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Segal NA, Nilges JM, Oo WM. Sex differences in osteoarthritis prevalence, pain perception, physical function and therapeutics. Osteoarthritis Cartilage 2024; 32:1045-1053. [PMID: 38588890 DOI: 10.1016/j.joca.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/19/2024] [Accepted: 04/02/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE Women have a higher prevalence of osteoarthritis (OA) and worse clinical courses than men. However, the underlying factors and therapeutic outcomes of these sex-specific differences are incompletely researched. This review examines the current state of knowledge regarding sex differences in OA prevalence, risk factors, pain severity, functional outcomes, and use and response to therapeutics. METHODS PubMed database was used with the title keyword combinations "{gender OR sex} AND osteoarthritis" plus additional manual search of the included papers for pertinent references, yielding 212 references. Additional references were added and 343 were reviewed for appropriateness. RESULTS Globally, women account for 60% of people with osteoarthritis, with a greater difference after age 40. The higher risk for women may be due to differences in joint anatomy, alignment, muscle strength, hormonal influences, obesity, and/or genetics. At the same radiographic severity, women have greater pain severity than men, which may be explained by biologically distinct pain pathways, differential activation of central pain pathways, differences in pain sensitivity, perception, reporting, and coping strategies. Women have greater limitations of physical function and performance than men independent of BMI, OA severity, injury history, and amount of weekly exercise. Women also have greater use of analgesic medications than men but less use of arthroplasty and poorer prognosis after surgical interventions. CONCLUSIONS The recognition of sex differences in OA manifestations and management could guide tailoring of sex-specific treatment protocols, and analysis of sex as a biological variable in future research would enhance development of precision medicine.
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Affiliation(s)
- Neil A Segal
- University of Kansas Medical Center, Kansas City, KS, USA; The University of Iowa, Iowa City, IA, USA.
| | | | - Win Min Oo
- The University of Sydney, Sydney, Australia; University of Medicine, Mandalay, Mandalay, Myanmar.
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2
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Quizon MJ, Deppen JN, Barber GF, Kalelkar PP, Coronel MM, Levit RD, García AJ. VEGF-delivering PEG hydrogels promote vascularization in the porcine subcutaneous space. J Biomed Mater Res A 2024; 112:866-880. [PMID: 38189109 PMCID: PMC10984793 DOI: 10.1002/jbm.a.37666] [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: 11/16/2023] [Revised: 12/21/2023] [Accepted: 12/24/2023] [Indexed: 01/09/2024]
Abstract
For cell therapies, the subcutaneous space is an attractive transplant site due to its large surface area and accessibility for implantation, monitoring, biopsy, and retrieval. However, its poor vascularization has catalyzed research to induce blood vessel formation within the site to enhance cell revascularization and survival. Most studies focus on the subcutaneous space of rodents, which does not recapitulate important anatomical features and vascularization responses of humans. Herein, we evaluate biomaterial-driven vascularization in the porcine subcutaneous space. Additionally, we report the first use of cost-effective fluorescent microspheres to quantify perfusion in the porcine subcutaneous space. We investigate the vascularization-inducing efficacy of vascular endothelial growth factor (VEGF)-delivering synthetic hydrogels based on 4-arm poly(ethylene) glycol macromers with terminal maleimides (PEG-4MAL). We compare three groups: a non-degradable hydrogel with a VEGF-releasing PEG-4MAL gel coating (Core+VEGF gel); an uncoated, non-degradable hydrogel (Core-only); and naïve tissue. After 2 weeks, Core+VEGF gel has significantly higher tissue perfusion, blood vessel area, blood vessel density, and number of vessels compared to both Core-only and naïve tissue. Furthermore, healthy vital signs during surgery and post-procedure metrics demonstrate the safety of hydrogel delivery. We demonstrate that VEGF-delivering synthetic hydrogels induce robust vascularization and perfusion in the porcine subcutaneous space.
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Affiliation(s)
- Michelle J. Quizon
- Woodruff School of Mechanical Engineering and Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, 315 Ferst Dr. NW, Atlanta, GA 30332, USA
| | - Juline N. Deppen
- Division of Cardiology, Emory University School of Medicine, 1440 Clifton Rd, Atlanta, GA 30322, USA
| | - Graham F. Barber
- Woodruff School of Mechanical Engineering and Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, 315 Ferst Dr. NW, Atlanta, GA 30332, USA
| | - Pranav P. Kalelkar
- Woodruff School of Mechanical Engineering and Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, 315 Ferst Dr. NW, Atlanta, GA 30332, USA
| | - María M. Coronel
- Woodruff School of Mechanical Engineering and Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, 315 Ferst Dr. NW, Atlanta, GA 30332, USA
| | - Rebecca D. Levit
- Division of Cardiology, Emory University School of Medicine, 1440 Clifton Rd, Atlanta, GA 30322, USA
| | - Andrés J. García
- Woodruff School of Mechanical Engineering and Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, 315 Ferst Dr. NW, Atlanta, GA 30332, USA
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3
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Kaneguchi A, Kanehara M, Yamaoka K, Umehara T, Ozawa J. Effects of sex differences on osteoarthritic changes after anterior cruciate ligament reconstruction in rats. Acta Histochem 2024; 126:152172. [PMID: 38943867 DOI: 10.1016/j.acthis.2024.152172] [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: 12/04/2023] [Revised: 06/20/2024] [Accepted: 06/20/2024] [Indexed: 07/01/2024]
Abstract
The prevalence of primary osteoarthritis is higher in females than males. However, it remains unclear if there are sex differences in the incidence of post-traumatic osteoarthritis after anterior cruciate ligament (ACL) reconstruction. In this study, we aimed to investigate the effects of sex on osteoarthritic changes after ACL reconstruction using an animal model. Rats were divided into the following four groups: male control, male ACL reconstruction, female control, and female ACL reconstruction. ACL reconstruction surgery was performed on the right knees of rats in the ACL reconstruction groups, while rats in the control groups did not undergo knee surgery. At 1, 4, and 12 weeks after surgery, cartilage degeneration in the medial tibial plateau and osteophyte formation in the proximal tibia were histologically assessed. After ACL reconstruction, an increase in the Mankin score, cartilage fissures, and osteophyte formation were detected within 12 weeks in both male and female rats, with similar degrees of these changes between males and females. However, changes in cartilage thickness and chondrocyte density after ACL reconstruction differed between males and females. Cartilage thickening was observed in male rats but not in female rats. The increase in chondrocyte density in the anterior region was detected in both males and females but was more pronounced in female rats. In conclusion, osteoarthritic changes were observed after ACL reconstruction in both male and female rats, but differences in changes in cartilage thickness and chondrocyte density were observed between males and females.
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Affiliation(s)
- Akinori Kaneguchi
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan.
| | - Marina Kanehara
- Major in Medical Engineering and Technology, Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan
| | - Kaoru Yamaoka
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan
| | - Takuya Umehara
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan
| | - Junya Ozawa
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan
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4
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Stewart HL, Gilbert D, Stefanovski D, Garman Z, Albro MB, Bais M, Grinstaff MW, Snyder BD, Schaer TP. A missed opportunity: A scoping review of the effect of sex and age on osteoarthritis using large animal models. Osteoarthritis Cartilage 2024; 32:501-513. [PMID: 38408635 DOI: 10.1016/j.joca.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/13/2024] [Accepted: 02/20/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE The objective was to critically analyze the published literature accounting for sex differences and skeletal age (open vs. closed physis) in preclinical animal models of OA, including the disaggregation of data by sex and skeletal maturity when data is generated from combined sex and/or multi-aged cohorts without proper confounding. METHOD A scoping literature review of PubMed, Web of Science, EMBASE, and SCOPUS was performed for studies evaluating the effect of sex and age in experimental studies and clinical trials utilizing preclinical large animal models of OA. RESULTS A total of 9727 papers were identified in large animal (dog, pig, sheep, goat, horse) models for preclinical OA research, of which 238 ex vivo and/or in vivo studies disclosed model type, animal species, sex, and skeletal age sufficient to analyze their effect on outcomes. Dogs, followed by pigs, sheep, and horses, were the most commonly used models. A paucity of preclinical studies evaluated the effect of sex and age in large animal models of naturally occurring or experimentally induced OA: 26 total studies reported some kind of analysis of the effects of sex or age, with 4 studies discussing the effects of sex only, 11 studies discussing the effects of age only, and 11 studies analyzing both the effects of age and sex. CONCLUSION Fundamental to translational research, OARSI is uniquely positioned to develop recommendations for conducting preclinical studies using large animal models of OA that consider biological mechanisms linked to sex chromosomes, skeletal age, castration, and gonadal hormones affecting OA pathophysiology and treatment response.
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Affiliation(s)
- Holly L Stewart
- Department of Clinical Studies New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA 19348, USA
| | - Derek Gilbert
- Department of Clinical Studies New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA 19348, USA
| | - Darko Stefanovski
- Department of Clinical Studies New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA 19348, USA
| | - Zoe Garman
- Departments of Biomedical Engineering and Chemistry, Boston University, Boston MA 02215, USA
| | - Michael B Albro
- Department of Mechanical Engineering, Boston University, Boston MA 02215, USA
| | - Manish Bais
- Boston University, Henry M. Goldman School of Dental Medicine, Boston MA 02118, USA
| | - Mark W Grinstaff
- Departments of Biomedical Engineering and Chemistry, Boston University, Boston MA 02215, USA
| | - Brian D Snyder
- Department of Orthopaedic Surgery, Boston Children's Hospital Boston, MA 02215, USA
| | - Thomas P Schaer
- Department of Clinical Studies New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA 19348, USA.
