The extent and distribution of cell death and matrix damage in impacted chondral explants varies with the presence of underlying bone

Effects of dexamethasone and dynamic loading on cartilage of human osteochondral explants challenged with inflammatory cytokines

Post-traumatic osteoarthritis (PTOA), characterized by articular cartilage degradation initiated in an inflammatory environment after traumatic joint injury, can lead to alterations in cartilage biomechanical properties. Low dose dexamethasone (Dex) shows chondroprotection in cartilage challenged with inflammatory cytokines, but little is known about the structural biomechanical response of human cartilage to Dex in such a diseased state. This study examined changes in the biomechanical properties and biochemical composition of the cartilage within human osteochondral explants in response to treatment with exogenous cytokines, Dex, and a regimen of cyclic loading at the start and end of culture. Osteochondral explants were harvested from five pairs of human ankle talocrural joints (Collins grade 0-1) and cultured for 10 days with/without exogenous cytokines (100 ng/mL TNFα, 50 ng/mL IL-6, 250 ng/mL sIL-6R) ± Dex (100 nM). Biomechanical testing on day-0 and day-10 enabled estimation of the unconfined compression equilibrium modulus (E_y), dynamic stiffness (E_d) and hydraulic permeability (k_p) of cartilage excised from bone, accompanied by biochemical assessment of media and cartilage tissue. Dex preserved chondrocyte cell viability and decreased sulfated glycosaminoglycan (sGAG) loss and nitric oxide release, but did not alter E_y, E_d and k_p (before or after loading) on day-10. In the cytokine/cytokine+Dex treated groups, sGAG content exhibited a weaker correlation with E_y and E_d than at baseline, suggesting an important role for structural rather than biochemical changes in producing biomechanical alterations in response to cytokines and Dex. These findings aid in forming a more complete profile of potential clinical effects of Dex for use in OA/PTOA treatment regimens.

Comparison between in vitro and in vivo cartilage overloading studies based on a systematic literature review

Methodological differences between in vitro and in vivo studies on cartilage overloading complicate the comparison of outcomes. The rationale of the current review was to (i) identify consistencies and inconsistencies between in vitro and in vivo studies on mechanically-induced structural damage in articular cartilage, such that variables worth interesting to further explore using either one of these approaches can be identified; and (ii) suggest how the methodologies of both approaches may be adjusted to facilitate easier comparison and therewith stimulate translation of results between in vivo and in vitro studies. This study is anticipated to enhance our understanding of the development of osteoarthritis, and to reduce the number of in vivo studies. Generally, results of in vitro and in vivo studies are not contradicting. Both show subchondral bone damage and intact cartilage above a threshold value of impact energy. At lower loading rates, excessive loads may cause cartilage fissuring, decreased cell viability, collagen network de-structuring, decreased GAG content, an overall damage increase over time, and low ability to recover. This encourages further improvement of in vitro systems, to replace, reduce, and/or refine in vivo studies. However, differences in experimental set up and analyses complicate comparison of results. Ways to bridge the gap include (i) bringing in vitro set-ups closer to in vivo, for example, by aligning loading protocols and overlapping experimental timeframes; (ii) synchronizing analytical methods; and (iii) using computational models to translate conclusions from in vitro results to the in vivo environment and vice versa. © 2018 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. J Orthop Res 9999:1-11, 2018.

Unfolding of membrane ruffles of in situ chondrocytes under compressive loads

Impact loading results in chondrocyte death. Previous studies implicated high tensile strain rates in chondrocyte membranes as the cause of impact-induced cell deaths. However, this hypothesis relies on the untested assumption that chondrocyte membranes unfold in vivo during physiological tissue compression, but do not unfold during impact loading. Although membrane unfolding has been observed in isolated chondrocytes during osmotically induced swelling and mechanical compression, it is not known if membrane unfolding also occurs in chondrocytes embedded in their natural extracellular matrix. This study was aimed at quantifying changes in membrane morphology of in situ superficial zone chondrocytes during slow physiological cartilage compression. Bovine cartilage-bone explants were loaded at 5 μm/s to nominal compressive strains ranging from 0% to 50%. After holding the final strains for 45 min, the loaded cartilage was chemically pre-fixed for 12 h. The cartilage layer was post-processed for visualization of cell ultrastructure using electron microscopy. The changes in membrane morphology in superficial zone cells were quantified from planar electron micrographs by measuring the roughness and the complexity of the cell surfaces. Qualitatively, the cell surface ruffles that existed before loading disappeared when cartilage was loaded. Quantitatively, the roughness and complexity of cell surfaces decreased with increasing load magnitudes, suggesting a load-dependent use of membrane reservoirs. Chondrocyte membranes unfold in a load-dependent manner when cartilage is compressed. Under physiologically meaningful loading conditions, the cells likely expand their surface through unfolding of the membrane ruffles, and therefore avoid direct stretch of the cell membrane. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:304-310, 2017.

Cartilage and chondrocyte response to extreme muscular loading and impact loading: Can in vivo pre-load decrease impact-induced cell death?

