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Tzanetis P, de Souza K, Robertson S, Fluit R, Koopman B, Verdonschot N. Numerical study of osteophyte effects on preoperative knee functionality in patients undergoing total knee arthroplasty. J Orthop Res 2024; 42:1943-1954. [PMID: 38602446 DOI: 10.1002/jor.25850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/20/2024] [Accepted: 03/30/2024] [Indexed: 04/12/2024]
Abstract
Osteophytes are routinely removed during total knee arthroplasty, yet the preoperative planning currently relies on preoperative computed tomography (CT) scans of the patient's osteoarthritic knee, typically including osteophytic features. This complicates the surgeon's ability to anticipate the exact biomechanical effects of osteophytes and the consequences of their removal before the operation. The aim of this study was to investigate the effect of osteophytes on ligament strains and kinematics, and ascertain whether the osteophyte volume and location determine the extent of this effect. We segmented preoperative CT scans of 21 patients, featuring different osteophyte severity, using image-based active appearance models trained to identify the osteophytic and preosteophytic bone geometries and estimate the cartilage thickness in the segmented surfaces. The patients' morphologies were used to scale a template musculoskeletal knee model. Osteophytes induced clinically relevant changes to the knee's functional behavior, but these were variable and patient-specific. Generally, severe osteophytic knees significantly strained the oblique popliteal ligament (OPL) and posterior capsule (PC) relative to the preosteophytic state. Furthermore, there was a marked effect on the lateral collateral ligament and anterolateral ligament (ALL) strains compared to mild and moderate osteophytic knees, and concurrent alterations in the tibial lateral-medial translation and external-internal rotation. We found a strong correlation between the OPL, PC, and ALL strains and posterolateral condylar and tibial osteophytes, respectively. Our findings may have implications for the preoperative planning in total knee arthroplasty, toward reproducing the physiological knee biomechanics as close as feasibly possible.
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Affiliation(s)
- Periklis Tzanetis
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | | | | | - René Fluit
- Faculty of Science and Engineering, University of Groningen, Groningen, The Netherlands
| | - Bart Koopman
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Nico Verdonschot
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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2
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Chamberlain C, Prabahar A, Kink J, Mueller E, Li Y, Yopp S, Capitini C, William M, Hematti P, Vanderby R, Jiang P. Modulating Mesenchymal Stromal Cell Microenvironment Alters Exosome RNA Content and Ligament Healing Capacity. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.22.563485. [PMID: 37961625 PMCID: PMC10634732 DOI: 10.1101/2023.10.22.563485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Although mesenchymal stromal cell (MSC) based therapies hold promise in regenerative medicine, their applications in clinical settings remain challenging due to issues such as immunocompatibility and cell stability. MSC-derived exosomes, small vesicles carrying various bioactive molecules, are a promising cell-free therapy to promote tissue regeneration. However, it remains unknown mainly regarding the ability to customize the content of MSC-derived exosomes, how alterations in the MSC microenvironment influence exosome content, and the effects of such modifications on healing efficiency and mechanical properties in tissue regeneration. In this study, we used an in vitro system of human MSC-derived exosomes and an in vivo rat ligament injury model to address these questions. We found a context-dependent correlation between exosomal and parent cell RNA content. Under native conditions, the correlation was moderate but heightened with microenvironmental changes. In vivo rat ligament injury model showed that MSC-derived exosomes increased ligament max load and stiffness. We also found that changes in the MSCs' microenvironment significantly influence the mechanical properties driven by exosome treatment. Additionally, a link was identified between altered exosomal microRNA levels and expression changes in microRNA targets in ligaments. These findings elucidate the nuanced interplay between MSCs, their exosomes, and tissue regeneration.
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3
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Hou X, Tian Y, Xu N, Li H, Yan M, Wang S, Li W. Overstrain on the longitudinal band of the cruciform ligament during flexion in the setting of sandwich deformity at the craniovertebral junction: a finite element analysis. Spine J 2023; 23:1721-1729. [PMID: 37385409 DOI: 10.1016/j.spinee.2023.06.387] [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: 11/30/2022] [Revised: 05/31/2023] [Accepted: 06/17/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND CONTEXT In the setting of "sandwich deformity" (concomitant C1 occipitalization and C2-3 nonsegmentation), the C1-2 joint becomes the only mobile joint in the craniovertebral junction. Atlantoaxial dislocation develops earlier with severer symptoms in sandwich deformity, which has been hypothesized to be due to the repetitive excessive tension in the ligaments between C1 and C2. PURPOSE To elucidate whether and how the major ligaments of the C1-2 joint are affected in sandwich deformity, and to find out the ligament most responsible for the earlier development and severer symptoms of atlantoaxial dislocation in sandwich deformity. STUDY DESIGN A finite element (FE) analysis study. METHODS A three-dimensional FE model from occiput to C5 was established using anatomical data from a thin-slice CT scan of a healthy volunteer. Sandwich deformity was simulated by eliminating any C0-1 and C2-3 segmental motion respectively. Flexion torque was applied, and the range of motion of each segment and the tension sustained by the major ligaments of C1-2 (including the transverse and longitudinal bands of the cruciform ligament, the alar ligaments, and the apical ligament) were analyzed. RESULTS Tension sustained by the longitudinal band of the cruciform ligament and the apical ligament during flexion is significantly larger in the FE model of sandwich deformity. In contrast, tension in the other ligaments is not significantly changed in the sandwich deformity model compared with the normal model. CONCLUSIONS Considering the importance of the longitudinal band of the cruciform ligament to the stability of the C1-2 joint, our findings implicate that the early onset, severe dislocation, and unique clinical manifestations of atlantoaxial dislocation in patients with sandwich deformity are mainly due to the enlarged force loaded on the longitudinal band of the cruciform ligament. CLINICAL SIGNIFICANCE The enlarged force loaded on the longitudinal band of the cruciform ligament can add to its laxity and thus reducing its ability to restrict the cranial migration of the odontoid process. This is in accordance with our clinical experience that dislocation of the atlantoaxial joint in patients with sandwich deformity is mainly craniocaudal, which means severer cranial neuropathy, Chiari deformity, and syringomyelia, and more difficult surgical treatment.
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Affiliation(s)
- Xiangyu Hou
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Rd, Haidian District, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Rd, Haidian District, Beijing, China
| | - Yinglun Tian
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Rd, Haidian District, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Rd, Haidian District, Beijing, China
| | - Nanfang Xu
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Rd, Haidian District, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Rd, Haidian District, Beijing, China
| | - Hui Li
- Beijing Engineering and Technology Research Center for Medical Endoplants, Building 1, Yard 9, Chengwan Street, Haidian District, Beijing, China
| | - Ming Yan
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Rd, Haidian District, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Rd, Haidian District, Beijing, China
| | - Shenglin Wang
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Rd, Haidian District, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Rd, Haidian District, Beijing, China.
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Rd, Haidian District, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Rd, Haidian District, Beijing, China
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Luetkemeyer CM, Neu CP, Calve S. A method for defining tissue injury criteria reveals that ligament deformation thresholds are multimodal. Acta Biomater 2023; 168:252-263. [PMID: 37433358 PMCID: PMC10530537 DOI: 10.1016/j.actbio.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/13/2023]
Abstract
Soft tissue injuries (such as ligament, tendon, and meniscus tears) are the result of extracellular matrix damage from excessive tissue stretching. Deformation thresholds for soft tissues, however, remain largely unknown due to a lack of methods that can measure and compare the spatially heterogeneous damage and deformation that occurs in these materials. Here, we propose a full-field method for defining tissue injury criteria: multimodal strain limits for biological tissues analogous to yield criteria that exist for crystalline materials. Specifically, we developed a method for defining strain thresholds for mechanically-driven fibrillar collagen denaturation in soft tissues, using regional multimodal deformation and damage data. We established this new method using the murine medial collateral ligament (MCL) as our model tissue. Our findings revealed that multiple modes of deformation contribute to collagen denaturation in the murine MCL, contrary to the common assumption that collagen damage is driven only by strain in the direction of fibers. Remarkably, hydrostatic strain (computed here with an assumption of plane strain) was the best predictor of mechanically-driven collagen denaturation in ligament tissue, suggesting crosslink-mediated stress transfer plays a role in molecular damage accumulation. This work demonstrates that collagen denaturation can be driven by multiple modes of deformation and provides a method for defining deformation thresholds, or injury criteria, from spatially heterogeneous data. STATEMENT OF SIGNIFICANCE: Understanding the mechanics of soft tissue injuries is crucial for the development of new technology for injury detection, prevention, and treatment. Yet, tissue-level deformation thresholds for injury are unknown, due to a lack of methods that combine full-field measurements of multimodal deformation and damage in mechanically loaded soft tissues. Here, we propose a method for defining tissue injury criteria: multimodal strain thresholds for biological tissues. Our findings reveal that multiple modes of deformation contribute to collagen denaturation, contrary to the common assumption that collagen damage is driven by strain in the fiber direction alone. The method will inform the development of new mechanics-based diagnostic imaging, improve computational modeling of injury, and be employed to study the role of tissue composition in injury susceptibility.
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Affiliation(s)
- Callan M Luetkemeyer
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, United States; Department of Mechanical Science and Engineering, University of Illinois Urbana-Champaign, Urbana, IL, United States.
| | - Corey P Neu
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, United States; Biomedical Engineering Program, University of Colorado Boulder, Boulder, CO, United States; BioFrontiers Institute, University of Colorado Boulder, Boulder, CO, United States
| | - Sarah Calve
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, United States; Biomedical Engineering Program, University of Colorado Boulder, Boulder, CO, United States; BioFrontiers Institute, University of Colorado Boulder, Boulder, CO, United States; Materials Science and Engineering Program, University of Colorado Boulder, Boulder, CO, United States
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5
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Singh S, Winkelstein BA. Characterization of the L4/L5 rat facet capsular ligament macromechanical and microstructural responses to tensile failure loading. J Biomech 2023; 157:111742. [PMID: 37523884 PMCID: PMC10475220 DOI: 10.1016/j.jbiomech.2023.111742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 07/22/2023] [Accepted: 07/26/2023] [Indexed: 08/02/2023]
Abstract
Low back pain is a prevalent condition that affects the global population. The lumbar facet capsular ligament is a source of pain since the collagenous tissue of the ligament is innervated with sensory neurons that deform with the capsule's stretch. Regional differences in the microstructural and macrostructural anatomy of the spinal facets affect its capsule's mechanical behavior. Although there are many studies of the cervical facet in human and rodent models, the lumbar capsular ligament's multiscale behavior is less well-defined. This study characterizes the macroscale and fiber-scale changes of the rat lumbar facet capsule during tensile failure loading. An integrated polarized light imaging setup captured local fiber alignment during 0.08 mm/s distraction of 7 lumbar facets. Force, displacement, strain, and circular variance were measured at several points along the failure curve: the first instance when the local collagen fiber network realigns differentially (anomalous realignment), yield, the first peak in force corresponding to the capsule's first failure, and peak force, defined as ultimate rupture. Those outcomes were compared across events. While each of force, displacement, and average maximum principal strain increased with applied tension, so did the circular variance of the collagen, suggesting that the fibers were becoming more disorganized. From the fiber alignment maps collected at each mechanical event, the number of anomalous realignment events were counted and found to increase dramatically with loading. The increased collagen disorganization and increasing regions of such disorganization in the facet capsule during loading can provide insights about how loading to the ligament afferent nerves may be activated and thereby produce pain.
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Affiliation(s)
- Sagar Singh
- Department of Bioengineering, University of Pennsylvania, 210 S 33rd St., Philadelphia, PA 19104, United States
| | - Beth A Winkelstein
- Department of Bioengineering, University of Pennsylvania, 210 S 33rd St., Philadelphia, PA 19104, United States; Department of Neurosurgery, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, United States.
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6
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Cretu B, Costache M, Cursaru A, Serban B, Spiridonica R, Popa M, Cirstoiu C, Iordache S. Restoring Anatomical Features in Primary Total Knee Arthroplasty. Cureus 2023; 15:e40616. [PMID: 37342300 PMCID: PMC10278159 DOI: 10.7759/cureus.40616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 06/22/2023] Open
Abstract
Today, the number of people affected by gonarthrosis symptoms is increasing proportionally. Total knee arthroplasty (TKA) is a successful intervention that aims to reduce pain and restore knee function. However, studies have shown that active young patients still have limitations in performing activities such as skiing, golfing, surfing, and dancing. Over the last few years, total knee arthroplasty has undergone significant changes. Most of the modern TKA implants are designed to reproduce the normal biomechanics of the knee joint, mimicking the physiological pattern with greater compliance in the medial compartment between the tibial insert and femoral condyle and less congruence on the lateral side. Unfortunately, functional outcomes are compromised in approximately half of TKA patients. This loss may be caused by the abnormal kinematics and inherent instability of many contemporary implants. The proper alignment of the femoral component during TKA is a crucial step that influences postoperative results. The position of the femoral component in the axial plane is responsible for flexion stability, knee joint kinematics, flexion alignment, and patellar tracking. The main goal when choosing a type of prosthesis is to achieve an adequate recovery that leads to an improvement in mobility and an increase in the efficiency of the quadriceps.