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Marvin JC, Brakewood ME, Poon MLS, Andarawis-Puri N. Regenerative MRL/MpJ tendon cells exhibit sex differences in morphology, proliferation, mechanosensitivity, and cell-ECM organization. J Orthop Res 2023; 41:2273-2286. [PMID: 37004178 DOI: 10.1002/jor.25562] [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: 09/16/2022] [Revised: 02/10/2023] [Accepted: 03/24/2023] [Indexed: 04/03/2023]
Abstract
Clinical and animal studies have reported the influence of sex on the incidence and progression of tendinopathy, which results in disparate structural and biomechanical outcomes. However, there remains a paucity in our understanding of the sex-specific biological mechanisms underlying effective tendon healing. To overcome this hurdle, our group has investigated the impact of sex on tendon regeneration using the super-healer Murphy Roths Large (MRL/MpJ) mouse strain. We have previously shown that the scarless healing capacity of MRL/MpJ patellar tendons is associated with sexually dimorphic regulation of gene expression for pathways involved in fibrosis, cell migration, adhesion, and extracellular matrix (ECM) remodeling following an acute mid-substance injury. Thus, we hypothesized that MRL/MpJ scarless tendon healing is mediated by sex-specific and temporally distinct orchestration of cell-ECM interactions. Accordingly, the present study comparatively evaluated MRL/MpJ tendon cells on two-dimensional (2D; glass) and scaffold platforms to examine cell behavior under biochemical and topographical cues associated with tendon homeostasis and healing. Female MRL/MpJ cells showed reduced 2D migration and spreading area accompanied by enhanced mechanosensing, ECM alignment, and fibronectin-mediated cell proliferation compared to male MRL/MpJ cells. Interestingly, female MRL/MpJ cells cultured on isotropic scaffolds showed diminished cell-ECM organization compared to male MRL/MpJ cells. Lastly, MRL/MpJ cells elicited enhanced cytoskeletal elongation and alignment, ECM deposition and organization, and connexin 43-mediated intercellular communication compared to male B6 cells, regardless of culture condition or sex. These results provide insight into the cellular features conserved within the MRL/MpJ phenotype and potential sex-specific targets for the development of more equitable therapeutics.
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Affiliation(s)
- Jason C Marvin
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA
| | - Molly E Brakewood
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA
| | - Mong L S Poon
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York, USA
| | - Nelly Andarawis-Puri
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York, USA
- Hospital for Special Surgery, New York, New York, USA
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Vari N, Marot V, Cavaignac M, Vieira TD, Bérard É, Cavaignac E. Factors Affecting Graft Remodeling and Anterior Cruciate Ligament Reconstruction: MRI Study of 180 Knees. Am J Sports Med 2023; 51:2073-2078. [PMID: 37249129 DOI: 10.1177/03635465231171947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Several factors affect the retear rate after anterior cruciate ligament (ACL) reconstruction, but there are few data on which factors affect graft remodeling. PURPOSE To determine which factors are associated with the remodeling of an ACL graft. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A retrospective longitudinal study was conducted to investigate the relationship between various exposure factors and the occurrence of an "event": graft remodeling measured with the signal-to-noise quotient (SNQ). Data were collected prospectively and analyzed retrospectively for this study. The endpoint was the SNQ on magnetic resonance imaging at postoperative 1 year. The effect of the following parameters on SNQ was investigated: sex, smoking habits, age at surgery, body mass index, time to surgery, time to return to sports, type of sport (in-line, pivot, contact), type of graft (free semitendinosus [ST] or attached ST), and addition of lateral tenodesis. RESULTS An overall 180 patients were enrolled (90 with each technique). The following factors were significantly and independently associated with the SNQ: attached ST graft (β = -2.624668; P < .001), age at the time of surgery (β = -0.7948476; P = .012), and time elapsed between the injury event and surgery (β = -0.7137424; P = .046). CONCLUSION Leaving the ST graft attached distally, being older at the time of surgery, and having more time elapse between the injury event and ACL reconstruction surgery were significantly associated with better graft remodeling.
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Affiliation(s)
- Nicolas Vari
- Musculoskeletal Institute, Hôpital Pierre Paul Riquet, CHU Toulouse, Toulouse, France
| | - Vincent Marot
- Orthopaedics Unit, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra
| | | | - Thais Dutra Vieira
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Émilie Bérard
- Department of Epidemiology, Health Economics and Public Health, UMR 1295 CERPOP, University of Toulouse, INSERM, UPS, Toulouse University Hospital, Toulouse, France
| | - Etienne Cavaignac
- Musculoskeletal Institute, Hôpital Pierre Paul Riquet, CHU Toulouse, Toulouse, France
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Flannery SW, Murray MM, Badger GJ, Ecklund K, Kramer DE, Fleming BC, Kiapour AM. Early MRI-based quantitative outcomes are associated with a positive functional performance trajectory from 6 to 24 months post-ACL surgery. Knee Surg Sports Traumatol Arthrosc 2023; 31:1690-1698. [PMID: 35704062 PMCID: PMC9751233 DOI: 10.1007/s00167-022-07000-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/04/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Quantitative magnetic resonance imaging (qMRI) has been used to determine the failure properties of ACL grafts and native ACL repairs and/or restorations. How these properties relate to future clinical, functional, and patient-reported outcomes remain unknown. The study objective was to investigate the relationship between non-contemporaneous qMRI measures and traditional outcome measures following Bridge-Enhanced ACL Restoration (BEAR). It was hypothesized that qMRI parameters at 6 months would be associated with clinical, functional, and/or patient-reported outcomes at 6 months, 24 months, and changes from 6 to 24 months post-surgery. METHODS Data of BEAR patients (n = 65) from a randomized control trial of BEAR versus ACL reconstruction (BEAR II Trial; NCT02664545) were utilized retrospectively for the present analysis. Images were acquired using the Constructive Interference in Steady State (CISS) sequence at 6 months post-surgery. Single-leg hop test ratios, arthrometric knee laxity values, and International Knee Documentation Committee (IKDC) subjective scores were determined at 6 and 24 months post-surgery. The associations between traditional outcomes and MRI measures of normalized signal intensity, mean cross-sectional area (CSA), volume, and estimated failure load of the healing ACL were evaluated based on bivariate correlations and multivariable regression analyses, which considered the potential effects of age, sex, and body mass index. RESULTS CSA (r = 0.44, p = 0.01), volume (r = 0.44, p = 0.01), and estimated failure load (r = 0.48, p = 0.01) at 6 months were predictive of the change in single-leg hop ratio from 6 to 24 months in bivariate analysis. CSA (βstandardized = 0.42, p = 0.01), volume (βstandardized = 0.42, p = 0.01), and estimated failure load (βstandardized = 0.48, p = 0.01) remained significant predictors when considering the demographic variables. No significant associations were observed between MRI variables and either knee laxity or IKDC when adjusting for demographic variables. Signal intensity was also not significant at any timepoint. CONCLUSION The qMRI-based measures of CSA, volume, and estimated failure load were predictive of a positive functional outcome trajectory from 6 to 24 months post-surgery. These variables measured using qMRI at 6 months post-surgery could serve as prospective markers of the functional outcome trajectory from 6 to 24 months post-surgery, aiding in rehabilitation programming and return-to-sport decisions to improve surgical outcomes and reduce the risk of reinjury. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Sean W Flannery
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Martha M Murray
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Gary J Badger
- Department of Medical Biostatistics, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Kirsten Ecklund
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dennis E Kramer
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Braden C Fleming
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Ata M Kiapour
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA.
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de Rousiers A, Rougereau G, Rousselin B, Langlais T, Rollet ME, Bauer T, Bachy M, Hardy A. Adaptation of the Signal Noise Quotient MRI classification for graft ligamentization analysis following ATFL and CFL anatomical reconstruction: Validation of the SNQA. Foot Ankle Surg 2023; 29:243-248. [PMID: 36774199 DOI: 10.1016/j.fas.2023.01.013] [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: 07/04/2022] [Revised: 12/19/2022] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Chronic ankle instability is the most frequent clinical sign of an antero tibiofibular (ATFL) and/or calcaneo fibular ligament (CFL) tear. One common surgical technique is to use the distal tendon of the gracilis muscle to reconstruct both the ATFL and CFL. In the knee, the hamstring tendons used in anterior cruciate ligament (ACL) reconstruction may go through structural modifications called "ligamentization ". A noninvasive MRI technique has been developed using the Signal/Noise Quotient to compare the signal of the graft following reconstruction to that of the posterior cruciate ligament. To our knowledge no studies have ever evaluated radiographic changes in the graft over time. The main goal of this study was to develop a specific MRI protocol to evaluate graft remodeling following ATFL and CFL reconstruction over time. METHODS A prospective study of the changes in the MRI signal of the ATFL-CFL graft 3-months postoperatively was performed in 20 patients. The main outcome was a comparison of the graft signal to that of the peroneal fibular tendon and the surrounding noise to determine the Ankle SNQ (SNQA). MRI images were evaluated by two senior radiologists to assess inter-rater reliability and then 2 weeks later for the intra-rater reproducibility. RESULTS The intraclass correlation (ICC) showed excellent inter- and intra rater reliability for the ATFL SNQA (0.96 and 0.91, respectively); and for the CFL SNQA, the ICC was 0.97 and 0.99, respectively. Bland-Altman analysis showed very limited bias in the interpretation of SNQA. CONCLUSION This preliminary study confirmed the inter- and intra- rater reliability of a new tool using the SNQA.