BACKGROUND

Impact loading causes cartilage damage and cell death. Pre-loading prior to impact loading may protect cartilage and chondrocytes. However, there is no systematic evidence and understanding of the effects of pre-load strategies on cartilage damage and chondrocyte death. This study aimed at determining the effects of the pre-load history on impact-induced chondrocyte death in an intact joint.

METHODS

Patellofemoral joints from 42 rabbits were loaded by controlled quadriceps muscle contractions and an external impacter. Two extreme muscular loading conditions were used: (i) a short-duration, high intensity, static muscle contraction, and (ii) a long-duration, low-intensity, cyclic muscle loading protocol. A 5-Joule centrally-oriented, gravity-accelerated impact load was applied to the joints. Chondrocyte viability was quantified following the muscular loading protocols, following application of the isolated impact loads, and following application of the impact loads that were preceded by the muscular pre-loads. Joint contact pressures were measured for all loading conditions by a pressure-sensitive film.

FINDINGS

Comparing to cartilage injured by impact loading alone, cartilage pre-loaded by static, maximal intensity, short-term muscle loads had lower cell death, while cartilage pre-loaded by repetitive, low-intensity, long-term muscular loads has higher cell death. The locations of peak joint contact pressures were not strongly correlated with the locations of greatest cell death occurrence.

INTERPRETATION

Static, high intensity, short muscular pre-load protected cells from impact injury, whereas repetitive, low intensity, prolonged muscular pre-loading to the point of muscular fatigue left the chondrocytes vulnerable to injury. However, cell death seems to be unrelated to the peak joint pressures.

Development of a Spring-Loaded Impact Device to Deliver Injurious Mechanical Impacts to the Articular Cartilage Surface

OBJECTIVE

Traumatic impacts on the articular joint surface in vitro are known to lead to degeneration of the cartilage. The main objective of this study was to develop a spring-loaded impact device that can be used to deliver traumatic impacts of consistent magnitude and rate and to find whether impacts cause catabolic activities in articular cartilage consistent with other previously reported impact models and correlated with the development of osteoarthritic lesions. In developing the spring-loaded impactor, the operating hypothesis is that a single supraphysiologic impact to articular cartilage in vitro can affect cartilage integrity, cell viability, sulfated glycosaminoglycan and inflammatory mediator release in a dose-dependent manner.

DESIGN

Impacts of increasing force are delivered to adult bovine articular cartilage explants in confined compression. Impact parameters are correlated with tissue damage, cell viability, matrix and inflammatory mediator release, and gene expression 24 hours postimpact.

RESULTS

Nitric oxide release is first detected after 7.7 MPa impacts, whereas cell death, glycosaminoglycan release, and prostaglandin E2 release are first detected at 17 MPa. Catabolic markers increase linearly to maximal levels after ≥36 MPa impacts.

CONCLUSIONS

A single supraphysiologic impact negatively affects cartilage integrity, cell viability, and GAG release in a dose-dependent manner. Our findings showed that 7 to 17 MPa impacts can induce cell death and catabolism without compromising the articular surface, whereas a 17 MPa impact is sufficient to induce increases in most common catabolic markers of osteoarthritic degeneration.

Chondrocyte deformation under extreme tissue strain in two regions of the rabbit knee joint

Articular cartilage and its native cells-chondrocytes-are exposed to a wide range of mechanical loading. Chondrocytes are responsible for maintaining the cartilage matrix, yet relatively little is known regarding their behavior under a complete range of mechanical loads or how cell mechanics are affected by region within the joint. The purpose of this study was to investigate chondrocyte deformations in situ under tissue loads ranging from physiological to extreme (0-80% nominal strain) in two regions of the rabbit knee joint (femoral condyles and patellae). Local matrix strains and cell compressive strains increased with increasing loads. At low loads the extracellular matrix (ECM) strains in the superficial zone were greater than the applied tissue strains, while at extreme loads, the local ECM strains were smaller than the applied strains. Cell compressive strains were always smaller than the applied tissue strains and, in our intact, in situ preparation, were substantially smaller than those previously found in hemi-cylindrical explants. This resulted in markedly different steady-state cell volume changes in the current study compared to those working with cartilage explants. Additionally, cells from different regions in the knee exhibited striking differences in deformation behavior under load. The current results suggest: (i) that the local extracellular and pericellular matrix environment is intimately linked to chondrocyte mechanobiology, protecting chondrocytes from potentially damaging strains at high tissue loads; and (ii) that cell mechanics are a function of applied load and local cartilage tissue structure.

Repeated measurement of mechanical properties in viable osteochondral explants following a single blunt impact injury

The objective of this work was to develop a method for repeated same-site measurement of mechanical properties suitable for the detection of degenerative changes in a biologically active explant model after a single blunt impact injury. Focal blunt impact injuries to articular surfaces lead to local cartilage degeneration and loss of mechanical properties. We employed a repeated measurement methodology to determine variations in mechanical same-site properties before and after injury in living cartilage, with the hypothesis that normalization with initial mechanical properties may provide a clearer evaluation of impact effects and improve our understanding of the biologic responses to impact injury. Bovine osteochondral explants were cultured for up to 14 days after impact injury. Indentation tests were performed before and after impact injury to assess relative changes in mechanical properties. Creep strain increased significantly in impacted explants after 7 days and in both impacted and control explants after 14 days. Further analysis at 14 days revealed decreases in stretch factor beta, creep time constant and local compressive modulus. A repeated measures methodology reliably detected changes in the mechanical behaviour of viable osteochondral explants after a single impact injury.

