluated on a 3 T scanner using the UTE-Adiab-T1ρ sequence under four sequential loading conditions: load = 0 N (Load0), load = 300 N (Load1), load = 500 N (Load2), and load = 0 N (Unload). UTE-Adiab-T1ρ was measured in the meniscus (M), femoral articular cartilage (FAC), tibial articular cartilage (TAC), articular cartilage regions uncovered by meniscus (AC-UC), and articular cartilage regions covered by meniscus (AC-MC) within region of interests (ROIs) manually selected by an experienced MR scientist. The Kruskal-Wallis test, with corrected significance level for multiple comparisons, was used to examine the UTE-Adiab-T1ρ differences between different loading conditions.

RESULTS

UTE-Adiab-T1ρ decreased in all grouped ROIs under both Load1 and Load2 conditions (-18.7% and - 16.9% for M, -18.8% and - 12.6% for FAC, -21.4% and - 10.7% for TAC, -26.2% and - 13.9% for AC-UC, and - 16.9% and - 10.7% for AC-MC). After unloading, average UTE-Adiab-T1ρ increased across all ROIs and within a lower range compared with the average UTE-Adiab-T1ρ decreases induced by the two previous loading conditions. The loading-induced differences were statistically non-significant.

CONCLUSIONS

While UTE-Adiab-T1ρ reduction by loading is likely an indication of tissue deformation, the increase of UTE-Adiab-T1ρ within a lower range by unloading implies partial tissue restoration. This study highlights the UTE-Adiab-T1ρ technique as an imaging marker of tissue function for detecting deformation patterns under loading.

Articular and Artificial Cartilage, Characteristics, Properties and Testing Approaches-A Review

The design and manufacture of artificial tissue for knee joints have been highlighted recently among researchers which necessitates an apt approach for its assessment. Even though most re-searches have focused on specific mechanical or tribological tests, other aspects have remained underexplored. In this review, elemental keys for design and testing artificial cartilage are dis-cussed and advanced methods addressed. Articular cartilage structure, its compositions in load-bearing and tribological properties of hydrogels, mechanical properties, test approaches and wear mechanisms are discussed. Bilayer hydrogels as a niche in tissue artificialization are presented, and recent gaps are assessed.

Stabilization of Damaged Articular Cartilage with Hydrogel-Mediated Reinforcement and Sealing

Cartilage injuries and subsequent tissue deterioration impact millions of patients. Since the regeneration of functional hyaline cartilage remains elusive, methods to stabilize the remaining tissue, and prevent further deterioration, would be of significant clinical utility and prolong joint function. Finite element modeling shows that fortification of the degenerate cartilage (Reinforcement) and reestablishment of a superficial zone (Sealing) are both required to restore fluid pressurization within the tissue and restrict fluid flow and matrix loss from the defect surface. Here, a hyaluronic acid (HA) hydrogel system is designed to both interdigitate with and promote the sealing of the degenerated cartilage. Interdigitating fortification restores both bulk and local pericellular tissue mechanics, reestablishing the homeostatic mechanotransduction of endogenous chondrocytes within the tissue. This HA therapy is further functionalized to present chemo mechanical cues that improve the attachment and direct the response of mesenchymal stem/stromal cells at the defect site, guiding localized extracellular matrix deposition to "seal" the defect. Together, these results support the therapeutic potential, across cell and tissue length scales, of an innovative hydrogel therapy for the treatment of damaged cartilage.

No pressure, no diamonds? - Static vs. dynamic compressive in-situ loading to evaluate human articular cartilage functionality by functional MRI

Biomechanical Magnetic Resonance Imaging (MRI) of articular cartilage, i.e. its imaging under loading, is a promising diagnostic tool to assess the tissue's functionality in health and disease. This study aimed to assess the response to static and dynamic loading of histologically intact cartilage samples by functional MRI and pressure-controlled in-situ loading. To this end, 47 cartilage samples were obtained from the medial femoral condyles of total knee arthroplasties (from 24 patients), prepared to standard thickness, and placed in a standard knee joint in a pressure-controlled whole knee-joint compressive loading device. Cartilage samples' responses to static (i.e. constant), dynamic (i.e. alternating), and no loading, i.e. free-swelling conditions, were assessed before (δ₀), and after 30 min (δ₁) and 60 min (δ₂) of loading using serial T1ρ maps acquired on a 3.0T clinical MRI scanner (Achieva, Philips). Alongside texture features, relative changes in T1ρ (Δ₁, Δ₂) were determined for the upper and lower sample halves and the entire sample, analyzed using appropriate statistical tests, and referenced to histological (Mankin scoring) and biomechanical reference measures (tangent stiffness). Histological, biomechanical, and T1ρ sample characteristics at δ₀ were relatively homogenous in all samples. In response to loading, relative increases in T1ρ were strong and significant after dynamic loading (Δ₁ = 10.3 ± 17.0%, Δ₂ = 21.6 ± 21.8%, p = 0.002), while relative increases in T1ρ after static loading and in controls were moderate and not significant. Generally, texture features did not demonstrate clear loading-related associations underlying the spatial relationships of T1ρ. When realizing the clinical translation, this in-situ study suggests that serial T1ρ mapping is best combined with dynamic loading to assess cartilage functionality in humans based on advanced MRI techniques.