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Affiliation(s)
- Arnaud de Rousiers
- Departement of Orthopedic Surgery, Ambroise Paré Hospital, APHP, 9 avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France.
| | - Grégoire Rougereau
- Departement of Orthopedic Surgery, Ambroise Paré Hospital, APHP, 9 avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - Benoit Rousselin
- Departement of Orthopedic Surgery, Ambroise Paré Hospital, APHP, 9 avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - Tristan Langlais
- Department of Pediatric Orthopedic Surgery, Trousseau Hospital, Sorbonne University, APHP, 26 avenue du Dr. Arnold Netter, 75012 Paris, France
| | - Marie-Eva Rollet
- Departement of Orthopedic Surgery, Ambroise Paré Hospital, APHP, 9 avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - Thomas Bauer
- Departement of Orthopedic Surgery, Ambroise Paré Hospital, APHP, 9 avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - Manon Bachy
- Department of Pediatric Orthopedic Surgery, Trousseau Hospital, Sorbonne University, APHP, 26 avenue du Dr. Arnold Netter, 75012 Paris, France; Université de Paris, B3OA, UMR CNRS 7052, INSERM U1271, 10 avenue de Verdun, 75010 Paris, France
| | - Alexandre Hardy
- Clinique du Sport, 28 boulevard Saint Marcel, 75005 Paris, France; GRC33 Sorbonne Université Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand Trousseau, 26 avenue du Dr Arnold Netter 75012 Paris
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9
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Howe D, Cone SG, Piedrahita JA, Collins B, Fordham LA, Griffith EH, Spang JT, Fisher MB. Sex-specific biomechanics and morphology of the anterior cruciate ligament during skeletal growth in a porcine model. J Orthop Res 2022; 40:1853-1864. [PMID: 34751996 PMCID: PMC9081289 DOI: 10.1002/jor.25207] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/24/2021] [Accepted: 10/23/2021] [Indexed: 02/04/2023]
Abstract
Pediatric anterior cruciate ligament (ACL) injuries are on the rise, and females experience higher ACL injury risk than males during adolescence. Studies in skeletally immature patients indicate differences in ACL size and joint laxity between males and females after the onset of adolescence. However, functional data regarding the ACL and its anteromedial and posterolateral bundles in the pediatric population remain rare. Therefore, this study uses a porcine model to investigate the sex-specific morphology and biomechanics of the ACL and its bundles throughout skeletal growth. Hind limbs from male and female Yorkshire pigs aged early youth to late adolescence were imaged using magnetic resonance imaging to measure the size and orientation of the ACL and its bundles, then biomechanically tested under anterior-posterior drawer using a robotic testing system. Joint laxity decreased (p < 0.001) while joint stiffness increased (p < 0.001) throughout skeletal growth in both sexes. The ACL was the primary stabilizer against anterior tibial loading, while the functional role of the anteromedial bundle increased with age (p < 0.001), with an earlier increase in males. ACL and posterolateral bundle cross-sectional area and ACL and anteromedial bundle length were larger in males than females during adolescence (p < 0.01 for all), while ACL and bundle sagittal angle remained similar between sexes. Additionally, in situ ACL stiffness versus cross-sectional area regressions were significant across skeletal growth (r2 = 0.75, p < 0.001 in males and r2 = 0.64, p < 0.001 in females), but not within age groups. This study has implications for age and sex-specific surgical intervention strategies and suggests the need for human studies.
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Affiliation(s)
- Danielle Howe
- Joint Department of Biomedical Engineering, North Carolina State University and the University of North Carolina- Chapel Hill; Raleigh, NC 27695,Comparative Medicine Institute, North Carolina State University; Raleigh, NC 27695
| | - Stephanie G. Cone
- Joint Department of Biomedical Engineering, North Carolina State University and the University of North Carolina- Chapel Hill; Raleigh, NC 27695,Comparative Medicine Institute, North Carolina State University; Raleigh, NC 27695,Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jorge A. Piedrahita
- Comparative Medicine Institute, North Carolina State University; Raleigh, NC 27695,Department of Molecular Biomedical Sciences, North Carolina State University; Raleigh, NC 27695
| | - Bruce Collins
- Comparative Medicine Institute, North Carolina State University; Raleigh, NC 27695,Department of Animal Science, North Carolina State University; Raleigh, NC 27695
| | - Lynn A. Fordham
- Department of Radiology, University of North Carolina- Chapel Hill; Chapel Hill, NC 27599
| | - Emily H. Griffith
- Department of Statistics, North Carolina State University; Raleigh, NC 27695
| | - Jeffrey T. Spang
- Department of Orthopaedics, University of North Carolina- Chapel Hill; Chapel Hill, NC 27599
| | - Matthew B. Fisher
- Joint Department of Biomedical Engineering, North Carolina State University and the University of North Carolina- Chapel Hill; Raleigh, NC 27695,Comparative Medicine Institute, North Carolina State University; Raleigh, NC 27695,Department of Orthopaedics, University of North Carolina- Chapel Hill; Chapel Hill, NC 27599,Corresponding Author Contact: Address: 4130 Engineering Building III, 911 Oval Drive, CB 7115, Raleigh, NC, 27695, Telephone: 919-515-5242, Fax: 919-513-3814,
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10
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Devana SK, Solorzano C, Nwachukwu B, Jones KJ. Disparities in ACL Reconstruction: the Influence of Gender and Race on Incidence, Treatment, and Outcomes. Curr Rev Musculoskelet Med 2022; 15:1-9. [PMID: 34970713 PMCID: PMC8804118 DOI: 10.1007/s12178-021-09736-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW Anterior cruciate ligament (ACL) rupture is a common injury that has important clinical and economic implications. We aimed to review the literature to identify gender, racial and ethnic disparities in incidence, treatment, and outcomes of ACL injury. RECENT FINDINGS Females are at increased risk for ACL injury compared to males. Intrinsic differences such as increased quadriceps angle and increased posterior tibial slope may be contributing factors. Despite lower rates of injury, males undergo ACL reconstruction (ACLR) more frequently. There is conflicting evidence regarding gender differences in graft failure and ACL revision rates, but males demonstrate higher return to sport (RTS) rates. Females report worse functional outcome scores and have worse biomechanical metrics following ACLR. Direct evidence of racial and ethnic disparities is limited, but present. White athletes have greater risk of ACL injury compared to Black athletes. Non-White and Spanish-speaking patients are less likely to undergo ACLR after ACL tear. Black and Hispanic youth have greater surgical delay to ACLR, increased risk for loss to clinical follow-up, and less physical therapy sessions, thereby leading to greater deficits in knee extensor strength during rehabilitation. Hispanic and Black patients also have greater risk for hospital admission after ACLR, though this disparity is improving. Females have higher rates of ACL injury with inconclusive evidence on anatomic predisposition and ACL failure rate differences between genders. Recent literature has suggested inferior RTS and functional outcomes following ACLR in females. Though there is limited and mixed data on incidence and outcome differences between races and ethnic groups, recent studies suggest there may be disparities in those who undergo ACLR and time to treatment.
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Affiliation(s)
- Sai K. Devana
- Department of Orthopaedic Surgery, University of California, Los Angeles, USA
| | - Carlos Solorzano
- Department of Orthopaedic Surgery, University of California, Los Angeles, USA
| | - Benedict Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, USA
| | - Kristofer J. Jones
- Department of Orthopaedic Surgery, University of California, Los Angeles, USA
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Association Between Knee Moments During Stair Navigation and Participant-Related Factors in Individuals With Anterior Cruciate Ligament Reconstruction: A Cross-Sectional Study. J Sport Rehabil 2021; 31:174-180. [PMID: 34794119 DOI: 10.1123/jsr.2021-0104] [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] [Received: 03/25/2021] [Revised: 08/03/2021] [Accepted: 08/18/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Altered knee joint mechanics may be related to quadriceps muscle strength, time since surgery, and sex following anterior cruciate ligament reconstruction (ACLR). The aim of this study was to investigate the association between knee moments, with participant-related factors during stair navigation post-ACLR. DESIGN Cross-sectional study. METHODS A total of 30 participants (14 women) with ACLR, on average 7.0 (SD 4.4) years postsurgery were tested during stair ascent and descent in a gait laboratory. Motion capture was conducted using a floor-embedded force plate and 11 infrared cameras. Quadriceps concentric and eccentric muscle strength was measured with an isokinetic dynamometer at 60°/s, and peak torques recorded. Multiple regression analyses were performed between external knee flexion and adduction moments, respectively, and quadriceps peak torque, sex, and time since ACLR. RESULTS Higher concentric quadriceps strength and female sex accounted for 55.7% of the total variance for peak knee flexion moment during stair ascent (P < .001). None of the independent variables accounted for variance in knee adduction moment (P = .698). No significant associations were found for knee flexion and adduction moments during for stair descent. CONCLUSION Higher quadriceps concentric strength and sex explains major variance in knee flexion moments during stair ascent. The strong association between muscle strength and external knee flexion moments during stair ascent indicate rehabilitation tailored for quadriceps may optimize knee mechanics, particularly for women.
