Effects of the Frequency and Duration of Cyclic Stress on the Mechanical Properties of Cultured Collagen Fascicles From the Rabbit Patellar Tendon

Regenerative Anterior Cruciate Ligament Healing in Youth and Adolescent Athletes: The Emerging Age of Recovery Science

Anterior cruciate ligament (ACL) injuries mainly arise from non-contact mechanisms during sport performance, with most injuries occurring among youth or adolescent-age athletes, particularly females. The growing popularity of elite-level sport training has increased the total volume, intensity and frequency of exercise and competition loading to levels that may exceed natural healing capacity. Growing evidence suggests that the prevailing mechanism that leads to non-contact ACL injury from sudden mechanical fatigue failure may be accumulated microtrauma. Given the consequences of primary ACL injury on the future health and quality of life of youth and adolescent athletes, the objective of this review is to identify key "recovery science" factors that can help prevent these injuries. Recovery science is any aspect of sports training (type, volume, intensity, frequency), nutrition, and sleep/rest or other therapeutic modalities that may prevent the accumulated microtrauma that precedes non-contact ACL injury from sudden mechanical fatigue failure. This review discusses ACL injury epidemiology, current surgical efficacy, the native ACL vascular network, regional ACL histological complexities such as the entheses and crimp patterns, extracellular matrix remodeling, the concept of causal histogenesis, exercise dosage and ligament metabolism, central nervous system reorganization post-ACL rupture, homeostasis regulation, nutrition, sleep and the autonomic nervous system. Based on this information, now may be a good time to re-think primary ACL injury prevention strategies with greater use of modified sport training, improved active recovery that includes well-planned nutrition, and healthy sleep patterns. The scientific rationale behind the efficacy of regenerative orthobiologics and concomitant therapies for primary ACL injury prevention in youth and adolescent athletes are also discussed.

Tendinopathy and tendon material response to load: What we can learn from small animal studies

Tendinopathy is a debilitating disease that causes as much as 30% of all musculoskeletal consultations. Existing treatments for tendinopathy have variable efficacy, possibly due to incomplete characterization of the underlying pathophysiology. Mechanical load can have both beneficial and detrimental effects on tendon, as the overall tendon response depends on the degree, frequency, timing, and magnitude of the load. The clinical continuum model of tendinopathy offers insight into the late stages of tendinopathy, but it does not capture the subclinical tendinopathic changes that begin before pain or loss of function. Small animal models that use high tendon loading to mimic human tendinopathy may be able to fill this knowledge gap. The goal of this review is to summarize the insights from in-vivo animal studies of mechanically-induced tendinopathy and higher loading regimens into the mechanical, microstructural, and biological features that help characterize the continuum between normal tendon and tendinopathy. STATEMENT OF SIGNIFICANCE: This review summarizes the insights gained from in-vivo animal studies of mechanically-induced tendinopathy by evaluating the effect high loading regimens have on the mechanical, structural, and biological features of tendinopathy. A better understanding of the interplay between these realms could lead to improved patient management, especially in the presence of painful tendon.

Altering the Mechanical Load Environment During Growth Does Not Affect Adult Achilles Tendon Properties in an Avian Bipedal Model

Tendon mechanical properties respond to altered load in adults, but how load history during growth affects adult tendon properties remains unclear. To address this question, we adopted an avian model in which we altered the mechanical load environment across the growth span. Animals were divided at 2 weeks of age into three groups: (1) an exercise control group given the opportunity to perform high-acceleration movements (EXE, n = 8); (2) a sedentary group restricted from high-intensity exercise (RES, n = 8); and (3) a sedentary group also restricted from high-intensity exercise and in which the gastrocnemius muscles were partially paralyzed using repeated bouts of botulinum toxin-A injections (RES-BTX, n = 8). Video analysis of bird movement confirmed the restrictions eliminated high-intensity exercise and did not alter time spent walking and sitting between groups. At skeletal maturity (33-35 weeks) animals were sacrificed for analysis, consisting of high-field MRI and material load testing, of both the entire free Achilles tendon and the tendon at the bone-tendon junction. Free tendon stiffness, modulus, and hysteresis were unaffected by variation in load environment. Further, the bone-tendon junction cross-sectional area, stress, and strain were also unaffected by variations in load environment. These results suggest that: (a) a baseline level of low-intensity activity (standing and walking) may be sufficient to maintain tendon growth; and (b) if this lower threshold of tendon load is met, non-mechanical mediated tendon growth may override the load-induced mechanotransduction signal attributed to tendon remodeling in adults of the same species. These results are important for understanding of musculoskeletal function and tendon health in growing individuals.

Muscle Stiffness of the Vastus Lateralis in Sprinters and Long-Distance Runners

PURPOSE

The stiffness of muscle-tendon units and of tendons in the lower legs plays important roles in sprinting and long-distance running. However, the association of muscle stiffness with sprinting and running remains unknown. This study aimed to identify the characteristics of muscle stiffness in sprinters and long-distance runners, and to determine how muscle stiffness is related to the performance of these athletes.

METHODS

In 22 male sprinters (SPR group), 22 male long-distance runners (LDR group), and 19 healthy untrained control male subjects (CON group), the muscle shear wave speed (a proxy for stiffness) of the vastus lateralis (VL) was measured under passive (resting) and active (contracting the knee extensors at 50% of maximal voluntary contraction) conditions, by using ultrasound shear wave elastography.

