1
|
Thompson JD, Howe D, Griffith EH, Fisher MB. Neo-Natal Castration Leads to Subtle Differences in Porcine Anterior Cruciate Ligament Morphology and Function in Adolescence. J Biomech Eng 2024; 146:011002. [PMID: 37831117 PMCID: PMC10680984 DOI: 10.1115/1.4063744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/19/2023] [Accepted: 10/06/2023] [Indexed: 10/14/2023]
Abstract
Female adolescent athletes are at a higher risk of tearing their anterior cruciate ligament (ACL) than male counterparts. While most work related to hormones has focused on the effects of estrogen to understand the increased risk of ACL injury, there are other understudied factors, including testosterone. The purpose of this study was to determine how surgical castration in the male porcine model influences ACL size and function across skeletal growth. Thirty-six male Yorkshire crossbreed pigs were raised to 3 (juvenile), 4.5 (early adolescent), and 6 months (adolescent) of age. Animals were either castrated (barrows) within 2 weeks after birth or were left intact (boars). Posteuthanasia, joint and ACL size were assessed via MRI, and biomechanics were assessed via a robotic testing system. Joint size increased throughout age, yet barrows had smaller joints than boars. ACL cross-sectional area (CSA), length, volume, and in situ stiffness increased with age, as did the percent contribution of the ACL anteromedial (AM) bundle to resisting loads. Boar ACL, AM bundle, and PL bundle volumes were 19%, 25%, and 15% larger than barrows across ages. However, ACL CSA, in situ stiffness, and bundle contribution were similar between boars and barrows. The barrows had smaller temporal increases in AM bundle function than boars, but these data were highly variable. Early and sustained loss in testosterone leads to subtle differences in ACL morphology but may not influence measures associated with increased injury risk, such as CSA or bundle forces in response to applied loads.
Collapse
Affiliation(s)
- Jacob D. Thompson
- Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina at Chapel Hill, Raleigh, NC 27695; Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27695
| | - Danielle Howe
- Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina at Chapel Hill, Raleigh, NC 27695; Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27695
| | - Emily H. Griffith
- Department of Statistics, North Carolina State University, Raleigh, NC 27695
| | - Matthew B. Fisher
- Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina at Chapel Hill, 4130 Engineering Building III, 1840 Entrepreneur Drive, CB 7115, Raleigh, NC 27695; Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27695; Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| |
Collapse
|
2
|
Nabeki S, Okada Y, Teramoto A, Shibata Y, Takahashi K, Shiwaku K, Kamiya T, Watanabe K, Fujimiya M, Fujie H, Yamashita T. The function of cruciate ligaments in bi-cruciate retaining Total knee arthroplasty with asymmetrical design. Clin Biomech (Bristol, Avon) 2023; 107:106038. [PMID: 37421831 DOI: 10.1016/j.clinbiomech.2023.106038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Bi-cruciate retaining total knee arthroplasty with an asymmetrical design may improve knee function and clinical outcomes. This study aimed to compare the kinematics, anteroposterior laxity, and in situ forces of the anterior and posterior cruciate ligaments of knees subjected to this treatment with those of healthy knees. METHODS Seven fresh-frozen cadaveric knees were tested using a robotic/universal force-moment sensor system. The kinematics during passive flexion-extension motion and anteroposterior laxity for native knee, treated knee, and treated knee with cruciate ligament transection states were investigated. The motions of the intact and treated knees during each test were repeated after anterior/posterior cruciate ligament transection to calculate the in situ force in the ligaments. FINDINGS The screw-home movement of normal knees disappeared after treatment. The in situ force of the anterior cruciate ligament in treated knees was higher than that in intact knees at ˃15° during flexion and at 60° and 90° against an anterior force. The in situ force of the posterior cruciate ligament in treated knees was higher at 0°, 15°, and 30° during flexion and at all flexion angles against a posterior force. INTERPRETATION The screw-home movement of normal knees decreased, and the in situ force of the anterior and posterior cruciate ligaments increased after treatment.