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12
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Zhang L, Wang R, Zhang P, Liu H, Wang G, Fu S. The employment of cynomolgus monkey as proprioceptive deficit model of the anterior cruciate ligament. J Orthop Surg (Hong Kong) 2021; 29:23094990211015519. [PMID: 34036869 DOI: 10.1177/23094990211015519] [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] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Clinically, a consensus of the treatment strategies of ACL grade 2 injury is not reached. Therefore, the present study established a proprioceptive deficit model of the ACL via an arthroscope to aid with further studying ACL grade 2 injury and treatment strategies. MATERIALS AND METHODS 12 cynomolgus monkeys were randomly divided into the model group and the blank control group. In the model group, 1/4 of the ACL was cut under an arthroscope, whereas no intervention was performed in the blank control group. Physiological data including the maximum degree of knee flexion, the thigh circumstance and the calf circumference were measured, and the Pivot-shift, Anterior and Lachman tests were also performed. Moreover, electrophysiological data including somatosensory evoked potentials (SEPs) and motor nerve conduction velocity (MNCV) were measured. SEPs and MNCV were assessed for the latent period and amplitude. RESULTS Comparing the data before and after the surgery, in the blank control group, no significant difference was observed. In the model group, significant difference was observed in the Pivot-shift, Anterior drawer and Lachman test (p < 0.05), indicating the instability of the ACL. Moreover, the latent period of SEPs and MNCV were significantly increased (p < 0.009), whereas the amplitude of SEPs and MNCV was significantly decreased (p < 0.009), indicating a degenerated proprioception of the knee joint. CONCLUSIONS Following cutting 1/4 of the ACL, the knee joint became unstable and proprioception was declined. The results indicated that the proprioceptive deficit model of the ACL was successfully established, which could promote further studying ACL injury.
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Affiliation(s)
- Lei Zhang
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China.,Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China.,Academician Workstation in Luzhou, Luzhou, Sichuan, People's Republic of China.,Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Guangzhou, Guangdong, People's Republic of China
| | - Ruihan Wang
- Clinical Medical College of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Ping Zhang
- Operating Theater, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Huan Liu
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China.,Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China.,Academician Workstation in Luzhou, Luzhou, Sichuan, People's Republic of China.,Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Guangzhou, Guangdong, People's Republic of China
| | - Guoyou Wang
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China.,Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China.,Academician Workstation in Luzhou, Luzhou, Sichuan, People's Republic of China.,Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Guangzhou, Guangdong, People's Republic of China
| | - Shijie Fu
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China.,Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China.,Academician Workstation in Luzhou, Luzhou, Sichuan, People's Republic of China.,Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Guangzhou, Guangdong, People's Republic of China
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13
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Takahashi T, Takeshita K. In Vivo biomechanical evaluations of suture anchors for repairing grade 3 superficial medial collateral ligament injury in a porcine model. J Orthop Surg (Hong Kong) 2021; 29:23094990211021536. [PMID: 34121508 DOI: 10.1177/23094990211021536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To clarify the biomechanical and radiological outcomes of superficial medial collateral ligament (sMCL) repair using suture anchors in a large animal model. METHODS The right sMCLs of nine male castrated pigs was completely detached at the femoral attachment. sMCL repair surgery was performed using two suture anchors. The same skin incision, sMCL exposure, and immediate wound closure were made at the left knee as a sham surgery. Magnetic resonance imaging was performed preoperatively and 4 weeks after surgery. The structural properties (upper yield load, maximum load, linear stiffness, and elongation at failure) of the femur-sMCL-tibia complex were determined. RESULTS During tensile testing, all the repaired sMCLs avulsed from the femoral attachment. There were no significant differences in the upper yield load, maximum load, linear stiffness, or elongation at failure between the groups 4 weeks after surgery or in the MRI-derived signal-to-noise quotients (SNQs) at the mid and tibial sMCL. The SNQs differed significantly at the femoral (2.7 ± 1.2 vs 0.3 ± 0.7; P = 0.00064) portions between groups. CONCLUSION The injured sMCLs biomechanically recovered after surgery using suture anchors even though the SNQs were higher than those with native contralateral sMCLs. For clinical relevance, sMCL repair of grade 3 sMCL injuries using suture anchors was both safe and successful with less tissue dissection.
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Affiliation(s)
- Tsuneari Takahashi
- Department of Orthopaedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Katsushi Takeshita
- Department of Orthopaedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
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14
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Reiter AJ, Schott HR, Castile RM, Cannon PC, Havlioglu N, Chamberlain AM, Lake SP. Females and males exhibit similar functional, mechanical, and morphological outcomes in a rat model of posttraumatic elbow contracture. J Orthop Res 2021; 39:2062-2072. [PMID: 33222267 PMCID: PMC8140065 DOI: 10.1002/jor.24918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/27/2020] [Accepted: 11/19/2020] [Indexed: 02/04/2023]
Abstract
Posttraumatic joint contracture (PTJC) is a debilitating condition characterized by loss of joint motion following injury. Previous work in a rat model of elbow PTJC investigated disease etiology, progression, and recovery in only male animals; this study explored sex-based differences. Rat elbows were subjected to a unilateral anterior capsulotomy and lateral collateral ligament transection followed by 42 days of immobilization and 42 days of free mobilization. Grip strength and gait were collected throughout the free mobilization period while joint mechanical testing, microcomputed tomography and histological analysis were performed postmortem. Overall, few differences were seen between sexes in functional, mechanical, and morphological outcomes with PTJC being similarly debilitating in male and female animals. Functional measures of grip strength and gait showed that, while some baseline differences existed between sexes, traumatic injury produced similar deficits that remained significantly different long-term when compared to control animals. Similarly, male and female animals both had significant reductions in joint range of motion due to injury. Ectopic calcification (EC), which had not been previously evaluated in this injury model, was present in all limbs on the lateral side. Injury caused increased EC volume but did not alter mineral density regardless of sex. Furthermore, histological analysis of the anterior capsule showed minor differences between sexes for inflammation and thickness but not for other histological parameters. A quantitative understanding of sex-based differences associated with this injury model will help inform future therapeutics aimed at reducing or preventing elbow PTJC.
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Affiliation(s)
- Alex J. Reiter
- Department of Mechanical Engineering & Materials Science, Washington University in St. Louis, St. Louis, MO
| | - Hayden R. Schott
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO
| | - Ryan M. Castile
- Department of Mechanical Engineering & Materials Science, Washington University in St. Louis, St. Louis, MO
| | | | - Necat Havlioglu
- Department of Pathology, John Cochran VA Medical Center, St. Louis, MO
| | - Aaron M. Chamberlain
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO
| | - Spencer P. Lake
- Department of Mechanical Engineering & Materials Science, Washington University in St. Louis, St. Louis, MO,Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO,Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO
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15
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Rojas G, Perelli S, Ibanez M, Formagnana M, Ormazabal I, Monllau JC. Effect of Modified Lemaire Anterolateral Extra-articular Tenodesis on the Magnetic Resonance Imaging Maturity Signal of Anterior Cruciate Ligament Hamstring Graft. Am J Sports Med 2021; 49:2379-2386. [PMID: 34133234 DOI: 10.1177/03635465211018858] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Lateral extra-articular tenodesis (LET) is one of the most widely used procedures to restore anterolateral stability. Clinical outcomes after the addition of LET to anterior cruciate ligament (ACL) reconstruction (ACLR) have been widely investigated; however, the potential influence of LET on the ACL ligamentization process has not been examined. PURPOSE/HYPOTHESIS The purpose was to use 10-month postoperative magnetic resonance imaging (MRI) scans to determine whether the maturity of grafts after hamstring autograft ACLR was affected by concomitant LET. The hypothesis was that when modified Lemaire lateral extra-articular tenodesis (MLLET) was performed, the MRI parameters of ACL graft maturity would be modified. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The study included patients treated between December 2017 and December 2018 who had undergone anatomic 3-strand hamstring tendon autograft ACLR, with or without concomitant MLLET, and had undergone MRI 10 months postoperatively. Thus, the study included 30 patients who had isolated ACLR and 22 patients who had ACLR plus MLLET. The 2 groups were comparable based on all criteria analyzed. To evaluate graft maturity, the signal-to-noise quotient (SNQ) was measured in 3 regions of interest of the proximal, midsubstance, and distal ACL graft. Lower SNQ ratios indicate less water content and, theoretically, better maturity and healing of the graft. RESULTS The mean ± SD for SNQ was 4.62 ± 4.29 (range, 3.12-6.19) in the isolated ACLR group and 7.59 ± 4.68 (range, 4.38-8.04) in the ACLR plus MLLET group (P = .012). Upon comparing the mean values of the 3 portions between the 2 groups, we found a significant difference between the 2 groups for the proximal and middle portions (P = .007 and P = .049, respectively) but no difference in the distal portion (P = .369). CONCLUSION At the 10-month follow-up, hamstring tendon autografts for anatomic ACLR with MLLET did not show the same MRI signal intensity compared with isolated hamstring anatomic ACLR.