RESULTS

The passive VL shear wave speed in SPR group was significantly lower than that in LDR group (P = 0.039). The active VL shear wave speed in LDR group was significantly higher than that in SPR (P = 0.022) and CON (P < 0.001) groups. In SPR group, the 100-m race time was negatively correlated to the passive VL shear wave speed (r = -0.483, P = 0.023) and positively correlated to the active VL shear wave speed (r = 0.522, P = 0.013). In the LDR group, the 5000-m race time was positively correlated to the passive VL shear wave speed (r = 0.438, P = 0.047) but not to the active VL shear wave speed.

CONCLUSION

The muscles of sprinters and long-distance runners exhibit characteristic stiffness that can be beneficial to their athletic performance. Passive and active muscle stiffness may play different roles in human locomotion, depending on locomotion speeds.

Magnetic biomaterials and nano-instructive tools as mediators of tendon mechanotransduction

Tendon tissues connect muscle to bone allowing the transmission of forces resulting in joint movement. Tendon injuries are prevalent in society and the impact on public health is of utmost concern. Thus, clinical options for tendon treatments are in demand, and tissue engineering aims to provide reliable and successful long-term regenerative solutions. Moreover, the possibility of regulating cell fate by triggering intracellular pathways is a current challenge in regenerative medicine. In the last decade, the use of magnetic nanoparticles as nano-instructive tools has led to great advances in diagnostics and therapeutics. Recent advances using magnetic nanomaterials for regenerative medicine applications include the incorporation of magnetic biomaterials within 3D scaffolds resulting in mechanoresponsive systems with unprecedented properties and the use of nanomagnetic actuators to control cell signaling. Mechano-responsive scaffolds and nanomagnetic systems can act as mechanostimulation platforms to apply forces directly to single cells and multicellular biological tissues. As transmitters of forces in a localized manner, the approaches enable the downstream activation of key tenogenic signaling pathways. In this minireview, we provide a brief outlook on the tenogenic signaling pathways which are most associated with the conversion of mechanical input into biochemical signals, the novel bio-magnetic approaches which can activate these pathways, and the efforts to translate magnetic biomaterials into regenerative platforms for tendon repair.

An in vitro investigation into the effects of 10 Hz cyclic loading on tenocyte metabolism

Tendinopathy is a prevalent, highly debilitating condition, with poorly defined etiology. A wide range of clinical treatments has been proposed, with systematic reviews largely supporting shock wave therapy or eccentric exercise. Characterizing these treatments have demonstrated both generate perturbations within tendon at a frequency of approximately 8-12 Hz. Consequently, it is hypothesized that loading in this frequency range initiates increased anabolic tenocyte behavior, promoting tendon repair. The primary aim of this study was to investigate the effects of 10 Hz perturbations on tenocyte metabolism, comparing gene expression in response to a 10 Hz and 1 Hz loading profile. Tenocytes from healthy and tendinopathic human tendons were seeded into 3D collagen gels and subjected to 15 minutes cyclic strain at 10 Hz or 1 Hz. Tenocytes from healthy tendon showed increased expression of all analyzed genes in response to loading, with significantly increased expression of inflammatory and degradative genes with 10 Hz, relative to 1 Hz loading. By contrast, whilst the response of tenocytes from tendinopathy tendon also increased with 10 Hz loading, the overall response profile was more varied and less intense, possibly indicative of an altered healing response. Through inhibition of the pathway, IL1 was shown to be involved in the degradative and catabolic response of cells to high-frequency loading, abrogating the loading response. This study has demonstrated for the first time that loading at a frequency of 10 Hz may enhance the metabolic response of tenocytes by initiating an immediate degradatory and inflammatory cell response through the IL1 pathway, perhaps as an initial stage of tendon healing.

Biomaterials to Mimic and Heal Connective Tissues

Connective tissue is one of the four major types of animal tissue and plays essential roles throughout the human body. Genetic factors, aging, and trauma all contribute to connective tissue dysfunction and motivate the need for strategies to promote healing and regeneration. The goal here is to link a fundamental understanding of connective tissues and their multiscale properties to better inform the design and translation of novel biomaterials to promote their regeneration. Major clinical problems in adipose tissue, cartilage, dermis, and tendon are discussed that inspire the need to replace native connective tissue with biomaterials. Then, multiscale structure-function relationships in native soft connective tissues that may be used to guide material design are detailed. Several biomaterials strategies to improve healing of these tissues that incorporate biologics and are biologic-free are reviewed. Finally, important guidance documents and standards (ASTM, FDA, and EMA) that are important to consider for translating new biomaterials into clinical practice are highligted.

Dynamic Loading and Tendon Healing Affect Multiscale Tendon Properties and ECM Stress Transmission

The extracellular matrix (ECM) is the primary biomechanical environment that interacts with tendon cells (tenocytes). Stresses applied via muscle contraction during skeletal movement transfer across structural hierarchies to the tenocyte nucleus in native uninjured tendons. Alterations to ECM structural and mechanical properties due to mechanical loading and tissue healing may affect this multiscale strain transfer and stress transmission through the ECM. This study explores the interface between dynamic loading and tendon healing across multiple length scales using living tendon explants. Results show that macroscale mechanical and structural properties are inferior following high magnitude dynamic loading (fatigue) in uninjured living tendon and that these effects propagate to the microscale. Although similar macroscale mechanical effects of dynamic loading are present in healing tendon compared to uninjured tendon, the microscale properties differed greatly during early healing. Regression analysis identified several variables (collagen and nuclear disorganization, cellularity, and F-actin) that directly predict nuclear deformation under loading. Finite element modeling predicted deficits in ECM stress transmission following fatigue loading and during healing. Together, this work identifies the multiscale response of tendon to dynamic loading and healing, and provides new insight into microenvironmental features that tenocytes may experience following injury and after cell delivery therapies.

