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Ma Z, Li DX, Lan X, Bubelenyi A, Vyhlidal M, Kunze M, Sommerfeldt M, Adesida AB. Short-term response of primary human meniscus cells to simulated microgravity. Cell Commun Signal 2024; 22:342. [PMID: 38907358 PMCID: PMC11191296 DOI: 10.1186/s12964-024-01684-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/27/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Mechanical unloading of the knee articular cartilage results in cartilage matrix atrophy, signifying the osteoarthritic-inductive potential of mechanical unloading. In contrast, mechanical loading stimulates cartilage matrix production. However, little is known about the response of meniscal fibrocartilage, a major mechanical load-bearing tissue of the knee joint, and its functional matrix-forming fibrochondrocytes to mechanical unloading events. METHODS In this study, primary meniscus fibrochondrocytes isolated from the inner avascular region of human menisci from both male and female donors were seeded into porous collagen scaffolds to generate 3D meniscus models. These models were subjected to both normal gravity and mechanical unloading via simulated microgravity (SMG) for 7 days, with samples collected at various time points during the culture. RESULTS RNA sequencing unveiled significant transcriptome changes during the 7-day SMG culture, including the notable upregulation of key osteoarthritis markers such as COL10A1, MMP13, and SPP1, along with pathways related to inflammation and calcification. Crucially, sex-specific variations in transcriptional responses were observed. Meniscus models derived from female donors exhibited heightened cell proliferation activities, with the JUN protein involved in several potentially osteoarthritis-related signaling pathways. In contrast, meniscus models from male donors primarily regulated extracellular matrix components and matrix remodeling enzymes. CONCLUSION These findings advance our understanding of sex disparities in knee osteoarthritis by developing a novel in vitro model using cell-seeded meniscus constructs and simulated microgravity, revealing significant sex-specific molecular mechanisms and therapeutic targets.
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Affiliation(s)
- Zhiyao Ma
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - David Xinzheyang Li
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, T6G 2R3, Canada
- Department of Civil and Environmental Engineering, Faculty of Engineering, AB, University of Alberta, Edmonton, T6G 2R3, Canada
| | - Xiaoyi Lan
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - Adam Bubelenyi
- Faculty of Science, AB, University of Alberta, Edmonton, T6G 2R3, Canada
| | - Margaret Vyhlidal
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - Melanie Kunze
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - Mark Sommerfeldt
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - Adetola B Adesida
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, T6G 2R3, Canada.
- Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, T6G 2R3, Canada.
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Korkusuz S, Kibar S, Özgören N, Arıtan S, Seçkinoğulları B, Balkan AF. Effect of Knee Hyperextension on Femoral Cartilage Thickness in Stroke Patients. Am J Phys Med Rehabil 2024; 103:371-376. [PMID: 37549370 DOI: 10.1097/phm.0000000000002323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
OBJECTIVE Knee hyperextension is one of the most common compensatory mechanisms in stroke patients. The first aim of the study was to measure knee hyperextension and femoral cartilage thickness in stroke patients. The second aim was to compare the femoral cartilage thickness of the paretic and nonparetic limbs in stroke patients with and without knee hyperextension. DESIGN Forty stroke patients were included in the study. The patients were divided into two groups according to the presence of knee hyperextension based on kinematic analyses performed during walking with a three-dimensional motion analysis system. The medial femoral cartilage, lateral femoral cartilage, and intercondylar cartilage thicknesses of the paretic and nonparetic sides of the patients were measured by ultrasonography. RESULTS In the study group, medial femoral cartilage, intercondylar, and lateral femoral cartilage thicknesses were less on the paretic side than on the nonparetic side, while the femoral cartilage thicknesses on the paretic and nonparetic sides were similar in the control group. Paretic side medial femoral cartilage and intercondylar thicknesses were less in the study group compared with the control group, and lateral femoral cartilage thickness was similar between the two groups. CONCLUSIONS Knee hyperextension during walking causes femoral cartilage degeneration in stroke patients.Clinical Trial code: NCT05513157.
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Affiliation(s)
- Süleyman Korkusuz
- From the Department of Therapy and Rehabilitation, Faculty of Health Sciences, Atılım University, Ankara, Turkey (SK); Department of Therapy and Rehabilitation, Vocational School of Health Services, Atılım University, Ankara, Turkey (SK); Faculty of Sport Sciences, Hacettepe University, Ankara, Turkey (NÖ, SA); and Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey (BS, AFB)
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Kato Y, Yamada S, Takazawa S, Hattori S, Okada T, Ohuchi H. Comparative study on clinical outcomes in autologous chondrocyte implantation using three-dimensional cultured JACC ® with collagen versus periosteum coverings. Sci Rep 2024; 14:9834. [PMID: 38684723 PMCID: PMC11058265 DOI: 10.1038/s41598-024-59798-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/15/2024] [Indexed: 05/02/2024] Open
Abstract
This study investigates the efficacy of a collagen membrane as a substitute for autologous periosteum in atelocollagen-assisted autologous chondrocyte implantation (ACI) using J-TEC autologous cultured cartilage (JACC®). Sixty-nine patients with knee joint chondral defects underwent ACI using JACC®-34 with periosteum-covered ACI (P-ACIs) and 35 with collagen-covered ACI (C-ACIs). Clinical outcomes were compared through patient-reported measures, International Cartilage Repair Society (ICRS) Cartilage Repair Assessment (CRA) scores at second-look arthroscopy one year postoperatively, and adverse event incidence. Postoperative subjective scores significantly improved up to two years, with no significant differences between P-ACI and C-ACI groups. However, C-ACI exhibited a lower adverse event rate (p = 0.034) and significantly higher ICRS CRA scores (p = 0.0001). Notably, C-ACI outperformed P-ACI in both femoral condyle and trochlea assessments (p = 0.0157 and 0.0005, respectively). While clinical outcomes were comparable, the use of a collagen membrane demonstrated superiority in ICRS CRA during second-look arthroscopy and adverse event occurrence.
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Affiliation(s)
- Yuki Kato
- Department of Sports Medicine, Kameda Medical Center, 929 Higashi-Cho, Kamogawa City, Chiba Prefecture, 296-8602, Japan.
| | - Shin Yamada
- Department of Sports Medicine, Kameda Medical Center, 929 Higashi-Cho, Kamogawa City, Chiba Prefecture, 296-8602, Japan
| | - Shuzo Takazawa
- Department of Sports Medicine, Kameda Medical Center, 929 Higashi-Cho, Kamogawa City, Chiba Prefecture, 296-8602, Japan
| | - Soichi Hattori
- Department of Sports Medicine, Kameda Medical Center, 929 Higashi-Cho, Kamogawa City, Chiba Prefecture, 296-8602, Japan
| | - Takuya Okada
- Department of Sports Medicine, Kameda Medical Center, 929 Higashi-Cho, Kamogawa City, Chiba Prefecture, 296-8602, Japan
| | - Hiroshi Ohuchi
- Department of Sports Medicine, Kameda Medical Center, 929 Higashi-Cho, Kamogawa City, Chiba Prefecture, 296-8602, Japan
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Gan D, Jin X, Wang X, Tao C, Yan Q, Jia Q, Huo S, Chen D, Yao Q, Xiao G. Pathological progress and remission strategies of osteoarthritic lesions caused by long-term joint immobilization. Arthritis Res Ther 2023; 25:237. [PMID: 38062473 PMCID: PMC10702075 DOI: 10.1186/s13075-023-03223-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE While joint immobilization is a useful repair method for intra-articular ligament injury and periarticular fracture, prolonged joint immobilization can cause multiple complications. A better understanding how joint immobilization and remobilization impact joint function and homeostasis will help clinicians develop novel strategies to reduce complications. DESIGN We first determined the effects of long-term immobilization on joint pain and osteophyte formation in patients after an extraarticular fracture or ligament injury. We then developed a mouse model of joint immobilization and harvested the knee joint samples at 2, 4, and 8 weeks. We further determined the effects of remobilization on recovery of the osteoarthritis (OA) lesions induced by immobilization in mice. RESULTS We found that the long-term (6 weeks) joint immobilization caused significant joint pain and osteophytes in patients. In mice, 2-week immobilization already induced moderate sensory innervation and increased pain sensitivity and infiltration in synovium without inducing marked osteophyte formation and cartilage loss. Long-term immobilization (4 and 8 weeks) induced more severe sensory innervation and inflammatory infiltration in synovium, massive osteophyte formation on both sides of the femoral condyle, and the edge of the tibial plateau and significant loss of the articular cartilage in mice. Remobilization, which ameliorates normal joint load and activity, restored to certain extent some of the OA lesions and joint function in mice. CONCLUSIONS Joint immobilization caused multiple OA-like lesions in both mice and humans. Joint immobilization induced progressive sensory innervation, synovitis, osteophyte formation, and cartilage loss in mice, which can be partially ameliorated by remobilization.
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Affiliation(s)
- Donghao Gan
- Department of Biochemistry, Guangdong Provincial Key Laboratory of Cell Microenvironment and Disease Research, Shenzhen Key Laboratory of Cell Microenvironment, School of Medicine, Southern University of Science and Technology, Shenzhen, China
| | - Xiaowan Jin
- Department of Biochemistry, Guangdong Provincial Key Laboratory of Cell Microenvironment and Disease Research, Shenzhen Key Laboratory of Cell Microenvironment, School of Medicine, Southern University of Science and Technology, Shenzhen, China
| | - Xiangpeng Wang
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Chu Tao
- Department of Biochemistry, Guangdong Provincial Key Laboratory of Cell Microenvironment and Disease Research, Shenzhen Key Laboratory of Cell Microenvironment, School of Medicine, Southern University of Science and Technology, Shenzhen, China
| | - Qinnan Yan
- Department of Biochemistry, Guangdong Provincial Key Laboratory of Cell Microenvironment and Disease Research, Shenzhen Key Laboratory of Cell Microenvironment, School of Medicine, Southern University of Science and Technology, Shenzhen, China
| | - Qingyun Jia
- Department of Orthopedics, Linyi People's Hospital, Linyi, China
| | - Shaochuan Huo
- Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Di Chen
- Research Center for Computer-Aided Drug Discovery, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Qing Yao
- Department of Biochemistry, Guangdong Provincial Key Laboratory of Cell Microenvironment and Disease Research, Shenzhen Key Laboratory of Cell Microenvironment, School of Medicine, Southern University of Science and Technology, Shenzhen, China.
| | - Guozhi Xiao
- Department of Biochemistry, Guangdong Provincial Key Laboratory of Cell Microenvironment and Disease Research, Shenzhen Key Laboratory of Cell Microenvironment, School of Medicine, Southern University of Science and Technology, Shenzhen, China.
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Ekici B, Ordahan B. Evaluation of the effect of high-intensity laser therapy (HILT) on function, muscle strength, range of motion, pain level, and femoral cartilage thickness in knee osteoarthritis: randomized controlled study. Lasers Med Sci 2023; 38:218. [PMID: 37743421 DOI: 10.1007/s10103-023-03887-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 09/16/2023] [Indexed: 09/26/2023]
Abstract
This study was designed as a double-blind randomized placebo-controlled study. The aim of this study was to evaluate the effects of high-intensity laser therapy (HILT) on pain, range of motion, function, muscle strength, and femoral cartilage thickness in patients with knee osteoarthritis. Sixty patients who were admitted between November 2021 and April 2022 and diagnosed with knee osteoarthritis based on anamnesis, physical examination, and imaging methods were included in the study. The patients observed during the research were randomly divided into two groups with 30 patients in each group. Hotpack, transcutaneous electrical nerve stimulation (TENS), exercise (5 days a week for a total of 15 sessions), and HILT (analgesic mode with a power of 10.0 w, energy density of 12 j/cm2, and 2 min for every 25 cm2, biostimulant mode with a power of 5.0 W, energy density of 120 j/cm2, and 10 min for each 25 cm2; total 9 sessions 3 days a week) were applied for 3 weeks for the first group, and hot pack, TENS, exercise (5 days a week for a total of 15 sessions), and sham laser treatment (0 W total 9 sessions 3 days a week) was applied for 3 weeks for the second group. The patients were evaluated with the determined scales before the treatment, at the end of the treatment, and at the third month. A goniometer was used to measure joint range of motion measurement, a visual analog scale (VAS) for pain, WOMAC Osteoarthritis Index to assess pain and function, Biodex System 3 isokinetic device for knee flexion-extension muscle strength measurement, and ultrasonography to measure femoral cartilage thickness. There was no statistically significant difference in VAS, range of motion, WOMAC, muscle strength, and femoral cartilage thickness measurement between the groups, whether before treatment, after treatment or at the third-month follow-up (p > 0.05). There was a statistically significant decrease in pain intensity, an increase in flexion range of motion, WOMAC, and femoral cartilage thickness in both groups (p < 0.005). A statistically significant increase was found in the average peak torque flexion muscle strength measurements at isokinetic 60°/s angular velocities in the post-treatment and third-month checkup compared to the pre-treatment analysis in both groups (p < 0.05). In conclusion, there was no statistically significant difference between HILT + exercise and placebo laser + exercise observed. However, the exercise program performed under the supervision of a physiotherapist has been shown to be effective in improving all parameters.