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Affiliation(s)
- Bogdan Cretu
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Mihai Costache
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Adrian Cursaru
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Bogdan Serban
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Razvan Spiridonica
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Mihnea Popa
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Catalin Cirstoiu
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Sergiu Iordache
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
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7
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Tzanetis P, Fluit R, de Souza K, Robertson S, Koopman B, Verdonschot N. Pre-Planning the Surgical Target for Optimal Implant Positioning in Robotic-Assisted Total Knee Arthroplasty. Bioengineering (Basel) 2023; 10:543. [PMID: 37237613 PMCID: PMC10215074 DOI: 10.3390/bioengineering10050543] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/19/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Robotic-assisted total knee arthroplasty can attain highly accurate implantation. However, the target for optimal positioning of the components remains debatable. One of the proposed targets is to recreate the functional status of the pre-diseased knee. The aim of this study was to demonstrate the feasibility of reproducing the pre-diseased kinematics and strains of the ligaments and, subsequently, use that information to optimize the position of the femoral and tibial components. For this purpose, we segmented the pre-operative computed tomography of one patient with knee osteoarthritis using an image-based statistical shape model and built a patient-specific musculoskeletal model of the pre-diseased knee. This model was initially implanted with a cruciate-retaining total knee system according to mechanical alignment principles; and an optimization algorithm was then configured seeking the optimal position of the components that minimized the root-mean-square deviation between the pre-diseased and post-operative kinematics and/or ligament strains. With concurrent optimization for kinematics and ligament strains, we managed to reduce the deviations from 2.4 ± 1.4 mm (translations) and 2.7 ± 0.7° (rotations) with mechanical alignment to 1.1 ± 0.5 mm and 1.1 ± 0.6°, and the strains from 6.5% to lower than 3.2% over all the ligaments. These findings confirm that adjusting the implant position from the initial plan allows for a closer match with the pre-diseased biomechanical situation, which can be utilized to optimize the pre-planning of robotic-assisted surgery.
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Affiliation(s)
- Periklis Tzanetis
- Department of Biomechanical Engineering, University of Twente, 7522 LW Enschede, The Netherlands
| | - René Fluit
- Faculty of Science and Engineering, University of Groningen, 9747 AG Groningen, The Netherlands
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | | | | | - Bart Koopman
- Department of Biomechanical Engineering, University of Twente, 7522 LW Enschede, The Netherlands
| | - Nico Verdonschot
- Department of Biomechanical Engineering, University of Twente, 7522 LW Enschede, The Netherlands
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
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8
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Luetkemeyer CM, Neu CP, Calve S. A method for defining tissue injury criteria reveals ligament deformation thresholds are multimodal. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.31.526318. [PMID: 36778317 PMCID: PMC9915655 DOI: 10.1101/2023.01.31.526318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Soft tissue injuries (such as ligament, tendon, and meniscus tears) are the result of extracellular matrix damage from excessive tissue stretching. Deformation thresholds for soft tissues, however, remain largely unknown due to a lack of methods that can measure and compare the spatially heterogeneous damage and deformation that occurs in these materials. Here, we propose a method for defining tissue injury criteria : multimodal strain limits for biological tissues analogous to yield criteria that exist for crystalline materials. Specifically, we developed a method for defining injury criteria for mechanically-driven fibrillar collagen denaturation in soft tissues, using regional multimodal deformation and damage data. We established this new method using the murine medial collateral ligament (MCL) as our model tissue. Our findings revealed that multiple modes of deformation contribute to collagen denaturation in the murine MCL, contrary to the common assumption that collagen damage is driven by strain in the fiber direction alone. Remarkably, our results indicated that hydrostatic strain, or volumetric expansion, may be the best predictor of mechanically-driven collagen denaturation in ligament tissue, suggesting crosslink-mediated stress transfer plays a role in molecular damage accumulation. This work demonstrates that collagen denaturation can be driven by multiple modes of deformation and provides a method for defining deformation thresholds, or injury criteria, from spatially heterogeneous data.
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9
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Laubrie JD, Bezmalinovic A, García-Herrera CM, Celentano DJ, Herrera EA, Avril S, Llanos AJ. Hyperelastic and damage properties of the hypoxic aorta treated with Cinaciguat. J Biomech 2023; 147:111457. [PMID: 36701962 DOI: 10.1016/j.jbiomech.2023.111457] [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: 05/10/2022] [Revised: 12/27/2022] [Accepted: 01/13/2023] [Indexed: 01/18/2023]
Abstract
Chronic hypoxia during gestation and postnatal period induces pulmonary hypertension, aorta stiffening and vascular remodeling. In this study, we hypothesized that a postnatal treatment with Cinaciguat, a guanylate cyclase activator, may improve the vascular function by enhancing NO-sGC pathways that induce vasodilation. To assess this, we collected aortas from six lambs gestated, born and raised at 3600 masl. Half of these lambs received a Cinaciguat postnatal treatment, while the other half was used as control (vehicle). Uniaxial tension was applied on samples of each group of aortas (control and Cinaciguat-treated) through cyclic loading. The obtained stress-stretch curves were used to identify constitutive parameters of a hyperelastic damage model. These material constants allowed us to assess the softening/dissipation behavior and to characterize the treatment effects. Results showed that Cinaciguat has an effect on the damage behavior at large strains, altering the damage onset under uniaxial tension. We conclude that Cinaciguat, as a vasodilator, can prevent the very early effects of vascular remodeling caused by perinatal hypoxia, and improve the aortic-tissue damage properties of hypoxic lambs.
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Affiliation(s)
- Joan D Laubrie
- Departamento de Ingeniería Mecánica, Facultad de Ingeniería, Universidad de Santiago de Chile, Santiago, Chile
| | - Alejandro Bezmalinovic
- Departamento de Ingeniería Mecánica, Facultad de Ingeniería, Universidad de Santiago de Chile, Santiago, Chile
| | - Claudio M García-Herrera
- Departamento de Ingeniería Mecánica, Facultad de Ingeniería, Universidad de Santiago de Chile, Santiago, Chile.
| | - Diego J Celentano
- Departamento de Ingeniería Mecánica y Metalúrgica, Instituto de Ingeniería Biológica y Médica, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Emilio A Herrera
- Programa de Fisiopatología, Facultad de Medicina, Instituto de Ciencias Biomédicas, Universidad de Chile, Santiago, Chile; International Center for Andean Studies (INCAS), Universidad de Chile, Putre, Chile
| | - Stéphane Avril
- Mines Saint-Etienne, Univ Jean Monnet, INSERM, U 1059 Sainbiose, F - 42023 Saint-Etienne, France
| | - Aníbal J Llanos
- Programa de Fisiopatología, Facultad de Medicina, Instituto de Ciencias Biomédicas, Universidad de Chile, Santiago, Chile; International Center for Andean Studies (INCAS), Universidad de Chile, Putre, Chile
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10
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Nyland J, Pyle B, Krupp R, Kittle G, Richards J, Brey J. ACL microtrauma: healing through nutrition, modified sports training, and increased recovery time. J Exp Orthop 2022; 9:121. [PMID: 36515744 PMCID: PMC9751252 DOI: 10.1186/s40634-022-00561-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Sports injuries among youth and adolescent athletes are a growing concern, particularly at the knee. Based on our current understanding of microtrauma and anterior cruciate ligament (ACL) healing characteristics, this clinical commentary describes a comprehensive plan to better manage ACL microtrauma and mitigate the likelihood of progression to a non-contact macrotraumatic ACL rupture. METHODS Medical literature related to non-contact ACL injuries among youth and adolescent athletes, collagen and ACL extracellular matrix metabolism, ACL microtrauma and sudden failure, and concerns related to current sports training were reviewed and synthesized into a comprehensive intervention plan. RESULTS With consideration for biopsychosocial model health factors, proper nutrition and modified sports training with increased recovery time, a comprehensive primary ACL injury prevention plan is described for the purpose of better managing ACL microtrauma, thereby reducing the incidence of non-contact macrotraumatic ACL rupture among youth and adolescent athletes. CONCLUSION Preventing non-contact ACL injuries may require greater consideration for reducing accumulated ACL microtrauma. Proper nutrition including glycine-rich collagen peptides, or gelatin-vitamin C supplementation in combination with healthy sleep, and adjusted sports training periodization with increased recovery time may improve ACL extracellular matrix collagen deposition homeostasis, decreasing sudden non-contact ACL rupture incidence likelihood in youth and adolescent athletes. Successful implementation will require compliance from athletes, parents, coaches, the sports medicine healthcare team, and event organizers. Studies are needed to confirm the efficacy of these concepts. LEVEL OF EVIDENCE V.
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Affiliation(s)
- J Nyland
- Norton Orthopedic Institute, 9880 Angies Way, Louisville, KY, 40241, USA.
- MSAT Program, Spalding University, 901 South Third St, Louisville, KY, USA.
- Department of Orthopaedic Surgery, University of Louisville, Louisville, KY, USA.
| | - B Pyle
- MSAT Program, Spalding University, 901 South Third St, Louisville, KY, USA
| | - R Krupp
- Norton Orthopedic Institute, 9880 Angies Way, Louisville, KY, 40241, USA
- Department of Orthopaedic Surgery, University of Louisville, Louisville, KY, USA
| | - G Kittle
- MSAT Program, Spalding University, 901 South Third St, Louisville, KY, USA
| | - J Richards
- Department of Orthopaedic Surgery, University of Louisville, Louisville, KY, USA
| | - J Brey
- Norton Orthopedic Institute, 9880 Angies Way, Louisville, KY, 40241, USA
- Department of Orthopaedic Surgery, University of Louisville, Louisville, KY, USA
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11
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Kwak DS, Kim YD, Cho N, Cho HJ, Ko J, Kim M, Choi JH, Lim D, Koh IJ. Guided-Motion Bicruciate-Stabilized Total Knee Arthroplasty Reproduces Native Medial Collateral Ligament Strain. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121751. [PMID: 36556953 PMCID: PMC9788414 DOI: 10.3390/medicina58121751] [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: 10/25/2022] [Revised: 11/11/2022] [Accepted: 11/26/2022] [Indexed: 12/05/2022]
Abstract
Background and Objectives: Guided-motion bicruciate-stabilized (BCS) total knee arthroplasty (TKA) includes a dual cam-post mechanism with an asymmetric bearing geometry that promotes normal knee kinematics and enhances anterior-posterior stability. However, it is unclear whether the improved biomechanics after guided-motion BCS TKA reproduce soft tissue strain similar to the strain generated by native knees. The purpose of this cadaveric study was to compare medial collateral ligament (MCL) strain between native and guided-motion BCS TKA knees using a video extensometer. Materials and Methods: Eight cadaver knees were mounted onto a customized knee squatting simulator to measure MCL strain during flexion in both native and guided-motion BCS TKA knees (Journey II-BCS; Smith & Nephew, Memphis, TN, USA). MCL strain was measured using a video extensometer (Mercury® RT RealTime tracking system, Sobriety s.r.o, Kuřim, Czech Republic). MCL strain level and strain distribution during knee flexion were compared between the native and guided-motion BCS TKA conditions. Results: The mean and peak MCL strain were similar between native and guided-motion BCS TKA knees at all flexion angles (p > 0.1). MCL strain distribution was similar between native and BCS TKA knees at 8 of 9 regions of interest (ROIs), while higher MCL strain was observed after BCS TKA than in the native knee at 1 ROI in the mid portion of the MCL at early flexion angles (p < 0.05 at ≤30° of flexion). Conclusions: Guided-motion BCS TKA restored the amount and distribution of MCL strain to the values observed on native knees.
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Affiliation(s)
- Dai-Soon Kwak
- Catholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Yong Deok Kim
- Joint Replacement Center, Eunpyeong St. Mary’s Hospital, Seoul 03312, Republic of Korea
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Nicole Cho
- Boston College, Morrissey College of Arts and Sciences, Chestnut Hill, MA 02467, USA
| | - Ho-Jung Cho
- Catholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Jaeryong Ko
- Joint Replacement Center, Eunpyeong St. Mary’s Hospital, Seoul 03312, Republic of Korea
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Minji Kim
- Department of Mechanical Engineering, Sejong University, Seoul 05006, Republic of Korea
| | - Jae Hyuk Choi
- Department of Mechanical Engineering, Sejong University, Seoul 05006, Republic of Korea
| | - Dohyung Lim
- Department of Mechanical Engineering, Sejong University, Seoul 05006, Republic of Korea
| | - In Jun Koh
- Joint Replacement Center, Eunpyeong St. Mary’s Hospital, Seoul 03312, Republic of Korea
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Correspondence: ; Tel.: +82-2-2030-2655; Fax: +82-2-2030-4629
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12
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Bartsoen L, Faes MGR, Wirix-Speetjens R, Moens D, Jonkers I, Sloten JV. Probabilistic planning for ligament-balanced TKA-Identification of critical ligament properties. Front Bioeng Biotechnol 2022; 10:930724. [PMID: 36466330 PMCID: PMC9713239 DOI: 10.3389/fbioe.2022.930724] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/30/2022] [Indexed: 04/04/2024] Open
Abstract
Total knee arthroplasty (TKA) failures are often attributed to unbalanced knee ligament loading. The current study aims to develop a probabilistic planning process to optimize implant component positioning that achieves a ligament-balanced TKA. This planning process accounts for both subject-specific uncertainty, in terms of ligament material properties and attachment sites, and surgical precision related to the TKA process typically used in clinical practice. The consequent uncertainty in the implant position parameters is quantified by means of a surrogate model in combination with a Monte Carlo simulation. The samples for the Monte Carlo simulation are generated through Bayesian parameter estimation on the native knee model in such a way that each sample is physiologically relevant. In this way, a subject-specific uncertainty is accounted for. A sensitivity analysis, using the delta-moment-independent sensitivity measure, is performed to identify the most critical ligament parameters. The designed process is capable of estimating the precision with which the targeted ligament-balanced TKA can be realized and converting this into a success probability. This study shows that without additional subject-specific information (e.g., knee kinematic measurements), a global success probability of only 12% is estimated. Furthermore, accurate measurement of reference strains and attachment sites critically improves the success probability of the pre-operative planning process. To allow more precise planning, more accurate identification of these ligament properties is required. This study underlines the relevance of investigating in vivo or intraoperative measurement techniques to minimize uncertainty in ligament-balanced pre-operative planning results, particularly prioritizing the measurement of ligament reference strains and attachment sites.