De novo generation in an in vivo rat model and biomechanical characterization of autologous transplants for ligament and tendon reconstruction

BACKGROUND

Surgical reconstruction of ligaments and tendons is frequently required in clinical practice. The commonly used autografts, allografts, or synthetic transplants present limitations in terms of availability, biocompatibility, cost, and mechanical properties that tissue bioengineering aims to overcome. It classically combines an exogenous extracellular matrix with cells, but this approach remains complex and expensive. Using a rat model, we tested a new bioengineering strategy for the in vivo and de novo generation of autologous grafts without the addition of extracellular matrix or cells, and analyzed their biomechanical and structural properties.

METHODS

A silicone perforated tubular implant (PTI) was designed and implanted in the spine of male Wistar rats to generate neo-transplants. The tensile load to failure, stiffness, Young modulus, and ultrastructure of the generated tissue were determined at 6 and 12weeks after surgery. The feasibility of using the transplant that was generated in the spine as an autograft for reconstruction of medial collateral ligaments (MCL) and Achilles tendons was also tested.

FINDINGS

Use of the PTI resulted in de novo transplant generation. Their median load to failure and Young modulus increased between 6 and 12weeks (respectively 12N vs 34N and 48MPa vs 178MPa). At 12weeks, the neo-transplants exhibited collagen bundles (mainly type III) parallel to their longitudinal axis and elongated fibroblasts. Six weeks after their transfer to replace the MCL or the Achilles tendon, the transplants were still present, with their ends healed at their insertion point.

INTERPRETATION

This animal study is a first step in the design and validation of a new bioengineering strategy to develop autologous transplants for ligament and tendon reconstructions.

Impact of rest duration on Achilles tendon structure and function following isometric training

Intervention programs are often sought to strengthen the Achilles tendon (AT) due to its high injury rate. Long rest periods between loading cycles have been found to increase collagen synthesis by tenocytes, suggesting rest duration may be important for tendon adaptation in vivo; however, exercise programs comparing long and short rest duration have not been directly compared. Fourteen adults completed a 12-week progressive training intervention; training sessions consisted of 5×10 isometric plantarflexion contractions each of 3-s duration performed at 90% of MVC three times weekly. Each leg was randomly allocated to long (LRT, 10-s rest) or short rest training (SRT, 3-s rest). We hypothesized that the leg allocated to LRT would demonstrate superior AT collagen organization compared to the leg receiving SRT, which would be related to improved biomechanical function. AT collagen organization and morphology were measured using ultrasound tissue characterization. AT properties were assessed before and after the intervention using a combination of dynamometry, ultrasound imaging, EMG, and motion capture. Contrary to our hypothesis, collagen organization did not improve following either training protocol; conversely, an unexpected decrease in echotype I proportion was seen after SRT (P<.001) but not LRT (P=.58), indicating an apparent protective effect of rest on collagen organization during isometric training. In contrast, AT adaptation was not appreciably enhanced by increasing intercycle rest duration; both protocols were equally effective at inducing significant strength gains and AT mechanical and material adaptation (P≤.001). Further research is necessary to identify optimal loading characteristics for injury prevention and rehabilitation.

Impact of cyclic mechanical stimulation on the expression of extracellular matrix proteins in human primary rotator cuff fibroblasts

PURPOSE

Mechanical stimulation plays an important role in the development and remodelling of tendons. The aim of the study was to evaluate the effects of mechanical stimulation on the expression of extracellular matrix proteins in human primary rotator cuff (RC) fibroblasts.

METHODS

RC fibroblasts were isolated from patients with degenerative RC tears and characterized using flow cytometry and immunohistochemistry. Cells were stimulated using the Flexcell FX5K™ Tension System. The stimulation regime was a uniaxial sinusoidal waveform with 10 % elongation and a frequency of 0.5 Hz, whereby each cycle consists of 10-s strain and 30-s relaxation. Data were normalized to mechanically unstimulated control groups for every experimental condition. RT-qPCR was performed to determine relative mRNA levels, and collagen production was measured by a colorimetric assay.

RESULTS

The positive expression of CD91 and CD10, and negativity for CD45 and CD4 confirmed the fibroblast phenotype of RC primary cells. RT-qPCR revealed that 10 % continuous cyclic strain for 7 and 14 days induced a significant increase in the mRNA expression both on the matrix metalloproteinases MMP1, MMP3, MMP13, and MMP14 and on the extracellular matrix proteins decorin, tenascin-C, and scleraxis. Furthermore, mechanically stimulated groups produced significantly higher amounts of total collagen.

CONCLUSION

These results may contribute to a better understanding of strain-induced tendon remodelling and will form the basis for the correct choice of applied force in rehabilitation after orthopaedic surgery. These findings underline the fact that early passive motion of the joint in order to induce remodelling of the tendon should be included within a rehabilitation protocol for rotator cuff repair.