Collapse
Affiliation(s)
- Shogo Nabeki
- Department of Orthopedic Surgery, Sapporo Medical University, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo 060-8543, Japan
| | - Yohei Okada
- Department of Orthopedic Surgery, Sapporo Medical University, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo 060-8543, Japan
| | - Atsushi Teramoto
- Department of Orthopedic Surgery, Sapporo Medical University, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo 060-8543, Japan.
| | - Yasuraku Shibata
- Tokyo Metropolitan University, 1-1 Minamiosawa, Hachioji-shi, Tokyo 192-0397, Japan
| | - Katsunori Takahashi
- Department of Orthopedic Surgery, Sapporo Medical University, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo 060-8543, Japan
| | - Kousuke Shiwaku
- Department of Orthopedic Surgery, Sapporo Medical University, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo 060-8543, Japan
| | - Tomoaki Kamiya
- Department of Orthopedic Surgery, Sapporo Medical University, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo 060-8543, Japan
| | - Kota Watanabe
- Second Division of Physical Therapy, Sapporo Medical University School of Health Sciences, Minami 1-jo Nishi 17-chome, Chuo-ku, Sapporo 060-8556, Japan
| | - Mineko Fujimiya
- 2nd Department of Anatomy, Sapporo Medical University, Minami 1-jo Nishi 17-chome, Chuo-ku, Sapporo 060-8556, Japan
| | - Hiromichi Fujie
- Tokyo Metropolitan University, 1-1 Minamiosawa, Hachioji-shi, Tokyo 192-0397, Japan
| | - Toshihiko Yamashita
- Department of Orthopedic Surgery, Sapporo Medical University, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo 060-8543, Japan
| |
Collapse
|
3
|
Thompson JD, Howe D, Griffith EH, Fisher MB. Neo-natal castration leads to subtle differences in porcine anterior cruciate ligament morphology and function in adolescence. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.24.524954. [PMID: 36747760 PMCID: PMC9900825 DOI: 10.1101/2023.01.24.524954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Female adolescent athletes are at a higher risk of tearing their anterior cruciate ligament (ACL) than male counterparts. While most work related to hormones has focused on the effects of estrogen to understand the increased risk of ACL injury, there are other understudied factors, including testosterone. The purpose of this study was to determine how surgical castration in the male porcine model influences ACL size and function across skeletal growth. Thirty-six male Yorkshire crossbreed pigs were raised to 3 (juvenile), 4.5 (early adolescent), and 6 months (adolescent) of age. Animals were either castrated (barrows) within 1-2 weeks after birth or were left intact (boars). Post-euthanasia, joint and ACL size were assessed via MRI, and biomechanics were assessed via a robotic testing system. Joint size increased throughout age, yet barrows had smaller joints than boars (p<0.001 for all measures). ACL cross-sectional area (CSA), length, volume, and stiffness increased with age (p<0.0001), as did ACL anteromedial (AM) bundle percent contribution to resisting loads (p=0.012). Boar ACL, AM bundle, and PL bundle volumes were 19% (p=0.002), 25% (p=0.003), and 15% (p=0.04) larger than barrows across ages. However, CSA, stiffness, and bundle contribution were similar between boars and barrows (p>0.05). The barrows had smaller temporal increases in AM bundle percent function than boars, but these data were highly variable. Thus, early and sustained loss in testosterone leads to subtle differences in ACL morphology, but may not influence measures associated with increased injury risk, such as CSA or bundle forces in response to applied loads.
Collapse
|
4
|
Stauffer TP, Kim BI, Grant C, Adams SB, Anastasio AT. Robotic Technology in Foot and Ankle Surgery: A Comprehensive Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:686. [PMID: 36679483 PMCID: PMC9864483 DOI: 10.3390/s23020686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/11/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
Recent developments in robotic technologies in the field of orthopaedic surgery have largely been focused on higher volume arthroplasty procedures, with a paucity of attention paid to robotic potential for foot and ankle surgery. The aim of this paper is to summarize past and present developments foot and ankle robotics and describe outcomes associated with these interventions, with specific emphasis on the following topics: translational and preclinical utilization of robotics, deep learning and artificial intelligence modeling in foot and ankle, current applications for robotics in foot and ankle surgery, and therapeutic and orthotic-related utilizations of robotics related to the foot and ankle. Herein, we describe numerous recent robotic advancements across foot and ankle surgery, geared towards optimizing intra-operative performance, improving detection of foot and ankle pathology, understanding ankle kinematics, and rehabilitating post-surgically. Future research should work to incorporate robotics specifically into surgical procedures as other specialties within orthopaedics have done, and to further individualize machinery to patients, with the ultimate goal to improve perioperative and post-operative outcomes.