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Affiliation(s)
- Laura Bartsoen
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | | | | | - David Moens
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Ilse Jonkers
- Movement Science Department, KU Leuven, Leuven, Belgium
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13
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Readioff R, Geraghty B, Kharaz YA, Elsheikh A, Comerford E. Proteoglycans play a role in the viscoelastic behaviour of the canine cranial cruciate ligament. Front Bioeng Biotechnol 2022; 10:984224. [PMID: 36457857 PMCID: PMC9705345 DOI: 10.3389/fbioe.2022.984224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/31/2022] [Indexed: 07/01/2024] Open
Abstract
Proteoglycans (PGs) are minor extracellular matrix proteins, and their contributions to the mechanobiology of complex ligaments such as the cranial cruciate ligament (CCL) have not been determined to date. The CCLs are highly susceptible to injuries, and their extracellular matrix comprises higher PGs content than the other major knee ligaments. Hence these characteristics make CCLs an ideal specimen to use as a model in this study. This study addressed the hypothesis that PGs play a vital role in CCL mechanobiology by determining the biomechanical behaviour at low strain rates before and after altering PGs content. For the first time, this study qualitatively investigated the contribution of PGs to key viscoelastic characteristics, including strain rate dependency, hysteresis, creep and stress relaxation, in canine CCLs. Femur-CCL-tibia specimens (n = 6 pairs) were harvested from canine knee joints and categorised into a control group, where PGs were not depleted, and a treated group, where PGs were depleted. Specimens were preconditioned and cyclically loaded to 9.9 N at 0.1, 1 and 10%/min strain rates, followed by creep and stress relaxation tests. Low tensile loads were applied to focus on the toe-region of the stress-strain curves where the non-collagenous extracellular matrix components take significant effect. Biochemical assays were performed on the CCLs to determine PGs and water content. The PG content was ∼19% less in the treated group than in the control group. The qualitative study showed that the stress-strain curves in the treated group were strain rate dependent, similar to the control group. The CCLs in the treated group showed stiffer characteristics than the control group. Hysteresis, creep characteristics (creep strain, creep rate and creep compliance), and stress relaxation values were reduced in the treated group compared to the control group. This study suggests that altering PGs content changes the microstructural organisation of the CCLs, including water molecule contents which can lead to changes in CCL viscoelasticity. The change in mechanical properties of the CCLs may predispose to injury and lead to knee joint osteoarthritis. Future studies should focus on quantitatively identifying the effect of PG on the mechanics of intact knee ligaments across broader demography.
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Affiliation(s)
- Rosti Readioff
- Department of Mechanical, Materials and Aerospace Engineering, School of Engineering, University of Liverpool, Liverpool, United Kingdom
- Faculty of Engineering, School of Mechanical Engineering, Institute of Medical and Biological Engineering, University of Leeds, Leeds, United Kingdom
- School of Dentistry, University of Liverpool, Liverpool, United Kingdom
- Department of Mechanical Engineering, University of Bath, Bath, United Kingdom
| | - Brendan Geraghty
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Yalda A. Kharaz
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Medical Research Council Versus Arthritis Centre for Integrated Research Into Musculoskeletal Ageing (CIMA), University of Liverpool, Liverpool, United Kingdom
| | - Ahmed Elsheikh
- Department of Mechanical, Materials and Aerospace Engineering, School of Engineering, University of Liverpool, Liverpool, United Kingdom
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
- NIHR Moorfields BRC, UCL Institute of Ophthalmology, London, United Kingdom
| | - Eithne Comerford
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Medical Research Council Versus Arthritis Centre for Integrated Research Into Musculoskeletal Ageing (CIMA), University of Liverpool, Liverpool, United Kingdom
- School of Veterinary Science, University of Liverpool, Neston, United Kingdom
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14
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Luxenburg D, Destine H, Rizzo MG, Constantinescu D, Ghali M, Kaplan LD, Baraga MG. The 50 Most Cited Articles in Knee Medial Collateral Ligament Injury Research. Orthop J Sports Med 2022; 10:23259671221124575. [PMID: 36199831 PMCID: PMC9528047 DOI: 10.1177/23259671221124575] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/21/2022] [Indexed: 11/27/2022] Open
Abstract
Background: Medial collateral ligament (MCL) injury is a common orthopaedic knee injury with a plethora of published articles regarding evaluation, treatment, and outcome. Purpose: To perform a comprehensive bibliometric analysis of the 50 most cited articles in MCL research. Study Design: Cross-sectional study. Methods: We performed a keyword search of the Institute for Scientific Information’s Web of Knowledge database for the identification of articles published before September 2021 encompassing the MCL. The conducted search yielded 9534 articles. The results were then filtered using predetermined guidelines and criteria, and the 50 most cited articles were selected for analysis. Extracted data included title, authors, citation count, year of publication, topic, journal, article type, country of origin, and level of evidence. Results: The selected 50 articles ranged from 1976 to 2013. The largest proportion was classified as having level 4 evidence (n = 12; 24%). The majority of the articles were published in the decade from 2000 to 2009 (n = 17; 34%), followed by 1990 to 1999 (n = 16; 32%). The mean raw citation score per article was 133 (range, 74-422). The most popular topic discussed was surgical technique and outcome (n = 14; 28%), followed by anatomy and biomechanics (n = 13; 26%). Conclusion: This study provides a comprehensive and objective measure of the most cited articles on MCL research. Knowledge of the characteristics of these most influential articles improves the understanding of MCL injury and can guide discussion for future research.
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Affiliation(s)
- Dylan Luxenburg
- UHealth Sports Medicine Institute, University of Miami Health Systems, Coral Gables, Florida, USA
| | - Henson Destine
- UHealth Sports Medicine Institute, University of Miami Health Systems, Coral Gables, Florida, USA
| | - Michael G. Rizzo
- UHealth Sports Medicine Institute, University of Miami Health Systems, Coral Gables, Florida, USA
| | - David Constantinescu
- UHealth Sports Medicine Institute, University of Miami Health Systems, Coral Gables, Florida, USA
| | - Miriyam Ghali
- UHealth Sports Medicine Institute, University of Miami Health Systems, Coral Gables, Florida, USA
| | - Lee D. Kaplan
- UHealth Sports Medicine Institute, University of Miami Health Systems, Coral Gables, Florida, USA
| | - Michael G. Baraga
- UHealth Sports Medicine Institute, University of Miami Health Systems, Coral Gables, Florida, USA
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15
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Lim D, Kwak DS, Kim M, Kim S, Cho HJ, Choi JH, Koh IJ. Kinematically aligned total knee arthroplasty restores more native medial collateral ligament strain than mechanically aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2022; 30:2815-2823. [PMID: 34312712 DOI: 10.1007/s00167-021-06680-y] [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: 04/03/2021] [Accepted: 07/22/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Kinematically aligned total knee arthroplasty (KA TKA) targets restoration of patient-specific alignment and soft tissue laxity. However, whether KA TKA reproduces native soft tissue strain remains unclear. This cadaveric study tested the hypothesis that KA TKA would better restore the quantitative strain and strain distribution of medial collateral ligament (MCL) to the native healthy knee compared to mechanically aligned (MA) TKA. METHODS Twenty-four fresh-frozen cadaver knees (12 pairs) were mounted on a customized knee squatting simulator to measure MCL strain during flexion. For each pair, one knee was assigned to KA TKA and the other to MA TKA. During KA TKA, the amount of femur and tibia resected was equivalent to implant thickness without MCL release using the calipered measuring technique. MA TKA was performed using conventional measured resection techniques. MCL strain was measured using a video extensometer (Mercury® RT RealTime tracking system, Sobriety s.r.o, Czech Republic). MCL strain and strain distribution during knee flexion were measured, and the measurements compared between native and post-TKA conditions. RESULTS Mean and peak MCL strain were similar between KA TKA and native knees at all flexion angles (p > 0.1 at all flexion angles) while mean strain at all flexion angles and peak strain at ≥ 60º of MA TKA were approximately twice those of the native knees (p < 0.05 at ≥ 60º of flexion). In addition, greater MCL strain was observed in 4 of 12 regions of interest (ROI) after MA TKA (M1, M2, P1 and P2) compared to the native knee, whereas after KA TKA, MCL strain measurements were similar at all but 1 ROI (P2). CONCLUSIONS KA TKA restored a more native amount and distribution of MCL strain compared to MA TKA. These findings provide clues for understanding why patients may experience better performance and more normal knee sensations after KA TKA compared to MA TKA. LEVEL OF EVIDENCE Therapeutic study, Level I.
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Affiliation(s)
- Dohyung Lim
- Department of Mechanical Engineering, Sejong University, Seoul, 05006, Republic of Korea
| | - Dai-Soon Kwak
- Catholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Minji Kim
- Department of Mechanical Engineering, Sejong University, Seoul, 05006, Republic of Korea
| | - Seoyeong Kim
- Department of Mechanical Engineering, Sejong University, Seoul, 05006, Republic of Korea
| | - Ho-Jung Cho
- Catholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Jae Hyuk Choi
- Department of Mechanical Engineering, Sejong University, Seoul, 05006, Republic of Korea
| | - In Jun Koh
- Joint Replacement Center, Eunpyeong St. Mary's Hospital, Seoul, 03312, Republic of Korea. .,Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea.
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16
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Colyn W, Cleymans A, Bruckers L, Houben R, Smeets K, Bellemans J. The lateral joint line opening: a radiographic indicative parameter for high grade varus knees. J Exp Orthop 2022; 9:51. [PMID: 35635581 PMCID: PMC9151933 DOI: 10.1186/s40634-022-00489-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/12/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose It is usually assumed that the severity of varus osteoarthritis (OA) of the knee is correlated with the axis deviation of the limb. Despite this, there is currently no clear radiographic definition to define a so-called ‘high degree’ varus knee, which is characterized by a pronounced lateral ligamentous laxity. The purpose of this study was to radiographically determine if the lateral joint line opening (LJLO) is an indicative parameter when defining so-called high grade varus knees. Methods Two hundred forty Full length radiographs of patients with end-stage varus osteoarthritis who were scheduled for Total knee arthroplasty (TKA) were evaluated. The Hip-knee-ankle-angle (HKA-angle), Joint-line-convergence-angle (JLCA) and the lateral joint line opening were measured. The lateral joint line opening is the shortest distance between the lateral tibial plateau and the deepest point of the lateral femoral condyle. Linear regression models were used to investigate the relationships between the radiographic measurements. Results Hip-knee-angle-angle, joint-line-conversion-angle, and lateral joint line opening were all positively correlated (p < 0.001). An increase of 1 mm lateral joint line opening causes an increase of 0.6° joint-line-conversion-angle (p = 0.029) below a cut-off point of 4.7 mm. For lateral opening values beyond 4.7 mm, the gradient increased to 1.2 (p < 0.001). A lateral joint line opening of 4.7 mm corresponds to a hip-knee-ankle-angle of 6.0° (95% CI [5.5; 6.5]). Conclusion A lateral joint line opening of more than 5 mm in end-stage OA knees is indicative of increased lateral joint laxity. Those knees can be radiographically classified as so-called ‘high-grade’ varus knees. Level of evidence Therapeutic study, Level III.
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17
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Fewster KM, Barrett JM, Callaghan JP. Characterizing the Mechanical and Viscoelastic Response of the Porcine Facet Joint Capsule Ligament in Response to a Simulated Impact. J Biomech Eng 2022; 144:1139235. [PMID: 35244145 DOI: 10.1115/1.4054022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Indexed: 11/08/2022]
Abstract
The facet capsule ligament (FCL) is a structure in the lumbar spine that constrains motions of the vertebrae. Subfailure loads can produce micro-damage resulting in increased laxity, decreased stiffness, and altered viscoelastic responses. Therefore, the purpose of this investigation was to determine the mechanical and viscoelastic properties of the FCL under various magnitudes of strain from control samples and samples that had been through an impact protocol. Two hundred FCL tissue samples were tested (20 Control & 180 Impacted). Impacted FCL tissue samples were obtained from functional spinal units that had been exposed to one of nine sub-failure impact conditions. All specimens underwent to following loading protocol: preconditioning with 5 cycles of 5% strain, followed by a 30 second rest period, 5 cycles of 10% strain and 1 cycle of 10% strain with a hold duration at 10% strain for 240 seconds (4 minutes). The same protocol followed for 30% and 50% strain. Measures of stiffness, hysteresis and force-relaxation were computed. No significant differences in stiffness were observed for impacted specimens in comparison to control. Impacted specimens from the 8g Flexed and 11g Flexed and Neutral conditions exhibited greater hysteresis during the cyclic-30% and cyclic-50% portion of the protocol in comparison to controls. In addition, specimens from the 8g and 11g Flexed conditions resulted in greater stress decay for the 50%-hold conditions. Results from this study demonstrate viscoelastic changes in FCL samples exposed to moderate and highspeed single impacts in a flexed posture.