Engineering Tendon: Scaffolds, Bioreactors, and Models of Regeneration

Tendons bridge muscle and bone, translating forces to the skeleton and increasing the safety and efficiency of locomotion. When tendons fail or degenerate, there are no effective pharmacological interventions. The lack of available options to treat damaged tendons has created a need to better understand and improve the repair process, particularly when suitable autologous donor tissue is unavailable for transplantation. Cells within tendon dynamically react to loading conditions and undergo phenotypic changes in response to mechanobiological stimuli. Tenocytes respond to ultrastructural topography and mechanical deformation via a complex set of behaviors involving force-sensitive membrane receptor activity, changes in cytoskeletal contractility, and transcriptional regulation. Effective ex vivo model systems are needed to emulate the native environment of a tissue and to translate cell-matrix forces with high fidelity. While early bioreactor designs have greatly expanded our knowledge of mechanotransduction, traditional scaffolds do not fully model the topography, composition, and mechanical properties of native tendon. Decellularized tendon is an ideal scaffold for cultivating replacement tissue and modeling tendon regeneration. Decellularized tendon scaffolds (DTS) possess high clinical relevance, faithfully translate forces to the cellular scale, and have bulk material properties that match natural tissue. This review summarizes progress in tendon tissue engineering, with a focus on DTS and bioreactor systems.

Eccentric or Concentric Exercises for the Treatment of Tendinopathies?

Synopsis Tendinopathy is a very common disorder in both recreational and elite athletes. Many individuals have recurrent symptoms that lead to chronic conditions and termination of sports activity. Exercise has become a popular and somewhat efficacious treatment regime, and isolated eccentric exercise has been particularly promoted. In this clinical commentary, we review the relevant evidence for different exercise regimes in tendinopathy rehabilitation, with particular focus on the applied loads that are experienced by the tendon and how the exercise regime may affect these applied loads. There is no convincing clinical evidence to demonstrate that isolated eccentric loading exercise improves clinical outcomes more than other loading therapies. However, the great variation and sometimes insufficient reporting of the details of treatment protocols may hamper the interpretation of what may be the optimal exercise regime with respect to parameters such as load magnitude, speed of movement, and recovery period between exercise sessions. Future studies should control for these loading parameters, evaluate various exercise dosages, and think beyond isolated eccentric exercises to arrive at firm recommendations regarding rehabilitation of individuals with tendinopathies. J Orthop Sports Phys Ther 2015;45(11):853-863. Epub 14 Oct 2015. doi:10.2519/jospt.2015.5910.

Enhancing proliferation and ECM expression of human ACL fibroblasts by sonic vibration

Effects of mechanical vibration on cell activity and behavior remain controversial: There has been evidence on both positive and negative effects. Furthermore, research on the anterior cruciate ligament (ACL) has as yet been limited and the frequency-related effects remain unknown, even though ACL injury is common and an injured ACL hardly spontaneously recovers. The object of this work was to address the influence of mechanical vibration on ACL fibroblasts, to determine the effects of frequencies, and to further study this effect at the cellular level. We found that sonic vibration affected ACL fibroblasts' proliferation and metabolism in a frequency-dependent manner, and 20 Hz gave rise to the most ACL cell activity and comprehensively increased extracellular matrix (ECM) contents, including collagen type I, collagen type III, fibronectin, elastin, tenascin, glycosaminoglycan (GAG), and the cytoskeleton protein vimentin. Thus, our results indicate that sonic vibration possesses frequency-dependent effects on proliferation and productivity of ACL fibroblast with an optimal frequency of 20 Hz under the present stimulation conditions, providing further information for future research in how vibrational stimulation manipulates ACL cellular behavior.

The (dys)functional extracellular matrix

The extracellular matrix (ECM) is a major component of the biomechanical environment with which cells interact, and it plays important roles in both normal development and disease progression. Mechanical and biochemical factors alter the biomechanical properties of tissues by driving cellular remodeling of the ECM. This review provides an overview of the structural, compositional, and mechanical properties of the ECM that instruct cell behaviors. Case studies are reviewed that highlight mechanotransduction in the context of two distinct tissues: tendons and the heart. Although these two tissues demonstrate differences in relative cell-ECM composition and mechanical environment, they share similar mechanisms underlying ECM dysfunction and cell mechanotransduction. Together, these topics provide a framework for a fundamental understanding of the ECM and how it may vary across normal and diseased tissues in response to mechanical and biochemical cues. This article is part of a Special Issue entitled: Mechanobiology.

EFFECTS OF CULTURE PERIODS AND LOADING ON BIOMECHANICAL PROPERTIES OF SHEEP COLLAGEN FASCICLES

Soft tissues (e.g., tendon, skin, cartilage) change their dimensions and properties in response to applied mechanical stress/strain, which is called remodeling. Experimental studies using tissue cultures were performed to understand the biomechanical properties of collagen fascicles under mechanical loads. Collagen fascicles were dissected from sheep Achilles tendons and loaded under 1, 2, and 3 kg for 2, 4, and 6 days under culture. The mechanical properties of collagen fascicles after being loaded into the culture media were determined using tensile tester, and resultant stress–strain curves, tangent modulus, tensile strength, and strain at failure values were compared with those in a non-loaded and non-cultured control group of fascicles. The tangent modulus and tensile strength of the collagen fascicles increased with the increasing remodeling load after two days of culture. However, these values gradually decreased with the increasing culture period compared with the control group. According to the results obtained in this study, the mechanical properties of collagen fascicles were improved by loading at two days of culture, most likely due to the remodeling of collagen fibers. However, after a period of remodeling, local strains on the collagen fibrils increased, and finally, the collagen fibrils broke down, decreasing the mechanical properties of the tissue.

