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Dulic O, Lalic I, Kecojevic V, Gavrilovic G, Abazovic D, Miskulin M, Maric D, Bumbasirevic M. Do knee injection portals affect clinical results of bone marrow aspirate concentrate injection in the treatment of osteoarthritis? A prospective randomized controlled study. Regen Med 2020; 15:1987-2000. [PMID: 33151802 DOI: 10.2217/rme-2020-0020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aim: To explore the effect that the location of needle placement has on efficacy and tolerability of bone marrow aspirate concentrate injections during treatment of knee osteoarthritis. Methods: Bone marrow aspirate concentrate injections were administered to 111 patients via superolateral, anteromedial or anterolateral portals. Pain was assessed by visual analog scale before and 3, 7, 14 and 21 days after intervention. Knee function was assessed by Western Ontario and McMaster Universities Osteoarthritis Index, Knee Injury and Osteoarthritis Outcome Score and International Knee Documentation Committee scores before and 1, 3, 6, 9 and 12 months after intervention. Results: Significant differences in Western Ontario and McMaster Universities Osteoarthritis Index, Knee Injury and Osteoarthritis Outcome Score and International Knee Documentation Committee scores were observed 12 months post intervention compared with baseline (p < 0.001 for all comparisons). No significant differences in outcome or pain scores were observed among groups. Conclusion: All portals demonstrated similar clinical benefits up to 12 months after intervention. Trial registration number: ClinicalTrials.gov (NCT03825133).
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Affiliation(s)
- Oliver Dulic
- University of Novi Sad, Medical Faculty, Clinical Center of Vojvodina, Department for Orthopedic Surgery & Traumatology, Hajduk Veljkova 1-9, Novi Sad, Serbia.,Department for Orthopedic Surgery & Traumatology Clinical Center of Vojvodina, Hajduk Veljkova 1-9, 21000 Novi Sad, Serbia
| | - Ivica Lalic
- University of Novi Sad, Medical Faculty, Clinical Center of Vojvodina, Department for Orthopedic Surgery & Traumatology, Hajduk Veljkova 1-9, Novi Sad, Serbia.,Department for Orthopedic Surgery & Traumatology Clinical Center of Vojvodina, Hajduk Veljkova 1-9, 21000 Novi Sad, Serbia
| | - Vaso Kecojevic
- University of Novi Sad, Medical Faculty, Clinical Center of Vojvodina, Department for Orthopedic Surgery & Traumatology, Hajduk Veljkova 1-9, Novi Sad, Serbia.,Department for Orthopedic Surgery & Traumatology Clinical Center of Vojvodina, Hajduk Veljkova 1-9, 21000 Novi Sad, Serbia
| | - Gordan Gavrilovic
- Atlas Hospital, Osmana Djikica 5, Belgrade, Serbia.,Department for Orthopedic Surgery & Traumatology Clinical Center of Vojvodina, Hajduk Veljkova 1-9, 21000 Novi Sad, Serbia
| | - Dzihan Abazovic
- Renova Hospital, Osmana Djikica 5, Belgrade, Serbia.,Department for Orthopedic Surgery & Traumatology Clinical Center of Vojvodina, Hajduk Veljkova 1-9, 21000 Novi Sad, Serbia
| | - Mladen Miskulin
- Specijalna bolnica za Neurokirurgiju i ortopediju Aksis, Zagreb, Petrovaradinska 1, 10000 ZAGREB, Croatia.,Department for Orthopedic Surgery & Traumatology Clinical Center of Vojvodina, Hajduk Veljkova 1-9, 21000 Novi Sad, Serbia
| | - Dusan Maric
- MD Orto Hospital, Futoski put 115, Novi Sad, Serbia.,Department for Orthopedic Surgery & Traumatology Clinical Center of Vojvodina, Hajduk Veljkova 1-9, 21000 Novi Sad, Serbia
| | - Marko Bumbasirevic
- University of Belgrade, Medical Faculty, Clinical Center of Serbia, Clinic for Orthopedic Surgery & Traumatology, Dr. Subotica 20, Belgrade, Serbia.,Department for Orthopedic Surgery & Traumatology Clinical Center of Vojvodina, Hajduk Veljkova 1-9, 21000 Novi Sad, Serbia
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Maricar N, Parkes MJ, Callaghan MJ, Felson DT, O'Neill TW. Do Clinical Correlates of Knee Osteoarthritis Predict Outcome of Intraarticular Steroid Injections? J Rheumatol 2020; 47:431-440. [PMID: 30936283 PMCID: PMC10563584 DOI: 10.3899/jrheum.180233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine whether clinical correlates of knee osteoarthritis (OA) affect the outcome of intraarticular steroid injections (IASI) in symptomatic knee OA. METHODS Men and women aged ≥ 40 years with painful knee OA who participated in an open-label trial of IASI completed questionnaires and clinical examination. The Outcome Measures in Rheumatology (OMERACT)-Osteoarthritis Research Society International (OARSI) criteria were used to assess response to therapy in the short term (within 2 weeks). Among those who initially responded, those whose pain had not returned to within 20% of the baseline Knee Injury and Osteoarthritis Outcome Score pain score at 6 months were characterized as longer-term responders. Log-binomial regression was used to examine factors associated with outcome. RESULTS One hundred ninety-nine participants were included, of whom 146 (73.4%) were short-term and 40 (20.1%) longer-term responders. Compared to short-term nonresponders, participants with these characteristics were more likely to be short-term responders: medial joint line tenderness [relative risk (RR) 1.42, 95% CI 1.10-1.82], medial and lateral joint line tenderness (RR 1.38, 95% CI 