Synthesis of a novel photopolymerized nanocomposite hydrogel for treatment of acute mechanical damage to cartilage

Intra-articular fractures initiate a cascade of pathobiological and pathomechanical events that culminate in post-traumatic osteoarthritis (PTOA). Hallmark features of PTOA include destruction of the cartilage matrix in combination with loss of chondrocytes and acute mechanical damage (AMD). Currently, treatment of intra-articular fractures essentially focuses completely on restoration of the macroanatomy of the joint. However, current treatment ignores AMD sustained by cartilage at the time of injury. We are exploring aggressive biomaterial-based interventions designed to treat the primary pathological components of AMD. This study describes the development of a novel injectable co-polymer solution that forms a gel at physiological temperatures that can be photocrosslinked, and can form a nanocomposite gel in situ through mineralization. The injectable co-polymer solution will allow the material to fill cracks in the cartilage after trauma. The mechanical properties of the nanocomposite are similar to those of native cartilage, as measured by compressive and shear testing. It thereby has the potential to mechanically stabilize and restore local structural integrity to acutely injured cartilage. Additionally, in situ mineralization ensures good adhesion between the biomaterial and cartilage at the interface, as measured through tensile and shear testing. Thus we have successfully developed a new injectable co-polymer which forms a nanocomposite in situ with mechanical properties similar to those of native cartilage, and which can bond well to native cartilage. This material has the potential to stabilize injured cartilage and prevent PTOA.

The metabolic dynamics of cartilage explants over a long-term culture period

INTRODUCTION

Although previous studies have been performed on cartilage explant cultures, the generalized dynamics of cartilage metabolism after extraction from the host are still poorly understood due to differences in the experimental setups across studies, which in turn prevent building a complete picture.

METHODS

In this study, we investigated the response of cartilage to the trauma sustained during extraction and determined the time needed for the cartilage to stabilize. Explants were extracted aseptically from bovine metacarpal-phalangeal joints and cultured for up to 17 days.

RESULTS

The cell viability, cell number, proteoglycan content, and collagen content of the harvested explants were analyzed at 0, 2, 10, and 17 days after explantation. A high percentage of the cartilage explants were found to be viable. The cell density initially increased significantly but stabilized after two days. The proteoglycan content decreased gradually over time, but it did not decrease to a significant level due to leakage through the distorted peripheral collagen network and into the bathing medium. The collagen content remained stable for most of the culture period until it dropped abruptly on day 17.

CONCLUSION

Overall, the tested cartilage explants were sustainable over long-term culture. They were most stable from day 2 to day 10. The degradation of the collagen on day 17 did not reach diseased levels, but it indicated the potential of the cultures to develop into degenerated cartilage. These findings have implications for the application of cartilage explants in pathophysiological fields.

Knee-to-ankle mosaicplasty for the treatment of osteochondral lesions of the ankle joint

BACKGROUND

Osteochondral lesions are frequently seen in athletes after ankle injuries. At this time, osteochondral autologous transplantation (OATS, mosaicplasty) is the only surgical treatment that replaces the entire osteochondral unit in symptomatic lesions.

PURPOSE

To evaluate the clinical and radiological midterm to long-term outcome of ankles treated with knee-to-ankle mosaicplasty.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

Clinical evaluation consisted of patient satisfaction, pain evaluation (visual analog scale [VAS]), American Orthopaedic Foot and Ankle Society (AOFAS) ankle score, sports activity score, range of motion, the radiological evaluation of magnetic resonance imaging (MRI), and single photon emission computed tomography-computed tomography (SPECT-CT) analysis of both the ankle and the knee joint.

RESULTS

Twelve of 21 patients (mean age, 43 years; male, 8; female, 4) were available for latest follow-up (mean, 72 months). At follow-up, patients reported a satisfaction rate of good to excellent in 92% (n = 11) and poor in 8% (n = 1). The average VAS pain score was 3.9 (preoperative, 5.9; P = .02), AOFAS ankle score significantly increased from 45.9 to 80.2 points (P < .0001), sports activity score remained significantly decreased with 1.25 (preinjury level, 2.3; P = .035), and ankle dorsiflexion was significantly reduced (P = .003). Knee pain was reported in 6 patients (50%). Radiologically, recurrent lesions were found in 10 of 10 cases (100%) and some degree of cartilage degeneration and discontinuity of the subchondral bone plate in 100%.

CONCLUSION

Indications for mosaicplasty with a plug transfer from the knee to the talus must be considered carefully, as at midterm, moderate outcome and considerable donor-site morbidity may be found.