Human Achilles tendon plasticity in response to cyclic strain: effect of rate and duration

High strain magnitude and low strain frequency are important stimuli for tendon adaptation. Increasing the rate and duration of the applied strain may enhance the adaptive responses. Therefore, our purpose was to investigate the effect of strain rate and duration on Achilles tendon adaptation. The study included two experimental groups (N=14 and N=12) and a control group (N=13). The participants of the experimental groups exercised according to a reference protocol (14 weeks, four times a week), featuring a high strain magnitude (~6.5%) and a low strain frequency (0.17 Hz, 3 s loading/3 s relaxation) on one leg and with either a higher strain rate (one-legged jumps) or a longer strain duration (12 s loading) on the other leg. The strain magnitude and loading volume were similar in all protocols. Before and after the interventions, the tendon stiffness, Young's modulus and cross-sectional area were examined using magnetic resonance imaging, ultrasound and dynamometry. The reference and long strain duration protocols induced significantly increased (P<0.05) tendon stiffness (57% and 25%), cross-sectional area (4.2% and 5.3%) and Young's modulus (51% and 17%). The increases in tendon stiffness and Young's modulus were higher in the reference protocol. Although region-specific tendon hypertrophy was also detected after the high strain rate training, there was only a tendency of increased stiffness (P=0.08) and cross-sectional area (P=0.09). The control group did not show any changes (P=0.86). The results provide evidence that a high strain magnitude, an appropriate strain duration and repetitive loading are essential components for an efficient adaptive stimulus for tendons.

Mechanical loading influences the effects of bisphosphonates on human periodontal ligament fibroblasts

OBJECTIVES

There is increasing evidence that bisphosphonates affect orthodontic tooth movement. The object of the study was to investigate the changes produced by tensile strain on human periodontal ligament fibroblasts (HPdLFs) treated with clodronate or zoledronate.

MATERIALS AND METHODS

HPdLF were cultured with 5 and 50 μM clodronate or zoledronate for 48 h and applied to tensile strain (TS) (5 and 10 %) for 12 h in vitro. Viability was verified by MTT assay and apoptosis rate via caspase 3/7 assay. Gene expression of receptor activator of nuclear factor kappa-B ligand (RANKL) and osteoprotegerin (OPG) was investigated using real-time PCR. OPG was also analyzed by ELISA and RANKL by immunocytochemical staining.

RESULTS

Zoledronate (50 μM) reduced the viability of HPdLF (76 vs 100 %) and combined with 5 % TS to 53 %. TS of 10 % and clodronate reduced viability to 79 % with increased caspase 3/7 activity. Clodronate (5 μM) led to a slight increase of OPG gene expression, zoledronate (5 μM) to a slight decrease. Combined with 5 % TS, both increased OPG gene expression (2-3-fold) and OPG synthesis. Zoledronate increased gene expression of RANKL (4-fold). Combined with 5 % of TS, this increase was abolished. TS of 10 % in combination amplified increase of RANKL ending up with a 9-fold gene expression by clodronate and high RANKL protein synthesis.

CONCLUSIONS

This study shows for the first time that mechanical loading alters the effects of bisphosphonates on viability, apoptosis rate, and OPG/RANKL system of HPdLF dependent on the applied strength. Low forces and bisphosphonates increase factors for bone apposition, whereas high forces combined with bisphosphonates stimulate osteoclastogenesis.

CLINICAL RELEVANCE

Mechanical loading of periodontal ligament with high strengths should be avoided during bisphosphonate therapy.

The long head of the biceps tendon is a suitable cell source for tendon tissue regeneration

INTRODUCTION

Tendon tissue engineering (TTE) tries to produce tendinous tissue of high quality to replace dysfunctional tissue. One possible application of TTE might be the replacement of ruptured tissue of the rotator cuff. Autologous tenocytes seem to be most suitable as no differentiation in vitro is necessary. Today it is still uncertain if there is a difference between tendon-derived cells (TDC) of different native tissues. Moreover, the search for suitable scaffolds is another important issue in TTE.

MATERIAL AND METHODS

This study compared TDC of the long head of the biceps tendon (LHB), the anterior cruciate ligament (ACL) and the tendon of the musculus semitendinosus (TMS). The TDC were isolated using the cell migration method. Cell morphology was assessed using light microscopy and gene expression was performed using polymerase chain reaction (PCR). Afterwards, cell seeding efficiency and proliferation were tested on a collagen I scaffold using the WST-1 assay. Results were confirmed using H + E staining.

RESULTS

The TDC of the LHB showed higher expression levels of collagen type I and decorin (p < 0.01) compared to TDC of other origin. Results showed efficient cell seeding and proliferation within the scaffold. Proliferation within the scaffold was not as high as when cells were cultivated without a scaffold.

CONCLUSIONS

The TDC of the LHB seems to be the most suitable cell source. Further research is necessary to find out if the results can be transferred to an in vivo model. The new collagen I scaffold seems to offer an opportunity to combine good biocompatibility and mechanical strength.

Achilles tendinopathy modulates force frequency characteristics of eccentric exercise

INTRODUCTION

Previous research has demonstrated that ground reaction force (GRF) recorded during eccentric ankle exercise is characterized by greater power in the 8- to 12-Hz bandwidth when compared with that recorded during concentric ankle exercise. Subsequently, it was suggested that vibrations in this bandwidth may underpin the beneficial effect of eccentric loading in tendon repair. However, this observation has been made only in individuals without Achilles tendinopathy. This research compared the force frequency characteristics of eccentric and concentric exercises in individuals with and without Achilles tendinopathy.

