Use of controlled mechanical stimulation in vivo to induce cartilage layer formation on the surface of osteotomized bone

Multiphoton microscope measurement-based biphasic multiscale analyses of knee joint articular cartilage and chondrocyte by using visco-anisotropic hyperelastic finite element method and smoothed particle hydrodynamics method

The articular cartilage of a knee joint has a variety of functions including dispersing stress and absorbing shock in the tissue and lubricating the surface region of cartilage. The metabolic activity of chondrocytes under the cyclic mechanical stimulations regenerates the morphology and function of tissues. Hence, the stress evaluation of the chondrocyte is a vital subject to assess the regeneration cycle in the normal walking condition and predict the injury occurrence in the accidents. Further, the threshold determination of stress for the chondrocytes activation is valuable for development of regenerative bioreactor of articular cartilage. In this study, in both macroscale and microscale analyses, the dynamic explicit finite element (FE) method was used for the solid phase and the smoothed particle hydrodynamics (SPH) method was used for the fluid phase. In the homogenization procedure, the representative volume element for the microscale finite element model was derived by using the multiphoton microscope measured 3D structure comprising 3 different layers: surface, middle, and deep layers. The layers had different anisotropic structural and rigidity characteristics because of the collagen fiber orientation. In both macroscale and microscale FE analyses, the visco-anisotropic hyperelastic constitutive law was used. Material properties were identified by experimentally determined stress-strain relationships of 3 layers. With respect to the macroscale and microscale SPH models for non-Newtonian viscous fluid, the previous observation results of interstitial fluid and proteoglycan were used to perform parameter identifications. Biphasic multiscale FE and SPH analyses were conducted under normal walking conditions. Therefore, the hydrostatic and shear stresses occurring in the chondrocytes caused by the compressive load and shear viscous flow were evaluated. These stresses will be used to design an ex-vivo bioreactor to regenerate the damaged articular cartilage, where chondrocytes are seeded in the culture chamber. To know the stress occurred on and in the chondrocytes is vitally important not only to understand the normal metabolic activity of the chondrocyte but also to develop a bioreactor of articular cartilage regeneration as the knee joint disease treatment.

A new distraction arthroplasty device using magnetic force; a cadaveric study

BACKGROUND

It is difficult for an articular cartilage injury to repair spontaneously. There are many procedures for treating cartilage injury, however there is no standard procedure for middle-aged patients who have diffuse knee osteoarthritis, especially of the lateral compartment. Therefore, Ochi developed a new distraction device that uses magnetic power to enlarge a joint space and promote cartilage regeneration with microfracture. The purpose of this study is to evaluate this new distraction arthroplasty system by using the cadaveric knee.

METHODS

This study used ten knees from six cadavers that were embalmed by Thiel's methods. The medial and lateral joint space was measured by AP radiographic view before and after distraction, and after weight-bearing to evaluate the joint distraction. The contact pressure of the medial and lateral compartments at the knee extension position by using a prescale film system was measured before and after weight-bearing with a 15 or 30-kg weight-bearing load to evaluate the effectiveness of this device.

FINDINGS

The lateral joint space significantly increased from the pre-distraction to the post-distraction; however, it did not change significantly between post-distraction and post-weight-bearing. With a 15 or 30-kg weight-bearing load, the contact pressure of the lateral compartment significantly decreased from the pre-distraction to the post-distraction.

INTERPRETATION

The most important advantage of this device is that it maintains a continuous distraction tension and enables almost the full range of motion of the knee. We believe that joint distraction by using magnetic force can be a promising option for cartilage injury in middle-aged patients.

Effect of gradual weight-bearing on regenerated articular cartilage after joint distraction and motion in a rabbit model

The purpose of this study was to clarify the effect of gradual weight bearing (GWB) on regenerating cartilage. We developed a novel external fixation device (EFD) with a controllable weight-bearing system and continuous passive motion (CPM). A full-thickness defect was created by resection of the entire articular surface of the tibial plateau after the EFD was fixed in the rabbit's left knee. In the GWB group (n=6), GWB was started 6 weeks after surgery. In the CPM group (n=6), CPM with EFD was applied in the same manner without GWB. The control group (n=5) received only joint distraction. All rabbits were sacrificed 9 weeks after surgery. The central one-third of the regenerated tissue was assessed and scored blindly using a grading scale modified from the International Cartilage Repair Society visual histological assessment scale. The areas stained by Safranin-O and type II collagen antibody were measured, and the percentage of each area was calculated. There was no significant difference in the histological assessment scale among the groups. The percentage of the type II collagen-positive area was significantly larger in the GWB group than in the CPM group. The present study suggests that optimal mechanical stress, such as GWB, may affect regeneration of cartilage, in vivo.