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Affiliation(s)
- Kayla M Fewster
- Department of Kinesiology, University of Waterloo, Waterloo, ON
| | - Jeff M Barrett
- Department of Kinesiology, University of Waterloo, Waterloo, ON
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18
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A mathematical model for viscoelastic properties of biological soft tissue. Theory Biosci 2022; 141:13-25. [PMID: 35112309 DOI: 10.1007/s12064-021-00361-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
A quaternary viscoelastic structure model with two characteristic times is presented to describe the viscoelastic properties of parallel-fibered collagen tissue. The comparison results of model prediction and experimental data of rabbit medial collateral ligaments show that the model could accurately describe viscoelastic behavior such as stress-relaxation, strain-strengthening and creep of bio-soft-tissue within a small scope of errors. To study the biomechanical mechanism of viscoelasticity that biological soft tissue shows, the influence of model parameters on viscoelastic behavior of bio-soft-tissue is analyzed and researched, which indicated that the major influential elements of stress-relaxation in bio-soft-tissue are elastic modulus, relaxation time and strain rate of proteoglycan-rich matrix. The influence of elastic modulus of collagen fibers on stress-relaxation is not significant. However, the nonlinearity of stress-strain curve and viscoelastic behavior of bio-soft-tissue mostly depends on recruitment and reorientation of collagen fibers under external loading.
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19
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Knapp A, Williams LN. Predicting the Effect of Localized ACL Damage on Neighbor Ligament Mechanics via Finite Element Modeling. Bioengineering (Basel) 2022; 9:bioengineering9020054. [PMID: 35200406 PMCID: PMC8869305 DOI: 10.3390/bioengineering9020054] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 11/16/2022] Open
Abstract
The anterior cruciate ligament (ACL) plays a pivotal role in support of the knee under loading. When damaged, it is known that substantial changes in the mechanics of the neighboring ligaments can be observed. However, a localized damage approach to investigating how ACL deficiency influences the neighboring ligaments has not been carried out. To do this, a finite element model, incorporating a continuum damage material model of the ACL, was implemented. Localized ACL damage was induced using high quadriceps force loading. Once damaged, anterior shear forces or tibial torque loadings were applied to the knee joint. The relative changes in stress contour and average mid-substance stress were examined for each of the neighboring ligaments following localized ACL damage. It was observed that localized ACL damage could produce notable changes in the mechanics of the neighboring knee ligaments, with non-homogenous stress contour shape changes and average stress magnitude being observed to increase in most cases, with a notable exception occurring in the MCL for both loading modes. In addition, the ligament bearing the most loading also changed with ACL deficiency. These changes carry implications as to morphological effects that may be induced following localized ACL damage, indicating that early diagnosis of ACL injury may be helpful in mitigating other complications post injury.
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20
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Fewster KM, Guo J, Zehr JD, Barrett JM, Laing AC, Callaghan JP. Strain Response in the Facet Joint Capsule During Physiological Joint Rotation and Translation Following a Simulated Impact Exposure: an in Vitro Porcine Model. J Biomech Eng 2021; 144:1129237. [PMID: 34897377 DOI: 10.1115/1.4053207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Indexed: 11/08/2022]
Abstract
Low back pain (LBP) is frequently reported following rear impact collisions. Knowledge of how the facet joint capsule (FJC) mechanically behaves before and after rear impact collisions may help explain LBP development despite negative radiographic evidence of gross tissue failure. This study quantified the Green strain tensor in the facet joint capsule during rotation and translation range-of-motion tests completed before and following an in vitro simulation of a rear impact collision. Eight FSUs (4 C3-C4, 4 C5-C6) were tested. Following a preload test, FSUs were flexed and extended at 0.5 degrees/second until an ±8 Nm moment was achieved. Anterior and posterior joint translation was then applied at 0.2 mm/s until a target ±400 N shear load was imposed. Markers were drawn on the facet capsule surface and their coordinates were tracked during pre- and post-impact range-of-motion tests. Strain was defined as the change in point configuration relative to the determined neutral joint posture. There were no significant differences (p > 0.05) observed in all calculated FJC strain components in rotation and translation before and after the simulated impact. Our results suggest that LBP development resulting from the initiation of strain-induced mechanoreceptors and nociceptors with the facet joint capsule is unlikely following a severe rear impact collision within the boundaries of physiological joint motion.
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Affiliation(s)
- Kayla M Fewster
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Joyce Guo
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Jackie D Zehr
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Jeff M Barrett
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Andrew C Laing
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Jack P Callaghan
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
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21
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Logerstedt DS, Ebert JR, MacLeod TD, Heiderscheit BC, Gabbett TJ, Eckenrode BJ. Effects of and Response to Mechanical Loading on the Knee. Sports Med 2021; 52:201-235. [PMID: 34669175 DOI: 10.1007/s40279-021-01579-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 11/30/2022]
Abstract
Mechanical loading to the knee joint results in a differential response based on the local capacity of the tissues (ligament, tendon, meniscus, cartilage, and bone) and how those tissues subsequently adapt to that load at the molecular and cellular level. Participation in cutting, pivoting, and jumping sports predisposes the knee to the risk of injury. In this narrative review, we describe different mechanisms of loading that can result in excessive loads to the knee, leading to ligamentous, musculotendinous, meniscal, and chondral injuries or maladaptations. Following injury (or surgery) to structures around the knee, the primary goal of rehabilitation is to maximize the patient's response to exercise at the current level of function, while minimizing the risk of re-injury to the healing tissue. Clinicians should have a clear understanding of the specific injured tissue(s), and rehabilitation should be driven by knowledge of tissue-healing constraints, knee complex and lower extremity biomechanics, neuromuscular physiology, task-specific activities involving weight-bearing and non-weight-bearing conditions, and training principles. We provide a practical application for prescribing loading progressions of exercises, functional activities, and mobility tasks based on their mechanical load profile to knee-specific structures during the rehabilitation process. Various loading interventions can be used by clinicians to produce physical stress to address body function, physical impairments, activity limitations, and participation restrictions. By modifying the mechanical load elements, clinicians can alter the tissue adaptations, facilitate motor learning, and resolve corresponding physical impairments. Providing different loads that create variable tensile, compressive, and shear deformation on the tissue through mechanotransduction and specificity can promote the appropriate stress adaptations to increase tissue capacity and injury tolerance. Tools for monitoring rehabilitation training loads to the knee are proposed to assess the reactivity of the knee joint to mechanical loading to monitor excessive mechanical loads and facilitate optimal rehabilitation.
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Affiliation(s)
- David S Logerstedt
- Department of Physical Therapy, University of the Sciences in Philadelphia, Philadelphia, PA, USA.
| | - Jay R Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, WA, Australia.,Orthopaedic Research Foundation of Western Australia, Perth, WA, Australia.,Perth Orthopaedic and Sports Medicine Research Institute, Perth, WA, Australia
| | - Toran D MacLeod
- Department of Physical Therapy, Sacramento State University, Sacramento, CA, USA
| | - Bryan C Heiderscheit
- Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
| | - Tim J Gabbett
- Gabbett Performance Solutions, Brisbane, QLD, Australia.,Centre for Health Research, University of Southern Queensland, Ipswich, QLD, Australia
| | - Brian J Eckenrode
- Department of Physical Therapy, Arcadia University, Glenside, PA, USA
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22
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Variation of the Three-Dimensional Femoral J-Curve in the Native Knee. J Pers Med 2021; 11:jpm11070592. [PMID: 34201685 PMCID: PMC8303343 DOI: 10.3390/jpm11070592] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 12/15/2022] Open
Abstract
The native femoral J-Curve is known to be a relevant determinant of knee biomechanics. Similarly, after total knee arthroplasty, the J-Curve of the femoral implant component is reported to have a high impact on knee kinematics. The shape of the native femoral J-Curve has previously been analyzed in 2D, however, the knee motion is not planar. In this study, we investigated the J-Curve in 3D by principal component analysis (PCA) and the resulting mean shapes and modes by geometric parameter analysis. Surface models of 90 cadaveric femora were available, 56 male, 32 female and two without respective information. After the translation to a bone-specific coordinate system, relevant contours of the femoral condyles were derived using virtual rotating cutting planes. For each derived contour, an extremum search was performed. The extremum points were used to define the 3D J-Curve of each condyle. Afterwards a PCA and a geometric parameter analysis were performed on the medial and lateral 3D J-Curves. The normalized measures of the mean shapes and the aspects of shape variation of the male and female 3D J-Curves were found to be similar. When considering both female and male J-Curves in a combined analysis, the first mode of the PCA primarily consisted of changes in size, highlighting size differences between female and male femora. Apart from changes in size, variation regarding aspect ratio, arc lengths, orientation, circularity, as well as regarding relative location of the 3D J-Curves was found. The results of this study are in agreement with those of previous 2D analyses on shape and shape variation of the femoral J-Curves. The presented 3D analysis highlights new aspects of shape variability, e.g., regarding curvature and relative location in the transversal plane. Finally, the analysis presented may support the design of (patient-specific) femoral implant components for TKA.
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23
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Pownder SL, Hayashi K, Lin BQ, Meyers KN, Caserto BG, Breighner RE, Potter HG, Koff MF. Differences in the magnetic resonance imaging parameter T2* may be identified during the course of canine patellar tendon healing: a pilot study. Quant Imaging Med Surg 2021; 11:1234-1246. [PMID: 33816163 DOI: 10.21037/qims-20-684] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Previous studies have utilized ultrashort echo (UTE) magnetic resonance imaging (MRI), and derived T2* maps, to evaluate structures with highly ordered collagen structures such as tendon. T2* maps may provide a noninvasive means to assess tendon damage and healing. This pilot study evaluated the longitudinal relationship of an induced mechanical strain on the patellar tendon with corresponding UTE T2* metrics, histologic and biomechanical evaluation at two post-operative time points. Methods A total of 27 patellar tendons in male Beagles were surgically subjected to stretching by a small diameter (SmD) or a large diameter (LgD) diameter rod to induce damage due to strain, and evaluated at 4- and 8-week intervals using quantitative MRI (qMRI), biomechanical testing, and histology. A separate set of 16 limbs were used as controls. Results The tendons experienced a 67% and 17% prolongation of short T2* values as compared to controls at 4 and 8 weeks post-operatively, respectively. Histologic analysis displayed a trend of increased collagen disruption at 4 weeks followed by presence of greater organization at 8 weeks. Biomechanical evaluation found a reduction of tendon modulus and failure strain at both time points, and an increase in cross-sectional area at 4 weeks as compared to controls. Conclusions These findings display tendon healing in response to an imposed strain and present the utility of qMRI to evaluate longitudinal differences of patellar tendon T2* values in a model of induced subclinical tendon damage. The qMRI technique of UTE provides a means to non-invasively evaluate the healing process of a mechanically damaged tendon.
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Affiliation(s)
- Sarah L Pownder
- MRI Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Kei Hayashi
- Cornell University College of Veterinary Medicine, Ithaca, NY, USA
| | - Bin Q Lin
- MRI Laboratory, Hospital for Special Surgery, New York, NY, USA
| | | | | | | | - Hollis G Potter
- MRI Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Matthew F Koff
- MRI Laboratory, Hospital for Special Surgery, New York, NY, USA
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Bartsoen L, Faes MGR, Wesseling M, Wirix-Speetjens R, Moens D, Jonkers I, Sloten JV. Computationally Efficient Optimization Method to Quantify the Required Surgical Accuracy for a Ligament Balanced TKA. IEEE Trans Biomed Eng 2021; 68:3273-3280. [PMID: 33780331 DOI: 10.1109/tbme.2021.3069330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study proposes a computationally efficient method to quantify the effect of surgical inaccuracies on ligament strain in total knee arthroplasty (TKA). More specifically, this study describes a framework to determine the implant position and required surgical accuracy that results in a ligament balanced post-operative outcome with a probability of 90%. METHODS The response surface method is used to translate uncertainty in the implant position parameters to uncertainty in the ligament strain. The designed uncertainty quantification technique allows for an optimization with feasible computational cost towards the planned implant position and the tolerated surgical error for each of the twelve degrees of freedom of the implant position. RESULTS It is shown that the error does not allow for a ligament balanced TKA with a probability of 90% using preoperative planning. Six critical implant position parameters can be identified, namely AP translation, PD translation, VV rotation, IE rotation for the femoral component and PD translation, VV rotation for the tibial component. CONCLUSION We introduced an optimization process that allows for the computation of the required surgical accuracy for a ligament balanced postoperative outcome using preoperative planning with feasible computational cost. SIGNIFICANCE Towards the research society, the proposed method allows for a computationally efficient uncertainty quantification on a complex model. Towards surgical technique developers, six critical implant position parameters were identified, which should be the focus when refining surgical accuracy of TKA, leveraging better patient satisfaction.