Collapse
Affiliation(s)
| | - Billy I. Kim
- School of Medicine, Duke University, Durham, NC 27710, USA
| | - Caitlin Grant
- School of Medicine, Duke University, Durham, NC 27710, USA
| | - Samuel B. Adams
- Departmen of Orthopaedic Surgery, Duke University, Durham, NC 27710, USA
| | | |
Collapse
|
5
|
Shiwaku K, Suzuki T, Shino K, Yamakawa S, Otsubo H, Okimura S, Suzuki D, Nabeki S, Teramoto A, Ohnishi H, Fujie H, Yamashita T. A Biomechanical Comparison of 2 Over-the-Top Anterior Cruciate Ligament Reconstruction Techniques: A Cadaveric Study Using a Robotic Simulator. Orthop J Sports Med 2022; 10:23259671221139876. [PMID: 36545379 PMCID: PMC9761224 DOI: 10.1177/23259671221139876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/13/2022] [Indexed: 12/15/2022] Open
Abstract
Background For skeletally immature patients, over-the-top (OTT) anterior cruciate ligament (ACL) reconstruction (ACLR) is preferred. However, increased anterior laxity at deep knee flexion angles remains concerning. We modified the procedure to proximally shift the graft fixation site on the femur to prevent graft loosening at higher knee flexion angles and named it the supra-OTT procedure. Purpose To compare anterior laxity and in situ forces of the ACL graft between conventional OTT and supra-OTT ACLR in a cadaveric model. Study Design Controlled laboratory study. Methods A total of 11 fresh-frozen cadaveric knee specimens underwent 4 robotic testing conditions: ACL intact, ACL resected, conventional OTT, and supra-OTT. For each condition, a 100-N load was applied at 0°, 15°, 30°, 60°, and 90° of knee flexion to simulate the Lachman test or anterior drawer test. In addition, a combined load of 5-N·m internal tibial torque and 10-N·m valgus torque was applied at 15° and 30° of knee flexion as a simulated pivot-shift test. Anterior tibial translation and in situ graft forces were recorded. The only difference between conventional OTT and supra-OTT ACLR was the graft fixation site on the femur. For conventional OTT ACLR, graft fixation was performed just on the proximal and lateral ends of the posterior condyle. For supra-OTT ACLR, the fixation point was around the proximal insertion of the lateral head of the gastrocnemius and the lateral edge of the posterior cortex, approximately 2 cm proximal to the conventional OTT position. Results On the simulated anterior drawer test at 60° and 90° of knee flexion, anterior tibial translation after supra-OTT ACLR was significantly smaller than after conventional OTT ACLR (P < .01). However, no significant differences were noted at other flexion angles or on the simulated pivot-shift test between the conventional OTT and supra-OTT procedures. Some overconstraint and higher graft forces were noted with both techniques, but the supra-OTT technique caused even more overconstraint at higher flexion angles. Conclusion Supra-OTT ACLR showed better biomechanical performance to control anterior laxity than conventional OTT ACLR at higher knee flexion angles. Clinical Relevance The supra-OTT procedure may improve anterior stability at deep knee flexion angles.