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Affiliation(s)
- Gonzalo Rojas
- Department of Orthopaedic Surgery, Hospital Regional de Talca, Talca, Chile.,Universidad Católica del Maule, Talca, Chile
| | - Simone Perelli
- Institut Català de Traumatologia i Medicina de l'Esport (ICATME)-Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Surgery and Morphologic Science, Orthopaedic Surgery Service, Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, Spain
| | - Maximiliano Ibanez
- Institut Català de Traumatologia i Medicina de l'Esport (ICATME)-Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mario Formagnana
- Institut Català de Traumatologia i Medicina de l'Esport (ICATME)-Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Orthopaedic Surgery, E. Agnelli Hospital, Pinerolo, Italy
| | - Inmaculada Ormazabal
- Radiology Department, Hospital Universitari Quiron Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Carlos Monllau
- Institut Català de Traumatologia i Medicina de l'Esport (ICATME)-Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Surgery and Morphologic Science, Orthopaedic Surgery Service, Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, Spain
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16
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Laplace-Builhé B, Bahraoui S, Jorgensen C, Djouad F. From the Basis of Epimorphic Regeneration to Enhanced Regenerative Therapies. Front Cell Dev Biol 2021; 8:605120. [PMID: 33585444 PMCID: PMC7873919 DOI: 10.3389/fcell.2020.605120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/14/2020] [Indexed: 01/01/2023] Open
Abstract
Current cell-based therapies to treat degenerative diseases such as osteoarthritis (OA) fail to offer long-term beneficial effects. The therapeutic effects provided by mesenchymal stem cell (MSC) injection, characterized by reduced pain and an improved functional activity in patients with knee OA, are reported at short-term follow-up since the improved outcomes plateau or, even worse, decline several months after MSC administration. This review tackles the limitations of MSC-based therapy for degenerative diseases and highlights the lessons learned from regenerative species to comprehend the coordination of molecular and cellular events critical for complex regeneration processes. We discuss how MSC injection generates a positive cascade of events resulting in a long-lasting systemic immune regulation with limited beneficial effects on tissue regeneration while in regenerative species fine-tuned inflammation is required for progenitor cell proliferation, differentiation, and regeneration. Finally, we stress the direct or indirect involvement of neural crest derived cells (NCC) in most if not all adult regenerative models studied so far. This review underlines the regenerative potential of NCC and the limitations of MSC-based therapy to open new avenues for the treatment of degenerative diseases such as OA.
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Affiliation(s)
| | | | - Christian Jorgensen
- IRMB, Univ Montpellier, INSERM, Montpellier, France.,CHU Montpellier, Montpellier, France
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17
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Cavaignac E, Mesnier T, Marot V, Fernandez A, Faruch M, Berard E, Sonnery-Cottet B. Effect of Lateral Extra-articular Tenodesis on Anterior Cruciate Ligament Graft Incorporation. Orthop J Sports Med 2020; 8:2325967120960097. [PMID: 33299900 PMCID: PMC7711232 DOI: 10.1177/2325967120960097] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/30/2020] [Indexed: 12/28/2022] Open
Abstract
Background: It has been shown that adding lateral extra-articular tenodesis (LET) to
standard anterior cruciate ligament (ACL) reconstruction significantly
decreases the loads on the ACL composite graft. To date, the possible effect
of LET on ACL graft incorporation is not known. Purpose: To compare the incorporation in tibial bone tunnels of a standard quadrupled
semitendinosus (ST4) graft to an ST4 graft plus LET at 1 year
postoperatively using magnetic resonance imaging (MRI). Study Design: Cohort study; Level of evidence, 3. Methods: A total of 62 patients who underwent ACL reconstruction were enrolled
prospectively: 31 received an ST4 graft, and 31 received an ST4 graft plus
LET. Graft incorporation was evaluated with MRI at the 1-year follow-up
visit. The following parameters were evaluated: signal-to-noise quotient
(SNQ), tibial tunnel widening, graft healing, and graft maturity according
to the Howell scale. The primary endpoint was the SNQ of the ST4 graft at 1
year postoperatively; this parameter was adjusted because of unequal
baseline characteristics between groups. Clinical and functional outcomes as
well as incorporation of the graft were analyzed as secondary endpoints. Results: The mean adjusted SNQ was 0.5 ± 2.1 (95% CI, 0.4-4.6) in the ST4 + LET group
and 5.9 ± 3.7 (95% CI, 4.7-7.0) in the ST4 group (P =
.0297). The mean tibial tunnel widening was 73.7% ± 42.2% in the ST4 + LET
group versus 77.5% ± 46.7% in the ST4 group (P = .5685).
Howell grade I, indicative of better graft maturity, was statistically more
frequent in the ST4 + LET group (P = .0379). No
statistically significant difference was seen between groups in terms of
graft healing (P = .1663). The Lysholm score was
statistically higher in the ST4 + LET group (P = .0058). No
significant differences were found between groups in terms of the
International Knee Documentation Committee subjective score
(P = .2683) or Tegner score (P =
.7428). The mean SNQ of the LET graft at the 1-year follow-up visit was 2.6
± 4.9. Conclusion: At 1 year postoperatively, the MRI appearance of ACL grafts showed generally
better incorporation and maturation when combined with LET.
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Affiliation(s)
- Etienne Cavaignac
- Department of Orthopedic Surgery and Trauma, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,I2R, Institut de Recherche Riquet, Toulouse, France
| | - Timothée Mesnier
- Department of Orthopedic Surgery and Trauma, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Vincent Marot
- Department of Orthopedic Surgery and Trauma, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Andrea Fernandez
- Department of Orthopedic Surgery and Trauma, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Marie Faruch
- Department of Radiology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Emilie Berard
- Department of Epidemiology, Health Economics and Public Health, Centre Hospitalier Universitaire de Toulouse, University of Toulouse III, Toulouse, France
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18
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Young age, female gender, Caucasian race, and workers' compensation claim are risk factors for reoperation following arthroscopic ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2020; 28:2213-2223. [PMID: 31813020 DOI: 10.1007/s00167-019-05798-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 11/12/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Given the increasing incidence of arthroscopic anterior cruciate ligament reconstruction (ACLR), mid- to long-term rates of reoperations were investigated on the ipsilateral knee following ACLR. METHODS New York Statewide Planning and Research Cooperative Systems (SPARCS) database was queried from 2003 to 2012 to identify patients with a primary ICD-9 diagnosis for ACL tear and concomitant CPT code for ACLR. Patients were longitudinally followed for at least 2 years to determine incidence and nature of subsequent ipsilateral knee procedures. RESULTS The inclusion criteria were met by 45,231 patients who had undergone ACLR between 2003 and 2012. Mean age was found to be 29.7 years (SD 11.6). Subsequent ipsilateral outpatient knee surgery after a mean of 25.7 ± 24.5 months was performed in 10.7% of patients. Revision ACLR was performed for nearly one-third of reoperations. Meniscal pathology was addressed in 58% of subsequent procedures. Age 19 or younger, female gender, worker's compensation (WC) insurance, and Caucasian race were identified as independent risk factors for any ipsilateral reoperation. An initial isolated ACLR and initial ACLR performed by a high-volume surgeon were found to be independently associated with lower reoperation rates. Tobacco use was not significant. Survival rates of 93.4%, 89.8% and 86.7% at 2-, 5- and 10 years, respectively, were found for any ipsilateral reoperation. CONCLUSION A 10.7% ipsilateral reoperation rate at an average of 25.9 (SD 24.5) months after ACLR and an overall ACLR revision rate of 3.1% were demonstrated by the analysis. Meniscal pathology was addressed in the majority of subsequent interventions. Age 19 or younger, female gender, Caucasian race, and WC claim were associated with reoperation. Initial isolated ACLR and procedure performed by high-volume surgeon were associated with reduced reoperation. LEVEL OF EVIDENCE Level III.
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19
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Barnett S, Badger GJ, Kiapour A, Yen YM, Henderson R, Freiberger C, Proffen B, Sant N, Trainor B, Fleming BC, Micheli LJ, Murray MM, Kramer DE. Females Have Earlier Muscle Strength and Functional Recovery After Bridge-Enhanced Anterior Cruciate Ligament Repair. Tissue Eng Part A 2020; 26:702-711. [PMID: 32589515 DOI: 10.1089/ten.tea.2020.0057] [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] [Indexed: 12/22/2022] Open
Abstract
Background: While a sex effect on outcomes following anterior cruciate ligament (ACL) reconstruction surgery has been previously documented, less is known following bridge-enhanced ACL repair (BEAR). We hypothesized that female sex would have significantly worse early functional outcomes and higher retear rates following primary repair of the ACL enhanced with a tissue-engineered scaffold. Methods: Sixty-five patients (28 males and 37 females), age 14-35 with a complete ACL tear underwent primary repair of the ACL enhanced with a tissue-engineered scaffold (bridge-enhanced ACL repair) within 45 days of injury. International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome (KOOS) scores, as well as instrumented anteroposterior (AP) laxity through KT-1000 testing and functional outcome measures were obtained at time points up to 2 years postoperatively and compared between males and females using mixed model repeated measures analyses and chi square tests. Results: There was no significant sex difference on the postoperative IKDC Subjective Score at 3, 6, 12, or 24 months or any of the five KOOS scores at 12 and 24 months. Instrumented AP laxity testing demonstrated mean (standard deviation) side-to-side differences that were similar in the two sexes at 2 years; 1.7 (2.7) mm and 1.5 (3.7) mm in females and males, respectively, p = 0.72. At 6 months postoperatively, males had a larger deficit in hamstring strength on the operated leg (14.0% vs. 1.7%; p = 0.03) and a larger deficit in quadriceps strength on the operated leg (11.3% vs. 2.0%; p = 0.004); however, no sex difference was noted at 12 or 24 months. Females demonstrated superior single leg hop testing at 6 and 12 months ([91.3% vs. 78.1%, p = 0.001], [96.9% vs. 87.0%, p = 0.01] respectively). There were no significant sex differences on ipsilateral (males; 14.3% vs. females; 13.9%, p = 1.00) or contralateral (males; 3.6% vs. females; 2.8%, p = 1.00) ACL reinjury rates. Conclusions: Female subjects had better hamstring and quadriceps strength indices at 6 months than males as well as better hop test results at the 6 and 12-month time period. Despite this, there was no significant sex difference on patient-reported outcomes and objective AP laxity testing at time points up to 2 years postoperatively. Impact statement This is the first study comparing sex specific outcomes following the bridge-enhanced ACL repair technique (BEAR). The results of this study suggest that females have earlier recovery of both muscle strength and functional outcomes compared to their male counterparts. This is an important finding when considering future modifications to postoperative care and rehabilitation in females and males following this tissue-engineered BEAR technique.