Articular Cartilage Friction, Strain, and Viability Under Physiological to Pathological Benchtop Sliding Conditions

In vivo, articular cartilage is exceptionally resistant to wear, damage, and dysfunction. However, replicating cartilage's phenomenal in vivo tribomechanics (i.e., high fluid load support, low frictions and strains) and mechanobiology on the benchtop has been difficult, because classical testing approaches tend to minimize hydrodynamic contributors to tissue function. Our convergent stationary contact area (cSCA) configuration retains the ability for hydrodynamically-mediated processes to contribute to interstitial hydration recovery and tribomechanical function via 'tribological rehydration'. Using the cSCA, we investigated how in situ chondrocyte survival is impacted by the presence of tribological rehydration during the reciprocal sliding of a glass counterface against a compressively loaded equine cSCA cartilage explant. When tribological rehydration was compromised during testing, by slow-speed sliding, 'pathophysiological' tribomechanical environments and high surface cell death were observed. When tribological rehydration was preserved, by high-speed sliding, 'semi-physiological' sliding environments and suppressed cell death were realized. Inclusion of synovial fluid during testing fostered 'truly physiological' sliding outcomes consistent with the in vivo environment but had limited influence on cell death compared to high-speed sliding in PBS. Subsequently, path analysis identified friction as a primary driver of cell death, with strain an indirect driver, supporting the contention that articulation mediated rehydration can benefit both the biomechanical properties and biological homeostasis of cartilage.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12195-021-00671-2.

The mechanical properties of tibiofemoral and patellofemoral articular cartilage in compression depend on anatomical regions

Articular cartilage in knee joint can be anatomically divided into different regions: medial and lateral condyles of femur; patellar groove of femur; medial and lateral plateaus of tibia covered or uncovered by meniscus. The stress-strain curves of cartilage in uniaxially unconfined compression demonstrate strain rate dependency and exhibit distinct topographical variation among these seven regions. The femoral cartilage is stiffer than the tibial cartilage, and the cartilage in femoral groove is stiffest in the knee joint. Compared with the uncovered area, the area covered with meniscus shows the stiffer properties. To investigate the origin of differences in macroscopic mechanical properties, histological analysis of cartilage in seven regions are conducted. The differences are discussed in terms of the cartilage structure, composition content and distribution. Furthermore, the commonly used constitutive models for biological tissues, namely Fung, Ogden and Gent models, are employed to fit the experimental data, and Fung and Ogden models are found to be qualified in representing the stiffening effect of strain rate.

Measurement of Three-Dimensional Internal Dynamic Strains in the Intervertebral Disc of the Lumbar Spine With Mechanical Loading and Golden-Angle Radial Sparse Parallel-Magnetic Resonance Imaging

BACKGROUND

Noninvasive measurement of internal dynamic strain can be potentially useful to characterize spine intervertebral disc (IVD) in the setting of injury or degenerative disease.

PURPOSE

To develop and demonstrate a noninvasive technique to quantify three-dimensional (3D) internal dynamic strains in the IVD using a combination of static mechanical loading of the IVD using a magnetic resonance imaging (MRI)-compatible ergometer.

STUDY TYPE

Prospective.

SUBJECTS

Silicone gel phantom studies were conducted to assess strain variation with load and repeatability. Mechanical testing was done on the phantoms to confirm MR results. Eight healthy human volunteers (four men and four woman, age = 29 ± 5 years) underwent MRI using a rest, static loading, and recovery paradigm. Repeatability tests were conducted in three subjects.

FIELD STRENGTH/SEQUENCE

MRI (3 T) with 3D continuous golden-angle radial sparse parallel (GRASP) and compressed sensing (CS) reconstruction.

ASSESSMENT

CS reconstruction of the images, motion deformation, and Lagrangian strain maps were calculated for five IVD segments from L1/L2 to L5/S1.

STATISTICAL TESTS

Ranges of displacement and strain in each subject and the resulting mean and standard deviation were calculated. Student t-tests were used to calculate changes in strain from loading to recovery. The correlation coefficient (CC) in the repeatability study was calculated.

RESULTS

The most compressive strain experienced by the IVD segments under loaded conditions was in the L4/L5 segment (-7.5 ± 2.9%). The change in minimum strain from load to recovery was the most for the L4/L5 segment (-7.5% to -5.0%, P = 0.026) and the least for the L1/L2 segment (-4.4% to -3.9%, P = 0.51). In vivo repeatability in three subjects shows strong correlation between scans in subjects done 6 months apart, with CCs equal to 0.86, 0.94, and 0.94 along principal directions.

DATA CONCLUSION

This study shows the feasibility of using static mechanical loading with continuous GRASP-MRI acquisition with CS reconstruction to measure 3D internal dynamic strains in the spine IVD.

