Comparison of Compressive Stress-Relaxation Behavior in Osteoarthritic (ICRS Graded) Human Articular Cartilage

Relations between Structure/Composition and Mechanics in Osteoarthritic Regenerated Articular Tissue: A Machine Learning Approach

In the context of a large animal model of early osteoarthritis (OA) treated by orthobiologics, the purpose of this study was to reveal relations between articular tissues structure/composition and cartilage viscoelasticity. Twenty-four sheep, with induced knee OA, were treated by mesenchymal stem cells in various preparations-adipose-derived mesenchymal stem cells (ADSCs), stromal vascular fraction (SVF), and amniotic endothelial cells (AECs)-and euthanized at 3 or 6 months to evaluate the (i) biochemistry of synovial fluid; (ii) histology, immunohistochemistry, and histomorphometry of articular cartilage; and (iii) viscoelasticity of articular cartilage. After performing an initial analysis to evaluate the correlation and multicollinearity between the investigated variables, this study used machine learning (ML) models-Variable Selection Using Random Forests (VSURF) and Extreme Gradient Boosting (XGB)-to classify variables according to their importance and employ them for interpretation and prediction. The experimental setup revealed a potential relation between cartilage elastic modulus and cartilage thickness (CT), synovial fluid interleukin 6 (IL6), and prostaglandin E2 (PGE2), and between cartilage relaxation time and CT and PGE2. SVF treatment was the only limit on the deleterious OA effect on cartilage viscoelastic properties. This work provides indications to future studies aiming to highlight these and other relationships and focusing on advanced regeneration targets.

Grading cartilage damage with diffuse reflectance spectroscopy: Optical markers and mechanical properties

Osteoarthritis (OA) is one of the most common joint diseases worldwide. Unfortunately, clinical methods lack the ability to detect OA in the early stages. Timely detection of the knee joint degradation at the level of tissue changes can prevent its progressive damage. Here, diffuse reflectance spectroscopy (DRS) in the NIR range was used to obtain optical markers of the cartilage damage grades and to assess its mechanical properties. It was observed that the water content obtained by DRS strongly correlates with the cartilage thickness (R = .82) and viscoelastic relaxation time (R = .7). Moreover, the spectral parameters, including water content (OH-band), protein content (CH-band), and scattering parameters allowed for discrimination between the cartilage damage grades (10^-4  < P ≤ 10^-3 ). The developed approach may become a valuable addition to arthroscopy, helping to identify lesions at the microscopic level in the early stages of OA and complement the surgical analysis.

Compressive Mechanical Behavior of Partially Oxidized Polyvinyl Alcohol Hydrogels for Cartilage Tissue Repair

Polyvinyl alcohol (PVA) hydrogels are extensively used as scaffolds for tissue engineering, although their biodegradation properties have not been optimized yet. To overcome this limitation, partially oxidized PVA has been developed by means of different oxidizing agents, obtaining scaffolds with improved biodegradability. The oxidation reaction also allows tuning the mechanical properties, which are essential for effective use in vivo. In this work, the compressive mechanical behavior of native and partially oxidized PVA hydrogels is investigated, to evaluate the effect of different oxidizing agents, i.e., potassium permanganate, bromine, and iodine. For this purpose, PVA hydrogels are tested by means of indentation tests, also considering the time-dependent mechanical response. Indentation results show that the oxidation reduces the compressive stiffness from about 2.3 N/mm for native PVA to 1.1 ÷ 1.4 N/mm for oxidized PVA. During the consolidation, PVA hydrogels exhibit a force reduction of about 40% and this behavior is unaffected by the oxidizing treatment. A poroviscoelastic constitutive model is developed to describe the time-dependent mechanical response, accounting for the viscoelastic polymer matrix properties and the flow of water molecules within the matrix during long-term compression. This model allows to estimate the long-term Young's modulus of PVA hydrogels in drained conditions (66 kPa for native PVA and 34-42 kPa for oxidized PVA) and can be exploited to evaluate their performances under compressive stress in vivo, as in the case of cartilage tissue engineering.

Optimization of In Situ Indentation Protocol to Map the Mechanical Properties of Articular Cartilage