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Affiliation(s)
- Burak Ekici
- Department of Physical Medicine and Rehabilitation, Necmettin Erbakan University, Konya, Turkey
| | - Banu Ordahan
- Department of Physical Medicine and Rehabilitation, Necmettin Erbakan University, Konya, Turkey.
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Miller L, Ramírez-Torres A, Rodríguez-Ramos R, Penta R. Effective Governing Equations for Viscoelastic Composites. MATERIALS (BASEL, SWITZERLAND) 2023; 16:4944. [PMID: 37512218 PMCID: PMC10381759 DOI: 10.3390/ma16144944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023]
Abstract
We derive the governing equations for the overall behaviour of linear viscoelastic composites comprising two families of elastic inclusions, subphases and/or fibres, and an incompressible Newtonian fluid interacting with the solid phases at the microscale. We assume that the distance between each of the subphases is very small in comparison to the length of the whole material (the macroscale). We can exploit this sharp scale separation and apply the asymptotic (periodic) homogenization method (AHM) which decouples spatial scales and leads to the derivation of the new homogenised model. It does this via upscaling the fluid-structure interaction problem that arises between the multiple elastic phases and the fluid. As we do not assume that the fluid flow is characterised by a parabolic profile, the new macroscale model, which consists of partial differential equations, is of Kelvin-Voigt viscoelastic type (rather than poroelastic). The novel model has coefficients that encode the properties of the microstructure and are to be computed by solving a single local differential fluid-structure interaction (FSI) problem where the solid and the fluid phases are all present and described by the one problem. The model reduces to the case described by Burridge and Keller (1981) when there is only one elastic phase in contact with the fluid. This model is applicable when the distance between adjacent phases is smaller than the average radius of the fluid flowing in the pores, which can be the case for various highly heterogeneous systems encountered in real-world (e.g., biological, or geological) scenarios of interest.
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Affiliation(s)
- Laura Miller
- School of Mathematics & Statistics, University of Glasgow, Glasgow G12 8QQ, UK
| | | | - Reinaldo Rodríguez-Ramos
- Facultad de Matemática y Computación, Universidad de La Habana, La Habana 10400, Cuba
- PPG-MCCT, Universidade Federal Fluminense, Av. dos Trabalhadores 420, Vila Sta. Cecília, Volta Redonda 27225-125, RJ, Brazil
| | - Raimondo Penta
- School of Mathematics & Statistics, University of Glasgow, Glasgow G12 8QQ, UK
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Ghoseiri K, Zucker-Levin A. Long-term locked knee ankle foot orthosis use: A perspective overview of iatrogenic biomechanical and physiological perils. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1138792. [PMID: 37214128 PMCID: PMC10192684 DOI: 10.3389/fresc.2023.1138792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/03/2023] [Indexed: 05/24/2023]
Abstract
A knee ankle foot orthosis (KAFO) may be prescribed to the person with severe neuromusculoskeletal impairment of the lower limb to promote walking stability. The locked knee ankle foot orthosis (L-KAFO) is among the KAFO's routinely prescribed; however, long-term use of the L-KAFO is associated with musculoskeletal (arthrogenic and myogenic) and integumentary changes, and gait asymmetry with increased energy expenditure. Consequently, the risk of developing low back pain, osteoarthritis of the lower limbs and spinal joints, skin dermatitis, and ulceration increases, all of which impact quality of life. This article synthesizes the iatrogenic biomechanical and physiological perils of long-term L-KAFO use. It promotes using recent advances in rehabilitation engineering to improve daily activities and independence for proper patient groups.
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Drapeau-Zgoralski V, Swift B, Caines A, Kerrigan A, Carsen S, Pickell M. Lateral Patellar Instability. J Bone Joint Surg Am 2023; 105:397-409. [PMID: 36728086 DOI: 10.2106/jbjs.22.00756] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
➤ Patellar instability represents a common problem with an evolving understanding and multifactorial pathoetiology. Treatment plans should be based on the identification of contributing anatomical factors and tailored to each individual patient. ➤ Risks for recurrent instability are dependent on several patient-specific factors including patella alta, increased tibial tubercle-to-trochlear groove (TT-TG) distance, trochlear dysplasia, younger skeletal age, and ligamentous laxity. ➤ Cartilage or osteochondral lesions and/or fractures are commonly observed in first-time patellar dislocation, and magnetic resonance imaging (MRI) should be strongly considered. Advanced imaging modalities, such as computed tomography (CT) or MRI, should also be obtained preoperatively to identify predisposing factors and guide surgical treatment. ➤ Medial patellofemoral ligament (MPFL) reconstruction with anatomical femoral tunnel positioning is associated with lower recurrence rates compared with MPFL repair and has become a common and successful reconstructive surgical option in cases of instability. ➤ Lateral retinacular tightness can be addressed with lateral retinacular release or lengthening, but these procedures should not be performed in isolation. ➤ Tibial tubercle osteotomy is a powerful reconstructive tool in the setting of underlying skeletal risk factors for instability and can be of particular benefit in the presence of increased TT-TG distance (>20 mm), and/or in the setting of patella alta. ➤ The indications for trochleoplasty are still developing along with the clinical evidence, but trochleoplasty may be indicated in some cases of severe trochlear dysplasia. Several surgical techniques have indications in specific clinical scenarios and populations, and indications, risks, and benefits to each are progressing with our understanding. ➤ Combined femoral derotational osteotomy and MPFL reconstruction can be considered for patients with a femoral anteversion angle of >30° to improve patient outcomes and reduce recurrence rates.
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Affiliation(s)
| | - Brendan Swift
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Andrew Caines
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Alicia Kerrigan
- Division of Orthopaedic Surgery, The Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Sasha Carsen
- Division of Orthopaedic Surgery, The Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Michael Pickell
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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Transcriptomic response of bioengineered human cartilage to parabolic flight microgravity is sex-dependent. NPJ Microgravity 2023; 9:5. [PMID: 36658138 PMCID: PMC9852254 DOI: 10.1038/s41526-023-00255-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/10/2023] [Indexed: 01/20/2023] Open
Abstract
Spaceflight and simulated spaceflight microgravity induced osteoarthritic-like alterations at the transcriptomic and proteomic levels in the articular and meniscal cartilages of rodents. But little is known about the effect of spaceflight or simulated spaceflight microgravity on the transcriptome of tissue-engineered cartilage developed from human cells. In this study, we investigate the effect of simulated spaceflight microgravity facilitated by parabolic flights on tissue-engineered cartilage developed from in vitro chondrogenesis of human bone marrow mesenchymal stem cells obtained from age-matched female and male donors. The successful induction of cartilage-like tissue was confirmed by the expression of well-demonstrated chondrogenic markers. Our bulk transcriptome data via RNA sequencing demonstrated that parabolic flight altered mostly fundamental biological processes, and the modulation of the transcriptome profile showed sex-dependent differences. The secretome profile analysis revealed that two genes (WNT7B and WNT9A) from the Wnt-signaling pathway, which is implicated in osteoarthritis development, were only up-regulated for female donors. The results of this study showed that the engineered cartilage tissues responded to microgravity in a sex-dependent manner, and the reported data offers a strong foundation to further explore the underlying mechanisms.
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10
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Williams JR, Neal K, Alfayyadh A, Capin JJ, Khandha A, Manal K, Snyder-Mackler L, Buchanan TS. Patellofemoral contact forces and knee gait mechanics 3 months after ACL reconstruction are associated with cartilage degradation 24 months after surgery. Osteoarthritis Cartilage 2023; 31:96-105. [PMID: 36252943 PMCID: PMC9771964 DOI: 10.1016/j.joca.2022.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/26/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Evaluate patellofemoral cartilage health, as assessed by quantitative magnetic resonance imaging (qMRI) T2 relaxation times, 24-months after ACL reconstruction (ACLR) and determine if they were associated with patellofemoral contact forces and knee mechanics during gait 3 months after surgery. DESIGN Thirty individuals completed motion analysis during overground walking at a self-selected speed 3 months after ACLR. An EMG-driven neuromusculoskeletal model was used to determine muscle forces, which were then used in a previously described model to estimate patellofemoral contact forces. Biomechanical variables of interest included peak patellofemoral contact force, peak knee flexion angle and moment, and walking speed. These same participants underwent a sagittal bilateral T2 mapping qMRI scan 24-months after surgery. T2 relaxation times were estimated for both patellar and trochlear cartilage. Paired t-tests were used to compare T2 relaxation times between limbs while Pearson correlations and linear regressions were utilized to assess the association between the biomechanical variables of interest and T2 relaxation times. RESULTS Prolonged involved limb trochlear T2 relaxation times (vs uninvolved) were present 24-months after surgery, indicating worse cartilage health. No differences were detected in patellar cartilage. Significant negative associations were present within the involved limb for all the biomechanical variables of interest 3 months after ACLR and trochlear T2 relaxation times at 24-months. No associations were found in patellar cartilage or within the uninvolved limb. CONCLUSIONS Altered involved limb trochlear cartilage health is present 24-months after ACLR and may be related to patellofemoral loading and other walking gait mechanics 3 months after surgery.
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Affiliation(s)
- J R Williams
- Department of Mechanical Engineering, University of Delaware, Newark, DE, USA.
| | - K Neal
- Department of Mechanical Engineering, University of Delaware, Newark, DE, USA.
| | - A Alfayyadh
- Biomechanics and Movement Science, University of Delaware, Newark, DE, USA; Physical Therapy and Rehabilitation Department, Jouf University, Jouf, Saudi Arabia.
| | - J J Capin
- Department of Physical Therapy, Marquette University, Milwaukee, WI, USA.
| | - A Khandha
- Department of Biomedical Engineering, University of Delaware, Newark, DE, USA.
| | - K Manal
- Biomechanics and Movement Science, University of Delaware, Newark, DE, USA; Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA.
| | - L Snyder-Mackler
- Biomechanics and Movement Science, University of Delaware, Newark, DE, USA; Department of Biomedical Engineering, University of Delaware, Newark, DE, USA; Department of Physical Therapy, University of Delaware, Newark, DE, USA.
| | - T S Buchanan
- Department of Mechanical Engineering, University of Delaware, Newark, DE, USA; Biomechanics and Movement Science, University of Delaware, Newark, DE, USA; Department of Biomedical Engineering, University of Delaware, Newark, DE, USA.
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11
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Mostakhdemin M, Nand A, Ramezani M. Tribological Evaluation of Silica Nanoparticle Enhanced Bilayer Hydrogels as A Candidate for Cartilage Replacement. Polymers (Basel) 2022; 14:polym14173593. [PMID: 36080668 PMCID: PMC9460628 DOI: 10.3390/polym14173593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/20/2022] [Accepted: 08/23/2022] [Indexed: 11/24/2022] Open
Abstract
Polymeric hydrogels can be used as artificial replacement for lesioned cartilage. However, modulating the hydrogel formulation that mimics articular cartilage tissue with respect to mechanical and tribological properties has remained a challenge. This study encompasses the tribological evaluation of a silica nanoparticle (SNP) loaded bilayer nanocomposite hydrogel (NCH), synthesized using acrylamide, acrylic acid, and alginate via modulated free-radical polymerization. Multi-factor pin-on-plate sliding wear experiments were carried out with a steel ball counterface using a linear reciprocating tribometer. Tribological properties of NCHs with 0.6 wt% SNPs showed a significant improvement in the wear resistance of the lubricious layer and a low coefficient of friction (CoF). CoF of both non-reinforced hydrogel (NRH) and NCH at maximum contact pressure ranged from 0.006 to 0.008, which is in the order of the CoF of healthy articular cartilage. Interfacial surface energy was analysed according to Johnson, Kendall, and Robert’s theory, and NCHs showed superior mechanical properties and surface energy compared to NRHs. Lubrication regimes’ models were drawn based on the Stribeck chart parameters, and CoF results were highlighted in the elastoviscous transition regime.
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Affiliation(s)
- Mohammad Mostakhdemin
- Department of Mechanical Engineering, Auckland University of Technology, Auckland 1010, New Zealand
- Correspondence: (M.M.); (M.R.)
| | - Ashveen Nand
- Faculty of Engineering, University of Auckland, Auckland 1010, New Zealand
| | - Maziar Ramezani
- Department of Mechanical Engineering, Auckland University of Technology, Auckland 1010, New Zealand
- Correspondence: (M.M.); (M.R.)
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12
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Lai WC, Bohlen HL, Fackler NP, Wang D. Osteochondral Allografts in Knee Surgery: Narrative Review of Evidence to Date. Orthop Res Rev 2022; 14:263-274. [PMID: 35979427 PMCID: PMC9377395 DOI: 10.2147/orr.s253761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 08/08/2022] [Indexed: 01/14/2023] Open
Abstract
Knee articular cartilage defects can result in significant pain and loss of function in active patients. Osteochondral allograft (OCA) transplantation offers a single-stage solution to address large chondral and osteochondral defects by resurfacing focal cartilage defects with mature hyaline cartilage. To date, OCA transplantation of the knee has demonstrated excellent clinical outcomes and long-term survivorship. However, significant variability still exists among clinicians with regard to parameters for graft acceptance, surgical technique, and rehabilitation. Technologies to optimize graft viability during storage, improve osseous integration of the allograft, and shorten recovery timelines after surgery continue to evolve. The purpose of this review is to examine the latest evidence on treatment indications, graft storage and surgical technique, patient outcomes and survivorship, and rehabilitation after surgery.