Chondrocyte death in mechanically injured articular cartilage--the influence of extracellular calcium

Calcium is thought to be an important regulator of chondrocyte death associated with articular cartilage injury. Our objective was to determine the influence of extracellular calcium on chondrocyte death following mechanical injury. Using a surgically relevant model of sharp mechanical injury (with a scalpel) and confocal laser scanning microscopy (CLSM), in situ chondrocyte death was quantified within the full thickness of articular cartilage as a function of medium calcium concentration and time (2.5 h and 7 days). Exposure of articular cartilage to calcium-free media (approximately 0 mM) significantly reduced superficial zone chondrocyte death after mechanical injury compared with exposure to calcium-rich media (2-20 mM, ANOVA at 2.5 h, p = 0.002). In calcium-rich media, although the extent of chondrocyte death increased with increasing medium calcium concentration, cell death remained localized to the superficial zone of articular cartilage over 7 days (ANOVA, p < 0.05). However, in calcium-free media, there was an increase in chondrocyte death within deeper zones of articular cartilage over 7 days. The early (within hours) chondroprotective effect in calcium-free media suggests that the use of joint irrigation solutions without added calcium may decrease chondrocyte death from mechanical injury during articular surgery. The delayed (within days) increase in chondrocyte death in calcium-free media supports the use of calcium supplementation in media used during cartilage culture for tissue engineering or transplantation.

P188 reduces cell death and IGF-I reduces GAG release following single-impact loading of articular cartilage

Prior joint injury predisposes an individual to developing post-traumatic osteoarthritis, for which there is presently no disease modifying treatment. In this condition, articular cartilage degenerates due to cell death and matrix breakdown, resulting in tissue with diminished biomechanical function. P188, a nonionic surfactant, and the growth factor IGF-I have been shown to decrease cell death. Additionally, IGF-I is known to have beneficial effects on cartilage matrix. The objective of this study was to determine the efficacy of P188, IGF-I, and their combination following articular cartilage impact injury with two energy levels, 1.1 J ("low") and 2.8 J ("high"), at 24 h and 1 week. Bovine articular cartilage with attached underlying bone was impacted at the low or high level. Impact sites were explanted and examined immediately, or cultured for 24 h or 1 week in serum-free media supplemented with P188 (8 mgml), IGF-I (100 ngml), or their combination. Gross morphology, cell viability, GAG release to the media, and tissue mechanical properties were assessed. Immediately postimpact, high level impacted tissue had significantly increased gross morphology scores, indicating tissue damage, which were maintained over 1 week. Gross scores following low impact were initially similar to nonimpacted controls, but, at 24 h and 1 week, low impact gross scores significantly increased compared to nonimpacted controls. Additionally, at 24 h, high impact resulted in increased cell death, and both low and high impacts had increased GAG release compared to nonimpacted controls. Furthermore, high impact caused decreased tissue stiffness at 24 h that appeared to worsen over 1 week, evident by the percent decrease from nonimpacted controls increasing from 16% to 26%. No treatment type studied mitigated this loss. The combination did not perform better than either individual treatment; however, following low impact at 1 week, P188 reduced cell death by 75% compared to no treatment and IGF-I decreased GAG release from the tissue by 49%. In conclusion, high impact resulted in immediate tissue changes that worsened over 1 week. Though not causing immediate changes, low impact also resulted in tissue degeneration evident by 24 h. No treatment studied was effective at 24 h, but by 1 week P188 and IGF-I ameliorated established detrimental changes occurring in articular cartilage postimpact. However, further work is needed to optimize treatment strategies to prevent and/or reverse cell death and matrix destruction in a way that maintains tissue mechanical properties, and hence its functionality.

Effect of osteochondral graft insertion forces on chondrocyte viability

BACKGROUND

Because chondrocytes are responsible for articular cartilage matrix synthesis and maintenance, reduced chondrocyte viability could compromise graft survival, healing, and clinical outcome.

HYPOTHESIS

Typical forces used in osteochondral grafting reduce the viability of the chondrocytes in the graft.

STUDY DESIGN

Controlled laboratory study.

METHODS

Osteochondral grafting was performed in 4 fresh-frozen cadaver knees (n = 16 per knee). Impact force was measured during extrusion of the donor graft from the harvester into the recipient site, seating the graft flush with the articular surface of the surrounding cartilage using a tamp, and recessing the graft surface below the recipient articular surface. The magnitudes of forces measured during cadaver surgery (200, 400, and 800 N) were reproduced using a drop-tower apparatus on 80 fresh osteochondral grafts harvested from knee blocks provided by tissue banks. Cell viability and glycosaminoglycan release in media were measured at 48 hours after injury.

RESULTS

Forces were relatively low (range, 124-356 N) during graft extrusion from the harvester into the recipient defect or during flush seating (range, 191-418 N) of the graft. Attempts to recess the graft generated significantly greater force (range, 147-685; P < .01). When the donor graft length was 2 mm longer than the depth of the recipient hole, the mean impact force generated was even higher (range, 240-1114 N) than the force seen in a donor graft of equal length. No reduction in viability was seen at 200-N and 400-N impacts. However, a significant decrease in chondrocyte viability was seen in the group impacted with 800 N (only 50% of cells were viable, compared with 91% in the sham group; P < .01). Glycosaminoglycan levels in culture media did not correlate significantly with insertion force.