Tissue engineering aims at developing complex composite scaffolds for articular cartilage repair. These scaffolds must exhibit a mechanical behavior similar to the whole osteochondral unit. In situ spherical indentation allows us to map the mechanical behavior of articular cartilage, avoiding removal of the underlying bone tissue. Little is known about the impact of grid spacing, indenter diameter, and induced deformation on the cartilage response to indentation. We investigated the impact of grid spacing (range: a to 3a, where a is the radius of the contact area between cartilage and indenter), indenter diameter (range: 1 to 8 mm), and deformation induced by indentation (constant indentation depth versus constant nominal deformation) on cartilage response. The bias induced by indentations performed in adjacent grid points was minimized with a 3a grid spacing. The cartilage response was indenter-dependent for diameters ranging between 1 and 6 mm with a nominal deformation of 15%. No significant differences were found using 6 mm and 8 mm indenters. Six mm and 8 mm indenters were used to map human articular cartilage with a grid spacing equal to 3a. Instantaneous elastic modulus E₀ was calculated for constant indentation depth and constant nominal deformation. E₀ value distribution did not change significantly by switching the two indenters, while dispersion decreased by 5-6% when a constant nominal deformation was applied. Such an approach was able to discriminate changes in tissue response due to doubling the indentation rate. The proposed procedure seems to reduce data dispersion and properly determine cartilage mechanical properties to be compared with those of complex composite scaffolds.

High-performance bilayer composites for the replacement of osteochondral defects

Two novel bilayer constructs for the repair of osteochondral defects were developed from nanofibers and ceramic particles embedded into PVA matrices, exhibiting multiple promising properties similar to those of corresponding natural tissues.

Articular cartilage optical properties in the near-infrared (NIR) spectral range vary with depth and tissue integrity

Optical properties of biological tissues in the NIR spectral range have demonstrated significant potential for in vivo diagnostic applications and are critical parameters for modelling light interaction in biological tissues. This study aims to investigate the optical properties of articular cartilage as a function of tissue depth and integrity. The results suggest consistent wavelength-dependent variation in optical properties between cartilage depth-wise zones, as well as between healthy and degenerated tissue. Also, statistically significant differences (p<0.05) in both optical properties were observed between the different cartilage depth-wise zones and as a result of tissue degeneration. When taken into account, the outcome of this study could enable accurate modelling of light interaction in cartilage matrix and could provide useful diagnostic information on cartilage integrity.

Rheometer enabled study of cartilage frequency-dependent properties

Despite the well-established dependence of cartilage mechanical properties on the frequency of the applied load, most research in the field is carried out in either load-free or constant load conditions because of the complexity of the equipment required for the determination of time-dependent properties. These simpler analyses provide a limited representation of cartilage properties thus greatly reducing the impact of the information gathered hindering the understanding of the mechanisms involved in this tissue replacement, development and pathology. More complex techniques could represent better investigative methods, but their uptake in cartilage research is limited by the highly specialised training required and cost of the equipment. There is, therefore, a clear need for alternative experimental approaches to cartilage testing to be deployed in research and clinical settings using more user-friendly and financial accessible devices. Frequency dependent material properties can be determined through rheometry that is an easy to use requiring a relatively inexpensive device; we present how a commercial rheometer can be adapted to determine the viscoelastic properties of articular cartilage. Frequency-sweep tests were run at various applied normal loads on immature, mature and trypsinased (as model of osteoarthritis) cartilage samples to determine the dynamic shear moduli (G*, G′ G″) of the tissues. Moduli increased with increasing frequency and applied load; mature cartilage had generally the highest moduli and GAG depleted samples the lowest. Hydraulic permeability (K_H) was estimated from the rheological data and decreased with applied load; GAG depleted cartilage exhibited higher hydraulic permeability than either immature or mature tissues. The rheometer-based methodology developed was validated by the close comparison of the rheometer-obtained cartilage characteristics (G*, G′, G″, K_H) with results obtained with more complex testing techniques available in literature. Rheometry is relatively simpler and does not require highly capital intensive machinery and staff training is more accessible; thus the use of a rheometer would represent a cost-effective approach for the determination of frequency-dependent properties of cartilage for more comprehensive and impactful results for both healthcare professional and R&D.

Can sodium MRI be used as a method for mapping of cartilage stiffness?

Objective

Sodium concentration is responsible for (at least part of) the stiffness of articular cartilage due to the osmotic pressure it generates. Therefore, we hypothesized that we could use sodium MRI to approximate the stiffness of cartilage to assess early cartilage degeneration.

Methods

Four human tibial plateaus were retrieved from patients undergoing total knee replacement (TKR), and their cartilage stiffness mapped with indentation testing, after which samples were scanned in a 7 T MRI to determine sodium concentration. The relation of biomechanical parameters to MRI sodium and glycosaminoglycan (GAG) concentration was explored by a linear mixed model.

Results

Weak correlations of GAG concentration with apparent peak modulus (p = 0.0057) and apparent equilibrium modulus (p = 0.0181) were observed and lack of correlation of GAG concentration versus MRI sodium concentration was observed. MRI sodium concentration was not correlated with apparent peak modulus, though a moderate correlation of MRI sodium concentration with permeability was shown (p = 0.0014).