METHODS

Eleven male adults with unilateral midportion Achilles tendinopathy and nine control male adults without tendinopathy participated in the research. Kinematics and GRF were recorded while the participants performed a common eccentric rehabilitation exercise protocol and a concentric equivalent. Ankle joint kinematics and the frequency power spectrum of the resultant GRF were calculated.

RESULTS

Eccentric exercise was characterized by a significantly greater proportion of spectral power between 4.5 and 11.5 Hz when compared with concentric exercise. There were no significant differences between limbs in the force frequency characteristics of concentric exercise. Eccentric exercise, in contrast, was defined by a shift in the power spectrum of the symptomatic limb, resulting in a second spectral peak at 9 Hz, rather than 10 Hz in the control limb.

CONCLUSIONS

Compared with healthy tendon, Achilles tendinopathy was characterized by lower frequency vibrations during eccentric rehabilitation exercises. This finding may be associated with changes in neuromuscular activation and tendon stiffness that have been shown to occur with tendinopathy and provides a possible rationale for the previous observation of a different biochemical response to eccentric exercise in healthy and injured Achilles tendons.

Osteogenic differentiation of periodontal fibroblasts is dependent on the strength of mechanical strain

OBJECTIVE

During orthodontic therapy the correct strength of mechanical strain plays a key role for bone remodelling during tooth movement. Aim of this study was to investigate the osteogenic differentiation of human periodontal ligament fibroblasts (HPdLF) depending on the applied strength of mechanical strain compared to osteoblasts (HOB).

DESIGN

HPdLF and HOB were loaded with different strengths (1%, 5% and 10%) of static mechanical strain (SMS) for 12h in vitro. Viability was verified by MTT and apoptosis by TUNEL assay. Gene expression of cyclin D1, collagen type-1 (COL-I), alkaline phosphatase (ALP), osteocalcin, osteoprotegerin (OPG) and receptor activator of the NF-κB ligand (RANKL) were investigated using RT-PCR. OPG and RANKL synthesis was measured by ELISA and ALP activity by colorimetric assay.

RESULTS

10% of SMS led to a decrease in cell viability of both cells lines, but no increased rate of apoptosis. RT-PCR showed the highest increase of cyclin D1 expression for HPdLF and HOB when applied to 5% of SMS, and HOB showed a doubling of COL-I gene expression. HPdLF and HOB showed a strength-dependent synthesis of OPG and ALP activity, whereas HOB demonstrated a decrease in OPG synthesis and ALP activity when applied to 10% of SMS.

CONCLUSION

Osteogenic differentiation of HPdLF correlates with increasing strength of SMS. HOB show decreased activity when applied to high SMS, demonstrating potential damage to the bone remodelling due to strain of high strength. SMS up to 5% provides the best conditions for bone formation at the tension site of tooth movement.

A Roadmap for the Design of Bioreactors in Mechanobiological Research and Engineering of Load-Bearing Tissues

In the field of tissue engineering, a bioreactor is a valuable instrument that mimics a physiological environment to maintain live tissues in vitro. Although bioreactors are conceptually relatively simple, the vast majority of current bioreactors (commercial and custom-built) are not fully adapted to current research needs. Designing the optimal bioreactor requires a very thorough approach to a series of steps in the product development process. These four basic steps are: (1) identifying the needs and technical requirements, (2) defining and evaluating the related concepts, (3) designing the apparatus and drawing up the blueprints, and (4) building and validating the apparatus. Furthermore, the design has to be adapted to the specific purpose of the research and how the tissues will be used. In the emerging field of bioreactor research, roadmaps are needed to assist tissue engineering researchers as they embark on this process. The necessary multidisciplinary expertise covering micromechanical design, mechatronics, viscoelasticity, tissue culture, and human ergonomics is not necessarily available to all research teams. Therefore, the challenge of adapting and conducting each step in the product development process is significant. This paper details our proposal for a roadmap to accompany researchers in identifying their needs and technical requirements: step one in the product development process. Our roadmap proposal is set up in two phases. Phase 1 is based on the analysis of the bioreactor use cycle and phase 2 is based on the analysis of one specific and critical step in the use cycle: conducting stimulation and characterization protocols with the bioreactor. A meticulous approach to these two phases minimizes the risk of forgetting important requirements and strengthens the probability of acquiring or designing a high performance bioreactor.

Plasticity of human Achilles tendon mechanical and morphological properties in response to cyclic strain

The purpose of the current study in combination with our previous published data (Arampatzis et al., 2007) was to examine the effects of a controlled modulation of strain magnitude and strain frequency applied to the Achilles tendon on the plasticity of tendon mechanical and morphological properties. Eleven male adults (23.9 ± 2.2 yr) participated in the study. The participants exercised one leg at low magnitude tendon strain (2.97 ± 0.47%), and the other leg at high tendon strain magnitude (4.72 ± 1.08%) of similar frequency (0.5 Hz, 1s loading, 1s relaxation) and exercise volume (integral of the plantar flexion moment over time) for 14 weeks, 4 days per week, 5 sets per session. The exercise volume was similar to the intervention of our earlier study (0.17 Hz frequency; 3s loading, 3s relaxation) allowing a direct comparison of the results. Before and after the intervention ankle joint moment has been measured by a dynamometer, tendon-aponeurosis elongation by ultrasound and cross-sectional area of the Achilles tendon by magnet resonance images (MRI). We found a decrease in strain at a given tendon force, an increase in tendon-aponeurosis stiffness and tendon elastic modulus of the Achilles tendon only in the leg exercised at high strain magnitude. The cross-sectional area (CSA) of the Achilles tendon did not show any statistically significant (P > 0.05) differences to the pre-exercise values in both legs. The results indicate a superior improvement in tendon properties (stiffness, elastic modulus and CSA) at the low frequency (0.17 Hz) compared to the high strain frequency (0.5 Hz) protocol. These findings provide evidence that the strain magnitude applied to the Achilles tendon should exceed the value, which occurs during habitual activities to trigger adaptational effects and that higher tendon strain duration per contraction leads to superior tendon adaptational responses.