Collapse
Affiliation(s)
- Kousuke Shiwaku
- Department of Orthopedic Surgery, Sapporo Medical University School
of Medicine, Sapporo, Japan
| | - Tomoyuki Suzuki
- Sapporo Maruyama Orthopedic Hospital, Sapporo, Japan.,Tomoyuki Suzuki, MD, PhD, Sapporo Maruyama Orthopedic Hospital,
North 7 West 27, Chuo-Ku, Sapporo, 060-0007 Japan (
)
| | - Konsei Shino
- Sports Orthopaedic Center, Yukioka Hospital, Osaka, Japan
| | - Satoshi Yamakawa
- Department of Sports Medical Biomechanics, Osaka University Graduate
School of Medicine, Suita, Japan
| | | | - Shinichiro Okimura
- Department of Orthopedic Surgery, Sapporo Medical University School
of Medicine, Sapporo, Japan
| | - Daisuke Suzuki
- Department of Health Science, Hokkaido Chitose College of
Rehabilitation, Chitose, Japan
| | - Shogo Nabeki
- Department of Orthopedic Surgery, Sapporo Medical University School
of Medicine, Sapporo, Japan
| | - Atsushi Teramoto
- Department of Orthopedic Surgery, Sapporo Medical University School
of Medicine, Sapporo, Japan
| | - Hirofumi Ohnishi
- Department of Public Health, Sapporo Medical University School of
Medicine, Sapporo, Japan
| | - Hiromichi Fujie
- Department of Mechanical Engineering, Tokyo Metropolitan University
Graduate School of Science, Tokyo, Japan
| | - Toshihiko Yamashita
- Department of Orthopedic Surgery, Sapporo Medical University School
of Medicine, Sapporo, Japan
| |
Collapse
|
6
|
Shiwaku K, Kamiya T, Suzuki D, Yamakawa S, Otsubo H, Suzuki T, Takahashi K, Okada Y, Teramoto A, Ohnishi H, Fujie H, Yamashita T. The Role of the Medial Meniscus in Anterior Knee Stability. Orthop J Sports Med 2022; 10:23259671221132845. [PMID: 36389621 PMCID: PMC9663633 DOI: 10.1177/23259671221132845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/12/2022] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Few studies have compared the force distribution between the anterolateral, posterolateral, and medial structures of the knee. PURPOSE To investigate the important structures in an intact knee contributing to force distribution in response to anterior tibial load. STUDY DESIGN Controlled laboratory study. METHODS Nine fresh-frozen cadaveric knee specimens underwent robotic testing. First, 100 N of anterior tibial load was applied to the intact knee at 0°, 15°, 30°, 60°, and 90° of knee flexion. The anterior cruciate ligament (ACL), anterolateral capsule, lateral collateral ligament, popliteal tendon, posterior root of the lateral meniscus, superficial medial collateral ligament, posterior root of the medial meniscus (MM), and posterior cruciate ligament were then completely transected in sequential order. After each transection, the authors reproduced the intact knee motion when a 100-N anterior tibial load was applied. By applying the principle of superposition, the resultant force of each structure was determined based on the 6 degrees of freedom force/torque data of each state. RESULTS At every measured knee flexion angle, the resultant force of the ACL was the largest of the tested structures. At knee flexion angles of 60° and 90°, the resultant force of the MM was larger than that of all other structures with the exception of the ACL. CONCLUSION The MM was identified as playing an important role in response to anterior tibial load at 60° and 90° of flexion. CLINICAL RELEVANCE In clinical settings, the ACL of patients with a poorly functioning MM, such as tear of the MM posterior root, should be monitored considering the large resultant force in response to an anterior tibial load.
Collapse
Affiliation(s)
- Kousuke Shiwaku
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tomoaki Kamiya
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Daisuke Suzuki
- Department of Health Science, Hokkaido Chitose College of Rehabilitation, Chitose, Japan
| | - Satoshi Yamakawa
- Department of Sports Medical Biomechanics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | | | | | - Katsunori Takahashi
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yohei Okada
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hirofumi Ohnishi
- Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiromichi Fujie
- Department of Mechanical Engineering, Graduate School of Science and Engineering, Tokyo Metropolitan University, Tokyo, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| |
Collapse
|
7
|
Howe D, Cone SG, Piedrahita JA, Collins B, Fordham LA, Griffith EH, Spang JT, Fisher MB. Sex-specific biomechanics and morphology of the anterior cruciate ligament during skeletal growth in a porcine model. J Orthop Res 2022; 40:1853-1864. [PMID: 34751996 PMCID: PMC9081289 DOI: 10.1002/jor.25207] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/24/2021] [Accepted: 10/23/2021] [Indexed: 02/04/2023]
Abstract
Pediatric anterior cruciate ligament (ACL) injuries are on the rise, and females experience higher ACL injury risk than males during adolescence. Studies in skeletally immature patients indicate differences in ACL size and joint laxity between males and females after the onset of adolescence. However, functional data regarding the ACL and its anteromedial and posterolateral bundles in the pediatric population remain rare. Therefore, this study uses a porcine model to investigate the sex-specific morphology and biomechanics of the ACL and its bundles throughout skeletal growth. Hind limbs from male and female Yorkshire pigs aged early youth to late adolescence were imaged using magnetic resonance imaging to measure the size and orientation of the ACL and its bundles, then biomechanically tested under anterior-posterior drawer using a robotic testing system. Joint laxity decreased (p < 0.001) while joint stiffness increased (p < 0.001) throughout skeletal growth in both sexes. The ACL was the primary stabilizer against anterior tibial loading, while the functional role of the anteromedial bundle increased with age (p < 0.001), with an earlier increase in males. ACL and posterolateral bundle cross-sectional area and ACL and anteromedial bundle length were larger in males than females during adolescence (p < 0.01 for all), while ACL and bundle sagittal angle remained similar between sexes. Additionally, in situ ACL stiffness versus cross-sectional area regressions were significant across skeletal growth (r2 = 0.75, p < 0.001 in males and r2 = 0.64, p < 0.001 in females), but not within age groups. This study has implications for age and sex-specific surgical intervention strategies and suggests the need for human studies.