LEVEL OF EVIDENCE

2 TECHNICAL EFFICACY STAGE: 1.

Comparative Tribology: Articulation-induced rehydration of cartilage across species

Articular cartilage is a robust tissue that facilitates load distribution and wear-free articulation in diarthrodial joints. These biomechanical capabilities are fundamentally tied to tissue hydration, whereby high interstitial fluid pressures and fluid load support facilitate the maintenance of low tissue strains and frictions. Our recent ex vivo studies of cartilage sliding biomechanics using the convergent stationary contact area (cSCA) configuration, first introduced by Dowson and colleagues, unexpectedly demonstrated that sliding alone can promote recovery of interstitial pressure and lubrication lost to static compression through a mechanism termed 'tribological rehydration.' Although exclusively examined in bovine stifle cartilage to date, we hypothesized that tribological rehydration, i.e., the ability to recover/modulate tissue strains and lubrication through sliding, is a universal behavior of articular cartilage. This study aimed to establish if, and to what extent, sliding-induced tribological rehydration is conserved in articular cartilage across a number of preclinical animal species/models and diarthrodial joints. Using a comparative approach, we found that articular cartilage from equine, bovine, ovine, and caprine stifles, and porcine stifle, hip, and tarsal joints all exhibited remarkably consistent sliding speed-dependent compression/strain recovery and lubrication behaviors under matched contact stresses (0.25 MPa). All cartilage specimens tested supported robust, tribological rehydration during high-speed sliding (>30 mm/s), which as a result of competitive recovery of interstitial lubrication, promoted remarkable decreases in kinetic friction during continuous sliding. The conservation of tribological rehydration across mammalian quadruped articular cartilage suggests that sliding-induced recovery of interstitial hydration represents an important tissue adaptation and largely understudied contributor to the biomechanics of cartilage and joints.

Influence of the Mechanical Environment on the Regeneration of Osteochondral Defects

Articular cartilage is a highly specialised connective tissue of diarthrodial joints which provides a smooth, lubricated surface for joint articulation and plays a crucial role in the transmission of loads. In vivo cartilage is subjected to mechanical stimuli that are essential for cartilage development and the maintenance of a chondrocytic phenotype. Cartilage damage caused by traumatic injuries, ageing, or degradative diseases leads to impaired loading resistance and progressive degeneration of both the articular cartilage and the underlying subchondral bone. Since the tissue has limited self-repairing capacity due its avascular nature, restoration of its mechanical properties is still a major challenge. Tissue engineering techniques have the potential to heal osteochondral defects using a combination of stem cells, growth factors, and biomaterials that could produce a biomechanically functional tissue, representative of native hyaline cartilage. However, current clinical approaches fail to repair full-thickness defects that include the underlying subchondral bone. Moreover, when tested in vivo, current tissue-engineered grafts show limited capacity to regenerate the damaged tissue due to poor integration with host cartilage and the failure to retain structural integrity after insertion, resulting in reduced mechanical function. The aim of this review is to examine the optimal characteristics of osteochondral scaffolds. Additionally, an overview on the latest biomaterials potentially able to replicate the natural mechanical environment of articular cartilage and their role in maintaining mechanical cues to drive chondrogenesis will be detailed, as well as the overall mechanical performance of grafts engineered using different technologies.

The Effect of Degeneration on Internal Strains and the Mechanism of Failure in Human Intervertebral Discs Analyzed Using Digital Volume Correlation (DVC) and Ultra-High Field MRI

The intervertebral disc (IVD) plays a main role in absorbing and transmitting loads within the spinal column. Degeneration alters the structural integrity of the IVDs and causes pain, especially in the lumbar region. The objective of this study was to investigate non-invasively the effect of degeneration on human 3D lumbar IVD strains (n = 8) and the mechanism of spinal failure (n = 10) under pure axial compression using digital volume correlation (DVC) and 9.4 Tesla magnetic resonance imaging (MRI). Degenerate IVDs had higher (p < 0.05) axial strains (58% higher), maximum 3D compressive strains (43% higher), and maximum 3D shear strains (41% higher), in comparison to the non-degenerate IVDs, particularly in the lateral and posterior annulus. In both degenerate and non-degenerate IVDs, peak tensile and shear strains were observed close to the endplates. Inward bulging of the inner annulus was observed in all degenerate IVDs causing an increase in the AF compressive, tensile, and shear strains at the site of inward bulge, which may predispose it to circumferential tears (delamination). The endplate is the spine's “weak link” in pure axial compression, and the mechanism of human vertebral fracture is associated with disc degeneration. In non-degenerate IVDs the locations of failure were close to the endplate centroid, whereas in degenerate IVDs they were in peripheral regions. These findings advance the state of knowledge on mechanical changes during degeneration of the IVD, which help reduce the risk of injury, optimize treatments, and improve spinal implant designs. Additionally, these new data can be used to validate computational models.