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Affiliation(s)
- Wilson C Lai
- Department of Orthopaedic Surgery, UCI Health, Orange, CA, USA
| | - Hunter L Bohlen
- Department of Orthopaedic Surgery, UCI Health, Orange, CA, USA
| | - Nathan P Fackler
- Department of Orthopaedic Surgery, UCI Health, Orange, CA, USA.,Georgetown University School of Medicine, Washington, DC, USA
| | - Dean Wang
- Department of Orthopaedic Surgery, UCI Health, Orange, CA, USA.,Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
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13
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Retameiro AC, Neves M, Tavares AL, Boaro CD, Rodriguez DF, Stein T, Costa RM, Bertolini GR, Ribeiro LF. Physical Exercise and Low-Level Laser Therapy Systemic Effects on the Ankle Joint in an Experimental Rheumatoid Arthritis Model. J Manipulative Physiol Ther 2022; 45:248-260. [DOI: 10.1016/j.jmpt.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 07/06/2022] [Accepted: 07/13/2022] [Indexed: 10/14/2022]
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14
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Crowley SG, Pedersen A, Fortney TA, Swindell HW, Saltzman BM, Popkin CA, Trofa DP. Rehabilitation Variability Following Osteochondral Autograft and Allograft Transplantation of the Knee. Cartilage 2022; 13:19476035221093071. [PMID: 35762400 PMCID: PMC9247380 DOI: 10.1177/19476035221093071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The aim of this study is to assess the variability of postoperative rehabilitation protocols used by orthopedic surgery residency programs for osteochondral autograft transplantation (OAT) and osteochondral allograft transplantation (OCA) of the knee. DESIGN Online postoperative OAT and OCA rehabilitation protocols from US orthopedic programs and the scientific literature were reviewed. A custom scoring rubric was developed to analyze each protocol for the presence of discrete rehabilitation modalities and the timing of each intervention. RESULTS A total of 16 programs (10.3%) from 155 US academic orthopedic programs published online protocols and a total of 35 protocols were analyzed. Twenty-one protocols (88%) recommended immediate postoperative bracing following OAT and 17 protocols (100%) recommended immediate postoperative bracing following OCA. The average time protocols permitted weight-bearing as tolerated (WBAT) was 5.2 weeks (range = 0-8 weeks) following OAT and 6.2 weeks (range = 0-8 weeks) following OCA. There was considerable variation in the inclusion and timing of strength, proprioception, agility, and pivoting exercises. Following OAT, 2 protocols (8%) recommended functional testing as criteria for return to sport at an average time of 12.0 weeks (range = 12-24 weeks). Following OCA, 1 protocol (6%) recommended functional testing as criteria for return to sport at an average time of 12.0 weeks (range = 12-24 weeks). CONCLUSION A minority of US academic orthopedic programs publish OAT and OCA rehabilitation protocols online. Among the protocols currently available, there is significant variability in the inclusion of specific rehabilitation components and timing of many modalities. Evidence-based standardization of elements of postoperative rehabilitation may help improve patient care and subsequent outcomes.
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Affiliation(s)
- Stephen G. Crowley
- Albany Medical Center, Albany, NY,
USA,Stephen G. Crowley, Albany Medical Center,
Albany, NY 12208, USA.
| | | | - Thomas A. Fortney
- Center for Shoulder, Elbow and Sports
Medicine, Columbia University, New York, NY, USA
| | | | | | - Charles A. Popkin
- Center for Shoulder, Elbow and Sports
Medicine, Columbia University, New York, NY, USA
| | - David P. Trofa
- Center for Shoulder, Elbow and Sports
Medicine, Columbia University, New York, NY, USA
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15
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Role of Osteotomy in Ligament Injuries: Updates on Corrective Osteotomy Combined Ligament Procedure Techniques. OPER TECHN SPORT MED 2022. [DOI: 10.1016/j.otsm.2022.150934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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16
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Williams JR, Neal K, Alfayyadh A, Khandha A, Manal K, Snyder-Mackler L, Buchanan TS. Patellofemoral contact forces after ACL reconstruction: A longitudinal study. J Biomech 2022; 134:110993. [PMID: 35182902 PMCID: PMC8976762 DOI: 10.1016/j.jbiomech.2022.110993] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/13/2021] [Accepted: 02/07/2022] [Indexed: 11/17/2022]
Abstract
Osteoarthritis (OA) development after ACL reconstruction (ACLR) is common. Patellofemoral OA after ACLR is as prevalent as tibiofemoral OA; however, few have explored the mechanisms leading to disease development in this compartment. Biomechanical alterations may be one mechanism responsible for post-traumatic knee OA. Patellofemoral contact forces during dynamic tasks, such as running and single leg hops, have been assessed at return to sport and later time points. The results of these studies, however, contradict each other, are only cross-sectional in nature, and are limited to specific points in time within the movement pattern. The purpose of this study was to assess patellofemoral contact forces 3, 6, and 24 months after ACLR during level walking over the entirety of the movement pattern. Patellofemoral contact forces were calculated after determination of muscle forces from a validated, subject-specific, EMG-driven neuromusculoskeletal model. Statistical parametric mapping was used to compare patellofemoral contact forces between limbs and across time points. Patellofemoral underloading of the involved limb (vs. uninvolved) was present at 3 months (p < 0.001 from 7 to 30% of stance) and 6 months (p = 0.001 from 11 to 23% of stance and p = 0.025 from 27 to 32%) after ACLR but was resolved by 24 months. Both limbs' load increased from 3 to 6 months. The involved limb displayed relatively consistent loads from 6 months onward, while the uninvolved limb's decreased back down towards their 3-month values. Overall, these results suggest that early patellofemoral underloading exists after ACLR and may be leading to patellofemoral OA development.
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Affiliation(s)
- Jack R Williams
- Department of Mechanical Engineering, University of Delaware, Newark, DE, United States.
| | - Kelsey Neal
- Department of Mechanical Engineering, University of Delaware, Newark, DE, United States
| | - Abdulmajeed Alfayyadh
- Biomechanics and Movement Science, University of Delaware, Newark, DE, United States
| | - Ashutosh Khandha
- Biomechanics and Movement Science, University of Delaware, Newark, DE, United States; Department of Biomedical Engineering, University of Delaware, Newark, DE, United States
| | - Kurt Manal
- Biomechanics and Movement Science, University of Delaware, Newark, DE, United States; Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - Lynn Snyder-Mackler
- Biomechanics and Movement Science, University of Delaware, Newark, DE, United States; Department of Biomedical Engineering, University of Delaware, Newark, DE, United States; Department of Physical Therapy, University of Delaware, Newark, DE, United States
| | - Thomas S Buchanan
- Department of Mechanical Engineering, University of Delaware, Newark, DE, United States; Biomechanics and Movement Science, University of Delaware, Newark, DE, United States; Department of Biomedical Engineering, University of Delaware, Newark, DE, United States
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17
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Monson JK, Schoenecker J, Matheson JW, O'Keefe J, Schwery N, Hickmann A. Modern Principles for Rehabilitation for Medial and Lateral Knee Ligament Surgery: How to Optimize Outcomes. OPER TECHN SPORT MED 2022. [DOI: 10.1016/j.otsm.2022.150915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Crowley SG, Swindell HW, Saltzman BM, Ahmad CS, Popkin CA, Trofa DP. Rehabilitation Variability Following Femoral Condyle and Patellofemoral Microfracture Surgery of the Knee. Cartilage 2021; 13:1801S-1813S. [PMID: 34151611 PMCID: PMC8808894 DOI: 10.1177/19476035211025818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the variability of postoperative rehabilitation protocols used by orthopedic surgery residency programs for microfracture of femoral condyle and patellofemoral lesions of the knee. DESIGN Online postoperative microfracture rehabilitation protocols from US orthopedic programs and the scientific literature were reviewed. A custom scoring rubric was developed to analyze each protocol for the presence of discrete rehabilitation modalities and the timing of each intervention. RESULTS A total of 18 programs (11.6%) from 155 US academic orthopedic programs' published online protocols and a total of 44 protocols were analyzed. Seventeen protocols (56.7%) recommended immediate postoperative bracing for femoral condyle lesions and 17 (89.5%) recommended immediate postoperative bracing for patellofemoral lesions. The average time to permitting weight-bearing as tolerated (WBAT) was 6.1 weeks (range, 0-8) for femoral condyle lesions and 3.7 weeks (range, 0-8 weeks) for patellofemoral lesions. There was considerable variation in the inclusion and timing of strength, proprioception, agility, and pivoting exercises. For femoral condyle lesions, 10 protocols (33.3%) recommended functional testing prior to return to sport at an average of 23.3 weeks postoperatively (range, 12-32 weeks). For patellofemoral lesions, 4 protocols (20.0%) recommended functional testing for return to sport at an average of 21.0 weeks postoperatively (range, 12-32 weeks). CONCLUSION A minority of US academic orthopedic programs publish microfracture rehabilitation protocols online. Among the protocols currently available, there is significant variability in the inclusion of specific rehabilitation components and timing of many modalities. Evidence-based standardization of elements of postoperative rehabilitation may help improve patient care and subsequent outcomes.
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Affiliation(s)
| | - Hasani W. Swindell
- Center for Shoulder, Elbow and Sports
Medicine, Columbia University, New York, NY, USA
| | | | - Christopher S. Ahmad
- Center for Shoulder, Elbow and Sports
Medicine, Columbia University, New York, NY, USA
| | - Charles A. Popkin
- Center for Shoulder, Elbow and Sports
Medicine, Columbia University, New York, NY, USA
| | - David P. Trofa
- Center for Shoulder, Elbow and Sports
Medicine, Columbia University, New York, NY, USA,David P. Trofa, Department of Orthopedic
Surgery, Columbia University Medical Center, New York, NY 10032, USA.
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19
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Han HJ, Lee K, Yoon HY. Case Report: Trans-Articular External Skeletal Fixation of the Hip for a Highly Comminuted Juxta-Articular Fracture of the Proximal Femur Caused by Gunshot Injury in a Cat. Front Vet Sci 2021; 8:652847. [PMID: 34350224 PMCID: PMC8328486 DOI: 10.3389/fvets.2021.652847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/24/2021] [Indexed: 12/01/2022] Open
Abstract
This report describes a novel surgical technique for trans-articular external skeletal fixation (TA-ESF) of the hip to stabilize a rare, highly comminuted juxta-articular fracture of the proximal femoral segment involving the metaphysis and diaphysis in a cat. A 2-year-old, castrated male, Korean shorthair cat was admitted for a left femoral fracture caused by gunshot injury. Radiographs and computed tomography (CT) scans revealed a highly comminuted proximal femoral diaphyseal fracture that involved the femoral neck and the greater trochanter. The left femoral head was intact on CT. Under fluoroscopic guidance, an intramedullary Steinmann pin was placed to align the femur, and five positive-profile, end-threaded pins were placed in the left hemipelvis and distal femur. A triangulated frame of connecting bars was constructed using Steinmann pins and epoxy resin for TA-ESF. This secured the pins placed in the pelvis and femur as well as the intramedullary pin, providing proximal femoral stabilization by trans-articular fixation of the hip. The cat began placing weight on the left pelvic limb 4 days postoperatively, and progressively obtained near-normal limb function by day 112. The TA-ESF was partially dismantled to a linear tie-in construct on day 64 and was completely removed on day 161. Final radiographs on day 161 revealed lack of bone healing in the proximal segment, especially femoral head and neck, despite functional recovery of the injured leg. At one year postoperatively, the cat had normal limb function without any noticeable complications. On follow-up 29 months after surgery, the owner reported that the cat had normal limb function without any noticeable complications. Despite insufficient bone healing in the cat, TA-ESF of the hip allowed for satisfactory functional recovery of this challenging juxta-articular fracture of the proximal femur, which was not amenable to stabilization with a traditional non-load-sharing fixation system.