Collapse
Affiliation(s)
- Danielle Howe
- Joint Department of Biomedical Engineering, North Carolina State University and the University of North Carolina- Chapel Hill; Raleigh, NC 27695,Comparative Medicine Institute, North Carolina State University; Raleigh, NC 27695
| | - Stephanie G. Cone
- Joint Department of Biomedical Engineering, North Carolina State University and the University of North Carolina- Chapel Hill; Raleigh, NC 27695,Comparative Medicine Institute, North Carolina State University; Raleigh, NC 27695,Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jorge A. Piedrahita
- Comparative Medicine Institute, North Carolina State University; Raleigh, NC 27695,Department of Molecular Biomedical Sciences, North Carolina State University; Raleigh, NC 27695
| | - Bruce Collins
- Comparative Medicine Institute, North Carolina State University; Raleigh, NC 27695,Department of Animal Science, North Carolina State University; Raleigh, NC 27695
| | - Lynn A. Fordham
- Department of Radiology, University of North Carolina- Chapel Hill; Chapel Hill, NC 27599
| | - Emily H. Griffith
- Department of Statistics, North Carolina State University; Raleigh, NC 27695
| | - Jeffrey T. Spang
- Department of Orthopaedics, University of North Carolina- Chapel Hill; Chapel Hill, NC 27599
| | - Matthew B. Fisher
- Joint Department of Biomedical Engineering, North Carolina State University and the University of North Carolina- Chapel Hill; Raleigh, NC 27695,Comparative Medicine Institute, North Carolina State University; Raleigh, NC 27695,Department of Orthopaedics, University of North Carolina- Chapel Hill; Chapel Hill, NC 27599,Corresponding Author Contact: Address: 4130 Engineering Building III, 911 Oval Drive, CB 7115, Raleigh, NC, 27695, Telephone: 919-515-5242, Fax: 919-513-3814,
| |
Collapse
|
8
|
Hirose T, Mae T, Ogasawara I, Yamakawa S, Nakata K, Ohori T, Tsujii A, Okada S. Meniscal Displacement and Loss of Load-Transmission Function After Radial Tear of the Lateral Meniscus in a Porcine Model: New Insights Into the Functional Dynamics of the Injured Meniscus. Am J Sports Med 2022; 50:1850-1857. [PMID: 35416074 DOI: 10.1177/03635465221090543] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal extrusion/translation has been used as an index for meniscal treatment. However, the relationship between meniscal displacement and the degree of meniscal tear or load-transmission function of the lateral meniscus (LM) remains unclear. PURPOSE To clarify the relationship between the width of the radial tear of the LM and (1) meniscal displacement or (2) resultant force through the meniscus under axial compressive load in the porcine model. STUDY DESIGN Controlled laboratory study. METHODS Eight intact porcine knees with or without a partial radial tear at the midbody of the LM (involving 30%, 60%, or 90% of its width) were investigated. Reflective markers were attached to the outer wall of the anterior, anteromiddle, posteromiddle, and posterior segments of the LM. A 300-N axial load was applied at 2 flexion angles (30° and 60°), and the 3-dimensional forces and trajectories of the knees were recorded. Marker movements were simultaneously tracked using a motion capture camera system. After total meniscectomy of the LM, the recorded knee trajectories were reproduced, and the resultant force through the LM was calculated (a force carried only by the meniscus in response to a load applied to the whole knee joint). RESULTS At both flexion angles, the change in distance (mean ± SD) between the anterior and posterior markers under load increased significantly more in the anteroposterior direction in LMs with a 90% tear than in intact LMs (30°, 0.4 ± 0.3 vs 1.4 ± 0.8 mm, P = .004; 60°, 0.1 ± 0.7 vs 1.4 ± 1.0 mm, P < .001 [intact vs 90% tear]). The change in distance between the anteromiddle and posteromiddle markers at 30° also significantly increased in LMs with a 90% tear (0.2 ± 0.2 vs 1.3 ± 1.2 mm, P = .02 [intact vs 90% tear]). The resultant force was significantly lower in LMs with a 90% tear than in intact LMs (30°, 125 ± 47 vs 48 ± 20 N, P < .001; 60°, 93 ± 46 vs 43 ± 11 N, P = .002 [intact vs 90% tear]). We found no significant differences in either meniscal displacements or resultant forces between intact LMs and those with 30% or 60% tears. CONCLUSION LMs with a 90%-width midbody radial tear lost load-transmission function with their displacement relative to the tibia primarily in the anteroposterior direction in the porcine model. CLINICAL RELEVANCE Even 1 mm of displacement after meniscal injury is evidence that the load-transmission function of the meniscus is greatly impaired. When a displaced torn LM is diagnosed in preoperative imaging, meniscal repair surgery should be considered.