A novel assessment of microstructural and mechanical behaviour of bilayer silica-reinforced nanocomposite hydrogels as a candidate for artificial cartilage

The complex structure of healthy articular cartilage facilitates the joint withstanding the imposed pressures and retaining interstitial fluid to lessen stresses on its soft tissue, while easing the locomotion and minimising friction between cartilage mates. Avascular nature of this tissue results in unrecoverable damaged lesions and severe pain over time. Polymeric hydrogels are promising candidate materials for the replacement of the damaged cartilage. Hence, a tough bilayer nanocomposite acrylamide-acrylic acid hydrogel reinforced with silica nanoparticles (SNPs) was designed and synthesised. The mechanical characterisations showed a significant increase in compressive strength up to 1.4 MPa and doubled elastic modulus (240 kPa) by utilising only 0.6 wt% SNPs compared to the non-reinforced hydrogel. The optimum amounts of monomers and SNPs resulted in the compression of samples up to 85% strain without failure. Viscoelastic responses improved as the stress relaxation lessened to half in all nanocomposite hydrogels. Diffusion rate theory was applied, and the results showed to what extent elastic modulus results in an improvement in stress relaxation. The proposed hydrogel formulation exhibited the poroelastic relaxation occurred before viscoelastic relaxation at the time elapses under stress relaxation tests. SEM images showed uniform funnel-like porosity with 570 μm thick lubricious layer, which is an important feature to retain interstitial fluid. Energy-dispersive X-ray spectroscopy was conducted to characterise the elemental composition within the polymeric macrostructure.

In vivo intervertebral disc deformation: intratissue strain patterns within adjacent discs during flexion-extension

The biomechanical function of the intervertebral disc (IVD) is a critical indicator of tissue health and pathology. The mechanical responses (displacements, strain) of the IVD to physiologic movement can be spatially complex and depend on tissue architecture, consisting of distinct compositional regions and integrity; however, IVD biomechanics are predominately uncharacterized in vivo. Here, we measured voxel-level displacement and strain patterns in adjacent IVDs in vivo by coupling magnetic resonance imaging (MRI) with cyclic motion of the cervical spine. Across adjacent disc segments, cervical flexion-extension of 10° resulted in first principal and maximum shear strains approaching 10%. Intratissue spatial analysis of the cervical IVDs, not possible with conventional techniques, revealed elevated maximum shear strains located in the posterior disc (nucleus pulposus) regions. IVD structure, based on relaxometric patterns of T₂ and T_1ρ images, did not correlate spatially with functional metrics of strain. Our approach enables a comprehensive IVD biomechanical analysis of voxel-level, intratissue strain patterns in adjacent discs in vivo, which are largely independent of MRI relaxometry. The spatial mapping of IVD biomechanics in vivo provides a functional assessment of adjacent IVDs in subjects, and provides foundational biomarkers for elastography, differentiation of disease state, and evaluation of treatment efficacy.

Microscale strain mapping demonstrates the importance of interface slope in the mechanics of cartilage repair

Achieving lateral integration of articular cartilage repair tissue with surrounding native cartilage remains a clinical challenge. Histological and bulk mechanical studies have identified extracellular matrix components that correlate with superior failure strength, but it is unclear how local changes in geometry and composition at the repair interface affect tissue strains under physiologic loading. Here, we investigated the effects of local compositional and interface geometry on lateral cartilage repair integration by coupling microscale Raman spectroscopy and confocal elastography to measure tissue strains under compressive and shear loading. Histological integration assessments did not have significant relationships with interface strains under compressive loading (p > 0.083) and only the perimeter attachment score was trending towards statistical significance with the |E_xy| strain tensor under shear loading (p = 0.050). Interface slope had a stronger correlation with local tissue strains under compressive and shear loading compared to compositional measures of GAG, collagen, or proteins (compressive loading |E_yy| tensor: R² = 0.400 (interface slope), 0.005 (GAG), 0.024 (collagen), and 0.012 (protein); shear loading |E_xy| tensor: R² = 0.457 (interface slope), 0.003 (GAG), 0.006 (collagen), and 0.000 (total protein)). These data support surgical publications detailing the need for vertical walls when debriding chondral defects. Current histological integration assessments and local compositional measures were insufficient for identifying the variation in interface strains under compressive and shear loading. Thus, our data points to the importance of controlling interface geometry at the time of surgery, which has implications for cartilage repair integration and long-term healing.

A 3-D constitutive model for finite element analyses of agarose with a range of gel concentrations