Relative contributions of mechanical degradation, enzymatic degradation, and repair of the extracellular matrix on the response of tendons when subjected to under- and over- mechanical stimulations in vitro

Tendon response to mechanical loading results in either homeostasis, improvement, or degeneration of tissue condition. In an effort to better understand the development of tendinopathies, this study investigated the mechanical and structural responses of tendons subjected to under- and over-stimulations (1.2% and 1.8% strain respectively, 1 Hz). The objective was to examine three sub-processes of tendon response: mechanical degradation, enzymatic degradation, and repair of the extracellular matrix. We subjected rat tail tendons to a 10-day stimulation protocol with four periods of 6 h each day: 30 min of stimulation and 5 h 30 min of rest. To investigate the contribution of the three sub-processes, we controlled the contribution of the cells through variations in the nutrient and protease inhibitor content in the in vitro solutions. Using nondestructive cyclic tests, we evaluated the daily changes in the peak stress. To assess structural changes, we carried out microscopic analyses at the end of the study period. We observed that the relative contributions of the sub-processes differed according to the stimulation amplitude. With over-stimulation of tendons immersed in DMEM, we succeeded in reducing enzymatic degradation and increasing peak stress. In under-stimulation, the addition of protease inhibitors was required to obtain the same result.

Compressive properties of cartilage-like tissues repaired in vivo with scaffold-free, tissue engineered constructs

BACKGROUND

It is crucial to develop an effective methodology for restoring adequate compressive properties to osteoarthritic cartilage. We have developed a scaffold-free tissue engineered construct cultured from synovium-derived mesenchymal stem cells. However, the compressive properties of cartilage-like tissues repaired with the construct have not been fully determined.

METHODS

Synovium-derived mesenchymal stem cells were cultured in Dulbecco's modified Eagle's medium to produce the tissue engineered construct. Implantation of the construct into cylindrically-shaped partial defects in femoral cartilage in an experimental porcine model was performed. Six months after implantation, cartilage-like tissues repaired with the construct were subjected to static and cyclic compression tests using a micro-unconfined compression test apparatus developed in our laboratory.

FINDINGS

The developed apparatus was validated in preliminary examinations. The repaired tissues exhibited rate-dependent viscoelastic properties; the compressive modulus was slightly lower than that of normal cartilage at a rate of 4 microm/s, while no difference was observed at a rate of 100 microm/s. In contrast, the repaired tissue without the construct exhibited rate-independent, non-viscoelastic properties. In the cyclic compression test, however, the compressive strain was significantly larger in both repaired tissues as compared with normal cartilage.

INTERPRETATION

Although the quasi-static compressive properties of the repaired tissue with the construct, indicating rate-dependent and viscoelastic behaviors, are comparable to normal cartilage, the cyclic compressive strain increases more rapidly than in normal cartilage. It is suggested that the differences between the tissues and normal cartilage are attributable to the increased permeability of the extracellular matrix.

Differential regulation of gene expression in isolated tendon fascicles exposed to cyclic tensile strain in vitro

Mechanical stimulus is a regulator of tenocyte metabolism. The present study investigated temporal regulation of the expression of selected genes by tenocytes in isolated fascicles subjected to tensile strain in vitro. Cyclic tensile strain with a 3% amplitude superimposed on a 2% static strain was provided for 10 min, followed by either an unstrained period or continuous cyclic strain until the end of a 24-h incubation period. mRNA expression of selected anabolic and catabolic genes were evaluated with quantitative PCR at 10 min, 1 h, 6 h, and 24 h. The application of 6-h cyclic strain significantly upregulated type III collagen mRNA expression in strained fascicles compared with unstrained controls, but no alterations were observed in mRNA expression of type I collagen and biglycan. Significant downregulation in the expression of the decorin core protein was observed in fascicles subjected to 24-h cyclic strain. MMP3 and MMP13 expression levels were upregulated by the application of 10 min of cyclic strain, followed by a progressive downregulation until the end of the incubation period in both the absence and the presence of the continuing cyclic strain. Accordingly, alterations in the expression of anabolic genes were limited to the upregulation of type III collagen by prolonged exposure to cyclic strain, whereas catabolic genes were upregulated by a small number of strain cycles and downregulated by a prolonged cyclic strain. These findings demonstrate distinctive patterns of mechanoregulation for anabolic and catabolic genes and help our understanding of tenocyte response to mechanical stimulation.

Tendon tissue engineering using scaffold enhancing strategies

Tendon traumas or diseases are prevalent and debilitating lesions that affect the quality of life among populations worldwide. As a novel solution, tendon tissue engineering aims to address these lesions by integrating engineered, living substitutes with their native counterparts in vivo, thereby restoring the defective functions in situ. For such a purpose, competent scaffolding materials are essential. To date, three major categories of scaffolding materials have been employed: polyesters, polysaccharides, and collagen derivatives. Furthermore, with these materials as a base, a variety of specialized methodologies have been developed or adopted to enhance neo-tendogenesis. These strategies include cellular hybridization, interfacing improvement, and physical stimulation.