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25
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Converse MI, Monson KL. Biaxial softening of isolated cerebral arteries following axial overstretch. J Mech Behav Biomed Mater 2021; 118:104447. [PMID: 33725523 DOI: 10.1016/j.jmbbm.2021.104447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 02/27/2021] [Accepted: 03/04/2021] [Indexed: 11/26/2022]
Abstract
Arteries play a critical role in carrying essential nutrients and oxygen throughout the brain; however, vessels can become damaged in traumatic brain injury (TBI), putting neural tissue at risk. Even in the absence of hemorrhage, large deformations can disrupt both the physiological and mechanical behavior of the cerebral vessels. Our group recently reported the effect of vessel overstretch on axial mechanics; however, that work did not address possible changes in circumferential mechanics that are critical to the regulation of blood flow. In order to address this in the present work, ovine middle cerebral arteries were isolated and overstretched axially to 10, 20, or 40% beyond the in vivo configuration. Results showed a statistically significant decrease in circumferential stiffness and strain energy, as well as an increase in vessel diameter following 40% overstretch (p < 0.05). These passive changes would lead to a decrease in vascular resistance and likely play a role in previous reports of cellular dysfunction. We anticipate that our findings will both increase understanding of vessel softening phenomena and also promote improved modeling of cerebrovascular mechanics following head trauma.
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Affiliation(s)
- Matthew I Converse
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, 84112, United States
| | - Kenneth L Monson
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, 84112, United States; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, 84112, United States.
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26
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Blaker CL, Zaki S, Little CB, Clarke EC. Long-term Effect of a Single Subcritical Knee Injury: Increasing the Risk of Anterior Cruciate Ligament Rupture and Osteoarthritis. Am J Sports Med 2021; 49:391-403. [PMID: 33378213 DOI: 10.1177/0363546520977505] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Rupture of the anterior cruciate ligament (ACL) is a well-known risk factor for the development of posttraumatic osteoarthritis (PTOA), but patients with the "same injury" can have vastly different trajectories for the onset and progression of disease. Minor subcritical injuries preceding the critical injury event may drive this disparity through preexisting tissue pathologies and sensory changes. PURPOSE To investigate the role of subcritical injury on ACL rupture risk and PTOA through the evaluation of pain behaviors, joint mechanics, and tissue structural change in a mouse model of knee injury. STUDY DESIGN Controlled laboratory study. METHODS Ten-week-old male C57BL/6J mice were allocated to naïve control and subcritical knee injury groups. Injury was induced by a single mechanical compression to the right hindlimb, and mice were evaluated using joint histopathology, anteroposterior joint biomechanics, pain behaviors (mechanical allodynia and hindlimb weightbearing), and isolated ACL tensile testing to failure at 1, 2, 4, or 8 weeks after injury. RESULTS Subcritical knee injury produced focal osteochondral lesions in the patellofemoral and lateral tibiofemoral compartments with no resolution for the duration of the study (8 weeks). These lesions were characterized by focal loss of proteoglycan staining, cartilage structural change, chondrocyte pathology, microcracks, and osteocyte cell loss. Injury also resulted in the rapid onset of allodynia (at 1 week), which persisted over time and reduced ACL failure load (P = .006; mean ± SD, 7.91 ± 2.01 N vs 9.37 ± 1.01 N in naïve controls at 8 weeks after injury), accompanied by evidence of ACL remodeling at the femoral enthesis. CONCLUSION The present study in mice establishes a direct effect of a single subcritical knee injury on the development of specific joint tissue pathologies (osteochondral lesions and progressive weakening of the ACL) and allodynic sensitization. These findings demonstrate a predisposition for secondary critical injuries (eg, ACL rupture) and an increased risk of PTOA onset and progression (structurally and symptomatically). CLINICAL RELEVANCE Subcritical knee injuries are a common occurrence and, based on this study, can cause persistent sensory and structural change. These findings have important implications for the understanding of risk factors of ACL injury and subsequent PTOA, particularly with regard to prevention and management strategies following an often underreported event.
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Affiliation(s)
- Carina L Blaker
- Murray Maxwell Biomechanics Laboratory, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, Faculty of Medicine and Health, Northern Clinical School, University of Sydney, St Leonards, Australia.,Raymond Purves Bone and Joint Research Laboratories, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, Faculty of Medicine and Health, Northern Clinical School, University of Sydney, St Leonards, Australia
| | - Sanaa Zaki
- Raymond Purves Bone and Joint Research Laboratories, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, Faculty of Medicine and Health, Northern Clinical School, University of Sydney, St Leonards, Australia.,Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Camperdown, Australia
| | - Christopher B Little
- Raymond Purves Bone and Joint Research Laboratories, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, Faculty of Medicine and Health, Northern Clinical School, University of Sydney, St Leonards, Australia
| | - Elizabeth C Clarke
- Murray Maxwell Biomechanics Laboratory, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, Faculty of Medicine and Health, Northern Clinical School, University of Sydney, St Leonards, Australia
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27
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Barrett JM, Fewster KM, Cudlip AC, Dickerson CR, Callaghan JP. The rate of tendon failure in a collagen fibre recruitment-based model. J Mech Behav Biomed Mater 2020; 115:104273. [PMID: 33373959 DOI: 10.1016/j.jmbbm.2020.104273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 11/30/2022]
Abstract
Accurate characterization of the mechanical response of collagenous tissues is critical for investigations into mechanisms of soft tissue injury. These tissues are inherently viscoelastic, exhibiting strain-rate dependent stiffnesses, creep, and stress-relaxation. The strain-rate features of the failure portion of the stress-strain curve are less well developed. Collagen-distribution based models are improving and capable of reproducing the non-linear aspects of the elastic response of soft tissues, but still require parameterization of failure regions. Therefore, the purpose of this investigation, was to determine whether the parameters characterizing the rate of damage accumulation in a collagen-distribution model are proportional to strain rate. Fifty rat tail tendons were subjected to one of five different strain rates (0.01, 0.05, 0.1, 0.15, 0.20 s-1) until failure in an uni-axial strain test. To test the hypothesis that the parameters associated with damage rate are proportional to strain rate, a collagen distribution model was employed with the parameters describing the rate of fibre damage being obtained by least-squares and regressed against the strain rate. The breaking function was found to be proportional to strain rate, with a proportionality constant of 60.7 s-1. Properties characterizing the failure portion of the stress-strain curves for rat tail tendons are also reported. The Young's Modulus did not vary with strain rate and was found to be 103.3 ± 49.5 MPa. Similarly, failure stresses and strains did not vary across the strain rates tested, and were 15.6 ± 6.1 MPa and 32.2 ± 9.1%, respectively.
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Affiliation(s)
- Jeff M Barrett
- University of Waterloo, Department of Kinesiology, Canada
| | | | - Alan C Cudlip
- University of Waterloo, Department of Kinesiology, Canada
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28
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Readioff R, Geraghty B, Elsheikh A, Comerford E. Viscoelastic characteristics of the canine cranial cruciate ligament complex at slow strain rates. PeerJ 2020; 8:e10635. [PMID: 33391887 PMCID: PMC7761198 DOI: 10.7717/peerj.10635] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/02/2020] [Indexed: 11/20/2022] Open
Abstract
Ligaments including the cruciate ligaments support and transfer loads between bones applied to the knee joint organ. The functions of these ligaments can get compromised due to changes to their viscoelastic material properties. Currently there are discrepancies in the literature on the viscoelastic characteristics of knee ligaments which are thought to be due to tissue variability and different testing protocols. The aim of this study was to characterise the viscoelastic properties of healthy cranial cruciate ligaments (CCLs), from the canine knee (stifle) joint, with a focus on the toe region of the stress-strain properties where any alterations in the extracellular matrix which would affect viscoelastic properties would be seen. Six paired CCLs, from skeletally mature and disease-free Staffordshire bull terrier stifle joints were retrieved as a femur-CCL-tibia complex and mechanically tested under uniaxial cyclic loading up to 10 N at three strain rates, namely 0.1%, 1% and 10%/min, to assess the viscoelastic property of strain rate dependency. The effect of strain history was also investigated by subjecting contralateral CCLs to an ascending (0.1%, 1% and 10%/min) or descending (10%, 1% and 0.1%/min) strain rate protocol. The differences between strain rates were not statistically significant. However, hysteresis and recovery of ligament lengths showed some dependency on strain rate. Only hysteresis was affected by the test protocol and lower strain rates resulted in higher hysteresis and lower recovery. These findings could be explained by the slow process of uncrimping of collagen fibres and the contribution of proteoglycans in the ligament extracellular matrix to intra-fibrillar gliding, which results in more tissue elongations and higher energy dissipation. This study further expands our understanding of canine CCL behaviour, providing data for material models of femur-CCL-tibia complexes, and demonstrating the challenges for engineering complex biomaterials such as knee joint ligaments.
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Affiliation(s)
- Rosti Readioff
- School of Engineering, University of Liverpool, Liverpool, UK
| | - Brendan Geraghty
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Ahmed Elsheikh
- School of Engineering, University of Liverpool, Liverpool, UK.,Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China.,UCL Institute of Ophthalmology, NIHR Moorfields BRC, London, UK
| | - Eithne Comerford
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,School of Veterinary Science, University of Liverpool, Neston, UK
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29
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Estébanez-de-Miguel E, González-Rueda V, Bueno-Gracia E, Pérez-Bellmunt A, López-de-Celis C, Caudevilla-Polo S. The immediate effects of 5-minute high-force long axis distraction mobilization on the strain on the inferior ilio-femoral ligament and hip range of motion: A cadaveric study. Musculoskelet Sci Pract 2020; 50:102262. [PMID: 33017732 DOI: 10.1016/j.msksp.2020.102262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/11/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The mechanical effects of hip joint mobilization on hip capsular-ligament tissue have never been studied. OBJECTIVE To evaluate the strain on the inferior ilio-femoral (IFF) ligament after 5 min of high-force long-axis distraction mobilization (LADM) and to analyse the immediate effects on hip range of motion (ROM). DESIGN Cross-sectional laboratory cadaveric study. METHODS Thirteen hips hip joints were mobilized from nine fresh-frozen cadavers (mean age, 75.6 ± 7.8 years). High-force LADM in open-packed position was maintained during 5 min. Strain on IFF ligament was measured with a microminiature differential variable reluctance transducer at the beginning and just before the end of high-force LADM. Hip flexion, extension, abduction and internal rotation ROM were assessed using a universal goniometer before and after joint mobilization. RESULTS The strain on IIF ligament increased 20.2 ± 8.5% after 5 min of high-force LADM, showing a significant increase (p = 0.004). Hip ROM also increased significantly (p < 0.05) with large effect sizes (d > 0.8). CONCLUSION The strain on IIF ligament and hip ROM increased significantly after 5 min of high-force LADM. The improvements on hip ROM appear to be related to the changes in the strain on capsular-ligament tissue after high-force LADM.
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Affiliation(s)
- Elena Estébanez-de-Miguel
- Department of Physiatrist and Nursery, Faculty of Heath Sciences, University of Zaragoza, Zaragoza, Spain.
| | - Vanessa González-Rueda
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona, Spain; Fundació Institut Universitari per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
| | - Elena Bueno-Gracia
- Department of Physiatrist and Nursery, Faculty of Heath Sciences, University of Zaragoza, Zaragoza, Spain
| | - Albert Pérez-Bellmunt
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona, Spain
| | - Carlos López-de-Celis
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona, Spain; Fundació Institut Universitari per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
| | - Santos Caudevilla-Polo
- Department of Physiatrist and Nursery, Faculty of Heath Sciences, University of Zaragoza, Zaragoza, Spain
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30
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Chamberlain CS, Kink JA, Wildenauer LA, McCaughey M, Henry K, Spiker AM, Halanski MA, Hematti P, Vanderby R. Exosome-educated macrophages and exosomes differentially improve ligament healing. STEM CELLS (DAYTON, OHIO) 2020; 39:55-61. [PMID: 33141458 PMCID: PMC7821004 DOI: 10.1002/stem.3291] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/01/2020] [Indexed: 01/01/2023]
Abstract
Recently, our group used exosomes from mesenchymal stromal/stem cells (MSCs) to simulate an M2 macrophage phenotype, that is, exosome-educated macrophages (EEMs). These EEMs, when delivered in vivo, accelerated healing in a mouse Achilles tendon injury model. For the current study, we first tested the ability of EEMs to reproduce the beneficial healing effects in a different rodent model, that is, a rat medial collateral ligament (MCL) injury model. We hypothesized that treatment with EEMs would reduce inflammation and accelerate ligament healing, similar to our previous tendon results. Second, because of the translational advantages of a cell-free therapy, exosomes alone were also examined to promote MCL healing. We hypothesized that MSC-derived exosomes could also alter ligament healing to reduce scar formation. Similar to our previous Achilles tendon results, EEMs improved mechanical properties in the healing ligament and reduced inflammation, as indicated via a decreased endogenous M1/M2 macrophage ratio. We also showed that exosomes improved ligament remodeling as indicated by changes in collagen production and organization, and reduced scar formation but without improved mechanical behavior in healing tissue. Overall, our findings suggest EEMs and MSC-derived exosomes improve healing but via different mechanisms. EEMs and exosomes each have attractive characteristics as therapeutics. EEMs as a cell therapy are terminally differentiated and will not proliferate or differentiate. Alternatively, exosome therapy can be used as a cell free, shelf-stable therapeutic to deliver biologically active components. Results herein further support using EEMs and/or exosomes to improve ligament healing by modulating inflammation and promoting more advantageous tissue remodeling.