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Affiliation(s)
- Samuel Barnett
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gary J Badger
- Department of Medical Biostatistics, University of Vermont, Burlington, Vermont, USA
| | - Ata Kiapour
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yi-Meng Yen
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rachael Henderson
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christina Freiberger
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Benedikt Proffen
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicholas Sant
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bethany Trainor
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Braden C Fleming
- Department of Orthopedics, Bioengineering Labs, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, Rhode Island, USA
| | - Lyle J Micheli
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Martha M Murray
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Dennis E Kramer
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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20
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Contartese D, Tschon M, De Mattei M, Fini M. Sex Specific Determinants in Osteoarthritis: A Systematic Review of Preclinical Studies. Int J Mol Sci 2020; 21:E3696. [PMID: 32456298 PMCID: PMC7279293 DOI: 10.3390/ijms21103696] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 12/23/2022] Open
Abstract
Osteoarthritis (OA) is a highly prevalent joint disease that primarily affects about 10% of the world's population over 60 years old. The purpose of this study is to systematically review the preclinical studies regarding sex differences in OA, with particular attention to the molecular aspect and gene expression, but also to the histopathological aspects. Three databases (PubMed, Scopus, and Web of Knowledge) were screened for eligible studies. In vitro and in vivo papers written in English, published in the last 11 years (2009-2020) were eligible. Participants were preclinical studies, including cell cultures and animal models of OA, evaluating sex differences. Independent extraction of articles and quality assessments were performed by two authors using predefined data fields and specific tools (Animals in Research Reporting In Vivo Experiments (ARRIVE) guideline and Systematic Review Centre for Laboratory animal Experimentation (SYRCLE) tool). Twenty-three studies were included in the review: 4 in vitro studies, 18 in vivo studies, and 1 both in vitro and in vivo study. From in vitro works, sex differences were found in the gene expression of inflammatory molecules, hormonal receptors, and in responsiveness to hormonal stimulation. In vivo research showed a great heterogeneity of animal models mainly focused on the histopathological aspects rather than on the analysis of sex-related molecular mechanisms. This review highlights that many gaps in knowledge still exist; improvementsin the selection and reporting of animal models, the use of advanced in vitro models, and multiomics analyses might contribute to developing a personalized gender-based medicine.
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Affiliation(s)
- Deyanira Contartese
- Laboratory of Preclinical and Surgical Studies, Rizzoli RIT Department, IRCCS–Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (D.C.); (M.F.)
| | - Matilde Tschon
- Laboratory of Preclinical and Surgical Studies, Rizzoli RIT Department, IRCCS–Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (D.C.); (M.F.)
| | - Monica De Mattei
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy;
| | - Milena Fini
- Laboratory of Preclinical and Surgical Studies, Rizzoli RIT Department, IRCCS–Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (D.C.); (M.F.)
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21
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Xu M, Zhang H, Yang X, Wang F, Yang L, Zhang H, Hu Y. The influence of donor and recipient characteristics on allograft tendons: a systematic review. Cell Tissue Bank 2020; 21:17-29. [PMID: 31897977 DOI: 10.1007/s10561-019-09803-5] [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: 09/09/2019] [Accepted: 12/09/2019] [Indexed: 11/26/2022]
Abstract
Tendon allograft has been an important alternative graft option aside from autograft. The outcome of reconstruction surgery is determined by donor and recipient related factors. The purpose of this article was to identified all studies reporting donor and recipient characteristics, including the age and gender of donors, along with the age, gender, activity level and smoking status of recipients, that affect the biomechanical properties and post-transplantation outcomes of allograft tendons. The systematic study search was based on MEDLINE via PubMed, Embase and the Cochrane Library databases. The reference lists of the included studies were used for hand searching (snowballing). The searching process was performed by two independent investigators, using search MESH term: "tendon", "allograft", and "person". Studies evaluating the influence of donor and recipient biological characteristics on the mechanical property and transplantation outcome of allograft were included. A total of 12 studies were selected for qualitative synthesis, including 6 studies evaluated the influence of donor characteristics, including age and gender, on the mechanical strength of tendon allograft. 6 studies assessed the influence of recipient characteristics, including age, gender, smoking status, and activity level, on the clinical outcome. As a conclusion, tendon allografts from donor younger than 40 years old were expected to have a higher mechanical property. Young patients or patients with a high level of activity were not recommended to receive allograft tendon when autograft is optional. There is no strong evidence supporting that neither donor or recipient gender affects the tendon allograft transplantation outcomes. Smoking history could increase the risk of complications.
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Affiliation(s)
- Mingyou Xu
- Graduate School, Tianjin Medical University, Tianjin, 300070, China
| | - Haoran Zhang
- Graduate School, Tianjin Medical University, Tianjin, 300070, China
| | - Xionggang Yang
- Graduate School, Tianjin Medical University, Tianjin, 300070, China
| | - Feng Wang
- Graduate School, Tianjin Medical University, Tianjin, 300070, China
| | - Li Yang
- Graduate School, Tianjin Medical University, Tianjin, 300070, China
| | - Hao Zhang
- Graduate School, Tianjin Medical University, Tianjin, 300070, China
| | - Yongcheng Hu
- Department of Orthopedic Oncology, Tianjin Hospital, Tianjin, 300211, China.
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Connizzo BK, Piet JM, Shefelbine SJ, Grodzinsky AJ. Age-associated changes in the response of tendon explants to stress deprivation is sex-dependent. Connect Tissue Res 2020; 61:48-62. [PMID: 31411079 PMCID: PMC6884684 DOI: 10.1080/03008207.2019.1648444] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose of the Study: The incidence of tendon injuries increases dramatically with age, which presents a major clinical burden. While previous studies have sought to identify age-related changes in extracellular matrix structure and function, few have been able to explain fully why aged tissues are more prone to degeneration and injury. In addition, recent studies have also demonstrated that age-related processes in humans may be sex-dependent, which could be responsible for muddled conclusions in changes with age. In this study, we investigate short-term responses through an ex vivo explant culture model of stress deprivation that specifically questions how age and sex differentially affect the ability of tendons to respond to altered mechanical stimulus.Materials and Methods: We subjected murine flexor explants from young (4 months of age) and aged (22-24 months of age) male and female mice to stress-deprived culture conditions for up to 1 week and investigated changes in viability, cell metabolism and proliferation, matrix biosynthesis and composition, gene expression, and inflammatory responses throughout the culture period.Results and Conclusions: We found that aging did have a significant influence on the response to stress deprivation, demonstrating that aged explants have a less robust response overall with reduced metabolic activity, viability, proliferation, and biosynthesis. However, age-related changes appeared to be sex-dependent. Together, this work demonstrates that the aging process and the subsequent effect of age on the ability of tendons to respond to stress-deprivation are inherently different based on sex, where male explants favor increased activity, apoptosis, and matrix remodeling while female explants favor reduced activity and tissue preservation.
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Affiliation(s)
- Brianne K. Connizzo
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, United States,Correspondence: Brianne K. Connizzo, 70 Massachusetts Avenue, NE47-377, Cambridge, MA 02139, T: 617-253-2469,
| | - Judith M. Piet
- Department of Bioengineering, Northeastern University, Boston, MA 02115, United States
| | - Sandra J. Shefelbine
- Department of Bioengineering, Northeastern University, Boston, MA 02115, United States,Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA 02115, United States
| | - Alan J. Grodzinsky
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, United States,Center for Biomedical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, United States,Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, United States,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
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23
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Cavaignac E, Marot V, Faruch M, Reina N, Murgier J, Accadbled F, Berard E, Chiron P. Hamstring Graft Incorporation According to the Length of the Graft Inside Tunnels. Am J Sports Med 2018; 46:348-356. [PMID: 29065271 DOI: 10.1177/0363546517733472] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) reconstruction with a quadrupled semitendinosus (ST4) graft is an evolution of the standard technique with 2 hamstring tendons (semitendinosus + gracilis [STG]). However, there is no published comparison of how well these 2 types of hamstring grafts are incorporated into the bone tunnels. Because the ST4 graft is shorter, there is less graft material inside the tunnels. PURPOSE To use magnetic resonance imaging (MRI) to compare graft incorporation in the tibial bone tunnels 1 year after ACL reconstruction with either an STG graft or ST4 graft. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Sixty-two patients who underwent ACL reconstruction were enrolled prospectively: 31 with an ST4 graft and 31 with an STG graft. The same surgical technique, fixation method, and postoperative protocol were used in both groups. Graft incorporation and ligamentization were evaluated with MRI after 1 year of follow-up. The following parameters were evaluated: signal-to-noise quotient (SNQ), tibial tunnel enlargement, signal intensity at the bone-graft interface, and graft signal according to the Howell scale. The number of participants needed to show that the mean SNQ did not differ between the 2 techniques was 31 in each group (with a 1-sided alpha of 2.5% and a 1-sided beta of 10.0%). The Student t test was used to compare the distribution of continuous secondary endpoints. RESULTS The mean SNQ was 5.2 ± 4.5 for the STG group and 5.9 ± 3.7 for the ST4 group ( P = .5100). The mean tibial tunnel widening was 93.7% ± 51.7% for the STG group versus 80.0% ± 42.9% for the ST4 group ( P = .2605). The groups did not differ in signal intensity at the bone-graft interface ( P = .7502) or in graft signal according to the Howell scale ( P = .4544). CONCLUSION At the 1-year postoperative follow-up, incorporation and ligamentization of the STG and ST4 grafts were the same based on MRI analysis. The results were at least as good with the ST4 technique as with the standard STG technique in terms of incorporation and ligamentization.