Hydrogels have seen widespread application across biomedical sciences and there is considerable interest in using hydrogels, including agarose, for creating in vitro three-dimensional environments to grow cells and study mechanobiology and mechanotransduction. Recent advances in the preparation of agarose gels enable successful encapsulation of viable cells at gel concentrations as high as 5%. Agarose with a range of gel concentrations can thus serve as an experimental model mimicking changes in the 3-D microenvironment of cells during disease progression and can facilitate experiments aimed at probing the corresponding mechanobiology, e.g. the evolving mechanobiology of chondrocytes during the progression of osteoarthritis. Importantly, whether stresses (forces) or strains (displacements) drive mechanobiology and mechanotransduction is currently unknown. We can use experiments to quantify mechanical properties of hydrogels, and imaging to estimate microstructure and even strains; however, only computational models can estimate intra-gel stresses in cell-seeded agarose constructs because the required in vitro experiments are currently impossible. Finite element modeling is well-established for (computational) mechanical analyses, but accurate constitutive models for modeling the 3-D mechanical environments of cells within high-stiffness agarose with varying gel concentrations are currently unavailable. In this study we aimed to establish a 3-D constitutive model of high-stiffness agarose with a range of gel concentrations. We applied a multi-step, physics-based optimization approach to separately fit subsets of model parameters and help achieve robust convergence. Our constitutive model, fitted to experimental data on progressive stress-relaxations, was able to predict reaction forces determined from independent experiments on cyclical loading. Our model has broad applications in finite element modeling aimed at interpreting mechanical experiments on agarose specimens seeded with cells, particularly in predicting distributions of intra-gel stresses. Our model and fitted parameters enable more accurate finite element simulations of high-stiffness agarose constructs, and thus better understanding of experiments aimed at mechanobiology, mechanotransduction, or other applications in tissue engineering.

A 3D, Dynamically Loaded Hydrogel Model of the Osteochondral Unit to Study Osteocyte Mechanobiology

Osteocytes are mechanosensitive cells that orchestrate signaling in bone and cartilage across the osteochondral unit. The mechanisms by which osteocytes regulate osteochondral homeostasis and degeneration in response to mechanical cues remain unclear. This study introduces a novel 3D hydrogel bilayer composite designed to support osteocyte differentiation and bone matrix deposition in a bone-like layer and to recapitulate key aspects of the osteochondral unit's complex loading environment. The bilayer hydrogel is fabricated with a soft cartilage-like layer overlaying a stiff bone-like layer. The bone-like layer contains a stiff 3D-printed hydrogel structure infilled with a soft, degradable, cellular hydrogel. The IDG-SW3 cells embedded within the soft hydrogel mature into osteocytes and produce a mineralized collagen matrix. Under dynamic compressive strains, near-physiological levels of strain are achieved in the bone layer (≤ 0.08%), while the cartilage layer bears the majority of the strains (>99%). Under loading, the model induces an osteocyte response, measured by prostaglandin E2, that is frequency, but not strain, dependent: a finding attributed to altered fluid flow within the composite. Overall, this new hydrogel platform provides a novel approach to study osteocyte mechanobiology in vitro in an osteochondral tissue-mimetic environment.

Glycosaminoglycan depletion increases energy dissipation in articular cartilage under high-frequency loading

High-frequency material behavior of cartilage at macroscopic lengths is not widely understood, despite a wide range of frequencies and contact lengths experienced in vivo. For example, cartilage at different stages of matrix integrity can experience high-frequency loading during traumatic impact, making high-frequency behavior relevant in the context of structural failure. Therefore, this study examined macroscopic dissipative and mechanical responses of intact and glycosaminoglycan (GAG)-depleted cartilage under previously unexplored high-frequency loading. These dynamic responses were complemented with the evaluation of quasi-static responses. A custom dynamic mechanical analyzer was used to obtain dynamic behavior, and stress relaxation testing was performed to obtain quasi-static behavior. Under high-frequency loading, cartilage energy dissipation increased with GAG depletion and decreased with strain; dynamic modulus exhibited opposite trends. Similarly, under quasi-static loading, equilibrium modulus and relaxation time of cartilage decreased with GAG depletion. The increased energy dissipation after GAG depletion under high-frequency loading was likely due to increased viscoelastic dissipation. These findings broaden our understanding of fundamental properties of cartilage as a function of solid matrix integrity in an unprecedented loading regime. They also provide a foundation for analyzing energy dissipation associated with cartilage failure induced by traumatic impact.

The Characteristic Recovery Time as a Novel, Noninvasive Metric for Assessing In Vivo Cartilage Mechanical Function

Osteoarthritis (OA) is a disease characterized by the degeneration of cartilage tissue, and is a leading cause of disability in the United States. The clinical diagnosis of OA includes the presence of pain and radiographic imaging findings, which typically do not present until advanced stages of the disease when treatment is difficult. Therefore, identifying new methods of OA detection that are sensitive to earlier pathological changes in cartilage, which may be addressed prior to the development of irreversible OA, is critical for improving OA treatment. A potentially promising avenue for developing early detection methods involves measuring the tissue’s in vivo mechanical response to loading, as changes in mechanical function are commonly observed in ex vivo studies of early OA. However, thus far the mechanical function of cartilage has not been widely assessed in vivo. Therefore, the purpose of this study was to develop a novel methodology that can be used to measure an in vivo mechanical property of cartilage: the characteristic recovery time. Specifically, in this study we quantified the characteristic recovery time of cartilage thickness after exercise in relatively young subjects with asymptomatic cartilage. Additionally, we measured baseline cartilage thickness and T1rho and T2 relaxation times (quantitative MRI) prior to exercise in these subjects to assess whether baseline MRI measures are predictive of the characteristic recovery time, to understand whether or not the characteristic recovery time provides independent information about cartilage’s mechanical state. Our results show that the mean recovery strain response across subjects was well-characterized by an exponential approach with a characteristic time of 25.2 min, similar to literature values of human characteristic times measured ex vivo. Further, we were unable to detect a statistically significant linear relationship between the characteristic recovery time and the baseline metrics measured here (T1rho relaxation time, T2 relaxation time, and cartilage thickness). This might suggest that the characteristic recovery time has the potential to provide additional information about the mechanical state of cartilage not captured by these baseline MRI metrics. Importantly, this study presents a noninvasive methodology for quantifying the characteristic recovery time, an in vivo mechanical property of cartilage. As mechanical response may be indicative of cartilage health, this study underscores the need for future studies investigating the characteristic recovery time and in vivo cartilage mechanical response at various stages of OA.