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Affiliation(s)
- Hyun-Jung Han
- Department of Veterinary Emergency and Critical Care, Konkuk Veterinary Medical Teaching Hospital, Konkuk University, Seoul, South Korea
| | - Kyeongpung Lee
- Department of Materials Science and Engineering, Seoul National University, Seoul, South Korea
| | - Hun-Young Yoon
- Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
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20
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Dowgierd K, Lipowicz A, Kulesa-Mrowiecka M, Wolański W, Linek P, Myśliwiec A. Efficacy of immediate physiotherapy after surgical release of zygomatico-coronoid ankylosis in a young child: A case report. Physiother Theory Pract 2021; 38:3187-3193. [PMID: 34266352 DOI: 10.1080/09593985.2021.1952672] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Temporomandibular joint ankylosis (TMJ ankylosis) manifests itself as a locked jaw and reduced mouth opening. We hypothesized that the efficacy of TMJ ankylosis surgery in a child may largely depend on physiotherapeutic management. CASE DESCRIPTION : In this case report, we present the treatment of a girl between 1 and 4 years of age, who was unable to open her jaws immediately after birth. Congenital ankylosis was diagnosed. INTERVENTION : Two models of therapeutic management were presented, with a surgical procedure to release bone fusion adopted as a starting point. In the first model, the rehabilitation procedure started 21 days after surgery. OUTCOMES : Despite rehabilitation, no clinical improvement was achieved (i.e. the child was still unable to open her jaws). In the second model, rehabilitation started from the day after surgery and management according to the second model allowed for obtaining therapeutic benefits. After therapy, the girl was able to abduct the mandible to a degree allowing for improved speech and the ability to crush food. CONCLUSIONS : This clinical case shows that the efficacy of surgical procedures may depend on the type of postoperative management. It was demonstrated that physiotherapy started immediately after the procedure to release the ankylosis improved the mandible mobility outcomes for this child.
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Affiliation(s)
- Krzysztof Dowgierd
- Department of Clinical Pediatrics, Regional Specialized Children's Hospital, Head and Neck Surgery Clinic for Children and Young Adults, University of Warmia and Mazury, Olsztyn, Poland
| | - Anna Lipowicz
- Department of Anthropology, Institute of Environmental Biology, Wroclaw University of Environmental and Life Sciences, Poland
| | - Małgorzata Kulesa-Mrowiecka
- Department of Physiotherapy, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University, Medical College, Cracow, Poland
| | - Wojciech Wolański
- Department of Biomechatronics, Faculty of Biomedical Engineering, Silesian University of Technology, Zabrze, Poland
| | - Paweł Linek
- Musculoskeletal Elastography and Ultrasonography Laboratory, Institute of Physiotherapy and Health Sciences, Academy of Physical Education, Katowice, Poland
| | - Andrzej Myśliwiec
- Laboratory of Physiotherapy and Physioprevention, Institute of Physiotherapy and Health Science, Academy of Physical Education, Katowice, Poland.,Specialized Physiotherapy Center, Rybnik, Poland
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21
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Evans-Pickett A, Longobardi L, Spang JT, Creighton RA, Kamath G, Davis-Wilson HC, Loeser R, Blackburn JT, Pietrosimone B. Synovial fluid concentrations of matrix Metalloproteinase-3 and Interluekin-6 following anterior cruciate ligament injury associate with gait biomechanics 6 months following reconstruction. Osteoarthritis Cartilage 2021; 29:1006-1019. [PMID: 33781899 PMCID: PMC8658576 DOI: 10.1016/j.joca.2021.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare gait biomechanics 6 months following anterior cruciate ligament (ACL) reconstruction (ACLR) between patients with the highest and lowest concentrations of synovial fluid (SF) interleukin-6 (IL-6) and matrix metalloproteinase-3 (MMP-3), as well as compared to uninjured controls. DESIGN SF concentrations of IL-6 and MMP-3 were collected 7 ± 4 days post injury in 38 ACL injured patients (55% female, 21±4yrs, 25.3 ± 5.2BMI). ACL injured individuals were stratified into the lowest and highest quartiles based on IL-6 (IL-6Lowest and IL-6Highest) and MMP-3 (MMP-3Lowest and MMP-3Highest) concentrations. Gait biomechanics were collected on the injured limb 6 months post-ACLR and in 38 uninjured controls (50% female, 21±3yrs, 23.8 ± 2.8BMI). Functional analyses of variance were used to compare vertical ground reaction force (vGRF), knee flexion angle (KFA), and internal knee extension moment (KEM) waveforms throughout stance phase of gait to determine the proportions of stance differing between limbs and groups. RESULTS Compared to uninjured controls, IL-6High and MMP-3High ACL subgroups demonstrated lesser vGRF (largest differences: IL-6, 7.88%BW; MMP-3, 11.05%BW) during early-stance and greater vGRF (largest differences: IL-6, 6.21%BW; MMP-3, 5.85%BW) in mid-stance, lesser KFA (largest differences: IL-6, 3.11°; MMP-3, 3.72°) and lesser KEM (largest differences: IL-6, 0.96%BW•m; MMP-3, 1.07%BW•m) in early-stance, as well as greater KFA in mid-stance (largest differences: IL-6, 1.5°; MMP-3, 2.95°). CONCLUSIONS High SF concentrations of a proinflammatory cytokine and a degradative enzyme early post-ACL injury are associated with aberrant gait biomechanics in the injured limb at 6 months post-ACLR (i.e., lesser vGRF, KFA and KEM) linked to posttraumatic osteoarthritis development.
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Affiliation(s)
- Alyssa Evans-Pickett
- MOTION Science Institute, Department of Exercise and
Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United
States,Human Movement Science Curriculum, University of
North Carolina at Chapel Hill, Chapel Hill, NC, United States,Corresponding Author: Alyssa Evans-Pickett, Ph.D.
Student, Department of Exercise and Sport Science, University of North Carolina
at Chapel Hill, 210 South Road Fetzer Hall, Chapel Hill, NC, 27599, United
States,
| | - Lara Longobardi
- Thurston Arthritis Research Center, University of
North Carolina at Chapel Hill, 27599, United States
| | - Jeffrey T. Spang
- Department of Orthopaedics, School of Medicine,
University of North Carolina at Chapel Hill, 27599, NC, United States
| | - R. Alexander Creighton
- Department of Orthopaedics, School of Medicine,
University of North Carolina at Chapel Hill, 27599, NC, United States
| | - Ganesh Kamath
- Department of Orthopaedics, School of Medicine,
University of North Carolina at Chapel Hill, 27599, NC, United States
| | - Hope C. Davis-Wilson
- MOTION Science Institute, Department of Exercise and
Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United
States,Human Movement Science Curriculum, University of
North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Richard Loeser
- Thurston Arthritis Research Center, University of
North Carolina at Chapel Hill, 27599, United States
| | - J. Troy Blackburn
- MOTION Science Institute, Department of Exercise and
Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United
States,Human Movement Science Curriculum, University of
North Carolina at Chapel Hill, Chapel Hill, NC, United States,Department of Orthopaedics, School of Medicine,
University of North Carolina at Chapel Hill, 27599, NC, United States
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and
Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United
States,Human Movement Science Curriculum, University of
North Carolina at Chapel Hill, Chapel Hill, NC, United States,Department of Orthopaedics, School of Medicine,
University of North Carolina at Chapel Hill, 27599, NC, United States
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22
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Mostakhdemin M, Nand A, Ramezani M. Articular and Artificial Cartilage, Characteristics, Properties and Testing Approaches-A Review. Polymers (Basel) 2021; 13:2000. [PMID: 34207194 PMCID: PMC8234542 DOI: 10.3390/polym13122000] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 12/25/2022] Open
Abstract
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.
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Affiliation(s)
- Mohammad Mostakhdemin
- Department of Mechanical Engineering, Auckland University of Technology, Auckland 1142, New Zealand
| | - Ashveen Nand
- School of Environmental and Animal Sciences, Unitec Institute of Technology, Auckland 1025, New Zealand;
- School of Healthcare and Social Practice, Unitec Institute of Technology, Auckland 1025, New Zealand
| | - Maziar Ramezani
- Department of Mechanical Engineering, Auckland University of Technology, Auckland 1142, New Zealand
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23
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Patel S, Amirhekmat A, Le R, Williams Iii RJ, Wang D. Osteochondral Allograft Transplantation in Professional Athletes: Rehabilitation and Return to Play. Int J Sports Phys Ther 2021; 16:941-958. [PMID: 34123544 PMCID: PMC8169007 DOI: 10.26603/001c.22085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/07/2021] [Indexed: 11/18/2022] Open
Abstract
For the treatment of large chondral and osteochondral defects of the knee, osteochondral allograft transplantation (OCA) is an effective solution with relatively high rates of return to sport. In professional athletes, rehabilitation following OCA is a critical component of the process of returning the athlete to full sports activity and requires a multidisciplinary team approach with frequent communication between the surgical and rehabilitation teams (physical therapists, athletic trainers, coaching staff). In this review, we describe our five-phase approach to progressive rehabilitation of the professional athlete after OCA, which takes into account the biological processes of healing and optimization of neuromuscular function required for the demands of elite-level sport. The principles of early range of motion, proper progression through the kinetic chain, avoidance of pain and effusion, optimization of movement, regimen individuation, and integration of sports-specific activities underlie proper recovery.
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Affiliation(s)
| | | | - Ryan Le
- University of California Irvine School of Medicine
| | | | - Dean Wang
- University of California Irvine School of Medicine; UCI Health
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24
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McDonnell AC, Eiken O, Mekjavic IB, Žlak N, Drobnič M. The influence of a sustained 10-day hypoxic bed rest on cartilage biomarkers and subchondral bone in females: The FemHab study. Physiol Rep 2021; 8:e14413. [PMID: 32333524 PMCID: PMC7182690 DOI: 10.14814/phy2.14413] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 03/11/2020] [Accepted: 03/16/2020] [Indexed: 12/19/2022] Open
Abstract
This study assessed the influence of a 10‐day hypoxic bed rest on cartilage biomarkers and subchondral bone density across the patellofemoral joint (PFJ). Within clinical settings hypoxic tissue may arise in several types of disorders. Furthermore, a hypoxic environment is being considered for space flight habitats in the near future. Female participants (N = 12) participated in this study comprising three 10‐day interventions: hypoxic ambulation (HAMB), normoxic bed rest (NBR), and hypoxic bed rest (HBR). Venous samples were collected prior to (day −2: Pre) and during the intervention (days 2 and 5), immediately before reambulation (D11) and 24 hr post intervention (R1). Blood samples were analyzed for: aggrecan, hyaluronan, Type IIA procollagen amino terminal propeptide (PIIANP), and cartilage oligomeric matrix protein (COMP). Total bone mineral density (BMD) in eight regions (2 mm × 10 mm) across the PFJ was determined. The three interventions (HAMB, HBR, and NBR) did not induce any significant changes in the cartilage biomarkers of hyaluronan or PIIANP. Aggrecan increased during the HAMB trial to 2.02 fold the Pre value. COMP decreased significantly in both NBR & HBR compared to HAMB on D5. There were significant differences in BMD measured across the PFJ from cortical patellar bone (735 to 800 mg/cm3) to femur trabecular (195 to 226 mg/cm3). However, there were no significant changes in BMD from Pre to Post bed rest. These results indicate that there were no significant detectable effects of inactivity/unloading on subchondral bone density. The biomarker of cartilage, COMP, decreased on D5, whereas the addition of hypoxia to bed rest had no effect, it appears that hypoxia in combination with ambulation counteracted this decrease.
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Affiliation(s)
- Adam C McDonnell
- Department of Automation, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia
| | - Ola Eiken
- Department of Environmental Physiology, Swedish Aerospace Physiology Centre, Royal Institute of Technology, Solna, Sweden
| | - Igor B Mekjavic
- Department of Environmental Physiology, Swedish Aerospace Physiology Centre, Royal Institute of Technology, Solna, Sweden.,Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Nik Žlak
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Matej Drobnič
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
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25
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Putignano C, Burris D, Moore A, Dini D. Cartilage rehydration: The sliding-induced hydrodynamic triggering mechanism. Acta Biomater 2021; 125:90-99. [PMID: 33676047 DOI: 10.1016/j.actbio.2021.02.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 10/22/2022]
Abstract
Loading-induced cartilage exudation causes loss of fluid from the tissue, joint space thinning and, in a long term prospective, the insurgence of osteoarthritis. Fortunately, experiments show that joints recover interstitial fluid and thicken during articulation after static loading, thus reversing the exudation process. Here, we provide the first original theoretical explanation to this crucial phenomenon, by implementing a numerical model capable of accounting for the multiscale porous lubrication occurring in joints. We prove that sliding-induced rehydration occurs because of hydrodynamic reasons and is specifically related to a wedge effect at the contact inlet. Furthermore, numerically predicted rehydration rates are consistent with experimentally measured rates and corroborate the robustness of the model here proposed. The paper provides key information, in terms of fundamental lubrication multiscale mechanisms, to understand the rehydration of cartilage and, more generally, of any biological tissue exhibiting a significant porosity: such a theoretical framework is, thus, crucial to inform the design of new effective cartilage-mimicking biomaterials. STATEMENT OF SIGNIFICANCE: Motion and, precisely, joints articulation ensures that cartilage tissues preserve adequate level of hydration and, thus, maintain excellent mechanical properties in terms of high resilience, considerable load-carrying capacity and remarkably low friction. Conversely, when statically loaded, cartilage starts to exudate, causing joint space thinning and, in the long term, possible osteoarthritis; joints motion is, thus, the key to prevent the degradation of the tissues. By developing a numerical multiscale lubrication theory, and by corroborating this approach with experiments, we provide the first original theoretical explanation to this motion-induced cartilage rehydration mechanism. Assessing the rehydration hydrodynamic origin is, in fact, fundamental not only to understand the joints physiology, but also to highlight a key requirement for cartilage-mimicking biomaterials.