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Affiliation(s)
- Connie S Chamberlain
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, Wisconsin, USA
| | - John A Kink
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA.,University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
| | - Linzie A Wildenauer
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, Wisconsin, USA
| | - Maxwell McCaughey
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, Wisconsin, USA
| | - Katie Henry
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, Wisconsin, USA
| | - Andrea M Spiker
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, Wisconsin, USA
| | - Matthew A Halanski
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Peiman Hematti
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA.,University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
| | - Ray Vanderby
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, Wisconsin, USA.,Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, USA
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31
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Barrett JM, Callaghan JP. A one-dimensional collagen-based biomechanical model of passive soft tissue with viscoelasticity and failure. J Theor Biol 2020; 509:110488. [PMID: 32931772 DOI: 10.1016/j.jtbi.2020.110488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Strains and sprains of soft tissues, including tendons and ligaments, are frequently occurring injuries. Musculoskeletal models show great promise in prediction and prevention of these injuries. However, these models rarely account for the viscoelastic properties of ligaments and tendons, much less their failure properties. The purpose of this project was to develop, simplify, and analyze a collagen-distribution model to address these limitations. MODEL DEVELOPMENT A distribution-moment approximation was applied to an existing partial differential equation model to reduce its computational complexity. The resulting model was equipped with a Voigt model in series, which endowed it with viscoelastic properties in addition to failure properties. RESULTS The model was able to reproduce the characteristic toe, linear, and failure regions ubiquitous throughout in-vitro tests on tissue specimens. In addition, it was able to reproduce a tri-phasic creep test consisting of an initial deformation, a steady-state, and failure. Stress-relaxation and hysteresis were also reproducible by the model. DISCUSSION AND CONCLUSION The ability to reproduce so many characteristics of biological tissues suggests more bio-fidelity was achieved by the reduced model was other currently available models. Future work to further improve its bio-fidelity is proposed for specific tendons and ligaments.
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Affiliation(s)
- Jeff M Barrett
- University of Waterloo, Department of Kinesiology, Waterloo, Ontario, Canada
| | - Jack P Callaghan
- University of Waterloo, Department of Kinesiology, Waterloo, Ontario, Canada.
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32
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Trajkovski A, Hribernik M, Kunc R, Kranjec M, Krašna S. Analysis of the mechanical response of damaged human cervical spine ligaments. Clin Biomech (Bristol, Avon) 2020; 75:105012. [PMID: 32371284 DOI: 10.1016/j.clinbiomech.2020.105012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 02/17/2020] [Accepted: 03/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cervical spine ligaments that protect the spinal cord and stabilize the spine are frequently injured in motor vehicle collisions and other traumatic situations. These injuries are usually incomplete, and often difficult to notice. The focus of the presented study is placed on analysis of the effect of subfailure load on the mechanical response of the three main cervical spine ligaments: the anterior and the posterior longitudinal ligament and the ligamentum flavum. METHODS A total of 115 samples of human cadaveric ligaments removed within 24-48 h after death have been tested. Uniaxial tension tests along the fiber direction were performed in physiological conditions on a custom designed test equipment. The ligaments were loaded into an expected damage zone at two different subfailure values (based on previously reported reference group of 46 samples), and then reloaded to failure. FINDINGS The main effect of a high subfailure load has proven to be the toe elongation change. The toe elongation increase is affected by the subfailure load value. While anterior and posterior longitudinal ligament showed similar changes, the smallest subfailure effect was found in ligamentum flavum. INTERPRETATIONS The normal physiological region of the cervical spine ligaments mechanical response is modified by a high subfailure load. The observed ligament injury significantly compromises ligament ability to give tensile support within physiological spinal motion.
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Affiliation(s)
- Ana Trajkovski
- Faculty of Mechanical Engineering, University of Ljubljana, Aškerčeva c. 6, 1000 Ljubljana, Slovenia.
| | - Marija Hribernik
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia.
| | - Robert Kunc
- Faculty of Mechanical Engineering, University of Ljubljana, Aškerčeva c. 6, 1000 Ljubljana, Slovenia.
| | - Matej Kranjec
- Faculty of Mechanical Engineering, University of Ljubljana, Aškerčeva c. 6, 1000 Ljubljana, Slovenia.
| | - Simon Krašna
- Faculty of Mechanical Engineering, University of Ljubljana, Aškerčeva c. 6, 1000 Ljubljana, Slovenia.
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33
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Rosario MV, Roberts TJ. Loading Rate Has Little Influence on Tendon Fascicle Mechanics. Front Physiol 2020; 11:255. [PMID: 32265742 PMCID: PMC7105874 DOI: 10.3389/fphys.2020.00255] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/05/2020] [Indexed: 11/13/2022] Open
Abstract
Mechanically, tendons behave like springs and store energy by stretching in proportion to applied stress. This relationship is potentially modified by the rate at which stress is applied, a phenomenon known as viscosity. Viscoelasticity, the combined effects of elasticity and viscosity, can affect maximum strain, the amount of stored energy, and the proportion of energy recovered (resilience). Previous studies of tendons have investigated the functional effects of viscoelasticity, but not at the intermediate durations of loading that are known to occur in fast locomotor events. In this study, we isolated tendon fascicles from rat tails and performed force-controlled tensile tests at rates between ∼10 MPa s–1 to ∼80 MPa s–1. At high rates of applied stress, we found that tendon fascicles strained less, stored less energy, and were more resilient than at low rates of stress (p = 0.007, p = 0.040, and p = 0.004, respectively). The measured changes, however, were very small across the range of strain rates studied. For example, the average strain for the slowest loading rate was 0.637% while it was 0.614% for the fastest loading. We conclude that although there is a measurable effect of loading rate on tendon mechanics, the effect is small and can be largely ignored in the context of muscle-actuated locomotion, with the possible exception of extreme muscle-tendon morphologies.
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Affiliation(s)
- Michael V Rosario
- Department of Ecology and Evolutionary Biology, Brown University, Providence, RI, United States.,Department of Biology, West Chester University, West Chester, PA, United States
| | - Thomas J Roberts
- Department of Ecology and Evolutionary Biology, Brown University, Providence, RI, United States
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34
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Ekwueme EC, Rao R, Mohiuddin M, Pellegrini M, Lee YS, Reiter MP, Jackson J, Freeman JW. Single-walled carbon nanohorns modulate tenocyte cellular response and tendon biomechanics. J Biomed Mater Res B Appl Biomater 2019; 108:1907-1914. [PMID: 31785088 DOI: 10.1002/jbm.b.34532] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 10/21/2019] [Accepted: 11/16/2019] [Indexed: 12/26/2022]
Abstract
Subfailure ligament and tendon injury remain a significant burden to global healthcare. Here, we present the use of biocompatible single-walled carbon nanohorns (CNH) as a potential treatment for the repair of sub-failure injury in tendons. First, in vitro exposure of CNH to human tenocytes revealed no change in collagen deposition but a significant decrease in cell metabolic activity after 14 days. Additionally, gene expression studies revealed significant downregulation of collagen Types I and III mRNA at 7 days with some recovery after 14 days of exposure. Biomechanical tests with explanted porcine digitorum tendons showed the ability of CNH suspensions to modulate tendon biomechanics, most notably elastic moduli immediately after treatment. in vivo experiments demonstrated the ability of CNH to persist in the damaged matrix of stretch-injured Sprague Dawley rat Achilles tendon but not significantly modify tendon biomechanics after 7 days of treatment. Although these results demonstrate the early feasibility of utility of CNH as a potential modality for tendon subfailure injury, additional work is needed to further validate and ensure clinical efficacy.
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Affiliation(s)
- Emmanuel C Ekwueme
- Department of Biomedical Engineering, Rutgers University, Piscataway, New Jersey
| | - Rohit Rao
- Department of Biomedical Engineering, Rutgers University, Piscataway, New Jersey
| | - Mahir Mohiuddin
- Department of Biomedical Engineering, Rutgers University, Piscataway, New Jersey
| | - Michael Pellegrini
- Department of Biomedical Engineering, Rutgers University, Piscataway, New Jersey
| | - Yong S Lee
- Department of Biomedical Engineering, Rutgers University, Piscataway, New Jersey
| | - Mary P Reiter
- Department of Biomedical Engineering, Rutgers University, Piscataway, New Jersey
| | - James Jackson
- Department of Biomedical Engineering, Rutgers University, Piscataway, New Jersey
| | - Joseph W Freeman
- Department of Biomedical Engineering, Rutgers University, Piscataway, New Jersey
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Hosseini Nasab SH, Smith CR, Schütz P, Postolka B, List R, Taylor WR. Elongation Patterns of the Collateral Ligaments After Total Knee Arthroplasty Are Dominated by the Knee Flexion Angle. Front Bioeng Biotechnol 2019; 7:323. [PMID: 31799245 PMCID: PMC6861521 DOI: 10.3389/fbioe.2019.00323] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/28/2019] [Indexed: 11/13/2022] Open
Abstract
The primary aim of this study was to assess the effects of total knee arthroplasty (TKA) implant design on collateral ligament elongation patterns that occur during level walking, downhill walking, and stair descent. Using a moving fluoroscope, tibiofemoral kinematics were captured in three groups of patients with different TKA implant designs, including posterior stabilized, medial stabilized, and ultra-congruent. The 3D in vivo joint kinematics were then fed into multibody models of the replaced knees and elongation patterns of virtual bundles connecting origin and insertion points of the medial and lateral collateral ligaments (MCL and LCL) were determined throughout complete cycles of all activities. Regardless of the implant design and activity type, non-isometric behavior of the collateral ligaments was observed. The LCL shortened with increasing knee flexion, while the MCL elongation demonstrated regional variability, ranging from lengthening of the anterior bundle to slackening of the posterior bundle. The implant component design did not demonstrate statistically significant effects on the collateral elongation patterns and this was consistent between the studied activities. This study revealed that post-TKA collateral ligament elongation is primarily determined by the knee flexion angle. The different anterior translation and internal rotation that were induced by three distinctive implant designs had minimal impact on the length change patterns of the collateral ligaments.
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Affiliation(s)
| | - Colin R Smith
- Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Pascal Schütz
- Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Barbara Postolka
- Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Renate List
- Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - William R Taylor
- Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
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Muench JR, Thelen DG, Henak CR. Interfibrillar shear behavior is altered in aging tendon fascicles. Biomech Model Mechanobiol 2019; 19:841-849. [PMID: 31707625 DOI: 10.1007/s10237-019-01251-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/04/2019] [Indexed: 12/11/2022]
Abstract
Tendon elongation involves both stretching and sliding between adjacent fascicles and fibers. Hence, age-related changes in tendon matrix properties may alter sliding behavior and thereby affect injury thresholds. The objective of this study was to investigate the effects of age on interfibrillar shear behavior in partial cut tendon fascicles. Cine microscopic imaging was used to track deformation patterns of intact and partial cut fascicles from mature (9 months, n = 10) and aged (32 months, n = 10) rat tail tendons. Finite element (FE) models coupled with experimental data provided insight into age-related changes in tissue constitutive properties that could give rise to age-dependent behavior. Intact fascicles from aged tendons exhibited a 28% lower linear region modulus and reduced toe region when compared to fascicles from mature tendons. Partial cut tendon fascicles consistently exhibited a shearing plane that extended longitudinally from the tip of the cut. Both mature and aged fascicles exhibited distinct failure that was observable in differential displacement across the shearing plane. However, aged fascicles exhibited 11-20% higher grip-to-grip strain at failure and tended to exhibit more variable and greater differential displacement at failure, when compared to mature fascicles. FE models suggest that this age-related change in shear behavior arises from a reduction in interfibrillar shear modulus with age. These data suggest that aging alters interfibrillar failure mechanisms and hence may contribute to the increased propensity for injury that is commonly seen in older tendons.
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Affiliation(s)
- Jared R Muench
- Department of Mechanical Engineering, University of Wisconsin-Madison, 3031 Mechanical Engineering Building, 1513 University Avenue, Madison, WI, 53706, USA
| | - Darryl G Thelen
- Department of Mechanical Engineering, University of Wisconsin-Madison, 3031 Mechanical Engineering Building, 1513 University Avenue, Madison, WI, 53706, USA.,Department of Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Drive, Madison, WI, USA.,Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI, USA
| | - Corinne R Henak
- Department of Mechanical Engineering, University of Wisconsin-Madison, 3031 Mechanical Engineering Building, 1513 University Avenue, Madison, WI, 53706, USA. .,Department of Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Drive, Madison, WI, USA. .,Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI, USA.