Collapse
Affiliation(s)
- Takehito Hirose
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tatsuo Mae
- Department of Sports Medical Biomechanics, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Issei Ogasawara
- Department of Health and Sports Sciences, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Satoshi Yamakawa
- Department of Sports Medical Biomechanics, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Ken Nakata
- Department of Health and Sports Sciences, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tomoki Ohori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Akira Tsujii
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Seiji Okada
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| |
Collapse
|
9
|
Ohori T, Mae T, Shino K, Fujie H, Hirose T, Tachibana Y, Yoshikawa H, Nakata K. Different effects of the lateral meniscus complete radial tear on the load distribution and transmission functions depending on the tear site. Knee Surg Sports Traumatol Arthrosc 2021; 29:342-351. [PMID: 32152692 DOI: 10.1007/s00167-020-05915-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 02/24/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE To compare the effect of the lateral meniscus (LM) complete radial tear at different tear sites on the load distribution and transmission functions. METHODS A compressive load of 300 N was applied to the intact porcine knees (n = 30) at 15°, 30°, 60°, 90°, and 120° of flexion. The LM complete radial tears were created at the middle portion (group M), the posterior portion (group P), or the posterior root (group R) (n = 10, each group), and the same loading procedure was followed. Finally, the recorded three-dimensional paths were reproduced on the LM-removed knees. The peak contact pressure (contact area) in the lateral compartment and the calculated in situ force of the LM under the principle of superposition were compared among the four groups (intact, group M, group P, and group R). RESULTS At all the flexion angles, the peak contact pressure (contact area) was significantly higher (lower) after creating the LM complete radial tear as compared to that in the intact state (p < 0.01). At 120° of flexion, group R represented the highest peak contact pressure (lowest contact area), followed by group P and group M (p < 0.05). The results of the in situ force carried by the LM were similar to those of the tibiofemoral contact mechanics. CONCLUSION The detrimental effect of the LM complete radial tear on the load distribution and transmission functions was greatest in the posterior root tear, followed by the posterior portion tear and the middle portion tear in the deep-flexed position. Complete radial tars of the meniscus, especially at the posterior root, should be repaired to restore the biomechanical function.