Adaptational responses of the human Achilles tendon by modulation of the applied cyclic strain magnitude

Tendons are able to remodel their mechanical and morphological properties in response to mechanical loading. However, there is little information about the effects of controlled modulation in cyclic strain magnitude applied to the tendon on the adaptation of tendon's properties in vivo. The present study investigated whether the magnitude of the mechanical load induced as cyclic strain applied to the Achilles tendon may have a threshold in order to trigger adaptation effects on tendon mechanical and morphological properties. Twenty-one adults (experimental group, N=11; control group, N=10) participated in the study. The participants of the experimental group exercised one leg at low-magnitude tendon strain (2.85+/-0.99%) and the other leg at high-magnitude tendon strain (4.55+/-1.38%) of similar frequency and volume. After 14 weeks of exercise intervention we found a decrease in strain at a given tendon force, an increase in tendon-aponeurosis stiffness and tendon elastic modulus and a region-specific hypertrophy of the Achilles tendon only in the leg exercised at high strain magnitude. These findings provide evidence of the existence of a threshold or set-point at the applied strain magnitude at which the transduction of the mechanical stimulus may influence the tensional homeostasis of the tendons. The results further show that the mechanical load exerted on the Achilles tendon during the low-strain-magnitude exercise is not a sufficient stimulus for triggering further adaptation effects on the Achilles tendon than the stimulus provided by the mechanical load applied during daily activities.

Time dependence of cyclic tensile strain on collagen production in tendon fascicles

Mechanical loading is a regulator of tissue metabolism in tendon, which may lead to alterations in structural and mechanical properties via mechanotransduction processes. The present study investigated specified responses of tenocyte metabolism in isolated tendon fascicles subjected to four loading regimes. Cyclic tensile strain of 3% amplitude superimposed on a 2% static strain was applied to the fascicles for 10min, 1, 6 or 24h of a 24-h incubation period. Collagen synthesis, assessed by [(3)H]-proline incorporation, was upregulated by the 24h straining regime, but was inhibited by the 10-min regime. Cyclic strain enhanced the retention of newly synthesised collagen within the matrix. More than 90% of the newly synthesised collagen was retained in all cases, but the long-term application of cyclic strain had less pronounced effects on the retention. These results indicate that collagen synthesis by tenocytes is controlled by a complex mechanosensitive process with a temporal component.

Biomechanical response of collagen fascicles to restressing after stress deprivation during culture

In vitro tissue culture experiments were performed to study the biomechanical response of collagen fascicles to restressing after exposure to non-loaded condition. Collagen fascicles of approximately 300 microm in diameter were aseptically dissected from rabbit patellar tendons. They were cultured under no-load condition for 1 week, and then under a static stress of approximately 1.2 MPa for the subsequent 1 or 2 weeks. After culture, their mechanical properties were determined with a micro-tensile tester, and were compared to those of fascicles cultured under no-load condition and non-cultured, control fascicles. Tangent modulus and tensile strength of the non-loaded fascicles were significantly lower than those of the control fascicles at 1 week and gradually decreased thereafter. However, the modulus and strength were increased by restressing. After 2-week restressing, both parameters were significantly greater than those of the time-matched, non-loaded fascicles, although these values were still significantly lower than those of the control fascicles. That is, the application of stress after exposure to non-loaded condition suppressed the deterioration of the biomechanical properties of fascicles, although it did not improve. These results indicate that a short period of stressing is not sufficient for cultured collagen fascicles to completely recover their mechanical properties, if they are once exposed to no-stress condition even for a short period of time. These are similar to previous results observed in tendons and ligaments inside the body.

Mechanical properties of the triceps surae tendon and aponeurosis in relation to intensity of sport activity

The purpose of the present study was to investigate whether the mechanical properties (i.e. force strain relationship) of the triceps surae tendon and aponeurosis relate to the performed sport activity in an intensity-dependent manner. This was done by comparing sprinters with endurance runners and subjects not active in sports. Sixty-six young male subjects (26+/-5 yr; 183+/-6 cm; 77.6+/-6.7 kg) participated in the study. Ten of these subjects were adults not active in sports, 28 were endurance runners and 28 sprinters. All subjects performed isometric maximal voluntary plantar flexion contractions (MVC) on a dynamometer. The distal aponeuroses of the gastrocnemius medialis (GM) was visualised by ultrasound during the MVC. The results showed that only the sprinters had higher normalised stiffness (relationship between tendon force and tendon strain) of the triceps surae tendon and aponeurosis and maximal calculated tendon forces than the endurance runners and the subjects not active in sports. Furthermore, including the data of all 66 examined participants tendon stiffness correlated significantly (r=0.817, P<0.001) with the maximal tendon force achieved during the MVC. It has been concluded that the mechanical properties of the triceps surae tendon and aponeurosis do not show a graded response to the intensity of the performed sport activity but rather remain at control level in a wide range of applied strains and that strain amplitude and/or frequency should exceed a given threshold in order to trigger additional adaptation effects. The results further indicate that subjects with higher muscle strength possibly increase the margin of tolerated mechanical loading of the tendon due to the greater stiffness of their triceps surae tendon and aponeurosis.