1.03-1.84), patellofemoral tenderness (RR 1.27, 95% CI 1.04-1.55), anserine tenderness (RR 1.27, 95% CI 1.06-1.52), and a belief that treatment would be effective [RR/unit increase (range 0-10) = 1.05 (1.01-1.09)]. Aspiration of joint fluid (RR 0.79, 95% CI 0.66-0.95) and previous ligament/meniscus injury (RR 0.63, 95% CI 0.44-0.91) were associated with a reduced risk of being a short-term responder. Compared to initial nonresponders and those whose pain recurred within 6 months, participants with a higher number of pain sites [RR/unit increase (range 0-10) = 0.83, 95% CI 0.72-0.97], chronic widespread pain (RR 0.32, 95% CI 0.10-0.98), perceived chronicity of disease [RR/unit increase (range 0-10) = 0.86, 95% CI 0.78-0.94], and a higher depression score [RR/unit increase (range 0-21) = 0.89, 95% CI 0.81-0.99] were less likely to be longer-term responders. CONCLUSION Among patients with symptomatic knee OA, tenderness around the knee was associated with better short-term outcome of IASI. However, clinical-related factors did not predict longer-term response, while those with chronic widespread pain and depressive symptoms were less likely to obtain longer-term benefits.
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Affiliation(s)
- Nasimah Maricar
- From the Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester; National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Sciences Centre; Department of Physiotherapy, Salford Royal NHS Foundation Trust; Department of Health Professions, Manchester Metropolitan University; Department of Rheumatology, Salford Royal NHS Foundation Trust, Manchester, UK; Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA.
- N. Maricar, PhD, MSc, BSc(Hons), Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Physiotherapy, Salford Royal NHS Foundation Trust; M.J. Parkes, BSc(Hons), Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre; M.J. Callaghan, Dip. in Physiotherapy, M.Phil, PhD, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Health Professions, Manchester Metropolitan University; D.T. Felson, AB, MD, MPH, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Clinical Epidemiology Unit, Boston University School of Medicine; T.W. O'Neill, MD, MSc, FRCP(I), FFPH, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Rheumatology, Salford Royal NHS Foundation Trust.
| | - Matthew J Parkes
- From the Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester; National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Sciences Centre; Department of Physiotherapy, Salford Royal NHS Foundation Trust; Department of Health Professions, Manchester Metropolitan University; Department of Rheumatology, Salford Royal NHS Foundation Trust, Manchester, UK; Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA
- N. Maricar, PhD, MSc, BSc(Hons), Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Physiotherapy, Salford Royal NHS Foundation Trust; M.J. Parkes, BSc(Hons), Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre; M.J. Callaghan, Dip. in Physiotherapy, M.Phil, PhD, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Health Professions, Manchester Metropolitan University; D.T. Felson, AB, MD, MPH, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Clinical Epidemiology Unit, Boston University School of Medicine; T.W. O'Neill, MD, MSc, FRCP(I), FFPH, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Rheumatology, Salford Royal NHS Foundation Trust
| | - Michael J Callaghan
- From the Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester; National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Sciences Centre; Department of Physiotherapy, Salford Royal NHS Foundation Trust; Department of Health Professions, Manchester Metropolitan University; Department of Rheumatology, Salford Royal NHS Foundation Trust, Manchester, UK; Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA
- N. Maricar, PhD, MSc, BSc(Hons), Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Physiotherapy, Salford Royal NHS Foundation Trust; M.J. Parkes, BSc(Hons), Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre; M.J. Callaghan, Dip. in Physiotherapy, M.Phil, PhD, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Health Professions, Manchester Metropolitan University; D.T. Felson, AB, MD, MPH, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Clinical Epidemiology Unit, Boston University School of Medicine; T.W. O'Neill, MD, MSc, FRCP(I), FFPH, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Rheumatology, Salford Royal NHS Foundation Trust
| | - David T Felson
- From the Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester; National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Sciences Centre; Department of Physiotherapy, Salford Royal NHS Foundation Trust; Department of Health Professions, Manchester Metropolitan University; Department of Rheumatology, Salford Royal NHS Foundation Trust, Manchester, UK; Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA
- N. Maricar, PhD, MSc, BSc(Hons), Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Physiotherapy, Salford Royal NHS Foundation Trust; M.J. Parkes, BSc(Hons), Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre; M.J. Callaghan, Dip. in Physiotherapy, M.Phil, PhD, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Health Professions, Manchester Metropolitan University; D.T. Felson, AB, MD, MPH, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Clinical Epidemiology Unit, Boston University School of Medicine; T.W. O'Neill, MD, MSc, FRCP(I), FFPH, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Rheumatology, Salford Royal NHS Foundation Trust