Collapse
Affiliation(s)
- Tomoki Ohori
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Konsei Shino
- Sports Orthopaedic Surgery Center, Yukioka Hospital, Osaka, Japan
| | - Hiromichi Fujie
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Tokyo, Japan
| | - Takehito Hirose
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yuta Tachibana
- Department of Sports Orthopaedics, Osaka Rosai Hospital, Osaka, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Ken Nakata
- Medicine for Sports and Performing Arts, Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| |
Collapse
|
10
|
Rothrauff BB, Sasaki H, Kihara S, Overholt KJ, Gottardi R, Lin H, Fu FH, Tuan RS, Alexander PG. Point-of-Care Procedure for Enhancement of Meniscal Healing in a Goat Model Utilizing Infrapatellar Fat Pad-Derived Stromal Vascular Fraction Cells Seeded in Photocrosslinkable Hydrogel. Am J Sports Med 2019; 47:3396-3405. [PMID: 31644307 DOI: 10.1177/0363546519880468] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Large radial tears of the meniscus involving the avascular region can compromise meniscal function and result in poor healing and subsequent osteochondral degeneration. Augmentation of surgical repairs with adipose-derived stromal vascular fraction (SVF), which contains mesenchymal stromal cells, may improve meniscal healing and preserve function (ie, chondroprotection). PURPOSES (1) To develop a goat model of a radial meniscal tear with resulting osteoarthritis and (2) to explore the efficacy of a 1-step procedure utilizing infrapatellar fat pad-derived SVF cells seeded in a photocrosslinkable hydrogel to enhance meniscal healing and mitigate osteochondral degeneration. STUDY DESIGN Controlled laboratory study. METHODS A full-thickness radial tear spanning 90% of the medial meniscal width was made at the junction of the anterior and middle bodies of the goat stifle joint. Tears received 1 of 3 interventions (n = 4 per group): untreated, repair, or repair augmented with photocrosslinkable methacrylated gelatin hydrogel containing 2.0 × 106 SVF cells/mL and 2.0 µg/mL of transforming growth factor β3. The contralateral (left) joint served as a healthy control. At 6 months, meniscal healing and joint health were evaluated by magnetic resonance imaging (MRI) and assessed by histological and macroscopic scoring. The Whole-Organ Magnetic Resonance Imaging Score and the presence of a residual tear, as evaluated with T2 MRI sequences, were determined by a single blinded orthopaedic surgeon. RESULTS When compared with tears left untreated or repaired with suture alone, augmented repairs demonstrated increased tissue formation in the meniscal tear site, as seen on MRI and macroscopically. Likewise, the neotissue of augmented repairs possessed a histological appearance more similar, although still inferior, to healthy meniscus. Osteochondral degeneration in the medial compartment, as evaluated by the Whole-Organ Magnetic Resonance Imaging Score and Inoue (macroscopic) scale, revealed increased degeneration in the untreated and repair groups, which was mitigated in the augmented repair group. Histological evaluation with a modified Mankin score showed a similar trend. In all measures of osteochondral degeneration, the augmented repair group did not differ significantly from the uninjured control. CONCLUSION A radial tear spanning 90% of the medial meniscal width in a goat stifle joint showed poor healing potential and resulted in osteochondral degeneration by 6 months, even if suture repair was performed. Augmentation of the repair with a photocrosslinkable hydrogel containing transforming growth factor β3 and SVF cells, isolated intraoperatively by rapid enzymatic digestion, improved meniscal healing and mitigated osteoarthritic changes. CLINICAL RELEVANCE Repair augmentation with an SVF cell-seeded hydrogel may support successful repair of meniscal tears previously considered irreparable.
Collapse
Affiliation(s)
- Benjamin B Rothrauff
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hiroshi Sasaki
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shinsuke Kihara
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kalon J Overholt
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Riccardo Gottardi
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hang Lin
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Freddie H Fu
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rocky S Tuan
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Peter G Alexander
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
11
|
Ohori T, Mae T, Shino K, Tachibana Y, Fujie H, Yoshikawa H, Nakata K. Complementary Function of the Meniscofemoral Ligament and Lateral Meniscus Posterior Root to Stabilize the Lateral Meniscus Posterior Horn: A Biomechanical Study in a Porcine Knee Model. Orthop J Sports Med 2019; 7:2325967118821605. [PMID: 30719478 PMCID: PMC6348525 DOI: 10.1177/2325967118821605] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: It has been demonstrated that the load distribution function of the lateral meniscus (LM) is compromised by resecting both the meniscofemoral ligament (MFL) and LM posterior root (LMPR). However, the effect of resecting these fibers on load transmission through the LM needs to be investigated. Purpose: To evaluate using a porcine knee model (1) the in situ forces of the MFL and LMPR and (2) the effect of resecting these fibers on the in situ force of the LM under a compressive load and valgus torque to the lateral knee compartment. Study Design: Controlled laboratory study. Methods: Twenty fresh-frozen porcine knees and a 6 degrees of freedom robotic system were utilized. An axial compressive load of 250 N and 5 N·m of valgus torque were applied to intact, MFL-deficient, LMPR-deficient, and MFL/LMPR-deficient knees at 30°, 60°, and 90° of flexion. The valgus angles under the applied loads were compared among the 4 states. The in situ forces of the MFL and LMPR under the applied loads were calculated under the principle of superposition. The in situ forces of the LM under the applied loads were also calculated and compared among the 4 conditions (intact, without the MFL, without LMPR, and without the MFL/LMPR). Results: The valgus angles significantly increased after resecting both the MFL and LMPR at all the flexion angles. The in situ forces of the MFL and LMPR changed reciprocally as the knee flexed. The in situ forces of the LM significantly decreased after resecting both the MFL and LMPR, although resecting only the MFL or LMPR represented no significant effect. Conclusion: The MFL and LMPR functioned complementarily as the posterior attachments of the LM against a compressive load and valgus torque to the lateral knee compartment in porcine knee joints. Clinical Relevance: If the LMPR is completely detached and needs to be repaired, the MFL should be preserved because it may provide some stability to the LM posterior horn and protect the repaired LMPR.