Discovery and validation of biomarkers to aid the development of safe and effective pain therapeutics: challenges and opportunities

Pain medication plays an important role in the treatment of acute and chronic pain conditions, but some drugs, opioids in particular, have been overprescribed or prescribed without adequate safeguards, leading to an alarming rise in medication-related overdose deaths. The NIH Helping to End Addiction Long-term (HEAL) Initiative is a trans-agency effort to provide scientific solutions to stem the opioid crisis. One component of the initiative is to support biomarker discovery and rigorous validation in collaboration with industry leaders to accelerate high-quality clinical research into neurotherapeutics and pain. The use of objective biomarkers and clinical trial end points throughout the drug discovery and development process is crucial to help define pathophysiological subsets of pain, evaluate target engagement of new drugs and predict the analgesic efficacy of new drugs. In 2018, the NIH-led Discovery and Validation of Biomarkers to Develop Non-Addictive Therapeutics for Pain workshop convened scientific leaders from academia, industry, government and patient advocacy groups to discuss progress, challenges, gaps and ideas to facilitate the development of biomarkers and end points for pain. The outcomes of this workshop are outlined in this Consensus Statement.

Finite deformation elastography of articular cartilage and biomaterials based on imaging and topology optimization

Tissues and engineered biomaterials exhibit exquisite local variation in stiffness that defines their function. Conventional elastography quantifies stiffness in soft (e.g. brain, liver) tissue, but robust quantification in stiff (e.g. musculoskeletal) tissues is challenging due to dissipation of high frequency shear waves. We describe new development of finite deformation elastography that utilizes magnetic resonance imaging of low frequency, physiological-level (large magnitude) displacements, coupled to an iterative topology optimization routine to investigate stiffness heterogeneity, including spatial gradients and inclusions. We reconstruct 2D and 3D stiffness distributions in bilayer agarose hydrogels and silicon materials that exhibit heterogeneous displacement/strain responses. We map stiffness in porcine and sheep articular cartilage deep within the bony articular joint space in situ for the first time. Elevated cartilage stiffness localized to the superficial zone is further related to collagen fiber compaction and loss of water content during cyclic loading, as assessed by independent T2 measurements. We additionally describe technical challenges needed to achieve in vivo elastography measurements. Our results introduce new functional imaging biomarkers, which can be assessed nondestructively, with clinical potential to diagnose and track progression of disease in early stages, including osteoarthritis or tissue degeneration.

An MRI-compatible varus-valgus loading device for whole-knee joint functionality assessment based on compartmental compression: a proof-of-concept study

OBJECTIVE

Beyond static assessment, functional techniques are increasingly applied in magnetic resonance imaging (MRI) studies. Stress MRI techniques bring together MRI and mechanical loading to study knee joint and tissue functionality, yet prototypical axial compressive loading devices are bulky and complex to operate. This study aimed to design and validate an MRI-compatible pressure-controlled varus-valgus loading device that applies loading along the joint line.

METHODS

Following the device's thorough validation, we demonstrated proof of concept by subjecting a structurally intact human cadaveric knee joint to serial imaging in unloaded and loaded configurations, i.e. to varus and valgus loading at 7.5 kPa (= 73.5 N), 15 kPa (= 147.1 N), and 22.5 kPa (= 220.6 N). Following clinical standard (PDw fs) and high-resolution 3D water-selective cartilage (WATSc) sequences, we performed manual segmentations and computations of morphometric cartilage measures. We used CT and radiography (to quantify joint space widths) and histology and biomechanics (to assess tissue quality) as references.

RESULTS

We found (sub)regional decreases in cartilage volume, thickness, and mean joint space widths reflective of areal pressurization of the medial and lateral femorotibial compartments.

DISCUSSION

Once substantiated by larger sample sizes, varus-valgus loading may provide a powerful alternative stress MRI technique.