In vivo mechanical condition plays an important role for appearance of cartilage tissue in ES cell transplanted joint

The objective of this study was to evaluate the effects of the mechanical environment on the formation of cartilage tissue in transplanted embryonic stem (ES) cells. Full-thickness osteochondral defects were created on the patella groove of SD rats, and ES cells (CCE ES cells obtained from 129/Sv/Ev mice and Green ES FM260 ES cells obtained from 129SV [D3] - Tg [NCAG-EGFP] CZ-001-FM260Osb mice) were transplanted into the defects embedded in collagen gel. The animals were randomly divided into either the joint-free group (JF group) or the joint-immobilized group (JI group) for 3 weeks after a week postoperatively. The results showed that cartilage-like tissue formed in the defects of the JF group whereas large teratomatous masses developed in the defects of the JI group. Some parts of the cartilage-like tissue and the teratomatous masses were positively stained with immunostain for GFP when the Green ES FM260 ES cells were transplanted. It is suggested that the environment plays an important role for ES cells in the process of repairing cartilage tissue in vivo.

Repair of large full-thickness articular cartilage defects by transplantation of autologous uncultured bone-marrow-derived mononuclear cells

The objective of this study was to investigate the feasibility of autologous uncultured bone marrow-derived mononuclear cell transplantation in large full-thickness cartilage regeneration. After fixing with a hinged external fixator, the entire surface of the left tibial plateau was resected and large full-thickness cartilage defects were formed in 48 rabbits. Animals were divided into four groups: autologous uncultured bone marrow-derived mononuclear cells with fibrin gel (BMC), autologous uncultured peripheral blood-derived mononuclear cells with fibrin gel (PBC), fibrin gel alone (GEL), or nothing (CON) transplanted to the articular cavity 7 days after the operation. The rabbits were killed 8 or 12 weeks after the operation. The repair of defects was investigated histologically and scored using a histological and histochemical grading scale that was modified from the International Cartilage Repair Society Visual Histological Assessment Scale. To evaluate the regenerated cartilage, we also morphometrically measured the staining area positive for Safranin-O or type II collagen and calculated the percentages of the positive staining areas with respect to the regenerated soft tissue area. Histological findings showed that the BMC group had superior cartilage repair compared with the other groups, and that the PBC and CON group showed better cartilage repair than did the GEL group. Histological scores and morphometrical measurements also showed the same results quantitively. The transplantation of autologous uncultured bone marrow-derived mononuclear cells contributes to articular cartilage repair. The easy and safe method used in this study is potentially viable for clinical application.

Regenerated soft tissue survival using repulsive force of magnetized devices: preliminary report

BACKGROUND

Large full-thickness cartilage defects in the weight-bearing area are difficult to treat. A new therapeutic strategy called the total joint regeneration (TJR) system is proposed for such large defects. The purpose of this study was to evaluate the effects of the magnet-type TJR device using a rabbit model.

METHODS

The magnetized devices were implanted in full-thickness chondral defects on the patellofemoral joints of rabbits. The specimens and surrounding tissue were harvested 4 weeks after the surgery and observed macroscopically and histologically. The thickness of the regenerated soft tissue on the femur joint surface was measured and compared. The difference between the two groups (magnetized and nonmagnetized) was significant at P < 0.05.

RESULTS

Some cartilaginous regeneration was seen in the repair tissue. However, about half of the experimental knees were omitted from the study because of some trouble, such as loosening of the device or patella fracture.

CONCLUSIONS

This study suggested that magnetized devices were useful for regenerating soft tissue by maintaining the joint space. Some hyaline cartilage-like tissue was regenerated partially on the magnetized devices. It was suggested that these devices might be useful for cartilage regeneration if the devices are improved.

Effect of low loading and joint immobilization for spontaneous repair of osteochondral defect in the knees of weightless (tail suspension) rats

BACKGROUND

Mechanical stimulation has a great influence on articular cartilage regeneration. The objective of this study was to clarify the temporal sequences of spontaneous repair of weightless or immobilized joints.

METHODS

An osteochondral defect was created in the femoral patellar groove of F344 rats. A tail-suspension procedure was performed to control the mechanical environment of the hindlimbs. The experimental knee joints were classified into three conditions: CONT, normal gait; LLB, low load-bearing; LLI, low load and immobilized. The repair processes up to 4 weeks were evaluated histologically.

RESULTS

The knee defects in the CONT and LLB conditions were repaired to a smooth surface with fibrous tissue and highly developed subchondral bone. The knees in the LLI condition had the lowest reformation rate of subchondral bone, although partial regeneration of hyaline cartilage-like tissue was seen at 4 weeks after the operation. Bulges of fibrous tissue from the defects were observed in the LLI condition.

CONCLUSIONS

These results, combined with our previous report, suggest that dynamic compressive strain stimulates regeneration of the joint surface structures. They also suggest that the contact condition of the defect with surface cartilage may play a role in the hyaline cartilage repair.

Repair of large full-thickness articular cartilage defects in the rabbit

We produced large full-thickness articular cartilage defects in 33 rabbits in order to evaluate the effect of joint distraction and autologous culture-expanded bone-marrow-derived mesenchymal cell transplantation (ACBMT) at 12 weeks. After fixing the knee on a hinged external fixator, we resected the entire surface of the tibial plateau. We studied three groups: 1) with and without joint distraction; 2) with joint distraction and collagen gel, and 3) with joint distraction and ACBMT and collagen gel.

The histological scores were significantly higher in the groups with ACBMT collagen gel (p < 0.05). The area of regenerated soft tissue was smaller in the group allowed to bear weight (p < 0.05). These findings suggest that the repair of large defects of cartilage can be enhanced by joint distraction, collagen gel and ACBMT.