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Crecelius CR, Van Landuyt KJ, Schaal R. Postoperative Management for Articular Cartilage Surgery in the Knee. J Knee Surg 2021; 34:20-29. [PMID: 33111278 DOI: 10.1055/s-0040-1718605] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The postoperative rehabilitation team plays a crucial role in optimizing outcomes after articular cartilage surgery. A comprehensive approach to postoperative physical therapy that considers the type of surgery, location in the knee, concurrent procedures, and patient-specific factors is imperative. While postoperative rehabilitation protocols should be specific to the patient and type of surgery performed and include phased rehabilitation goals and activities, the key principles for postoperative rehabilitation apply across the spectrum of articular cartilage surgeries and patients. These key principles consist of preoperative assessments that include physical, mental, and behavioral components critical to recovery; education and counseling with respect to expectations and compliance; and careful monitoring and adjustments throughout the rehabilitation period based on consistent communication among rehabilitation, surgical, and imaging teams to ensure strict patient compliance with restrictions, activities, and timelines to optimize functional outcomes after surgery.
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Affiliation(s)
- Cory R Crecelius
- Department of Orthopaedic Surgery Physical Therapy, University of Missouri, Columbia, Missouri.,University of Missouri Joint Preservation Center, Columbia, Missouri
| | - Karra J Van Landuyt
- Department of Orthopaedic Surgery Physical Therapy, University of Missouri, Columbia, Missouri
| | - Robert Schaal
- Department of Orthopaedic Surgery Physical Therapy, University of Missouri, Columbia, Missouri
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Liphardt AM, Mündermann A, Heer M, Achtzehn S, Niehoff A, Mester J. Locomotion replacement exercise cannot counteract cartilage biomarker response to 5 days of immobilization in healthy adults. J Orthop Res 2020; 38:2373-2382. [PMID: 32458495 DOI: 10.1002/jor.24753] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 04/28/2020] [Accepted: 05/11/2020] [Indexed: 02/04/2023]
Abstract
Biomarkers of cartilage metabolism are sensitive to changes in the biological and mechanical environment and can indicate early changes in cartilage homeostasis. The purpose of this study was to determine if a daily locomotion replacement program can serve as a countermeasure for changes in cartilage biomarker serum concentration caused by immobilization. Ten healthy male subjects (mean ± 1 standard deviation; age: 29.4 ± 5.9 years; body mass: 77.7 ± 4.1 kg) participated in the crossover 5-day bed rest study with three interventions: control (CON), standing (STA), and locomotion replacement training (LRT). Serum samples were taken before, during, and after bed rest. Biomarker concentrations were measured using commercial enzyme-linked immunosorbent assays. Cartilage oligomeric matrix protein (COMP) levels after 24 hours of bed rest decreased independently of the intervention (-16.8% to -9.8%) and continued to decrease until 72 hours of bed rest (minimum, -23.2% to -20.6%). LRT and STA did not affect COMP during bed rests (P = .056) but there was a strong tendency for a slower decrease with LRT (-9.4%) and STA (-11.7%) compared with CON (-16.8%). MMP-3 levels decreased within the first 24 hours of bed rest (CON: -22.3%; STA: -14.7%; LRT: -17%) without intervention effect. Both COMP and MMP-3 levels recovered to baseline levels during the 6-day recovery period. MMP-1, MMP-9, and TNF-α levels were not affected by immobilization or intervention. COMP and MMP-3 are mechano-sensitive cartilage biomarkers affected by immobilization, and simple interventions such as standing upright or LRT during bed rest cannot prevent these changes. Clinical significance: simple locomotion interventions cannot prevent cartilage biomarker change during bed rest.
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Affiliation(s)
- Anna-Maria Liphardt
- Department of Internal Medicine 3-Rheumatology and Immunology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.,Institute of Biomechanics and Orthopaedics, German Sport University Cologne (DSHS Köln), Köln, Germany
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Martina Heer
- Department of Nutrition and Food Science-Nutrition Physiology, University of Bonn, Bonn, Germany.,Department of Nutrition, International University of Applied Sciences Bad Honnef (IUBH), Bad Honnef, Germany
| | - Silvia Achtzehn
- Institute of Cardiology and Sports Medicine, German Sport University Cologne (DSHS Köln), Köln, Germany.,The German Research Centre of Elite Sport Cologne (Momentum), German Sport University Cologne (DSHS Köln), Köln, Germany
| | - Anja Niehoff
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne (DSHS Köln), Köln, Germany.,Cologne Center for Musculoskeletal Biomechanics (CCMB), Faculty of Medicine, University of Cologne, Köln, Germany
| | - Joachim Mester
- The German Research Centre of Elite Sport Cologne (Momentum), German Sport University Cologne (DSHS Köln), Köln, Germany
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Jain D, Belay ES, Anderson JA, Garrett WE, Lau BC. Are Weightbearing Restrictions Required After Microfracture for Isolated Chondral Lesions of the Knee? A Review of the Basic Science and Clinical Literature. Sports Health 2020; 13:111-115. [PMID: 32723000 DOI: 10.1177/1941738120938662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
CONTEXT A strict rehabilitation protocol is traditionally followed after microfracture, including weightbearing restrictions for 2 to 6 weeks. However, such restrictions pose significant disability, especially in a patient population that is younger and more active. EVIDENCE ACQUISITION An extensive literature review was performed through PubMed and Google Scholar of all studies through December 2018 related to microfracture, including biomechanical, basic science, and clinical studies. For inclusion, clinical studies had to report weightbearing status and outcomes with a minimum 12-month follow-up. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 3. RESULTS Review of biomechanical and biology studies suggest new forming repair tissue is protected from shear forces of knee joint loading by the cartilaginous margins of the defect. This margin acts as a shoulder to maintain axial height and allow for tissue remodeling up to at least 12 months after surgery, well beyond current weight bearing restriction trends. A retrospective case-control study showed that weightbearing status postoperatively had no effect on clinical outcomes in patients who underwent microfracture for small chondral (<2 mm2) defects. In fact, 1 survey showed that many orthopaedic surgeons currently do not restrict weightbearing after microfracture. CONCLUSION This clinical literature review suggests that weightbearing restrictions may not be required after microfracture for isolated tibiofemoral chondral lesions of the knee. STRENGTH OF RECOMMENDATION TAXONOMY C.
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Affiliation(s)
- Deeptee Jain
- Division of Spine Surgery, Department of Orthopaedic Surgery at Washington University, St. Louis, Missouri
| | - Elshaday S Belay
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - John A Anderson
- Department of Sports Medicine, Rothman Institute, Philadelphia, Pennsylvania
| | - William E Garrett
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Brian C Lau
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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Effects of Immobilization and Re-Mobilization on Knee Joint Arthrokinematic Motion Quality. J Clin Med 2020; 9:jcm9020451. [PMID: 32041248 PMCID: PMC7074294 DOI: 10.3390/jcm9020451] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/18/2020] [Accepted: 02/05/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Knee immobilization is a common intervention for patients with traumatic injuries. However, it usually leads to biomechanical/morphological disturbances of articular tissues. These changes may contribute to declining kinetic friction-related quality of arthrokinematics; however, this phenomenon has not been analyzed in vivo and remains unrecognized. Thus, the aim of the present study is to investigate the effect of immobilization and subsequent re-mobilization on the quality of arthrokinematics within the patellofemoral joint, analyzed by vibroarthrography (VAG). METHODS Thirty-four patients after 6-weeks of knee immobilization and 37 controls were analyzed. The (VAG) signals were collected during knee flexion/extension using an accelerometer. Patients were tested on the first and last day of the 2-week rehabilitation program. RESULTS Immobilized knees were characterized by significantly higher values of all VAG parameters when compared to controls (p < 0.001) on the first day. After 2 weeks, the participants in the rehabilitation program that had immobilized knees showed significant improvement in all measurements compared to the baseline condition, p < 0.05. However, patients did not return to normal VAG parameters compared to controls. CONCLUSION Immobilization-related changes within the knee cause impairments of arthrokinematic function reflected in VAG signal patterns. The alterations in joint motion after 6 weeks of immobilization may be partially reversible; however, the 2-week physiotherapy program is not sufficient for full recovery.
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Jayabalan P, Kocherginsky M, Chang AH, Rouleau GW, Koloms KL, Lee J, Dunlop D, Chang RW, Sharma L. Physical Activity and Worsening of Radiographic Findings in Persons With or at Higher Risk of Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2019; 71:198-206. [PMID: 30238649 DOI: 10.1002/acr.23756] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 09/11/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The benefits of physical activity among persons with or at higher risk for knee osteoarthritis are well established. However, activity levels in this population are low, in part due to concern that activity will damage the knee joint. We hypothesized that sedentary and moderate-vigorous physical activity are each associated with greater risk of radiographic worsening of knee OA. METHODS In Osteoarthritis Initiative participants with or at higher risk for knee OA enrolled in an accelerometer substudy at 48 months (study baseline), physical activity was measured by a uniaxial accelerometer (ActiGraph GT1M). Radiographic progression was defined as any 48 month to 96 month worsening of Kellgren/Lawrence (K/L) grade scores. All analyses were knee-level; we used multivariable logistic regression with generalized estimating equations, adjusting for key covariates. RESULTS Of the 1,206 participants, 631 (52%) were female, the mean ± SD age was 64 ± 9 years, and mean ± SD body mass index (BMI) was 28 ± 5. The mean ± SD average daily sedentary activity was 602 ± 86 minutes, average daily light activity was 284 ± 75 minutes, and average daily moderate-vigorous activity was 20 ± 20 minutes. In 1,978 knees, 267 (14%) had worsening of K/L grade scores. In the multivariable model, age, sex, BMI, and pain, were associated with K/L grade worsening, but neither sedentary activity (adjusted odds ratio [OR] 0.99 [95% confidence interval (95% CI) 0.97-1.01]) nor moderate-vigorous activity (adjusted OR 1.00 [95% CI 0.91-1.09]) were associated with K/L grade worsening. CONCLUSION In persons with or at higher risk for knee OA, age, sex, BMI, and pain, but not objectively measured average daily minutes of sedentary or moderate-vigorous activity, were associated with subsequent worsening of K/L grade. Whether findings differ in persons with more severe knee OA and/or engaged more frequently in moderate-vigorous activity should be examined in future studies.
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Affiliation(s)
- Prakash Jayabalan
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Alison H Chang
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Gerald W Rouleau
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kimberly L Koloms
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jungwha Lee
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dorothy Dunlop
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rowland W Chang
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Leena Sharma
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
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31
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Qiu L, Perez J, Emerson C, Barrera CM, Zhong J, Nham F, Jose J, Lesniak BP, Kaplan LD, Baraga MG. Biochemical changes in knee articular cartilage of novice half-marathon runners. J Int Med Res 2019; 47:5671-5679. [PMID: 31566042 PMCID: PMC6862918 DOI: 10.1177/0300060519874140] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective To evaluate changes in knee articular cartilage of novice half-marathon runners using magnetic resonance imaging T2 relaxation time mapping. Methods Healthy subjects were recruited from local running clubs who met the following inclusion criteria: (i) age 18–45 years; (ii) body mass index less than 30 kg/m2; (iii) had participated in one half-marathon or less (none within the previous 6 months); (iv) run less than 20 km/week; (v) no previous knee injury or surgery; (vi) no knee pain. T2 signals were measured pre- and post-race to evaluate the biochemical changes in articular cartilage after the subjects run a half-marathon. Results A significant increase in the mean ± SD T2 relaxation time was seen in the outer region of the medial tibial plateau (50.1 ± 2.4 versus 54.7 ± 2.6) and there was a significant decrease in T2 relaxation time in the lateral femoral condyle central region (50.2 ± 4.5 versus 45.4 ± 2.9). There were no significant changes in the patella, medial femoral condyle and lateral tibia articular surfaces. Conclusion An increase in T2 relaxation time occurs in the medial tibial plateau of novice half-marathon runners. This limited region of increased T2 values, when compared with complete medial compartment involvement seen in studies of marathon runners, may represent an association between distance run and changes seen in articular cartilage T2 values.