CONCLUSION

Typical graft insertion forces did not significantly reduce chondrocyte viability. However, increased graft length relative to the depth of the recipient hole and attempts to recess the graft generated higher forces, which reduced chondrocyte viability.

CLINICAL RELEVANCE

Any theoretical benefits of cancellous bone compaction that may occur in grafts that are recessed or are longer than the recipient holes must be balanced against the potential reduction in chondrocyte viability.

Wear-lines and split-lines of human patellar cartilage: relation to tensile biomechanical properties

BACKGROUND

Articular cartilage undergoes age-associated degeneration, resulting in both structural and functional biomechanical changes. At early stages of degeneration, wear-lines develop in the general direction of joint movement. With aging, cartilage exhibits a decrease in tensile modulus. The tensile modulus of cartilage has also been related to the orientation of the collagen network, as revealed by split-lines.

OBJECTIVE

To determine the relative contribution of wear-line and split-line orientation on the tensile biomechanical properties of human patellar cartilage from different depths.

METHODS

In human patellar cartilage, wear- and split-lines are aligned parallel to each other at the proximal facet, and perpendicular to each other at the medial facet. Using superficial, middle, and deep cartilage sections from these two sites, tensile samples were prepared in two orthogonal orientations. Thus, for each depth, there were four groups of samples, with their long axes were aligned either parallel or perpendicular to wear-line direction and also aligned parallel or perpendicular to split-line direction. Uniaxial tensile tests were performed to assess equilibrium and ramp moduli.

RESULTS

Tensile equilibrium moduli varied with wear-line orientation (P<0.05) and depth (P<0.001), in an interactive manner (P<0.05), and tended to vary with split-line orientation (P=0.16). In the superficial layer, equilibrium and ramp modulus were higher when the samples were loaded parallel to wear-lines (P<0.05).

CONCLUSION

These results indicate that mild wear (i.e., wear-line formation) at the articular surface has deleterious functional effects on articular cartilage and represent an early aging-associated degenerative change. The identification and recognition of functional biomechanical consequences of wear-lines are useful for planning and interpreting tensile biomechanical tests in human articular cartilage.

Effects of doxycycline on articular cartilage GAG release and mechanical properties following impact

The effects of doxycycline were examined on articular cartilage glycosaminoglycan (GAG) release and biphasic mechanical properties following two levels of impact loading at 1 and 2 weeks post-injury. Further, treatment for two continuous weeks was compared to treatment for only the 1st week of a 2-week culture period. Following impact at two levels, articular cartilage explants were cultured for 1 or 2 weeks with 0, 50, or 100 microM doxycycline. Histology, GAG release to the media, and creep indentation biomechanical properties were examined. The "High" (2.8 J) impact level had gross surface damage, whereas "Low" (1.1 J) impact was indiscernible from non-impacted controls. GAG staining decreased after High impact, but doxycycline did not visibly affect staining. High impact resulted in decreased aggregate moduli at both 1 and 2 weeks and increased permeability at 2 weeks, but tissue mechanical properties were not affected by doxycycline treatment. At 1 week, High impact resulted in more GAG release compared to non-impacted controls. However, following High impact, 100 microM doxycycline reduced cumulative GAG release at 1 and 2 weeks by 30% and 38%, respectively, compared to no treatment. Interestingly, there was no difference in GAG release comparing 2 weeks continuous treatment with 1 week on, 1 week off. These results support the hypothesis that doxycycline can mitigate GAG release from articular cartilage following impact loads. However, doxycycline was unable to prevent the loss of tissue stiffness observed post-impact, presumably due to initial matrix damage resulting solely from mechanical trauma.

Association of knee bone bruise frequency with time postinjury and type of soft tissue injury

This study correlated the frequency of bone bruises with soft tissue injuries in the knee and examined bruise frequency as a function of time postinjury. Magnetic resonance imaging of 1546 patients revealed bone bruises in 19% of patients without an associated meniscal or ligamentous injury. For those patients presenting with at least one meniscoligamentous injury, the frequency of bruising was 60% at 0 to 4 weeks, 42% at 4 to 10 weeks, and 31% at 10 to 26 weeks postinjury. The frequency of bruising varied with the presence of concomitant injuries, with the greatest frequency of bruises (78%) observed in patients with anterior cruciate ligament injuries.

Temporal effects of impact on articular cartilage cell death, gene expression, matrix biochemistry, and biomechanics

Articular cartilage injury can cause post-traumatic osteoarthritis, but early processes leading to the disease are not well understood. The objective of this study was to characterize two levels of impact loading at 24 h, 1 week, and 4 weeks in terms of cell death, gene expression, extracellular matrix biochemistry, and tissue biomechanical properties. The data show cell death increased and tissue stiffness decreased by 24 h following High impact (2.8 J). These degradative changes persisted at 1 and 4 weeks, and were further accompanied by measurable changes in ECM biochemistry. Moreover, following High impact at 24 h there were specific changes in gene expression that distinguished injured tissue from adjacent tissue that was not loaded. In contrast, Low impact (1.1 J) showed little change from control specimens at 24 h or 1 week. However, at 4 weeks, a significant increase in cell death and significant decrease in tissue stiffness were present. The constellation of findings indicates Low impacted tissue exhibited a delayed biological response. The study characterizes a model system for examining the biology of articular cartilage post-impact, as well as identifies possible time points and success criteria to be used in future studies employing intervention agents.