Cartilage and collagen mechanics under large-strain shear within in vivo and at supraphysiogical temperatures

Human joints, particularly those of extremities, experience a significant range of temperatures in vivo. Joint temperature influences the mechanics of both joint and cartilage, and the mechanics of cartilage can affect the temperature of both joint and cartilage. Thermal treatments and tissue repairs, such as thermal chondroplasty, and ex vivo tissue engineering may also expose cartilage to supraphysiological temperatures. Furthermore, although cartilage undergoes principally compressive loads in vivo, shear strain plays a significant role at larger compressive strains. Thus, we aimed to determine whether and how the bulk mechanical responses of cartilage undergoing large-strain shear change (1) within the range of temperatures relevant in vivo, and (2) both during and after supraphysiological thermal treatments. We completed large-strain shear tests (10 and 15%) at four thermal conditions: 24^∘C and 40^∘C to span the in vivo range, and 70^∘C and 24^∘C repeated after 70^∘C to explore mechanics during and after potential treatments. We calculated the bulk mechanical responses (strain-energy dissipation densities, peak-to-peak shear stresses, and peak-effective shear moduli) as of function of temperature and used statistical methods to probe significant differences. To probe the mechanisms underlying differences we assessed specimens, principally the type II collagen, with imaging (second harmonic generation and transmission electron microscopies, and histology) and assessed the temperature-dependent mechanics of type II collagen molecules within cartilage using steered molecular dynamics simulations. Our results suggest that the bulk mechanical responses of cartilage depend significantly on temperature both within the in vivo range and at supraphysiological temperatures, showing significant reductions in all mechanical measures with increasing temperature. Using imaging and simulations we determined that one underlying mechanism explaining our results may be changes in the molecular deformation profiles of collagen molecules versus temperature, likely compounded at larger length scales. These new insights into the mechanics of cartilage and collagen may suggest new treatment targets for damaged or osteoarthritic cartilage.

Functional MRI Mapping of Human Meniscus Functionality and its Relation to Degeneration

Meniscus pathology may promote early osteoarthritis. This study assessed human meniscus functionality (i.e. its response to loading) ex vivo based on quantitative T1, T1ρ, and T2 mapping as a function of histological degeneration and loading. Forty-five meniscus samples of variable degeneration were harvested from the lateral meniscus body region of 45 patients during total knee arthroplasties. Samples underwent serial mapping on a 3.0-T MRI scanner (Achieva, Philips) using a force-controlled and torque-inducing compressive loading device. Samples were measured at three loading positions, i.e. unloaded, loaded to 2 bar (compression force 37 N) and 4 bar (69 N). Histology (Pauli classification) and biomechanics (Elastic Modulus) served as references. Based on histology, samples were trichotomized as grossly intact (n = 14), mildly degenerative (n = 16), and moderate-to-severely degenerative (n = 15) and analyzed using appropriate parametric and non-parametric tests. For T1, we found loading-induced decreases in all samples, irrespective of degeneration. For T1ρ, zonal increases in intact (apex) and decreases in degenerative samples (base) were found, while for T2, changes were ambiguous. In conclusion, force-controlled loading and serial MR imaging reveal response-to-loading patterns in meniscus. Zonal T1ρ response-to-loading patterns are most promising in differentiating degeneration, while T1 and T2 aren’t clearly related to degeneration.and may provide an imaging-based indication of functional tissue properties.

Detrimental effects of long sedentary bouts on the biomechanical response of cartilage to sliding

Purpose/Aim: Epidemiological evidence suggests, contrary to popular mythos, that increased exercise/joint activity does not place articular cartilage at increased risk of disease, but instead promotes joint health. One explanation for this might be activity-induced cartilage rehydration; where joint articulation drives restoration of tissue hydration, thickness, and dependent tribomechanical outcomes (e.g., load support, stiffness, and lubricity) lost to joint loading. However, there have been no studies investigating how patterning of intermittent articulation influences the hydration and biomechanical functions of cartilage.Materials and Methods: Here we leveraged the convergent stationary contact area (cSCA) testing configuration and its unique ability to drive tribological rehydration, to elucidate how intermittency of activity affects the biomechanical functions of bovine stifle cartilage under well-controlled sliding conditions that have been designed to model a typical "day" of human joint activity.Results: For a fixed volume of "daily" activity (30 min) and sedentary time (60 min), breaking up intermittent activity into longer and less-frequent bouts (corresponding to longer continuous sedentary periods) resulted in the exposure of articular cartilage to markedly greater strains, losses of interstitial pressure, and friction coefficients.Conclusions: These results demonstrated that the regularity of ex vivo activity regimens, specifically the duration of sedentary bouts, had a dominant effect on the biomechanical functions of articular cartilage. In more practical terms, the results suggest that brief but regular movement patterns (e.g., every hour) may be biomechanically preferred to long and infrequent movement patterns (e.g., a long walk after a sedentary day) when controlling for daily activity volume (e.g., 30 min).

Chondrocyte viability is lost during high-rate impact loading by transfer of amplified strain, but not stress, to pericellular and cellular regions

OBJECTIVE

Deleterious impact loading to cartilage initiates post-traumatic osteoarthritis (OA). While cytokine and enzyme levels regulate disease progression, specific mechanical cues that elucidate cellular OA origins merit further investigation. We defined the dominant pericellular and cellular strain/stress transfer mechanisms following bulk-tissue injury associated with cell death.

