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Schwer J, Ignatius A, Seitz AM. The biomechanical properties of human menisci: A systematic review. Acta Biomater 2024; 175:1-26. [PMID: 38092252 DOI: 10.1016/j.actbio.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/09/2023] [Accepted: 12/06/2023] [Indexed: 01/08/2024]
Abstract
Biomechanical characterization of meniscal tissue ex vivo remains a critical need, particularly for the development of suitable meniscus replacements or therapeutic strategies that target the native mechanical properties of the meniscus. To date, a huge variety of test configurations and protocols have been reported, making it extremely difficult to compare the respective outcome parameters, thereby leading to misinterpretation. Therefore, the purpose of this systematic review was to identify test-specific parameters that contribute to uncertainties in the determination of mechanical properties of the human meniscus and its attachments, which derived from common quasi-static and dynamic tests in tension, compression, and shear. Strong evidence was found that the determined biomechanical properties vary significantly depending on the specific test parameters, as indicated by up to tenfold differences in both tensile and compressive properties. Test mode (stress relaxation, creep, cyclic) and configuration (unconfined, confined, in-situ), specimen shape and dimensions, preconditioning regimes, loading rates, post-processing of experimental data, and specimen age and degeneration were identified as the most critical parameters influencing the outcome measures. In conclusion, this work highlights an unmet need for standardization and reporting guidelines to facilitate comparability and may prove beneficial for evaluating the mechanical properties of novel meniscus constructs. STATEMENT OF SIGNIFICANCE: The biomechanical properties of the human meniscus have been studied extensively over the past decades. However, it remains unclear to what extent both test protocol and specimen-related differences are responsible for the enormous variability in material properties. Therefore, this systematic review analyzes the biomechanical properties of the human meniscus in the context of the underlying testing protocol. The most sensitive parameters affecting the determination of mechanical properties were identified and critically discussed. Currently, it is of utmost importance for scientists evaluating potential meniscal scaffolds and biomaterials to have a control group rather than a direct comparison to the literature. Standardization of both test procedures and reporting requirements is needed to improve and accelerate the development of meniscal replacement constructs.
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Affiliation(s)
- Jonas Schwer
- Institute of Orthopedic Research and Biomechanics, Center for Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Anita Ignatius
- Institute of Orthopedic Research and Biomechanics, Center for Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Andreas Martin Seitz
- Institute of Orthopedic Research and Biomechanics, Center for Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany.
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Berni M, Marchiori G, Cassiolas G, Grassi A, Zaffagnini S, Fini M, Lopomo NF, Maglio M. Anisotropy and inhomogeneity of permeability and fibrous network response in the pars intermedia of the human lateral meniscus. Acta Biomater 2021; 135:393-402. [PMID: 34411754 DOI: 10.1016/j.actbio.2021.08.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 02/07/2023]
Abstract
Within the human tibiofemoral joint, meniscus plays a key role due to its peculiar time-dependent mechanical characteristics, inhomogeneous structure and compositional features. To better understand the pathophysiological mechanisms underlying this essential component, it is mandatory to analyze in depth the relationship between its structure and the function it performs in the joint. Accordingly, the aim of this study was to evaluate the behavior of both solid and fluid phases of human meniscus in response to compressive loads, by integrating mechanical assessment and histological analysis. Cubic specimens were harvested from seven knee lateral menisci, specifically from anterior horn, pars intermedia and posterior horn; unconfined compressive tests were then performed according to three main loading directions (i.e., radial, circumferential and vertical). Fibril modulus, matrix modulus and hydraulic permeability of the tissue were thence estimated through a fibril-network-reinforced biphasic model. Tissue porosity and collagen fibers arrangement were assessed through histology for each region and related to the loading directions adopted during mechanical tests. Regional and strain-dependent constitutive parameters were finally proposed for the human lateral meniscus, suggesting an isotropic behavior of both the horns, and a transversely isotropic response of the pars intermedia. Furthermore, the histological findings supported the evidences highlighted by the compressive tests. Indeed, this study provided novel insights concerning the functional behavior of human menisci by integrating mechanical and histological characterizations and thus highlighting the key role of this component in knee contact mechanics and presenting fundamental information that can be used in the development of tissue-engineered substitutes. STATEMENT OF SIGNIFICANCE: This work presents an integration to the approaches currently used to model the mechanical behavior of the meniscal tissue. This study assessed in detail the regional and directional contributions of both the meniscal solid and fluid phases during compressive response, providing also complementary histological evidence. Within this updated perspective, both knee computational modeling and meniscal tissue engineering can be improved to have an effective impact on the clinical practice.