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Affiliation(s)
- Leiyu Qiu
- Department of Radiology, Affiliated Hospital of Wenzhou Medical College Zhuji People's Hospital, Wenzhou, Zhejiang Province, China
| | - Jose Perez
- The University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, FL, USA.,Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Christopher Emerson
- The University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, FL, USA
| | - Carlos M Barrera
- The University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, FL, USA
| | - Jianping Zhong
- Department of Radiology, Affiliated Hospital of Wenzhou Medical College Zhuji People's Hospital, Wenzhou, Zhejiang Province, China
| | - Fong Nham
- Herbert Wertherim College of Medicine, Miami, FL, USA
| | - Jean Jose
- The University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, FL, USA.,Department of Radiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Bryson P Lesniak
- The University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, FL, USA.,Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Lee D Kaplan
- The University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, FL, USA.,Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Michael G Baraga
- The University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, FL, USA.,Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
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Cavendish PA, Everhart JS, Peters NJ, Sommerfeldt MF, Flanigan DC. Osteochondral Allograft Transplantation for Knee Cartilage and Osteochondral Defects. JBJS Rev 2019; 7:e7. [DOI: 10.2106/jbjs.rvw.18.00123] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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33
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Vermeulen D, van der Valk MR, Kaas L. Plaster, splint, brace, tape or functional mobilization after first-time patellar dislocation: what's the evidence? EFORT Open Rev 2019; 4:110-114. [PMID: 30993012 PMCID: PMC6440297 DOI: 10.1302/2058-5241.4.180016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
With an incidence of 5.8 per 100,000 per year, patellar dislocations are commonly seen in the emergency department. Surprisingly, there are only a few studies available that focus on the results of the different non-surgical treatment options after first-time patellar dislocation. The aim of this review is to provide an overview of the most recent and relevant studies on the rationales and results of the non-surgical treatment for first-time patellar dislocation. Patellar instability mainly affects young and active patients, with a peak incidence of 29 per 100 000 per year in adolescents. The medial patellofemoral ligament, a main passive restraint for lateral translation of the patella, is torn in lateral patellofemoral dislocations. Treatment of first-time patellar dislocation can be either conservative or surgical. There are two options in conservative management of first-time patellar dislocation: immobilization using a cylinder cast or removable splint, or, second, functional mobilization after applying a brace or patellar tape. The current available literature of conservative treatment after a first-time patellar dislocation is little and of low quality of evidence. Conclusions should be drawn with care, new research focussing on non-surgical treatment is therefore strongly needed.
Cite this article: EFORT Open Rev 2019;4:110-114. DOI: 10.1302/2058-5241.4.180016
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Affiliation(s)
- Daan Vermeulen
- Department of Orthopaedic Surgery, St. Antonius Hospital, Nieuwegein, Utrecht, The Netherlands
| | - Mara Rosa van der Valk
- Department of Orthopaedic Surgery, St. Antonius Hospital, Nieuwegein, Utrecht, The Netherlands
| | - Laurens Kaas
- Department of Orthopaedic Surgery, St. Antonius Hospital, Nieuwegein, Utrecht, The Netherlands
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Allen SR, Wright A. Stem cell therapy for knee osteoarthritis: a narrative review of a rapidly evolving treatment with implications for physical therapy management. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2019.1585674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Sophie Ruth Allen
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Anthony Wright
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
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Li X, Sun Y, Zhou Z, Zhang D, Jiao J, Hu M, Hassan CR, Qin YX. Mitigation of Articular Cartilage Degeneration and Subchondral Bone Sclerosis in Osteoarthritis Progression Using Low-Intensity Ultrasound Stimulation. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:148-159. [PMID: 30322672 PMCID: PMC6289639 DOI: 10.1016/j.ultrasmedbio.2018.08.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 08/24/2018] [Accepted: 08/28/2018] [Indexed: 06/08/2023]
Abstract
The purpose of this study was to evaluate the effect of low-intensity ultrasound on articular cartilage and subchondral bone alterations in joints under normal and functional disuse conditions during osteoarthritis (OA) progression. Total of thirty 5-mo-old female Sprague-Dawley rats were randomly assigned to six groups (n = 5/group): age-matched group, OA group, OA + ultrasound (US) group, hindlimb suspension (HLS) group, HLS + OA group and HLS + OA + US group. The surgical anterior cruciate ligament was used to induce OA in the right knee joints. After 2 wk of OA induction, low-intensity ultrasound generated with a 3-MHz transducer with 20% pulse duty cycle and 30 mW/cm2 acoustic intensity was delivered to the right knee joints for 20 min a day, 5 d a week for a total of 6 wk. Then, the right tibias were harvested for micro-computed tomography, histologic and mechanical analysis. Micro-computed tomography results indicated that the thickness and sulfated glycosaminoglycan content of cartilage decreased, but the thickness of the subchondral cortical bone plate and the formation of subchondral trabecular bone increased in the OA group under the normal joint use condition. Furthermore, histologic results revealed that chondrocyte density and arrangement in cartilage corrupted and the underlying subchondral bone increased during OA progression. These changes were accompanied by reductions in mechanical parameters in OA cartilage. However, fewer OA symptoms were observed in the HLS + OA group under the joint disuse condition. The cartilage degeneration and subchondral bone sclerosis were alleviated in the US treatment group, especially under normal joint use condition. In conclusion, low-intensity ultrasound could improve cartilage degeneration and subchondral sclerosis during OA progression. Also, it could provide a promising strategy for future clinical treatment for OA patients.
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Affiliation(s)
- Xiaofei Li
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - Yueli Sun
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - Zhilun Zhou
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - Dongye Zhang
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - Jian Jiao
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - Minyi Hu
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - Chaudhry Raza Hassan
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - Yi-Xian Qin
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA.
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Wang T, Pelletier MH, Christou C, Oliver R, Mobbs RJ, Walsh WR. A novel in vivo large animal model of lumbar spinal joint degeneration. Spine J 2018; 18:1896-1909. [PMID: 29800709 DOI: 10.1016/j.spinee.2018.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/10/2018] [Accepted: 05/17/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Degenerative disc disease (DDD) is a common, widespread socioeconomic problem. Appropriate large animal models of DDD are required for improved understanding and to serve as preclinical test beds for therapeutic strategies. PURPOSE To evaluate the effects of short and medium duration immobilization on the sheep lumbar intervertebral disc (IVD) and facet joints (FJs), and to establish a large animal model for DDD research. STUDY DESIGN An in vivo sheep model evaluating the effect of short- and medium-term immobilization on disc degeneration. METHODS Eighteen sheep were equally randomized into three groups: short-term (6-week) immobilization (n=6), medium-term (26-week) immobilization (n=6), and control (no surgery) (n=6). Immobilization of L3-L4 was achieved with pedicle screw and rod implantation, the IVD was kept intact, and the annulus and end plates were not disrupted. The IVD and FJs were assessed with planar radiography, computerized tomography (CT), magnetic resonance imaging (MRI), pure moment biomechanical testing, and histologic analysis. RESULTS Disc height was reduced for 6- and 26-week immobilization groups. The MRI and histologic analysis demonstrated significant disc degeneration for both immobilized groups compared with control, but no statistical difference was detected between short- and medium-term duration. Progressive degenerative changes in FJs were observed with micro-CT and histologic end points. Immobilization significantly reduced lateral bending and flexion-extension range of motion. CONCLUSIONS The mechanical environment set up by immobilization alone is capable of inducing lumbar disc degeneration at both 6 and 26 weeks in sheep. Longer duration immobilization did not advance disc degeneration process beyond of that found with short duration. The present model produces a degenerative disc with intact annulus and without acute injury, more closely representing the scenario common in human disc degeneration. This provides a suitable large animal in vivo model for the evaluation of the new therapies for disc degeneration. Further studies would do well to examine the effect of remobilization after immobilization in this model.
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Affiliation(s)
- Tian Wang
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Prince of Wales Hospital, Gate 6, Avoca St, Randwick, Sydney, NSW 2031, Australia
| | - Matthew H Pelletier
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Prince of Wales Hospital, Gate 6, Avoca St, Randwick, Sydney, NSW 2031, Australia
| | - Chris Christou
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Prince of Wales Hospital, Gate 6, Avoca St, Randwick, Sydney, NSW 2031, Australia
| | - Rema Oliver
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Prince of Wales Hospital, Gate 6, Avoca St, Randwick, Sydney, NSW 2031, Australia
| | - Ralph J Mobbs
- Neurospine Clinic, Prince of Wales Hospital, University of New South Wales, Barker St, Randwick, Sydney, NSW 2031, Australia
| | - William R Walsh
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Prince of Wales Hospital, Gate 6, Avoca St, Randwick, Sydney, NSW 2031, Australia.
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Wuest SL, Caliò M, Wernas T, Tanner S, Giger-Lange C, Wyss F, Ille F, Gantenbein B, Egli M. Influence of Mechanical Unloading on Articular Chondrocyte Dedifferentiation. Int J Mol Sci 2018; 19:ijms19051289. [PMID: 29693628 PMCID: PMC5983850 DOI: 10.3390/ijms19051289] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/13/2018] [Accepted: 04/18/2018] [Indexed: 01/10/2023] Open
Abstract
Due to the limited self-repair capacity of articular cartilage, the surgical restoration of defective cartilage remains a major clinical challenge. The cell-based approach, which is known as autologous chondrocyte transplantation (ACT), has limited success, presumably because the chondrocytes acquire a fibroblast-like phenotype in monolayer culture. This unwanted dedifferentiation process is typically addressed by using three-dimensional scaffolds, pellet culture, and/or the application of exogenous factors. Alternative mechanical unloading approaches are suggested to be beneficial in preserving the chondrocyte phenotype. In this study, we examined if the random positioning machine (RPM) could be used to expand chondrocytes in vitro such that they maintain their phenotype. Bovine chondrocytes were exposed to (a) eight days in static monolayer culture; (b) two days in static monolayer culture, followed by six days of RPM exposure; and, (c) eight days of RPM exposure. Furthermore, the experiment was also conducted with the application of 20 mM gadolinium, which is a nonspecific ion-channel blocker. The results revealed that the chondrocyte phenotype is preserved when chondrocytes go into suspension and aggregate to cell clusters. Exposure to RPM rotation alone does not preserve the chondrocyte phenotype. Interestingly, the gene expression (mRNA) of the mechanosensitive ion channel TRPV4 decreased with progressing dedifferentiation. In contrast, the gene expression (mRNA) of the mechanosensitive ion channel TRPC1 was reduced around fivefold to 10-fold in all of the conditions. The application of gadolinium had only a minor influence on the results. This and previous studies suggest that the chondrocyte phenotype is preserved if cells maintain a round morphology and that the ion channel TRPV4 could play a key role in the dedifferentiation process.
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Affiliation(s)
- Simon L Wuest
- Lucerne University of Applied Sciences and Arts, School of Engineering and Architecture, Institute of Medical Engineering, Space Biology Group, CH-6052 Hergiswil, Switzerland.
- University of Bern, Institute for Surgical Technology and Biomechanics, Tissue and Organ Mechanobiology, CH-3014 Bern, Switzerland.
| | - Martina Caliò
- Lucerne University of Applied Sciences and Arts, School of Engineering and Architecture, Institute of Medical Engineering, Space Biology Group, CH-6052 Hergiswil, Switzerland.
- University of Bern, Institute for Surgical Technology and Biomechanics, Tissue and Organ Mechanobiology, CH-3014 Bern, Switzerland.
| | - Timon Wernas
- Lucerne University of Applied Sciences and Arts, School of Engineering and Architecture, Institute of Medical Engineering, Space Biology Group, CH-6052 Hergiswil, Switzerland.
| | - Samuel Tanner
- Lucerne University of Applied Sciences and Arts, School of Engineering and Architecture, Institute of Medical Engineering, Space Biology Group, CH-6052 Hergiswil, Switzerland.
| | - Christina Giger-Lange
- Lucerne University of Applied Sciences and Arts, School of Engineering and Architecture, Institute of Medical Engineering, Space Biology Group, CH-6052 Hergiswil, Switzerland.
| | - Fabienne Wyss
- Lucerne University of Applied Sciences and Arts, School of Engineering and Architecture, Institute of Medical Engineering, Space Biology Group, CH-6052 Hergiswil, Switzerland.
| | - Fabian Ille
- Lucerne University of Applied Sciences and Arts, School of Engineering and Architecture, Institute of Medical Engineering, Space Biology Group, CH-6052 Hergiswil, Switzerland.
| | - Benjamin Gantenbein
- University of Bern, Institute for Surgical Technology and Biomechanics, Tissue and Organ Mechanobiology, CH-3014 Bern, Switzerland.
| | - Marcel Egli
- Lucerne University of Applied Sciences and Arts, School of Engineering and Architecture, Institute of Medical Engineering, Space Biology Group, CH-6052 Hergiswil, Switzerland.