Indentation probing of human articular cartilage: Effect on chondrocyte viability

BACKGROUND

Clinical arthroscopic probes based on indentation testing are being developed. However, the biological effects of certain design parameters (i.e., tip geometry and size) and loading protocols (i.e., indentation depth, rate, and repetition) on human articular cartilage are unclear.

OBJECTIVE

Determine if indenter design and indentation protocol modulate mechanical injury of probed cartilage samples.

METHODS

The objectives of this study were to determine the effects of indentation testing using clinically applicable tips (0.4mm radius, plane- or sphere-ended) and protocols (indentation depths of 100, 200, or 300 microm, applied at a rate of 50 or 500 microm/s) on the extent and the pattern of chondrocyte death, should it occur. Grossly normal osteochondral blocks were harvested from human talar dome, indented, stained with live/dead dyes, and imaged en face on a fluorescence microscope.

RESULTS

The occurrence and the extent of cell death generally increased with indentation depth, being undetected at an indentation depth of 100 microm but marked at 300 microm. In addition, tip geometry affected the pattern of cell death: ring- and solid circle-shaped areas of cell deaths were apparent when compressed to 300 microm using plane- and sphere-ended indenters.

CONCLUSION

Indenter design and indentation protocol modulated the extent and the pattern of chondrocyte death. These results have implications for designing indentation probes and protocols, as well as clinicians performing arthroscopic probing.

The effect of finite compressive strain on chondrocyte viability in statically loaded bovine articular cartilage

Recent studies have reported that certain regimes of compressive loading of articular cartilage result in increased cell death in the superficial tangential zone (STZ). The objectives of this study were (1) to test the prevalent hypothesis that preferential cell death in the STZ results from excessive compressive strain in that zone, relative to the middle and deep zones, by determining whether cell death correlates with the magnitude of compressive strain and (2) to test the corollary hypothesis that the viability response of cells is uniform through the thickness of the articular layer when exposed to the same loading environment. Live cartilage explants were statically compressed by approximately 65% of their original thickness, either normal to the articular surface (axial loading) or parallel to it (transverse loading). Cell viability after 12 h was compared to the local strain distribution measured by digital image correlation. Results showed that the strain distribution in the axially loaded samples was highest in the STZ (77%) and lowest in the deep zone (55%), whereas the strain was uniformly distributed in the transversely loaded samples (64%). In contrast, axially and transversely loaded samples exhibited very similar profiles of cell death through the depth, with a preferential distribution in the STZ. Unloaded control samples showed negligible cell death. Thus, under prolonged static loading, depth-dependent variations in chondrocyte death did not correlate with the local depth-dependent compressive strain, and the prevalent hypothesis must be rejected. An alternative hypothesis, suggested by these results, is that superficial zone chondrocytes are more vulnerable to prolonged static loading than chondrocytes in the middle and deep zones.

Treatment with the non-ionic surfactant poloxamer P188 reduces DNA fragmentation in cells from bovine chondral explants exposed to injurious unconfined compression

Excessive mechanical loading to a joint has been linked with the development of post-traumatic osteoarthritis (OA). Among the suspected links between impact trauma to a joint and associated degeneration of articular cartilage is an acute reduction in chondrocyte viability. Recently, the non-ionic surfactant poloxamer 188 (P188) has been shown to reduce by approximately 50% the percentage of non-viable chondrocytes 24 h post-injury in chondral explants exposed to 25 MPa of unconfined compression. There is a question whether these acutely 'saved' chondrocytes will continue to degrade over time, as P188 is only thought to act by acute repair of damaged cell membranes. In order to investigate the degradation of traumatized chondrocytes in the longer term, the current study utilized TUNEL staining to document the percentage of cells suffering DNA fragmentation with and without an immediate 24 h period of exposure of the explants to P188 surfactant. In the current study, as in the previous study by this laboratory, chondral explants were excised from bovine metacarpophalangeal joints and subjected to 25 MPa of unconfined compression. TUNEL staining was performed at 1 h, 4 days, and 7 days post-impact. The current study found that P188 was effective in reducing the percentage of cells with DNA fragmentation in impacted explants by approximately 45% at 4 and 7 days post-impact. These data suggest that early P188 intervention was effective in preventing DNA fragmentation of injured chondrocytes. The current hypothesis is that this process was mitigated by the acute repair of damaged plasma membranes by the non-ionic surfactant P188, and that most repaired cells did not continue to degrade as measured by the fragmentation of their DNA.