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Affiliation(s)
- Etienne Cavaignac
- Department of Orthopedic Surgery and Trauma, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Vincent Marot
- Department of Orthopedic Surgery and Trauma, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Marie Faruch
- Department of Radiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Nicolas Reina
- Department of Orthopedic Surgery and Trauma, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Jérôme Murgier
- Department of Orthopedic Surgery and Trauma, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Franck Accadbled
- Department of Orthopedic Surgery, Hôpital des Enfants, Toulouse, France
| | - Emilie Berard
- Department of Epidemiology, Health Economics and Public Health, UMR1027 INSERM-Université de Toulouse III, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Philippe Chiron
- Department of Orthopedic Surgery and Trauma, Hôpital Pierre-Paul Riquet, Toulouse, France
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Xiong G, Lingampalli N, Koltsov JC, Leung LL, Bhutani N, Robinson WH, Chu CR. Men and Women Differ in the Biochemical Composition of Platelet-Rich Plasma. Am J Sports Med 2018; 46:409-419. [PMID: 29211968 PMCID: PMC8487642 DOI: 10.1177/0363546517740845] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Autologous platelet-rich plasma (PRP) is widely used for a variety of clinical applications. However, clinical outcome studies have not consistently shown positive effects. The composition of PRP differs based on many factors. An improved understanding of factors influencing the composition of PRP is important for the optimization of PRP use. HYPOTHESIS Age and sex influence the PRP composition in healthy patients. STUDY DESIGN Controlled laboratory study. METHODS Blood from 39 healthy patients was collected at a standardized time and processed into leukocyte-poor PRP within 1 hour of collection using the same laboratory centrifuge protocol and frozen for later analysis. Eleven female and 10 male patients were "young" (aged 18-30 years), while 8 male and 10 female patients were "older" (aged 45-60 years). Thawed PRP samples were assessed for cytokine and growth factor levels using a multiplex assay and enzyme-linked immunosorbent assay. The platelet count and high-sensitivity C-reactive protein levels were measured. Two-way analysis of variance determined age- and sex-based differences. RESULTS Platelet and high-sensitivity C-reactive protein concentrations were similar in PRP between the groups ( P = .234). Male patients had higher cytokine and growth factor levels in PRP compared with female patients for inflammatory cytokines such as interleukin-1 beta (IL-1β) (9.83 vs 7.71 pg/mL, respectively; P = .008) and tumor necrosis factor-alpha (TNF-α) (131.6 vs 110.5 pg/mL, respectively; P = .048); the anti-inflammatory IL-1 receptor antagonist protein (IRAP) (298.0 vs 218.0 pg/mL, respectively; P < .001); and growth factors such as fibroblast growth factor-basic (FGF-basic) (237.9 vs 194.0 pg/mL, respectively; P = .01), platelet-derived growth factor (PDGF-BB) (3296.2 vs 2579.3 pg/mL, respectively; P = .087), and transforming growth factor-beta 1 (TGF-β1) (118.8 vs 92.8 ng/mL, respectively; P = .002). Age- but not sex-related differences were observed for insulin-like growth factor-1 (IGF-1) ( P < .001). Age and sex interaction terms were not significant. While mean differences were significant, there was also substantial intragroup variability. CONCLUSION This study in healthy patients shows differences in the composition of PRP between men and women, with sex being a greater factor than age. There was also proteomic variability within the groups. These data support a personalized approach to PRP treatment and highlight the need for a greater understanding of the relationships between proteomic factors in PRP and clinical outcomes. CLINICAL RELEVANCE Variability in the proteomic profile of PRP may affect tissue and clinical responses to treatment. These data suggest that clinical studies should account for the composition of PRP used.
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Affiliation(s)
- Grace Xiong
- Department of Orthopaedic Surgery, Stanford University
School of Medicine, Stanford, California, USA
- Veterans Affairs Palo Alto Health Care System, Palo
Alto, California, USA
| | - Nithya Lingampalli
- Veterans Affairs Palo Alto Health Care System, Palo
Alto, California, USA
- Division of Immunology and Rheumatology, Department
of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jayme C.B. Koltsov
- Department of Orthopaedic Surgery, Stanford University
School of Medicine, Stanford, California, USA
| | - Lawrence L. Leung
- Veterans Affairs Palo Alto Health Care System, Palo
Alto, California, USA
- Division of Hematology, Department of Medicine,
Stanford University School of Medicine, Stanford, California, USA
| | - Nidhi Bhutani
- Department of Orthopaedic Surgery, Stanford University
School of Medicine, Stanford, California, USA
| | - William H. Robinson
- Veterans Affairs Palo Alto Health Care System, Palo
Alto, California, USA
- Division of Immunology and Rheumatology, Department
of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Constance R. Chu
- Department of Orthopaedic Surgery, Stanford University
School of Medicine, Stanford, California, USA
- Veterans Affairs Palo Alto Health Care System, Palo
Alto, California, USA
- Address correspondence to Constance R. Chu, MD,
Department of Orthopaedic Surgery, Stanford University School of Medicine, 450
Broadway Street, MC 6342, Redwood City, CA 94063, USA
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Bryant J, Yi P, Miller L, Peek K, Lee D. Potential Sex Bias Exists in Orthopaedic Basic Science and Translational Research. J Bone Joint Surg Am 2018; 100:124-130. [PMID: 29342062 DOI: 10.2106/jbjs.17.00458] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Potential sex bias has been shown in general surgery basic science and translational research, with unequal representation of male and female specimens. Because basic science research forms the foundation for clinical studies on which patient care is based, it is important that this research equally consider both sexes. The purpose of this study was to determine if potential sex bias exists in the basic science and translational orthopaedic literature. METHODS A systematic review was conducted of all articles published in 2014 in The Journal of Bone & Joint Surgery, Clinical Orthopaedics and Related Research, The Bone & Joint Journal, and the Journal of Orthopaedic Research (JOR). All original research articles utilizing animals, cells, or cadavers were included. The data abstracted included study type, sex of specimen studied, and presence of sex-based reporting of data. A second review was performed of all basic science articles published in JOR in 1994, 2004, and 2014 to compare sex bias trends across 3 decades. Distributions of variables were compared using the Fisher exact test, with significance defined as p < 0.05. RESULTS Of 1,693 articles reviewed, 250 (15%) were included: 122 animal-based studies (49%), 71 cell-based studies (28%), and 57 human cadaver-based studies (23%). Overall, authors in 88 studies (35%) did not report the sex of animals, cells, or cadavers used. Of 162 studies in which the authors did report sex, 69 (43%) utilized male only, 40 (25%) utilized female only, and 53 (33%) utilized both sexes. Of those studies that used both sexes, authors in only 7 studies (13%) reported sex-based results. A subanalysis of JOR articles across 3 decades revealed a significant increase in studies specifying sex (p = 0.01) from 2004 to 2014. CONCLUSIONS Potential sex bias exists in orthopaedic surgery basic science and translational research, with an overrepresentation of male specimens. CLINICAL RELEVANCE Inequality in sex representation must be addressed as basic science and translational research creates the foundation for subsequent clinical research, which ultimately informs clinical care.
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Affiliation(s)
- Jessica Bryant
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Paul Yi
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Liane Miller
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kacy Peek
- Department of Orthopaedic Surgery, University of Washington, Seattle, Washington
| | - Daniel Lee
- Albany Medical College, Albany, New York
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Zhang L, Guan T, Qi J, Zhang S, Zhou X, Liu Y, Fu S. A model of anterior cruciate ligament injury in cynomolgus monkeys developed via arthroscopic surgery. Exp Ther Med 2018; 15:2239-2246. [PMID: 29456631 PMCID: PMC5795381 DOI: 10.3892/etm.2018.5722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 01/05/2018] [Indexed: 12/16/2022] Open
Abstract
The anterior cruciate ligament (ACL) is an important structure that maintains the stability of knee joints. Animal models of ACL injury are helpful to explore its underlying mechanisms, and strategies for prevention, treatment and rehabilitation. Therefore, the aim of the present study was to develop an efficient model of ACL injury in cynomolgus monkeys via arthroscopic techniques. In the present study, 18 cynomolgus monkeys were randomly divided into a model group (n=6), a sham operation group (n=6) and a blank control group (n=6). One-quarter of the ACL was removed under arthroscopy in the model group. In the sham operation group, only arthroscopic exploration was performed as a control. In the blank control group, monkeys were housed under the same conditions for the same length of time. Magnetic resonance imaging examination was performed pre- and post-operatively, as well as measurements of the circumference of the thigh and calf, and of the maximum flexion degree of the knee. Anterior drawer test, Lachman test and pivot-shift tests were also performed. The results revealed that the injured side of the knees in the model group became unstable, as determined from evaluation of the physical tests. In conclusion, based on these findings, the modeling method of ACL injury was effective, and may contribute to the associated research concerning ACL injury.