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Lin YC, Hall AC, Simpson AHRW. A novel organ culture model of a joint for the evaluation of static and dynamic load on articular cartilage. Bone Joint Res 2018; 7:205-212. [PMID: 29922437 PMCID: PMC5987700 DOI: 10.1302/2046-3758.73.bjr-2017-0320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The purpose of this study was to create a novel ex vivo organ culture model for evaluating the effects of static and dynamic load on cartilage. METHODS The metatarsophalangeal joints of 12 fresh cadaveric bovine feet were skinned and dissected aseptically, and cultured for up to four weeks. Dynamic movement was applied using a custom-made machine on six joints, with the others cultured under static conditions. Chondrocyte viability and matrix glycosaminoglycan (GAG) content were evaluated by the cell viability probes, 5-chloromethylfluorescein diacetate (CMFDA) and propidium iodide (PI), and dimethylmethylene blue (DMMB) assay, respectively. RESULTS Chondrocyte viability in the static model decreased significantly from 89.9% (sd 2.5%) (Day 0) to 66.5% (sd 13.1%) (Day 28), 94.7% (sd 1.1%) to 80. 9% (sd 5.8%) and 80.1% (sd 3.0%) to 46.9% (sd 8.5%) in the superficial quarter, central half and deep quarter of cartilage, respectively (p < 0.001 in each zone; one-way analysis of variance). The GAG content decreased significantly from 6.01 μg/mg (sd 0.06) (Day 0) to 4.71 μg/mg (sd 0.06) (Day 28) (p < 0.001; one-way analysis of variance). However, with dynamic movement, chondrocyte viability and GAG content were maintained at the Day 0 level over the four-week period without a significant change (chondrocyte viability: 92.0% (sd 4.0%) (Day 0) to 89.9% (sd 0.2%) (Day 28), 93.1% (sd 1.5%) to 93.8% (sd 0.9%) and 85.6% (sd 0.8%) to 84.0% (sd 2.9%) in the three corresponding zones; GAG content: 6.18 μg/mg (sd 0.15) (Day 0) to 6.06 μg/mg (sd 0.09) (Day 28)). CONCLUSION Dynamic joint movement maintained chondrocyte viability and cartilage GAG content. This long-term whole joint culture model could be of value in providing a more natural and controlled platform for investigating the influence of joint movement on articular cartilage, and for evaluating novel therapies for cartilage repair.Cite this article: Y-C. Lin, A. C. Hall, A. H. R. W. Simpson. A novel organ culture model of a joint for the evaluation of static and dynamic load on articular cartilage. Bone Joint Res 2018;7:205-212. DOI: 10.1302/2046-3758.73.BJR-2017-0320.
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Affiliation(s)
- Y-C. Lin
- Department of Orthopaedic Surgery, University of Edinburgh, The Chancellor’s Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK and Taipei Medical University-Shuang Ho Hospital, Zhonghe District, New Taipei City, 23561, Taiwan
| | - A. C. Hall
- Centre for Integrative Physiology, University of Edinburgh, Hugh Robson Building, George Square, Edinburgh EH8 9XD, UK
| | - A. H. R. W. Simpson
- Department of Orthopaedics, University of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, UK
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Graham BT, Moore AC, Burris DL, Price C. Mapping the spatiotemporal evolution of solute transport in articular cartilage explants reveals how cartilage recovers fluid within the contact area during sliding. J Biomech 2018; 71:271-276. [PMID: 29454544 DOI: 10.1016/j.jbiomech.2018.01.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/12/2018] [Accepted: 01/28/2018] [Indexed: 01/25/2023]
Abstract
The interstitial fluid within articular cartilage shields the matrix from mechanical stresses, reduces friction and wear, enables biochemical processes, and transports solutes into and out of the avascular extracellular matrix. The balanced competition between fluid exudation and recovery under load is thus critical to the mechanical and biological functions of the tissue. We recently discovered that sliding alone can induce rapid solute transport into buried cartilage contact areas via a phenomenon termed tribological rehydration. In this study, we use in situ confocal microscopy measurements to track the spatiotemporal propagation of a small neutral solute into the buried contact area to clarify the fluid mechanics underlying the tribological rehydration phenomenon. Sliding experiments were interrupted by periodic static loading to enable scanning of the entire contact area. Spatiotemporal patterns of solute transport combined with tribological data suggested pressure driven flow through the extracellular matrix from the contact periphery rather than into the surface via a fluid film. Interestingly, these testing interruptions also revealed dynamic, repeatable and history-independent fluid loss and recovery processes consistent with those observed in vivo. Unlike the migrating contact area, which preserves hydration by moving faster than interstitial fluid can flow, our results demonstrate that the stationary contact area can maintain and actively recover hydration through a dynamic competition between load-induced exudation and sliding-induced recovery. The results demonstrate that sliding contributes to the recovery of fluid and solutes by cartilage within the contact area while clarifying the means by which it occurs.
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Affiliation(s)
- Brian T Graham
- Department of Mechanical Engineering, University of Delaware, Newark, DE, United States.
| | - Axel C Moore
- Department of Biomedical Engineering, University of Delaware, Newark, DE, United States.
| | - David L Burris
- Department of Mechanical Engineering, University of Delaware, Newark, DE, United States; Department of Biomedical Engineering, University of Delaware, Newark, DE, United States.
| | - Christopher Price
- Department of Mechanical Engineering, University of Delaware, Newark, DE, United States; Department of Biomedical Engineering, University of Delaware, Newark, DE, United States.
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Tsuang YH, Lin YS, Chen LT, Cheng CK, Sun JS. Effect of Dynamic Compression on in vitro Chondrocyte Metabolism. Int J Artif Organs 2018; 31:439-49. [DOI: 10.1177/039139880803100510] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background Chondrocytes can detect and respond to the mechanical environment by altering their metabolism. This study was designed to explore the effects of dynamic compression on chondrocyte metabolism. Methods Chondrocytes were harvested from newborn Wistar rats. After 7 days of expansion, chondrocytes embedded in agarose discs underwent uniaxial unconfined dynamic compression loads at different amplitudes (5%, 10%, and 15%) and frequencies (0.5 Hz, 1.0 Hz, 2.0 Hz, and 3.0 Hz) with a duration of 24 hours. The delayed effects on the chondrocytes were studied at 1, 3, and 7 days after the experiment. Results The results showed that at 10% strain, higher-frequency compression pressure can enhance the proliferation of chondrocytes. The synthesis of glycosaminoglycan (GAG) increased at 10%-15% strain and a 1-Hz load. The synthesis of nitric oxide (NO) increased at the 0.5-Hz load; while decreasing at the 15% strain. With 10% strain, 1 Hz dynamic compression, the proliferation of chondrocytes and GAG synthesis increased and persisted for 7 days, and NO synthesis decreased at the third and seventh days of culture. Conclusions This study showed that chondrocytes respond metabolically to compressive loading, which is expected to modulate the growth and the resultant biomechanical properties of these tissue-engineered constructs during culture.
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Affiliation(s)
- Y.-H. Tsuang
- Department of Orthopedic Surgery, Taipei City Hospital, Taipei, Taiwan - ROC
| | - Y.-S. Lin
- Institute of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan - ROC
| | - L.-T. Chen
- Department of Research and Development, Healthbanks Biotechnology Corporation, Taipei, Taiwan - ROC
| | - C.-K. Cheng
- Institute of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan - ROC
| | - J.-S. Sun
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan - ROC
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan - ROC
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Du PZ, Markolf KL, Lama CJ, McAllister DR, Jones KJ. Contact Forces Acting on Large Femoral Osteochondral Allografts During Forced Knee Extension. Am J Sports Med 2017; 45:2804-2811. [PMID: 28737981 DOI: 10.1177/0363546517715726] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A single cylindrical graft plug is commonly used for large focal femoral defects during osteochondral allograft (OCA) transplantation. Excessive contact force (CF) on a proud plug could compromise initial healing. CFs during forced knee extension are of particular interest because this maneuver is used by therapists to restore early postoperative range of motion. HYPOTHESIS A proud OCA plug will significantly increase the CF and significantly decrease the knee extension angle (KEA). STUDY DESIGN Controlled laboratory study. METHODS Eleven human knee specimens had miniature load cells installed in both femoral condyles at standardized locations representative of clinical defects. Each load cell had a 20-mm-diameter cylinder of native bone/cartilage attached at its precise anatomic location. Four spacers, 0.5 mm in thickness, were inserted sequentially between each load cell and its mounting bracket to create proud plug conditions of 0.5 to 2 mm. Measurements of the CF and KEA were recorded at extension moment levels up to 8 N·m. RESULTS At 8 N·m, the mean CFs for flush plugs were 149 ± 18 N (lateral) and 34 ± 13 N (medial). The mean increases in the medial CF (compared with flush) for 0.5-mm, 1-mm, 1.5-mm, and 2-mm proud conditions were 31 N (+91%), 64 N (+188%), 111 N (+325%), and 154 N (+451%), respectively. Corresponding increases for lateral proud plugs were 55 N (+37%), 120 N (+81%), 162 N (+109%), and 210 N (+141%), respectively. The CFs (and CF increases) for lateral grafts were significantly ( P < .05) higher than corresponding values for medial grafts at each proudness condition. Medial plug proudness had no consistent effect on the KEA. A 1-mm proud lateral plug significantly reduced the KEA by -1.6° (0 N·m) and -0.9° (2 N·m). CONCLUSION Graft proudness of only 0.5 mm significantly increased CFs during forced knee extension, emphasizing the surgical precision necessary to achieve normal CF levels. CLINICAL RELEVANCE It is believed that some amount of CF is beneficial in the early stages of graft healing, and our findings suggest that forced knee extension may be well suited for this purpose. However, the surgeon should be aware that large extension moments can also generate relatively high CFs, especially if the plug is proud.
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Affiliation(s)
- Peter Z Du
- New York Medical College, Valhalla, New York, USA
| | - Keith L Markolf
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Christopher J Lama
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - David R McAllister
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kristofer J Jones
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Vieira L, Lovison K, Kunz RI, Antunes JS, Bertolini GRF, Brancalhão RMC, Ribeiro LDFC. Resistance exercise recovers the structure of cartilage and synovial membrane of the ankle joint of rats after sciatic compression. MOTRIZ: REVISTA DE EDUCACAO FISICA 2017. [DOI: 10.1590/s1980-6574201700030001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
| | - Keli Lovison
- Universidade Estadual do Oeste do Paraná, Brazil
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Assessment of Relationships Between Joint Motion Quality and Postural Control in Patients With Chronic Ankle Joint Instability. J Orthop Sports Phys Ther 2017; 47:570-577. [PMID: 27814667 DOI: 10.2519/jospt.2017.6836] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Controlled laboratory study, cross-sectional. Background Lateral ankle sprains are among the most common injuries encountered during athletic participation. Following the initial injury, there is an alarmingly high risk of reinjury and development of chronic ankle instability (CAI), which is dependent on a combination of factors, including sensorimotor deficits and changes in the biomechanical environment of the ankle joint. Objective To evaluate CAI-related disturbances in arthrokinematic motion quality and postural control and the relationships between them. Methods Sixty-three male subjects (31 with CAI and 32 healthy controls) were enrolled in the study. For arthrokinematic motion quality analysis, the vibroarthrographic signals were collected during ankle flexion/extension motion using an acceleration sensor and described by variability (variance of mean squares [VMS]), amplitude (mean of 4 maximal and 4 minimal values [R4]), and frequency (vibroarthrographic signal bands of 50 to 250 Hz [P1] and 250 to 450 Hz [P2]) parameters. Using the Biodex Balance System, single-leg dynamic balance was measured by overall, anteroposterior, and mediolateral stability indices. Results Values of vibroarthrographic parameters (VMS, R4, P1 and P2) were significantly higher in the CAI group than those in the control group (P<.01). Similar results were obtained for all postural control parameters (overall, anteroposterior, and mediolateral stability indices; P<.05). Moreover, correlations between the overall stability index and VMS, and P1 and P2, as well as between the anteroposterior stability index and P1 and P2, were observed in the CAI patient group, but not in controls. Conclusion In patients with CAI, deficits in both quality of ankle arthrokinematic motion and postural control were present. Therefore, physical therapy interventions focused on improving ankle neuromuscular control and arthrokinematic function are necessary in CAI patient care. J Orthop Sports Phys Ther 2017;47(8):570-577. Epub 4 Nov 2016. doi:10.2519/jospt.2017.6836.
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Chang NJ, Lee KW, Chu CJ, Shie MY, Chou PH, Lin CC, Liang PI. A Preclinical Assessment of Early Continuous Passive Motion and Treadmill Therapeutic Exercises for Generating Chondroprotective Effects After Anterior Cruciate Ligament Rupture. Am J Sports Med 2017; 45:2284-2293. [PMID: 28520463 DOI: 10.1177/0363546517704847] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury is a well-known risk factor for the development of posttraumatic osteoarthritis (PTOA). However, whether using continuous passive motion (CPM) with or without additional treadmill exercise (TRE) in early ACL injury might provide chondroprotective effects and further decrease the risk of PTOA has yet to be determined. HYPOTHESIS CPM may offer an enhanced chondroprotective effect, but TRE may attenuate that effect due to the mechanical stress on the joint and inflammatory cytokines in the joint. STUDY DESIGN Controlled laboratory study. METHODS Thirty adult New Zealand White male rabbits were randomly allocated to sedentary (SED), CPM, TRE, or CPM+TRE groups. Each rabbit underwent an ACL transection (ACLT) on the right knee, with the contralateral knee used as an internal control (sham). The 4 joint surfaces (ie, medial and lateral femoral condyles and tibial plateaus) were evaluated 4 weeks after surgery for gross appearance, histological characteristics, and quantitative osteoarthritis (OA) scores. RESULTS Overall, at the end of testing, the CPM group experienced the best protective therapeutic effects in all compartments. In gross appearance, CPM resulted in normal articular surfaces, while the TRE and SED groups exhibited surface abrasion. Histological analysis showed significant differences in articular cartilage status. The CPM group had significantly better histological OA scores ( P < .01), corresponding to the smoothest cartilage surface and sound chondrocyte and collagen arrangement. This group also showed abundant glycosaminoglycan (GAG) content and a sound growth microenvironment, with significantly lower expression levels of the inflammatory cytokine tumor necrosis factor α and the apoptotic marker caspase 3. In contrast, the TRE and SED groups showed several features of damage: distinct graded cartilage abrasion; damaged collagen fibers, corresponding to noticeable collagen type X (osteoarthritic cartilage); reduced cartilage thickness; fewer cartilaginous cells; and the appearance of chondrocyte clusters. These groups also showed loss of GAG, corresponding to higher levels of inflammatory cytokines and apoptosis of articular chondrocytes. Furthermore, the CPM+TRE group displayed visible pathological changes in the superficial cartilage, indicating that early loading exercise may contribute to osteoarthritis. The sham treatment showed no difference in the changes in all compartments between groups. CONCLUSION Immediate CPM therapy produces a superior in situ microenvironment for reducing the occurrence of PTOA after ACL injury without reconstruction in rabbits. CLINICAL RELEVANCE These data suggest that immediate application of CPM therapy may be necessary to create a sound microenvironment in joints and possibly to decrease the risk of PTOA without or while awaiting ACL reconstruction. In contrast, both early active loading exercise and inactivity lead to the development of PTOA.