Effect of Compressive Strain on Cell Viability in Statically Loaded Articular Cartilage

Physiological loading of articulating joints is necessary for normal cartilage function. However, conditions of excessive overloading or trauma can cause cartilage injury resulting in matrix damage and cell death. The objective of this study was to evaluate chondrocyte viability within mechanically compressed articular cartilage removed from immature and mature bovine knees. Twenty-three mature and 68 immature cartilage specimens were subjected to static uniaxial confined-creep compressions of 0-70% and the extent of cell death was measured using fluorescent microscopic imaging. In both age groups, cell death was always initiated at the articular surface and increased linearly in depth with increasing strain magnitude. However, most of the cell death was localized within the superficial zone (SZ) of the cartilage matrix with the depth never greater than approximately 500 microm or 25% of the thickness of the test specimen. The immature cartilage was found to have a significantly greater (> 2 times) amount (depth) of cell death compared to the mature cartilage, especially at the higher strains. This finding was attributed to the lower compressive modulus of the immature cartilage in the SZ compared to that of the mature cartilage, resulting in a greater local matrix strain and concomitant cell surface membrane strain in this zone when the matrix was compressed. These results provide further insight into the capacity of articular cartilage in different age groups to resist the severity of traumatic injury from compressive loads.

Exposure to a standard culture medium alters the response of cartilage explants to injurious unconfined compression

Previous studies on chondral explants have not clearly described to what extent the degree and the distribution of cell death are dependent on the amount of free swelling seen during tissue equilibration in a standard culture medium. The current study hypothesized that increased fluid content inside equilibrated chondral explants, when subjected to injurious compression, would lead to greater matrix damage during unconfined compression. Equilibrated and non-equilibrated chondral explants were loaded to 30 MPa at a fast rate of loading ( approximately 600 MPa/s). Stress-strain curves were documented for each explant. Matrix damage was assessed by the length of surface fissures. Chondrocyte viability was also measured in the various layers of the explants. The stiffness of the equilibrated specimens was less than non-equilibrated specimens, and it correlated with the amount of fluid absorbed during equilibration. More matrix damage and associated cell death in the superficial zone were documented in equilibrated than non-equilibrated explants, and these correlated positively with fluid absorbed during equilibration. This study indicated that equilibration of chondral explants in a standard culture medium alters their response to mechanical loading in terms of stiffness, matrix damage and cell viability.

The autologous osteochondral transplantation of the knee: clinical results, radiographic findings and histological aspects

INTRODUCTION

The osteochondral transplantation (OCT) is a well accepted treatment option for focal cartilage lesions in the knee joint, whereas the fate of the transplanted cartilage is still unclear and the clinical outcome is variable. The purpose of this study was to evaluate the histological character of autologous transplanted cartilage and to correlate technical aspects and the patients' history with the clinical outcome.

MATERIAL AND METHODS

The OCT was performed in 27 patients (median age of 32 (22-43) years) with a focal chondral lesion at the medial femoral condyle. We investigated the clinical outcome after a median follow-up of 13.5 (5-28) months using the Lysholm-score and the integration of the transplanted plugs using an MRI-scoring system. Biopsy specimens from representative patients (n = 8) were evaluated with histological staining and immunohistochemistry.

RESULTS

The median Lysholm-score was 80 (range 45-98). The wide range of the Lysholm-score in clinical outcome did not show significant differences in: follow-up, concomitant injuries, defect size or genesis. The MRI analysis revealed in all cases a regular osseous integration of the subchondral bone, but a failed chondral integration. The congruency of the plugs to the joint surface was often incorrect, however a correlation between the MRI-score and the clinical outcome could not be shown. Histology of the transplanted cartilage revealed small changes in immunohistochemistry after a relatively short-term follow-up, whereas the cartilage has still the typical hyaline character. Often, the surrounding cartilage consists of fibrous and granulation tissue.

CONCLUSION

The congruency of the joint surface can not be restored to the original status, particularly in larger defects with irregular shapes. However, we did not find any aspects which affected the function of the knee joint following OCT. It can be assumed that remaining lesions at the surrounding cartilage could maintain the inflammatory process and therefore maintain the pain and a low knee function. Further investigations are needed to specify the effects of the OCT on the transplanted cartilage and its influence on the later clinical outcome.

The limitation of acute necrosis in retro-patellar cartilage after a severe blunt impact to the in vivo rabbit patello-femoral joint

We have previously shown that surface lesions and acute necrosis of chondrocytes are produced by severe levels of blunt mechanical load, generating contact pressures greater than 25 MPa, on chondral and osteochondral explants. We have also found surface lesions and chronic degradation of retro-patellar cartilage within 3 years following a 6J impact intensity with an associated average pressure of 25 MPa in the rabbit patello-femoral joint. We now hypothesized that cellular necrosis is produced acutely in the retro-patellar cartilage in this model as a result of a 6J impact and that an early injection of the non-ionic surfactant, poloxamer 188 (P188), would significantly reduce the percentage of necrotic cells in the traumatized cartilage. Eighteen rabbits were equally divided into a 'time zero' group and two other groups carried out for 4 days. One '4 day' group was administered a 1.5 ml injection of P188 into the impacted joint immediately after trauma, while the other was injected with a placebo solution. Impact trauma produced surface lesions on retro-patellar cartilage in all groups. Approximately 15% of retro-patellar chondrocytes suffered acute necrosis in the 'time zero' and '4-day no poloxamer' groups. In contrast, significantly fewer cells (7%) suffered necrosis in the poloxamer group, most markedly in the superficial cartilage layer. The use of P188 surfactant early after severe trauma to articular cartilage may allow sufficient time for damaged cells to heal, which may in turn mitigate the potential for post-traumatic osteoarthritis. Additional studies are needed to improve the efficacy of this surfactant and to determine the long-term health of joint cartilage after P188 intervention.