Discussion and conclusion

Although there was correlation between GAG concentration and cartilage stiffness, this was not similar with sodium concentration as measured by MRI. Thus, if the correlation between MRI sodium imaging and GAG concentration could be resolved, this strategy for assessing cartilage functional quality still holds promise.

Electronic supplementary material

The online version of this article (10.1007/s10334-020-00893-x) contains supplementary material, which is available to authorized users.

Human articular cartilage mechanosensitivity is related to histological degeneration - a functional MRI study

OBJECTIVE

To investigate changes in response to sequential pressure-controlled loading and unloading in human articular cartilage of variable histological degeneration using serial T1ρ mapping.

METHOD

We obtained 42 cartilage samples of variable degeneration from the medial femoral condyles of 42 patients undergoing total knee replacement. Samples were placed in a standardized artificial knee joint within an MRI-compatible whole knee-joint compressive loading device and imaged before (δ₀), during (δ_ld1, δ_ld2, δ_ld3, δ_ld4, δ_ld5) and after (δ_rl1, δ_rl2, δ_rl3, δ_rl4, δ_rl5) pressure-controlled loading to 0.663 ± 0.021 kN (94% body weight) using serial T1ρ mapping (spin-lock multigradient echo sequence; 3.0T MRI system [Achieva, Philips]). Reference assessment included histology (Mankin scoring) and conventional biomechanics (Tangent stiffness). We dichotomized sample into intact (n = 21) and degenerative (n = 21) based on histology and analyzed data using Mann Whitney, Kruskal Wallis, one-way ANOVA tests and Spearman's correlation, respectively.

RESULTS

At δ₀, we found no significant differences between intact and degenerative samples, while the response-to-loading patterns were distinctly different. In intact samples, T1ρ increases were consistent and non-significant, while in degenerative samples, T1ρ increases were significantly higher (P = 0.004, δ0 vs δld1, δ0 vs δld3), yet undulating and variable. With unloading, T1ρ increases subsided, yet were persistently elevated beyond δ0.

CONCLUSION

Cartilage mechanosensitivity is related to histological degeneration and assessable by serial T1ρ mapping. Unloaded, T1ρ characteristics are not significantly different in intact vs degenerative cartilage, while load bearing is organized in intact cartilage and disorganized in degenerative cartilage.

A Non-linear Viscoelastic Model of the Incudostapedial Joint

The ossicular joints of the middle ear can significantly affect middle-ear function, particularly under conditions such as high-intensity sound pressures or high quasi-static pressures. Experimental investigations of the mechanical behaviour of the human incudostapedial joint have shown strong non-linearity and asymmetry in tension and compression tests, but some previous finite-element models of the joint have had difficulty replicating such behaviour. In this paper, we present a finite-element model of the joint that can match the asymmetry and non-linearity well without using different model structures or parameters in tension and compression. The model includes some of the detailed structures of the joint seen in histological sections. The material properties are found from the literature when available, but some parameters are calculated by fitting the model to experimental data from tension, compression and relaxation tests. The model can predict the hysteresis loops of loading and unloading curves. A sensitivity analysis for various parameters shows that the geometrical parameters have substantial effects on the joint mechanical behaviour. While the joint capsule affects the tension curve more, the cartilage layers affect the compression curve more.

The evolving large-strain shear responses of progressively osteoarthritic human cartilage

OBJECTIVE

The composition and structure of articular cartilage evolves during the development and progression of osteoarthritis (OA) resulting in changing mechanical responses. We aimed to assess the evolution of the intrinsic, large-strain mechanics of human articular cartilage-governed by collagen and proteoglycan and their interactions-during the progression of OA.

DESIGN

We completed quasi-static, large-strain shear tests on 64 specimens from ten donors undergoing total knee arthroplasty (TKA), and quantified the corresponding state of OA (OARSI grade), structural integrity (PLM score), and composition (glycosaminoglycan and collagen content).

RESULTS

We observed nonlinear stress-strain relationships with distinct hystereses for all magnitudes of applied strain where stiffnesses, nonlinearities, and hystereses all reduced as OA advanced. We found a reduction in energy dissipation density up to 80% in severely degenerated (OARSI grade 4, OA-4) vs normal (OA-1) cartilage, and more importantly, we found that even cartilage with a normal appearance in structure and composition (OA-1) dissipated 50% less energy than healthy (control) load-bearing cartilage (HL₀). Changes in stresses and stiffnesses were in general less pronounced and did not allow us to distinguish between healthy load-bearing controls and very early-stage OA (OA-1), or to distinguish consistently among different levels of degeneration, i.e., OARSI grades.

CONCLUSIONS

Our results suggest that reductions in energy dissipation density can be detected by bulk-tissue testing, and that these reductions precede visible signs of degeneration. We highlight the potential of energy dissipation, as opposed to stress- or stiffness-based measures, as a marker to diagnose early-stage OA.