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Matsunaga R, Takahashi Y, Takahashi RH, Nagao T, Shishido T, Tateiwa T, Pezzotti G, Yamamoto K. A new method for diagnosing biochemical abnormalities of anterior cruciate ligament (ACL) in human knees: A Raman spectroscopic study. Acta Biomater 2019; 99:284-294. [PMID: 31525535 DOI: 10.1016/j.actbio.2019.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/07/2019] [Accepted: 09/11/2019] [Indexed: 12/21/2022]
Abstract
Anterior cruciate ligament (ACL) plays an essential role in knee joint stability and kinematics. The microstructural irregularities such as cellular changes and disorganization of the extracellular matrix (ECM) alter the mechanical properties of the ligament, leading to a significant knee functional instability and progression of osteoarthritis (OA). So far, the identification of the local abnormality in ACL has routinely relied on invasive analytical techniques such as histology or biochemical assays. The non-invasive diagnosis using magnetic resonance imaging (MRI) is still limited to identifying the presence/absence of partial/complete ruptures and mucoid degeneration. In this study, laser micro-Raman spectroscopy with near-infrared excitation (785 nm) was applied to human ACL in order to establish optical algorithms for non-destructively diagnosing a degeneration state at molecular level. Raman spectra were obtained from 44 ex-vivo ACL specimens, and these were subsequently classified as an early (subclinical) and advanced (clinical) level of tissue degradation based on the histopathological scoring system. The significant differences in Raman peak intensities were found between the different degeneration groups, which were assigned to the vibrational modes of nucleic acids in cells, collagens, and phospholipids. Linear discriminant analysis (LDA) was performed to identify cut-off values for the distributions of Raman intensity and intensity ratios, which enable to best discriminate between the early and advanced degenerated tissues. Raman intensity algorithms derived from I1101/I1749, [I1002/I1516vs. I1101/I1749], and [I1002/I1749vs. I1101/I1749], yielded a maximum diagnostic sensitivity of 100%, specificity of 80%, and accuracy of 91% for discriminating the degeneration severity. STATEMENT OF SIGNIFICANCE: In this study, laser micro-Raman spectroscopy was applied to human anterior cruciate ligament (ACL) to establish optical algorithms for non-destructively diagnosing the tissue degeneration at molecular level. To our knowledge, this is the first report on Raman diagnosis for human ACL. Linear discriminant analysis (LDA) was performed to identify cut-off values for Raman intensity and intensity ratios, which enable to best discriminate between an early (subclinical) and advanced (clinical) level of ACL degeneration. The intensity ratios of I1101/I1749, [I1002/I1516vs. I1101/I1749], and [I1002/I1749vs. I1101/I1749] yielded a maximum diagnostic sensitivity of 100%, specificity of 80%, and accuracy of 91% for discriminating the ACL degeneration. The present findings might contribute to expanding clinical diagnostic possibilities for non-invasively identifying tissue degeneration.
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Henninger HB, Ellis BJ, Scott SA, Weiss JA. Contributions of elastic fibers, collagen, and extracellular matrix to the multiaxial mechanics of ligament. J Mech Behav Biomed Mater 2019; 99:118-126. [PMID: 31351401 DOI: 10.1016/j.jmbbm.2019.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 05/29/2019] [Accepted: 07/19/2019] [Indexed: 12/21/2022]
Abstract
Elastin is a biopolymer known to provide resilience to extensible biologic tissues through elastic recoil of its highly crosslinked molecular network. Recent studies have demonstrated that elastic fibers in ligament provide significant resistance to tensile and especially shear stress. We hypothesized that the biomechanics of elastic fibers in ligament could be described as transversely isotropic with both fiber and matrix components in a multi-material mixture. Similarly, we hypothesized that material coefficients derived using the experimental tensile response could be used to predict the experimental shear response. Experimental data for uniaxial and transverse tensile testing of control tissues, and those enzymatically digested to disrupt elastin, were used as inputs to a material coefficient optimization algorithm. An additive decomposition of the strain energy was used to model the total stress as the sum of contributions from collagen fibers, elastic fibers, elastic matrix, and ground substance matrix. Matrices were modeled as isotropic Veronda-Westmann hyperelastic materials, whereas fiber families were modeled as piecewise exponential-linear hyperelastic materials. Optimizations provided excellent fits to the tensile experimental data for each treatment case and material model. Given the disparity in magnitude of stresses between longitudinal and transverse/shear tests and agreement between models and experiments, the hypothesized transversely isotropic material of elastin symmetry was supported. In addition, the coefficients derived from uniaxial and transverse tensile experiments provided reasonable predictions of the experimental behavior during shear deformation. The magnitudes of coefficients representing stress, nonlinearity, and stiffness supported the experimental evidence that elastic fibers dominate the low strain tensile and shear response of ligament. These findings demonstrate that the additive decomposition modeling strategy can represent each discrete fiber and matrix constituent and their relative contribution to the material response of the tissue. These experimental data and the validated constitutive model provide essential inputs and a framework to refine existing computational models of ligament and tendon mechanics by explicitly representing the mechanical contributions of elastic fibers.
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Affiliation(s)
- Heath B Henninger
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA; Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA; Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Benjamin J Ellis
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA; Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
| | - Sara A Scott
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Jeffrey A Weiss
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA; Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA; Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA.
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Tendon and Ligament Injuries in Elite Rugby: The Potential Genetic Influence. Sports (Basel) 2019; 7:sports7060138. [PMID: 31167482 PMCID: PMC6628064 DOI: 10.3390/sports7060138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 01/13/2023] Open
Abstract
This article reviews tendon and ligament injury incidence and severity within elite rugby union and rugby league. Furthermore, it discusses the biological makeup of tendons and ligaments and how genetic variation may influence this and predisposition to injury. Elite rugby has one of the highest reported injury incidences of any professional sport. This is likely due to a combination of well-established injury surveillance systems and the characteristics of the game, whereby high-impact body contact frequently occurs, in addition to the high intensity, multispeed and multidirectional nature of play. Some of the most severe of all these injuries are tendon and ligament/joint (non-bone), and therefore, potentially the most debilitating to a player and playing squad across a season or World Cup competition. The aetiology of these injuries is highly multi-factorial, with a growing body of evidence suggesting that some of the inter-individual variability in injury susceptibility may be due to genetic variation. However, little effort has been devoted to the study of genetic injury traits within rugby athletes. Due to a growing understanding of the molecular characteristics underpinning the aetiology of injury, investigating genetic variation within elite rugby is a viable and worthy proposition. Therefore, we propose several single nucleotide polymorphisms within candidate genes of interest; COL1A1, COL3A1, COL5A1, MIR608, MMP3, TIMP2, VEGFA, NID1 and COLGALT1 warrant further study within elite rugby and other invasion sports.
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Safa B, Lee A, Santare MH, Elliott DM. Evaluating Plastic Deformation and Damage as Potential Mechanisms for Tendon Inelasticity using a Reactive Modeling Framework. J Biomech Eng 2019; 141:2731931. [PMID: 31004138 DOI: 10.1115/1.4043520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Indexed: 12/12/2022]
Abstract
Inelastic behaviors, such as softening, a progressive decrease in modulus before failure, occur in tendon and are important aspect in degeneration and tendinopathy. These inelastic behaviors are generally attributed to two potential mechanisms: plastic deformation and damage. However, it is not clear which is primarily responsible. In this study, we evaluated these potential mechanisms of tendon inelasticity by using a recently developed reactive inelasticity model (RIE), which is a structurally-inspired continuum mechanics framework that models tissue inelasticity based on the molecular bond kinetics. Using RIE, we formulated two material models, one specific to plastic deformation and the other to damage. The models were independently fit to published experimental tensile tests of rat tail tendons. We quantified the inelastic effects and compared the performance of the two models in fitting the mechanical response during loading, relaxation, unloading, and reloading phases. Additionally, we validated the models by using the resulting fit parameters to predict an independent set of experimental stress-strain curves from ramp-to-failure tests. Overall, the models were both successful in fitting the experiments and predicting the validation data. However, the results did not strongly favor one mechanism over the other. As a result, to distinguish between plastic deformation and damage, different experimental protocols will be needed. Nevertheless, these findings suggest the potential of RIE as a comprehensive framework for studying tendon inelastic behaviors.
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Affiliation(s)
- Babak Safa
- Department of Mechanical Engineering, Department of Biomedical Engineering, University of Delaware, Newark, Delaware 19716
| | - Andrea Lee
- Department of Biomedical Engineering, University of Delaware, Newark, Delaware 19716
| | - Michael H Santare
- ASME Fellow, Department of Mechanical Engineering, Department of Biomedical Engineering, University of Delaware Newark, Delaware 19716
| | - Dawn M Elliott
- ASME Fellow, Department of Biomedical Engineering, Department of Mechanical Engineering, University of Delaware Newark, Delaware 19716
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In vivo kinematics and ligamentous function of the knee during weight-bearing flexion: an investigation on mid-range flexion of the knee. Knee Surg Sports Traumatol Arthrosc 2019; 28:797-805. [PMID: 30972464 PMCID: PMC6786938 DOI: 10.1007/s00167-019-05499-y] [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] [Received: 01/11/2019] [Accepted: 03/27/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To investigate the in vivo femoral condyle motion and synergistic function of the ACL/PCL along the weight-bearing knee flexion. METHODS Twenty-two healthy human knees were imaged using a combined MRI and dual fluoroscopic imaging technique during a single-legged lunge (0°-120°). The medial and lateral femoral condyle translation and rotation (measured using geometric center axis-GCA), and the length changes of the ACL/PCL were analyzed at: low (0°-30°), mid-range (30°-90°) and high (90°-120°) flexion of the knee. RESULTS At low flexion (0°-30°), the strains of the ACL and the posterior-medial bundle of the PCL decreased. The medial condyle showed anterior translation and lateral condyle posterior translation, accompanied with a sharp increase in external GCA rotation (internal tibial rotation). As the knee continued flexion in mid-range (30°-90°), both ACL and PCL were slack (with negative strain values). The medial condyle moved anteriorly before 60° of flexion and then posteriorly, accompanied with a slow increase of GCA rotation. As the knee flexed in high flexion (90°-120°), only the PCL had increasingly strains. Both medial and lateral condyles moved posteriorly with a rather constant GCA rotation. CONCLUSIONS The ACL and PCL were shown to play a reciprocal and synergistic role during knee flexion. Mid-range reciprocal anterior-posterior femoral translation or laxity corresponds to minimal constraints of the ACL and PCL, and may represent a natural motion character of normal knees. The data could be used as a valuable reference when managing the mid-range "instability" and enhancing high flexion capability of the knee after TKAs. LEVEL OF EVIDENCE Level IV.
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Ortún-Terrazas J, Cegoñino J, Santana-Penín U, Santana-Mora U, Pérez Del Palomar A. A porous fibrous hyperelastic damage model for human periodontal ligament: Application of a microcomputerized tomography finite element model. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2019; 35:e3176. [PMID: 30628171 DOI: 10.1002/cnm.3176] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 11/21/2018] [Accepted: 12/16/2018] [Indexed: 06/09/2023]
Abstract
The periodontal ligament (PDL) is a soft biological tissue that connects the tooth with the trabecular bone of the mandible. It plays a key role in load transmission and is primarily responsible for bone resorption and most common periodontal diseases. Although several numerical studies have analysed the biomechanical response of the PDL, most did not consider its porous fibrous structure, and only a few analysed damage to the PDL. This study presents an innovative numerical formulation of a porous fibrous hyperelastic damage material model for the PDL. The model considers two separate softening phenomena: fibre alignment during loading and fibre rupture. The parameters for the material model characterization were fitted using experimental data from the literature. Furthermore, the experimental tests used for characterization were computationally modelled to verify the material parameters. A finite element model of a portion of a human mandible, obtained by microcomputerized tomography, was developed, and the proposed constitutive model was implemented for the PDL. Our results confirm that damage to the PDL may occur mainly because of overpressure of the interstitial fluid, while large forces must be applied to damage the PDL fibrous network. Moreover, this study clarifies some aspects of the relationship between PDL damage and the bone remodelling process.