Gene expression profile of mechanically impacted bovine articular cartilage explants

Traumatic injury to a joint can initiate cartilage degradation. Blunt trauma increases matrix damage and decreases proteoglycan synthesis in in vitro models. Few studies have investigated gene expression of articular cartilage (AC) following mechanical loading. Recent advances in microarray technology allow analysis of a number of genes, and may elucidate pathways of AC degradation. In the present study, we used a bovine cDNA microarray to determine how acute trauma of cartilage explants in the absence of underlying bone alters gene expression. Results indicate that at least 19 genes were differentially expressed at 3 h after trauma. Fourteen genes were up-regulated and five genes were down-regulated relative to control explants. The up-regulated genes included cytokine and chemokine receptors, enzymes, and molecules involved in signal transduction. Genes of adhesion molecules and apoptosis were down-regulated. The results of this study highlight the potential benefits of using a bovine cDNA microarray to study cartilage metabolism.

The use of a non-ionic surfactant (P188) to save chondrocytes from necrosis following impact loading of chondral explants

While current injury criteria for the automotive industry are based on bone fracture, the majority of knee injuries suffered in collisions each year do not involve fracture of bone. Instead, clinical studies of traumatic joint injury often document early pain and development of chronic diseases, such as osteoarthritis. Previous studies suggest chronic disease can be initiated by cell death that occurs in articular cartilage during mechanical trauma to the joint. In the current investigation early necrosis of chondrocytes was investigated after blunt trauma to chondral explants. A non-ionic surfactant (P188) was explored as a potential tool for early intervention into the disease process, as this surfactant has been shown to repair damaged membranes in other cell lines. Three groups of adult bovine chondral explants were equilibrated for 48 h in culture media. Two groups were then loaded to 25 MPa in unconfined compression. Half the specimens in each group were incubated in media supplemented with 8 mg/ml P188 immediately after loading, while the other half was returned to standard media. At 1 and 24 h the percentages of live and dead cells in compressed and control groups were determined with a cell viability stain. At 1 h post-trauma, P188 incubated specimens had a significantly increased percentage of live cells in the superficial zone versus the no-P188 group. At 24 h the percentages of live cells in all three zones of the P188-treated explants were significantly greater than in the no treatment group. This study showed that P188 surfactant could help restore the integrity of cell membranes in cartilage damaged by blunt mechanical trauma. With the ability of P188 to "save" chondrocytes from early necrotic death using in vitro chondral explants, its role in prevention of a post-traumatic osteoarthritis in a diarthrodial joint should be further explored using in vivo animal models.

Cartilage tolerates single impact loads of as much as half the joint fracture threshold

We hypothesized that one mechanical insult could affect cellular proliferation, matrix turnover, and the structural integrity of cartilage, and that these effects would be dose dependent and time dependent. One impact load of low impact (14.4 MPa +/- 2.1 MPa), medium impact (22.8 MPa +/- 5.8 MPa), or high impact (55.5 MPa +/- 12.6 MPa) was administered to the posterior aspect of the medial femoral condyle of New Zealand White rabbits using a previously validated pendulum device. Animals were euthanized at 2, 6, and 12 weeks after impact, and the impacted and sham (contralateral limb) cartilage were harvested. Each specimen was assessed by light microscopy and by immunohistochemical methods. Although impacted specimens had greater loss of proteoglycan staining than sham cartilage, these changes were neither dose dependent nor time dependent. No structural damage, enzymatic proteoglycan or collagen breakdown, or cellular proliferation was identified in the different impact groups. Articular cartilage is a resilient tissue, particularly in situ, and can tolerate single impact loads of as much as 45% of the joint fracture threshold without considerable disruption or degradation.

Basic fibroblast growth factor mediates transduction of mechanical signals when articular cartilage is loaded

OBJECTIVE

To determine whether the basic fibroblast growth factor (bFGF) mediates signal transduction in articular cartilage in response to mechanical loading.

METHODS

Articular cartilage from porcine metacarpophalangeal or knee joints was cyclically loaded (62.5-250N) for 2 minutes in the absence or presence of a bFGF receptor inhibitor, SB 402451 (250 nM). Activation of the extracellularly regulated kinase MAP kinase ERK was measured by Western blot analysis. Changes in protein synthesis were assessed by measuring the incorporation of (35)S-Met/Cys into proteins secreted by cartilage explants or by isolated chondrocytes.

RESULTS

Rapid activation of the ERK MAP kinase occurred when articular cartilage was loaded. This was dependent upon release of the bFGF because it was restricted by the FGF receptor inhibitor. Loaded explants were shown to release bFGF. Loading or bFGF stimulation of explants induced synthesis and secretion of tissue inhibitor of metalloproteinases 1 (TIMP-1), which was inhibited by SB 402451.

CONCLUSION

Cyclical loading of articular cartilage causes bFGF-dependent activation of ERK and synthesis of TIMP-1.