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Affiliation(s)
- Nai-Jen Chang
- Department of Sports Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Kuan-Wei Lee
- Department of Sports Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Chih-Jou Chu
- Department of Sports Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Ming-You Shie
- 3D Printing Medical Research Center, China Medical University Hospital, North District, Taichung City, Taiwan
| | - Pei-Hsi Chou
- Department of Sports Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Chih-Chan Lin
- Laboratory Animal Center, Department of Medical Research, Chi-Mei Medical Center, Yongkang District, Tainan City, Taiwan
| | - Peir-In Liang
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
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Kane MS, Lau K, Crawford DC. Rehabilitation and Postoperative Management Practices After Osteochondral Allograft Transplants to the Distal Femur: A Report From the Metrics of Osteochondral Allografts (MOCA) Study Group 2016 Survey. Sports Health 2017; 9:555-563. [PMID: 28719761 PMCID: PMC5665113 DOI: 10.1177/1941738117717011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Context: We present the current spectrum of postoperative management practices for patients receiving distal femur osteochondral allograft (OCA) transplants. Evidence Acquisition: The Joint Restoration Foundation database was examined in cooperation with the Metrics of Osteochondral Allografts study group to identify 121 surgeons who had performed at least 1 OCA transplant in the past year; 63% of surgeons responded. Study Design: Clinical survey. Level of Evidence: Level 3. Results: Postoperative weightbearing restrictions ranged from immediate nonweightbearing with full weightbearing by 12 weeks to immediate weightbearing as tolerated. Most surgeons who performed fewer (<10) OCA transplants per year followed the most restrictive protocol, while surgeons who performed more (>20) OCA transplants per year followed the least restrictive protocol. One-third of surgeons with the most restrictive protocol were more likely to change their protocol to be less restrictive over time, while none of those with the least restrictive protocol changed their protocol over time. Fifty-five percent of surgeons permitted return to full activity at 26 weeks, while 27% of surgeons lifted restrictions at 16 weeks. Conclusion: Characterization of the spectrum of postoperative management practices after OCA transplantation provides a foundation for future investigations regarding patient outcomes and associated cost to establish best practice guidelines. Fundamentally, surgeons with more experience with this procedure tended to be more aggressive with their postoperative rehabilitation guidelines. Most commonly, rehabilitation provided for some degree of limited weightbearing; however, the spectrum also included immediate full weightbearing practices.
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Affiliation(s)
- Marie S Kane
- Department of Orthopaedics & Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Karlee Lau
- Department of Orthopaedics & Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Dennis C Crawford
- Department of Orthopaedics & Rehabilitation, Oregon Health & Science University, Portland, Oregon
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Nomura M, Sakitani N, Iwasawa H, Kohara Y, Takano S, Wakimoto Y, Kuroki H, Moriyama H. Thinning of articular cartilage after joint unloading or immobilization. An experimental investigation of the pathogenesis in mice. Osteoarthritis Cartilage 2017; 25:727-736. [PMID: 27916560 DOI: 10.1016/j.joca.2016.11.013] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 11/19/2016] [Accepted: 11/25/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Moderate mechanical stress generated by normal joint loading and movement is essential for the maintenance of healthy articular cartilage. However, the effects of reduced loading caused by the absence of weight bearing or joint motion on articular cartilage and subchondral bone is still poorly understood. We aimed to characterize morphological and metabolic responses of articular cartilage and subchondral bone to decreased mechanical stress in vivo. METHODS Mice were subjected to periods of hindlimb unloading by tail suspension or external fixation of the knee joints. The articular surface was observed with digital microscope and the epiphyseal bone was assessed by micro-CT analysis. Articular cartilage and subchondral bone were further evaluated by histomorphometric, histochemical, and immunohistochemical analyses. RESULTS The joint surface was intact, but thickness of both the total and uncalcified layer of articular cartilage were decreased both after joint unloading and immobilization. Subchondral bone atrophy with concomitant marrow expansion predisposed osteoclast activity at bone surface to invade into cartilaginous layer. Uncalcified cartilage showed decreased aggrecan content and increased aggrecanase expression. Alkaline phosphatase (ALP) activity was increased at uncalcified cartilage, whereas decreased at calcified cartilage. The distributions of hypertrophic chondrocyte markers remained unchanged. CONCLUSION Thinning of articular cartilage induced by mechanical unloading may be mediated by metabolic changes in chondrocytes, including accelerated aggrecan catabolism and exquisitely modulated matrix mineralization, and cartilage matrix degradation and resorption by subchondral osteoclasts. Cartilage degeneration without chondrocyte hypertrophy under unloading condition indicate the possible existence of mechanism which is different from osteoarthritis pathogenesis.
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Affiliation(s)
- M Nomura
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Tomogaoka 7-10-2, Suma-ku, Kobe, 654-0142, Japan.
| | - N Sakitani
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Tomogaoka 7-10-2, Suma-ku, Kobe, 654-0142, Japan.
| | - H Iwasawa
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Tomogaoka 7-10-2, Suma-ku, Kobe, 654-0142, Japan; Department of Rehabilitation, St. Marianna University School of Medicine, Sugao 2-16-1, Miyamae-ku, Kawasaki, 216-8511, Japan.
| | - Y Kohara
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Tomogaoka 7-10-2, Suma-ku, Kobe, 654-0142, Japan.
| | - S Takano
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Tomogaoka 7-10-2, Suma-ku, Kobe, 654-0142, Japan.
| | - Y Wakimoto
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Tomogaoka 7-10-2, Suma-ku, Kobe, 654-0142, Japan.
| | - H Kuroki
- School of Health Sciences, Graduate School of Medicine, Kyoto University, Kawahara-cho, Shogoin 53, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan.
| | - H Moriyama
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Tomogaoka 7-10-2, Suma-ku, Kobe, 654-0142, Japan.
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Wilk KE, Arrigo CA. Rehabilitation Principles of the Anterior Cruciate Ligament Reconstructed Knee: Twelve Steps for Successful Progression and Return to Play. Clin Sports Med 2017; 36:189-232. [PMID: 27871658 DOI: 10.1016/j.csm.2016.08.012] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The rehabilitation process begins immediately after injury to the anterior cruciate ligament (ACL). The goal of preoperative rehabilitation is to prepare the patient for surgery. Current rehabilitation programs focus on strengthening exercises and proprioceptive and neuromuscular control drills to provide a neurologic stimulus. It is also important to address preexisting factors, especially for the female athlete, that may predispose to future injury, such as hip and hamstring weakness. Our goal in the rehabilitation program is to restore full, unrestricted function and to assist the patient to return to 100% of the preinjury level while achieving excellent long-term outcomes.
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Affiliation(s)
- Kevin E Wilk
- Champion Sports Medicine, 805 Saint Vincent's Drive, Suite G100, Birmingham, AL 35205, USA; American Sports Medicine Institute, Birmingham, AL, USA.
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te Moller NC, van Weeren PR. How exercise influences equine joint homeostasis. Vet J 2017; 222:60-67. [DOI: 10.1016/j.tvjl.2017.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 03/14/2017] [Accepted: 03/23/2017] [Indexed: 02/02/2023]
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Van Rossom S, Smith CR, Zevenbergen L, Thelen DG, Vanwanseele B, Van Assche D, Jonkers I. Knee Cartilage Thickness, T1ρ and T2 Relaxation Time Are Related to Articular Cartilage Loading in Healthy Adults. PLoS One 2017; 12:e0170002. [PMID: 28076431 PMCID: PMC5226797 DOI: 10.1371/journal.pone.0170002] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 12/27/2016] [Indexed: 11/19/2022] Open
Abstract
Cartilage is responsive to the loading imposed during cyclic routine activities. However, the local relation between cartilage in terms of thickness distribution and biochemical composition and the local contact pressure during walking has not been established. The objective of this study was to evaluate the relation between cartilage thickness, proteoglycan and collagen concentration in the knee joint and knee loading in terms of contact forces and pressure during walking. 3D gait analysis and MRI (3D-FSE, T1ρ relaxation time and T2 relaxation time sequence) of fifteen healthy subjects were acquired. Experimental gait data was processed using musculoskeletal modeling to calculate the contact forces, impulses and pressure distribution in the tibiofemoral joint. Correlates to local cartilage thickness and mean T1ρ and T2 relaxation times of the weight-bearing area of the femoral condyles were examined. Local thickness was significantly correlated with local pressure: medial thickness was correlated with medial condyle contact pressure and contact force, and lateral condyle thickness was correlated with lateral condyle contact pressure and contact force during stance. Furthermore, average T1ρ and T2 relaxation time correlated significantly with the peak contact forces and impulses. Increased T1ρ relaxation time correlated with increased shear loading, decreased T1ρ and T2 relaxation time correlated with increased compressive forces and pressures. Thicker cartilage was correlated with higher condylar loading during walking, suggesting that cartilage thickness is increased in those areas experiencing higher loading during a cyclic activity such as gait. Furthermore, the proteoglycan and collagen concentration and orientation derived from T1ρ and T2 relaxation measures were related to loading.
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Affiliation(s)
- Sam Van Rossom
- Human movement biomechanics research group, Department of kinesiology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Colin Robert Smith
- Department of mechanical engineering, University of Wisconsin-Madison, Madison, United States of America
| | - Lianne Zevenbergen
- Human movement biomechanics research group, Department of kinesiology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Darryl Gerard Thelen
- Department of mechanical engineering, University of Wisconsin-Madison, Madison, United States of America
- Department of biomedical engineering, University of Wisconsin-Madison, Madison, United States of America
- Department of orthopedics and rehabilitation, University of Wisconsin-Madison, Madison, United States of America
| | - Benedicte Vanwanseele
- Human movement biomechanics research group, Department of kinesiology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Dieter Van Assche
- Musculoskeletal rehabilitation research group, Department of rehabilitation sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Ilse Jonkers
- Human movement biomechanics research group, Department of kinesiology, Katholieke Universiteit Leuven, Leuven, Belgium
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Moore AC, Burris DL. Tribological rehydration of cartilage and its potential role in preserving joint health. Osteoarthritis Cartilage 2017; 25:99-107. [PMID: 27693500 DOI: 10.1016/j.joca.2016.09.018] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/15/2016] [Accepted: 09/22/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE During exercise, cartilage recovers interstitial fluid lost during inactivity, which explains how tissue thickness and joint space are maintained over time. This recovery phenomenon is currently explained by a combination of osmotic swelling during intermittent bath exposure and sub-ambient pressurization during unloading. This paper tests an alternate hypothesis that cartilage can retain and recover interstitial fluid in the absence of bath exposure and unloading when physiological hydrodynamics are present. METHOD Stationary cartilage-on-flat experiments were conducted to eliminate intermittent bath exposure as a potential contributor to fluid uptake. In situ compression measurements were used to monitor the loss, retention, and recovery of interstitial fluid during testing in saline. Samples were left larger than the contact area to preserve a convergence zone for hydrodynamic pressurization. RESULTS Interstitial fluid lost during static loading was recovered during sliding in the absence of unloading and contact migration; fluid recovery in a stationary contact cannot be explained by biphasic theory and suggests a fundamentally new contributor to the recovery process. We call the phenomenon 'tribological rehydration' because recovery was induced by sliding rather than by unloading or migration. Sensitivities to sliding speed, surface permeability, and nature of the convergence wedge are consistent with the hypothesis that hydrodynamic effects underlie the tribological rehydration phenomenon. CONCLUSIONS This study demonstrates that cartilage can retain and recover interstitial fluid without migration or unloading. The results suggest that hydrodynamic effects in the joint are not only important contributors to lubrication, they are likely equally important to the preservation of joint space.
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Affiliation(s)
- A C Moore
- Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
| | - D L Burris
- Department of Biomedical Engineering, University of Delaware, Newark, DE, USA; Department of Mechanical Engineering, University of Delaware, Newark, DE, USA.
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