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Affiliation(s)
- Lei Zhang
- Department of Orthopedics, The Affiliated T.C.M Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Taiyuan Guan
- Department of Orthopedics, The Affiliated T.C.M Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Ji Qi
- Department of Orthopedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Shaoqun Zhang
- Department of Orthopedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Xin Zhou
- Department of Orthopedics, The Affiliated T.C.M Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Yang Liu
- Department of Orthopedics, The Affiliated T.C.M Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Shijie Fu
- Department of Orthopedics, The Affiliated T.C.M Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
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27
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Zhang L, Qi J, Zeng Y, Zhang S, Fu S, Zhou X, Ping R, Li Y. Proprioceptive Changes in Bilateral Knee Joints Following Unilateral Anterior Cruciate Ligament Injury in Cynomolgus Monkeys. Med Sci Monit 2018; 24:105-113. [PMID: 29305572 PMCID: PMC5767072 DOI: 10.12659/msm.905160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 07/16/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The anterior cruciate ligament (ACL) is one of the most important structures maintaining stability of knee joints, and the proprioception of the ACL plays a key role in it. If the ACL is injured in the unilateral knee joint, it changes nerve electrophysiology, morphology, and quantity of the proprioceptors in the bilateral ACL. The aim of this study was to explore the proprioceptive changes in the bilateral knee joints following unilateral ACL injury, and to provide a theoretical foundation and ideas for clinical treatment. MATERIAL AND METHODS Nine normal cynomolgus monkeys were chosen and used to developed a model of unilateral ACL injury, and 3 monkeys without modeling were used as blank control. At the 4th, 8th, and 12th weeks, the changes in ACL nerves were inspected using electrophysiology [somatosensory evoked potentials (SEPs) and motor nerve conduction velocity (MCV)], and the changes of morphology and quantity of the proprioceptors in ACL were observed and measured under gold chloride staining. RESULTS On the injured and contralateral knee joints, the incubations were extended and the amplitudes were decreased over time. In addition, with the extension of time, the total number of proprioceptors in the ACL decreased, and the variable number of proprioceptors in the ACL increased. CONCLUSIONS ACL injury leads to attenuation of proprioception on the injured side, and also leads to the attenuation of proprioception on the contralateral side, and there is a tendency could get worse over time.
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Affiliation(s)
- Lei Zhang
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Ji Qi
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Yan Zeng
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, P.R. China
| | - Shaoqun Zhang
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Shijie Fu
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, P.R. China
| | - Xin Zhou
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, P.R. China
| | - Ruiyue Ping
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, P.R. China
| | - Yikai Li
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, P.R. China
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Cone SG, Warren PB, Fisher MB. Rise of the Pigs: Utilization of the Porcine Model to Study Musculoskeletal Biomechanics and Tissue Engineering During Skeletal Growth. Tissue Eng Part C Methods 2017; 23:763-780. [PMID: 28726574 PMCID: PMC5689129 DOI: 10.1089/ten.tec.2017.0227] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 07/14/2017] [Indexed: 12/17/2022] Open
Abstract
Large animal models play an essential role in the study of tissue engineering and regenerative medicine (TERM), as well as biomechanics. The porcine model has been increasingly used to study the musculoskeletal system, including specific joints, such as the knee and temporomandibular joints, and tissues, such as bone, cartilage, and ligaments. In particular, pigs have been utilized to evaluate the role of skeletal growth on the biomechanics and engineered replacements of these joints and tissues. In this review, we explore the publication history of the use of pig models in biomechanics and TERM discuss interspecies comparative studies, highlight studies on the effect of skeletal growth and other biological considerations in the porcine model, and present challenges and emerging opportunities for using this model to study functional TERM.
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Affiliation(s)
- Stephanie G. Cone
- Department of Biomedical Engineering, North Carolina State University, Raleigh, North Carolina and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina
| | - Paul B. Warren
- Department of Biomedical Engineering, North Carolina State University, Raleigh, North Carolina and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina
| | - Matthew B. Fisher
- Department of Biomedical Engineering, North Carolina State University, Raleigh, North Carolina and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina
- Department of Orthopaedics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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29
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Khandha A, Manal K, Wellsandt E, Capin J, Snyder-Mackler L, Buchanan TS. Gait mechanics in those with/without medial compartment knee osteoarthritis 5 years after anterior cruciate ligament reconstruction. J Orthop Res 2017; 35:625-633. [PMID: 27082166 PMCID: PMC5065735 DOI: 10.1002/jor.23261] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 04/08/2016] [Indexed: 02/04/2023]
Abstract
The objective of the study was to evaluate differences in gait mechanics 5 years after unilateral anterior cruciate ligament reconstruction surgery, for non-osteoarthritic (n = 24) versus osteoarthritic (n = 9) subjects. For the involved knee, the osteoarthritic group demonstrated significantly lower peak knee flexion angles (non-osteoarthritic = 24.3 ± 4.6°, osteoarthritic = 19.1 ± 2.9°, p = 0.01) and peak knee flexion moments (non-osteoarthritic = 5.3 ± 1.2% Body Weight × Height, osteoarthritic = 4.4 ± 1.2% Body Weight × Height, p = 0.05). Differences in peak knee adduction moment approached significance, with a higher magnitude for the osteoarthritic group (non-osteoarthritic = 2.4 ± 0.8% Body Weight × Height, osteoarthritic = 2.9 ± 0.5% Body Weight × Height, p = 0.09). Peak medial compartment joint load was evaluated using electromyography-informed neuromusculoskeletal modeling. Peak medial compartment joint load in the involved knee for the two groups was not different (non-osteoarthritic = 2.4 ± 0.4 Body Weight, osteoarthritic = 2.3 ± 0.6 Body Weight). The results suggest that subjects with dissimilar peak knee moments can have similar peak medial compartment joint load magnitudes. There was no evidence of inter-limb asymmetry for either group. Given the presence of inter-group differences (non-osteoarthritic vs. osteoarthritic) for the involved knee, but an absence of inter-limb asymmetry in either group, it may be necessary to evaluate how symmetry is achieved, over time, and to differentiate between good versus bad inter-limb symmetry, when evaluating knee gait parameters. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:625-633, 2017.
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Affiliation(s)
- Ashutosh Khandha
- Department of Biomedical Engineering, University of Delaware, 540 South College Avenue, Newark, Delaware 19713
| | - Kurt Manal
- Department of Mechanical Engineering, University of Delaware, Newark, Delaware
| | | | - Jacob Capin
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | | | - Thomas S. Buchanan
- Department of Biomedical Engineering, University of Delaware, 540 South College Avenue, Newark, Delaware 19713,Department of Mechanical Engineering, University of Delaware, Newark, Delaware
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Fryhofer GW, Freedman BR, Hillin CD, Salka NS, Pardes AM, Weiss SN, Farber DC, Soslowsky LJ. Postinjury biomechanics of Achilles tendon vary by sex and hormone status. J Appl Physiol (1985) 2016; 121:1106-1114. [PMID: 27633741 DOI: 10.1152/japplphysiol.00620.2016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 09/12/2016] [Indexed: 12/11/2022] Open
Abstract
Achilles tendon ruptures are common injuries. Sex differences are present in mechanical properties of uninjured Achilles tendon, but it remains unknown if these differences extend to tendon healing. We hypothesized that ovariectomized females (OVX) and males would exhibit inferior postinjury tendon properties compared with females. Male, female, and OVX Sprague-Dawley rats (n = 32/group) underwent acclimation and treadmill training before blunt transection of the Achilles tendon midsubstance. Injured hindlimbs were immobilized for 1 wk, followed by gradual return to activity and assessment of active and passive hindlimb function. Animals were euthanized at 3 or 6 wk postinjury to assess tendon structure, mechanics, and composition. Passive ankle stiffness and range of motion were superior in females at 3 wk; however, by 6 wk, passive and active function were similar in males and females but remained inferior in OVX. At 6 wk, female tendons had greater normalized secant modulus, viscoelastic behavior, and laxity compared with males. Normalized secant modulus, cross-sectional area and tendon glycosaminoglycan composition were inferior in OVX compared with females at 6 wk. Total fatigue cycles until tendon failure were similar among groups. Postinjury muscle fiber size was better preserved in females compared with males, and females had greater collagen III at the tendon injury site compared with males at 6 wk. Despite male and female Achilles tendons withstanding similar durations of fatigue loading, early passive hindlimb function and tendon mechanical properties, including secant modulus, suggest superior healing in females. Ovarian hormone loss was associated with inferior Achilles tendon healing.
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Affiliation(s)
- George W Fryhofer
- McKay Orthopaedic Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin R Freedman
- McKay Orthopaedic Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cody D Hillin
- McKay Orthopaedic Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nabeel S Salka
- McKay Orthopaedic Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Adam M Pardes
- McKay Orthopaedic Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephanie N Weiss
- McKay Orthopaedic Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel C Farber
- McKay Orthopaedic Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Louis J Soslowsky
- McKay Orthopaedic Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Blackburn JT, Pietrosimone B, Harkey MS, Luc BA, Pamukoff DN. Inter-limb differences in impulsive loading following anterior cruciate ligament reconstruction in females. J Biomech 2016; 49:3017-3021. [DOI: 10.1016/j.jbiomech.2016.07.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 05/18/2016] [Accepted: 07/26/2016] [Indexed: 11/26/2022]
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