Collapse
Affiliation(s)
- Tomoki Ohori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Konsei Shino
- Sports Orthopaedic Surgery Center, Yukioka Hospital, Osaka, Japan
| | - Yuta Tachibana
- Sports Orthopaedic Surgery Center, Yukioka Hospital, Osaka, Japan
| | - Hiromichi Fujie
- Department of Intelligent Mechanical Systems, Faculty of System Design, Tokyo Metropolitan University, Tokyo, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Ken Nakata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| |
Collapse
|
12
|
Bell KM, Rahnemai-Azar AA, Irarrazaval S, Guenther D, Fu FH, Musahl V, Debski RE. In situ force in the anterior cruciate ligament, the lateral collateral ligament, and the anterolateral capsule complex during a simulated pivot shift test. J Orthop Res 2018; 36:847-853. [PMID: 28782837 DOI: 10.1002/jor.23676] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 07/24/2017] [Indexed: 02/04/2023]
Abstract
The role of the anterolateral capsule complex in knee rotatory stability remains controversial. Therefore, the objective of this study was to determine the in situ forces in the anterior cruciate ligament (ACL), the anterolateral capsule, the lateral collateral ligament (LCL), and the forces transmitted between each region of the anterolateral capsule in response to a simulated pivot shift test. A robotic testing system applied a simulated pivot shift test continuously from full extension to 90° of flexion to intact cadaveric knees (n = 7). To determine the magnitude of the in situ forces, kinematics of the intact knee were replayed in position control mode after the following procedures were performed: (i) ACL transection; (ii) capsule separation; (iii) anterolateral capsule transection; and (iii) LCL transection. A repeated measures ANOVA was performed to compare in situ forces between each knee state (*p < 0.05). The in situ force in the ACL was significantly greater than the forces transmitted between each region of the anterolateral capsule at 5° and 15° of flexion but significantly lower at 60°, 75°, and 90° of flexion. This study demonstrated that the ACL is the primary rotatory stabilizer at low flexion angles during a simulated pivot shift test in the intact knee, but the anterolateral capsule plays an important secondary role at flexion angles greater than 60°. Furthermore, the contribution of the "anterolateral ligament" to rotatory knee stability in this study was negligible during a simulated pivot shift test. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:847-853, 2018.
Collapse
Affiliation(s)
- Kevin M Bell
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, 15219, Pennsylvania.,Department of Orthopaedic Surgery, University of Pittsburgh, Kaufman Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, 15213, Pennsylvania
| | - Ata A Rahnemai-Azar
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, 15219, Pennsylvania.,Department of Orthopaedic Surgery, University of Pittsburgh, Kaufman Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, 15213, Pennsylvania
| | - Sebastian Irarrazaval
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, 15219, Pennsylvania.,Department of Orthopaedic Surgery, University of Pittsburgh, Kaufman Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, 15213, Pennsylvania
| | - Daniel Guenther
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, 15219, Pennsylvania.,Department of Orthopaedic Surgery, University of Pittsburgh, Kaufman Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, 15213, Pennsylvania
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, Kaufman Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, 15213, Pennsylvania
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, 15219, Pennsylvania.,Department of Orthopaedic Surgery, University of Pittsburgh, Kaufman Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, 15213, Pennsylvania
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, 15219, Pennsylvania.,Department of Orthopaedic Surgery, University of Pittsburgh, Kaufman Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, 15213, Pennsylvania.,Department of Bioengineering, University of Pittsburgh, 302 Benedum Hall, 3700 O'Hara Street, Pittsburgh, 15260, Pennsylvania
| |
Collapse
|