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Afara IO, Shaikh R, Nippolainen E, Querido W, Torniainen J, Sarin JK, Kandel S, Pleshko N, Töyräs J. Characterization of connective tissues using near-infrared spectroscopy and imaging. Nat Protoc 2021; 16:1297-1329. [PMID: 33462441 DOI: 10.1038/s41596-020-00468-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/20/2020] [Indexed: 02/06/2023]
Abstract
Near-infrared (NIR) spectroscopy is a powerful analytical method for rapid, non-destructive and label-free assessment of biological materials. Compared to mid-infrared spectroscopy, NIR spectroscopy excels in penetration depth, allowing intact biological tissue assessment, albeit at the cost of reduced molecular specificity. Furthermore, it is relatively safe compared to Raman spectroscopy, with no risk of laser-induced photothermal damage. A typical NIR spectroscopy workflow for biological tissue characterization involves sample preparation, spectral acquisition, pre-processing and analysis. The resulting spectrum embeds intrinsic information on the tissue's biomolecular, structural and functional properties. Here we demonstrate the analytical power of NIR spectroscopy for exploratory and diagnostic applications by providing instructions for acquiring NIR spectra, maps and images in biological tissues. By adapting and extending this protocol from the demonstrated application in connective tissues to other biological tissues, we expect that a typical NIR spectroscopic study can be performed by a non-specialist user to characterize biological tissues in basic research or clinical settings. We also describe how to use this protocol for exploratory study on connective tissues, including differentiating among ligament types, non-destructively monitoring changes in matrix formation during engineered cartilage development, mapping articular cartilage proteoglycan content across bovine patella and spectral imaging across the depth-wise zones of articular cartilage and subchondral bone. Depending on acquisition mode and experiment objectives, a typical exploratory study can be completed within 6 h, including sample preparation and data analysis.
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Affiliation(s)
- Isaac O Afara
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Queensland, Australia.
| | - Rubina Shaikh
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio, Finland
| | - Ervin Nippolainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - William Querido
- Department of Bioengineering, Temple University, Philadelphia, PA, USA
| | - Jari Torniainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Jaakko K Sarin
- Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio, Finland
| | - Shital Kandel
- Department of Bioengineering, Temple University, Philadelphia, PA, USA
| | - Nancy Pleshko
- Department of Bioengineering, Temple University, Philadelphia, PA, USA
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Queensland, Australia
- Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio, Finland
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Near-Infrared Spectroscopy for Mapping of Human Meniscus Biochemical Constituents. Ann Biomed Eng 2020; 49:469-476. [PMID: 32720092 PMCID: PMC7773612 DOI: 10.1007/s10439-020-02578-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/16/2020] [Indexed: 12/13/2022]
Abstract
Degenerative changes in meniscus are diagnosed during surgery by means of mechanical testing and visual evaluation. This method is qualitative and highly subjective, providing very little information on the internal state of the meniscus. Thus, there is need for novel quantitative methods that can support decision-making during arthroscopic surgery. In this study, we investigate the potential of near-infrared spectroscopy (NIRS) for mapping the biochemical constituents of human meniscus, including water, uronic acid, and hydroxyproline contents. Partial least squares regression models were developed using data from 115 measurement locations of menisci samples extracted from 7 cadavers and 11 surgery patient donors. Model performance was evaluated using an independent test set consisting of 55 measurement locations within a meniscus sample obtained from a separate cadaver. The correlation coefficient of calibration (ρtraining), test set (ρtest), and root-mean-squared error of test set (RMSEP) were as follows: water (ρtraining = 0.61, ρtest = 0.39, and RMSEP = 2.27 percentage points), uronic acid (ρtraining = 0.68, ρtest = 0.69, and RMSEP = 6.09 basis points), and hydroxyproline (ρtraining = 0.84, ρtest = 0.58, and error = 0.54 percentage points). In conclusion, the results suggest that NIRS could enable rapid arthroscopic mapping of changes in meniscus biochemical constituents, thus providing means for quantitative assessment of meniscus degeneration.
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Torniainen J, Ristaniemi A, Sarin JK, Mikkonen S, Afara IO, Stenroth L, Korhonen RK, Töyräs J. Near Infrared Spectroscopic Evaluation of Ligament and Tendon Biomechanical Properties. Ann Biomed Eng 2018; 47:213-222. [PMID: 30238376 DOI: 10.1007/s10439-018-02125-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/30/2018] [Indexed: 12/23/2022]
Abstract
Knee ligaments and tendons are collagen-rich viscoelastic connective tissues that provide vital mechanical stabilization and support to the knee joint. Deterioration of ligaments has an adverse effect on the health of the knee and can eventually lead to ligament rupture and osteoarthritis. In this study, the feasibility of near infrared spectroscopy (NIRS) was, for the first time, tested for evaluation of ligament and tendon mechanical properties by performing measurements on bovine stifle joint ligament (N = 40) and patellar tendon (N = 10) samples. The mechanical properties of the samples were determined using a uniaxial tensile testing protocol. Partial least squares regression models were then developed to determine if morphological, viscoelastic, and quasi-static properties of the samples could be predicted from the NIR spectra. Best performance of NIRS in predicting mechanical properties was observed for toughness at yield point (median [Formula: see text], median normalized [Formula: see text]), toughness at failure point (median [Formula: see text], median normalized [Formula: see text]), and the ultimate strength of the ligament/tendon (median [Formula: see text], median normalized [Formula: see text]). Thus, we show that NIRS is capable of estimating ligament and tendon biomechanical properties, especially in parameters related to tissue failure. We believe this method could substantially enhance the currently limited arthroscopic evaluation of ligaments and tendons.
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Affiliation(s)
- Jari Torniainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland. .,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.
| | - Aapo Ristaniemi
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Jaakko K Sarin
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Santtu Mikkonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Isaac O Afara
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Lauri Stenroth
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Rami K Korhonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
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