| | - Terence W O'Neill
- From the Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester; National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Sciences Centre; Department of Physiotherapy, Salford Royal NHS Foundation Trust; Department of Health Professions, Manchester Metropolitan University; Department of Rheumatology, Salford Royal NHS Foundation Trust, Manchester, UK; Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA
- N. Maricar, PhD, MSc, BSc(Hons), Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Physiotherapy, Salford Royal NHS Foundation Trust; M.J. Parkes, BSc(Hons), Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre; M.J. Callaghan, Dip. in Physiotherapy, M.Phil, PhD, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Health Professions, Manchester Metropolitan University; D.T. Felson, AB, MD, MPH, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Clinical Epidemiology Unit, Boston University School of Medicine; T.W. O'Neill, MD, MSc, FRCP(I), FFPH, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Rheumatology, Salford Royal NHS Foundation Trust
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Patel JM, Saleh KS, Burdick JA, Mauck RL. Bioactive factors for cartilage repair and regeneration: Improving delivery, retention, and activity. Acta Biomater 2019; 93:222-238. [PMID: 30711660 PMCID: PMC6616001 DOI: 10.1016/j.actbio.2019.01.061] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 01/25/2019] [Accepted: 01/29/2019] [Indexed: 12/29/2022]
Abstract
Articular cartilage is a remarkable tissue whose sophisticated composition and architecture allow it to withstand complex stresses within the joint. Once injured, cartilage lacks the capacity to self-repair, and injuries often progress to joint wide osteoarthritis (OA) resulting in debilitating pain and loss of mobility. Current palliative and surgical management provides short-term symptom relief, but almost always progresses to further deterioration in the long term. A number of bioactive factors, including drugs, corticosteroids, and growth factors, have been utilized in the clinic, in clinical trials, or in emerging research studies to alleviate the inflamed joint environment or to promote new cartilage tissue formation. However, these therapies remain limited in their duration and effectiveness. For this reason, current efforts are focused on improving the localization, retention, and activity of these bioactive factors. The purpose of this review is to highlight recent advances in drug delivery for the treatment of damaged or degenerated cartilage. First, we summarize material and modification techniques to improve the delivery of these factors to damaged tissue and enhance their retention and action within the joint environment. Second, we discuss recent studies using novel methods to promote new cartilage formation via biofactor delivery, that have potential for improving future long-term clinical outcomes. Lastly, we review the emerging field of orthobiologics, using delivered and endogenous cells as drug-delivering "factories" to preserve and restore joint health. Enhancing drug delivery systems can improve both restorative and regenerative treatments for damaged cartilage. STATEMENT OF SIGNIFICANCE: Articular cartilage is a remarkable and sophisticated tissue that tolerates complex stresses within the joint. When injured, cartilage cannot self-repair, and these injuries often progress to joint-wide osteoarthritis, causing patients debilitating pain and loss of mobility. Current palliative and surgical treatments only provide short-term symptomatic relief and are limited with regards to efficiency and efficacy. Bioactive factors, such as drugs and growth factors, can improve outcomes to either stabilize the degenerated environment or regenerate replacement tissue. This review highlights recent advances and novel techniques to enhance the delivery, localization, retention, and activity of these factors, providing an overview of the cartilage drug delivery field that can guide future research in restorative and regenerative treatments for damaged cartilage.
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Affiliation(s)
- Jay M Patel
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States; Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA 19104, United States
| | - Kamiel S Saleh
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States; Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA 19104, United States
| | - Jason A Burdick
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States; Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA 19104, United States; Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Robert L Mauck
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States; Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA 19104, United States; Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA 19104, United States.
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