METHOD

Using an in vitro model, we investigated rate-dependent loading and spatial localization of cell viability in acute indentation and time-course studies. Atomic force microscopy (AFM) and magnetic resonance imaging (MRI) confirmed depth-wise changes in cartilage micro-/macro-mechanics and structure post-indentation. To understand the transfer of loading to cartilage domains, we computationally modeled full-field strain and stress measures in interstitial matrix, pericellular and cellular regions.

RESULTS

Chondrocyte viability decreased following rapid impact (80%/s) vs slow loading (0.1%/s) or unloaded controls. Viability was lost immediately during impact within regions near the indenter-tissue contact but did not change over 7 days of tissue culture. AFM studies revealed a loss of stiffness following 80%/s loading, and MRI studies confirmed an increased tensile and shear strain, but not relaxometry. Image-based patterns of chondrocyte viability closely matched computational estimates of amplified maximum principal and shear strain in interstitial matrix, pericellular and cellular regions.

CONCLUSION

Rapid indentation worsens chondrocyte death and degrades cartilage matrix stiffness in indentation regions. Cell death at high strain rates may be driven by elevated tensile strains, but not matrix stress. Strain amplification beyond critical thresholds in the pericellular matrix and cells may define a point of origin for early damage in post-traumatic OA.

The clot thickens: Autologous and allogeneic fibrin sealants are mechanically equivalent in an ex vivo model of cartilage repair

Fibrin sealants are commonly used in cartilage repair surgeries to adhere cells or grafts into a cartilage defect. Both autologous and commercial allogeneic fibrin sealants are used in cartilage repair surgeries, yet there are no studies characterizing and comparing the mechanical properties of fibrin sealants from all-autologous sources. The objectives of this study were to investigate (i) the effect of fibrinogen and thrombin sources on failure mechanics of sealants, and (ii) how sealants affect the adhesion of particulated cartilage graft material (BioCartilage) to surrounding cartilage under physiological loading. Allogeneic thrombin and fibrinogen were purchased (Tisseel), and autologous sources were prepared from platelet-rich plasma (PRP) and platelet-poor plasma (PPP) generated from human blood. To compare failure characteristics, sealants were sandwiched between cartilage explants and pulled to failure. The effect of sealant on the adhesion of BioCartilage graft to cartilage was determined by quantifying microscale strains at the graft-cartilage interface using an in vitro cartilage defect model subjected to shear loading at physiological strains well below failure thresholds. Fibrinogen sources were not equivalent; PRP fibrinogen created sealants that were more brittle, failed at lower strains, and resulted in sustained higher strains through the graft-cartilage interface depth compared to PPP and allogeneic sources. PPP clotted slower compared to PRP, suggesting PPP may percolate deeper into the repair to provide more stability through the tissue depth. There was no difference in bulk failure properties or microscale strains at the graft-cartilage interface between the purely autologous sealant (autologous thrombin + PPP fibrinogen) and the commercial allogeneic sealant. Clinical Significance: All-autologous fibrin sealants fabricated with PPP have comparable adhesion strength as commercial allogeneic sealants in vitro, whereas PRP creates an inferior all-autologous sealant that sustains higher strains through the graft-cartilage interface depth.

Human articular cartilage mechanosensitivity is related to histological degeneration - a functional MRI study

OBJECTIVE

To investigate changes in response to sequential pressure-controlled loading and unloading in human articular cartilage of variable histological degeneration using serial T1ρ mapping.

METHOD

We obtained 42 cartilage samples of variable degeneration from the medial femoral condyles of 42 patients undergoing total knee replacement. Samples were placed in a standardized artificial knee joint within an MRI-compatible whole knee-joint compressive loading device and imaged before (δ₀), during (δ_ld1, δ_ld2, δ_ld3, δ_ld4, δ_ld5) and after (δ_rl1, δ_rl2, δ_rl3, δ_rl4, δ_rl5) pressure-controlled loading to 0.663 ± 0.021 kN (94% body weight) using serial T1ρ mapping (spin-lock multigradient echo sequence; 3.0T MRI system [Achieva, Philips]). Reference assessment included histology (Mankin scoring) and conventional biomechanics (Tangent stiffness). We dichotomized sample into intact (n = 21) and degenerative (n = 21) based on histology and analyzed data using Mann Whitney, Kruskal Wallis, one-way ANOVA tests and Spearman's correlation, respectively.

RESULTS

At δ₀, we found no significant differences between intact and degenerative samples, while the response-to-loading patterns were distinctly different. In intact samples, T1ρ increases were consistent and non-significant, while in degenerative samples, T1ρ increases were significantly higher (P = 0.004, δ0 vs δld1, δ0 vs δld3), yet undulating and variable. With unloading, T1ρ increases subsided, yet were persistently elevated beyond δ0.

CONCLUSION

Cartilage mechanosensitivity is related to histological degeneration and assessable by serial T1ρ mapping. Unloaded, T1ρ characteristics are not significantly different in intact vs degenerative cartilage, while load bearing is organized in intact cartilage and disorganized in degenerative cartilage.