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Affiliation(s)
- Javier Ortún-Terrazas
- Group of Biomaterials, Aragon Institute of Engineering Research (I3A), Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain
| | - José Cegoñino
- Group of Biomaterials, Aragon Institute of Engineering Research (I3A), Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain
| | - Urbano Santana-Penín
- School of Dentistry, Faculty of Medicine and Odontology, Santiago de Compostela University, Santiago de Compostela, Spain
| | - Urbano Santana-Mora
- School of Dentistry, Faculty of Medicine and Odontology, Santiago de Compostela University, Santiago de Compostela, Spain
| | - Amaya Pérez Del Palomar
- Group of Biomaterials, Aragon Institute of Engineering Research (I3A), Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain
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Singh S, Kartha S, Bulka BA, Stiansen NS, Winkelstein BA. Physiologic facet capsule stretch can induce pain & upregulate matrix metalloproteinase-3 in the dorsal root ganglia when preceded by a physiological mechanical or nonpainful chemical exposure. Clin Biomech (Bristol, Avon) 2019; 64:122-130. [PMID: 29523370 PMCID: PMC6067996 DOI: 10.1016/j.clinbiomech.2018.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 12/22/2017] [Accepted: 01/15/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Neck pain from cervical facet loading is common and induces inflammation and upregulation of nerve growth factor (NGF) that can sensitize the joint afferents. Yet, the mechanisms by which these occur and whether afferents can be pre-conditioned by certain nonpainful stimuli are unknown. This study tested the hypothesis that a nonpainful mechanical or chemical insult predisposes a facet joint to generate pain after a later exposure to typically nonpainful distraction. METHODS Rats were exposed to either a nonpainful distraction or an intra-articular subthreshold dose of NGF followed by a nonpainful distraction two days later. Mechanical hyperalgesia was measured daily and C6 dorsal root ganglia (DRG) tissue was assayed for NGF and matrix metalloproteinase-3 (MMP-3) expression on day 7. FINDINGS The second distraction increased joint displacement and strains compared to its first application (p = 0.0011). None of the initial exposures altered behavioral sensitivity in either of the groups being pre-conditioned or in controls; but, sensitivity was established in both groups receiving a second distraction within one day that lasted until day 7 (p < 0.024). NGF expression in the DRG was increased in both groups undergoing a pre-conditioning exposure (p < 0.0232). Similar findings were observed for MMP-3 expression, with a pre-conditioning exposure increasing levels after an otherwise nonpainful facet distraction. INTERPRETATION These findings suggest that nonpainful insults to the facet joint, when combined, can generate painful outcomes, possibly mediated by upregulation of MMP-3 and mature NGF.
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Affiliation(s)
- Sagar Singh
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich Hall, Philadelphia, PA 19104, USA
| | - Sonia Kartha
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich Hall, Philadelphia, PA 19104, USA
| | - Ben A Bulka
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich Hall, Philadelphia, PA 19104, USA
| | - Nicholas S Stiansen
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich Hall, Philadelphia, PA 19104, USA
| | - Beth A Winkelstein
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich Hall, Philadelphia, PA 19104, USA; Department of Neurosurgery, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich Hall, Philadelphia, PA 19104, USA.
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Zitnay JL, Weiss JA. Load transfer, damage, and failure in ligaments and tendons. J Orthop Res 2018; 36:3093-3104. [PMID: 30175857 PMCID: PMC6454883 DOI: 10.1002/jor.24134] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/14/2018] [Indexed: 02/04/2023]
Abstract
The function of ligaments and tendons is to support and transmit loads applied to the musculoskeletal system. These tissues are often able to perform their function for many decades; however, connective tissue disease and injury can compromise ligament and tendon integrity. A range of protein and non-protein constituents, combined in a complex structural hierarchy from the collagen molecule to the tissue and covering nanometer to centimeter length scales, govern tissue function, and impart characteristic non-linear material behavior. This review summarizes the structure of ligaments and tendons, the roles of their constituent components for load transfer across the hierarchy of structure, and the current understanding of how damage occurs in these tissues. Disease and injury can alter the constituent make-up and structural organization of ligaments and tendons, affecting tissue function, while also providing insight to the role and interactions of individual constituents. The studies and techniques presented here have helped to understand the relationship between tissue constituents and the physical mechanisms (e.g., stretching, sliding) that govern material behavior at and between length scales. In recent years, new techniques have been developed to probe ever smaller length scales and may help to elucidate mechanisms of load transfer and damage and the molecular constituents involved in the in the earliest stages of ligament and tendon damage. A detailed understanding of load transfer and damage from the molecular to the tissue level may elucidate targets for the treatment of connective tissue diseases and inform practice to prevent and rehabilitate ligament and tendon injuries. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:3093-3104, 2018.
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Affiliation(s)
- Jared L. Zitnay
- Department of Bioengineering, and Scientific Computing and Imaging Institute University of Utah
| | - Jeffrey A. Weiss
- Department of Bioengineering, and Scientific Computing and Imaging Institute University of Utah,Department of Orthopaedics, University of Utah
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Peloquin JM, Santare MH, Elliott DM. Short cracks in knee meniscus tissue cause strain concentrations, but do not reduce ultimate stress, in single-cycle uniaxial tension. ROYAL SOCIETY OPEN SCIENCE 2018; 5:181166. [PMID: 30564409 PMCID: PMC6281910 DOI: 10.1098/rsos.181166] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 10/19/2018] [Indexed: 05/15/2023]
Abstract
Tears are central to knee meniscus pathology and, from a mechanical perspective, are crack-like defects (cracks). In many materials, cracks create stress concentrations that cause progressive local rupture and reduce effective strength. It is currently unknown if cracks in meniscus have these consequences; if they do, this would have repercussions for management of meniscus pathology. The objective of this study was to determine if a short crack in meniscus tissue, which mimics a preclinical meniscus tear, (a) causes crack growth and reduces effective strength, (b) creates a near-tip strain concentration and (c) creates unloaded regions on either side of the crack. Specimens with and without cracks were tested in uniaxial tension and compared in terms of macroscopic stress-strain curves and digital image correlation strain fields. The strain fields were used as an indicator of stress concentrations and unloaded regions. Effective strength was found to be insensitive to the presence of a crack (potential effect < 0.86 s.d.; β = 0.2), but significant strain concentrations, which have the potential to lead to long-term accumulation of tissue or cell damage, were observed near the crack tip.
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Affiliation(s)
- John M. Peloquin
- Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
| | - Michael H. Santare
- Department of Mechanical Engineering, University of Delaware, Newark, DE, USA
| | - Dawn M. Elliott
- Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
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Sample SJ, Racette MA, Hans EC, Volstad NJ, Schaefer SL, Bleedorn JA, Little JP, Waller KR, Hao Z, Block WF, Muir P. Use of a platelet-rich plasma-collagen scaffold as a bioenhanced repair treatment for management of partial cruciate ligament rupture in dogs. PLoS One 2018; 13:e0197204. [PMID: 29920524 PMCID: PMC6008044 DOI: 10.1371/journal.pone.0197204] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 04/27/2018] [Indexed: 01/14/2023] Open
Abstract
Dogs are commonly affected with cruciate ligament rupture (CR) and associated osteoarthritis (OA), and frequently develop a second contralateral CR. Platelet rich plasma (PRP) is a component of whole blood that contains numerous growth factors, which in combination with a collagen scaffold may act to promote bioenhanced primary repair of ligament. This study tested the hypothesis that treatment of partial stable CR stifles with an intra-articular collagen scaffold and PRP would decrease the disease progression, synovitis and risk of complete CR over a 12-month study period. We conducted a prospective cohort study of 29 client-owned dogs with an unstable stifle due to complete CR and stable contralateral stifle with partial CR. All dogs were treated with tibial plateau leveling osteotomy (TPLO) on the unstable stifle and a single intra-articular application of PRP-collagen in the stable partial CR stifle. Dogs were evaluated at the time of diagnosis, and at 10-weeks and 12-months after treatment. We evaluated correlation between both development of complete CR and time to complete CR with diagnostic tests including bilateral stifle radiographs, 3.0 Tesla magnetic resonance (MR) imaging, and bilateral stifle arthroscopy. Additionally, histologic evaluation of synovial biopsies, C-reactive protein (CRP) concentrations in serum and synovial fluid, and synovial total nucleated cell count, were determined. Results indicated that a single application of PRP-collagen in partial CR stifles of client owned dogs is not an effective disease-modifying therapy for the prevention of progression to complete CR. Radiographic effusion, arthroscopic evaluation of cranial cruciate ligament (CrCL) damage, and MR assessment of ligament fiber tearing in partial CR stifles correlated with progression to complete CR over the 12-month follow-up period. We determined that the best predictive model for development of complete CR in PRP-collagen treated partial CR stifles included variables from multiple diagnostic modalities.
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Affiliation(s)
- Susannah J. Sample
- Comparative Orthopaedic Research Laboratory, Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Molly A. Racette
- Comparative Orthopaedic Research Laboratory, Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Eric C. Hans
- Comparative Orthopaedic Research Laboratory, Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Nicola J. Volstad
- Comparative Orthopaedic Research Laboratory, Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Susan L. Schaefer
- Comparative Orthopaedic Research Laboratory, Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Jason A. Bleedorn
- Comparative Orthopaedic Research Laboratory, Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Jeffrey P. Little
- Comparative Orthopaedic Research Laboratory, Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Kenneth R. Waller
- Comparative Orthopaedic Research Laboratory, Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Zhengling Hao
- Comparative Orthopaedic Research Laboratory, Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Walter F. Block
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Peter Muir
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- * E-mail:
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Biomechanical property and modelling of venous wall. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2018; 133:56-75. [DOI: 10.1016/j.pbiomolbio.2017.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/13/2017] [Accepted: 11/15/2017] [Indexed: 11/18/2022]
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Zhang S, Zarei V, Winkelstein BA, Barocas VH. Multiscale mechanics of the cervical facet capsular ligament, with particular emphasis on anomalous fiber realignment prior to tissue failure. Biomech Model Mechanobiol 2018; 17:133-145. [PMID: 28821971 PMCID: PMC5809183 DOI: 10.1007/s10237-017-0949-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 08/04/2017] [Indexed: 12/11/2022]
Abstract
The facet capsular ligaments encapsulate the bilateral spinal facet joints and are common sources of painful injury due to afferent innervation. These ligaments exhibit architectural complexity, which is suspected to contribute to the experimentally observed lack of co-localization between macroscopic strain and microstructural tissue damage. The heterogeneous and multiscale nature of this ligament, combined with challenges in experimentally measuring its microscale mechanics, hinders the ability to understand sensory mechanisms under normal or injurious loading. Therefore, image-based, subject-specific, multiscale finite-element models were constructed to predict the mechanical responses of the human cervical facet capsular ligament under uniaxial tensile stretch. The models precisely simulated the force-displacement responses for all samples ([Formula: see text]) and showed promise in predicting the magnitude and location of peak regional strains at two different displacements. Yet, there was a loss of agreement between the model and experiment in terms of fiber organization at large tissue stretch, possibly due to a lack of accounting for tissue failure. The mean fiber stretch ratio predicted by the models was found to be significantly higher in regions that exhibited anomalous fiber realignment experimentally than in regions with normal realignment ([Formula: see text]). The development of microstructural abnormalities was associated with the predicted fiber-level stretch ([Formula: see text]), but not with the elemental maximum principal stress or maximum principal strain by logistic regression. The multiscale models elucidate a potential mechanical basis for predicting injury-prone tissue domains and for defining the relationships between macroscopic ligament stretch and microscale pathophysiology in the subfailure regime.
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Affiliation(s)
- Sijia Zhang
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Vahhab Zarei
- Department of Mechanical Engineering, University of Minnesota - Twin Cities, Minneapolis, MN, 55455, USA
| | - Beth A Winkelstein
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Victor H Barocas
- Department of Biomedical Engineering, University of Minnesota - Twin Cities, Minneapolis, MN, 55455, USA.
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Converse MI, Walther RG, Ingram JT, Li Y, Yu SM, Monson KL. Detection and characterization of molecular-level collagen damage in overstretched cerebral arteries. Acta Biomater 2018; 67:307-318. [PMID: 29225149 PMCID: PMC5794621 DOI: 10.1016/j.actbio.2017.11.052] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 11/21/2017] [Accepted: 11/29/2017] [Indexed: 12/22/2022]
Abstract
It is well established that overstretch of arteries alters their mechanics and compromises their function. However, the underlying structural mechanisms behind these changes are poorly understood. Utilizing a recently developed collagen hybridizing peptide (CHP), we demonstrate that a single mechanical overstretch of an artery produces molecular-level unfolding of collagen. In addition, imaging and quantification of CHP binding revealed that overstretch produces damage (unfolding) among fibers aligned with the direction of loading, that damage increases with overstretch severity, and that the onset of this damage is closely associated with tissue yielding. These findings held true for both axial and circumferential loading directions. Our results are the first to identify stretch-induced molecular damage to collagen in blood vessels. Furthermore, our approach is advantageous over existing methods of collagen damage detection as it is non-destructive, readily visualized, and objectively quantified. This work opens the door to revealing additional structure-function relationships in arteries. We anticipate that this approach can be used to better understand arterial damage in clinically relevant settings such as angioplasty and vascular trauma. Furthermore, CHP can be a tool for the development of microstructurally-based constitutive models and experimentally validated computational models of arterial damage and damage propagation across physical scales. STATEMENT OF SIGNIFICANCE Arteries play a critical role by carrying oxygen and essential nutrients throughout the body. However, trauma to the head and neck, as well as surgical interventions, can overstretch arteries and alter their mechanics. In order to better understand the cause of these changes, we employ a novel collagen hybridizing peptide (CHP) to study collagen damage in overstretched arteries. Our approach is unique in that we go beyond the fiber- and fibril-level and characterize molecular-level disruption. In addition, we image and quantify fluorescently-labeled CHP to reveal a new structure-property relationship in arterial damage. We anticipate that our approach can be used to better understand arterial damage in clinically relevant settings such as angioplasty and vascular trauma.
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Affiliation(s)
- Matthew I Converse
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT 84112, United States
| | - Raymond G Walther
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT 84112, United States
| | - Justin T Ingram
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112, United States
| | - Yang Li
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112, United States
| | - S Michael Yu
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112, United States; Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT 84112, United States
| | - Kenneth L Monson
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT 84112, United States; Department of Bioengineering, University of Utah, Salt Lake City, UT 84112, United States.
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