1
|
Zandiyeh P, Parola LR, Costa MQ, Hague MJ, Molino J, Fleming BC, Beveridge JE. Long-Term Bilateral Neuromuscular Function and Knee Osteoarthritis after Anterior Cruciate Ligament Reconstruction. Bioengineering (Basel) 2023; 10:812. [PMID: 37508839 PMCID: PMC10376226 DOI: 10.3390/bioengineering10070812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
Neuromuscular function is thought to contribute to posttraumatic osteoarthritis (PTOA) risk in anterior cruciate ligament (ACL)-reconstructed (ACLR) patients, but sensitive and easy-to-use tools are needed to discern whether complex muscle activation strategies are beneficial or maladaptive. Using an electromyography (EMG) signal analysis technique coupled with a machine learning approach, we sought to: (1) identify whether ACLR muscle activity patterns differed from those of healthy controls, and (2) explore which combination of patient outcome measures (thigh muscle girth, knee laxity, hop distance, and activity level) predicted the extent of osteoarthritic changes via magnetic resonance imaging (MRI) in ACLR patients. Eleven ACLR patients 10-15 years post-surgery and 12 healthy controls performed a hop activity while lower limb muscle EMG was recorded bilaterally. Osteoarthritis was evaluated based on MRI. ACLR muscle activity patterns were bilaterally symmetrical and differed from those of healthy controls, suggesting the presence of a global adaptation strategy. Smaller ipsilateral thigh muscle girth was the strongest predictor of inferior MRI scores. The ability of our EMG analysis approach to detect meaningful neuromuscular differences that could ultimately be related to thigh muscle girth provides the foundation to further investigate a direct link between muscle activation patterns and PTOA risk.
Collapse
Affiliation(s)
- Payam Zandiyeh
- Department of Orthopaedic Surgery, University of Texas Health Sciences Center at Houston, Houston, TX 77030, USA;
| | - Lauren R. Parola
- Department of Orthopaedics, Rhode Island Hospital/Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Meggin Q. Costa
- Department of Orthopaedics, Rhode Island Hospital/Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Madalyn J. Hague
- Department of Orthopaedics, Rhode Island Hospital/Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Janine Molino
- Department of Orthopaedics, Rhode Island Hospital/Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
- Lifespan Biostatistics, Epidemiology, Research Design, & Informatics Core, Rhode Island Hospital, Providence, RI 02903, USA
| | - Braden C. Fleming
- Department of Orthopaedics, Rhode Island Hospital/Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Jillian E. Beveridge
- Department of Orthopaedics, Rhode Island Hospital/Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| |
Collapse
|
2
|
Parola LR, Pinette MP, Proffen BL, Sant NJ, Karamchedu NP, Costa MQ, Molino J, Fleming BC, Murray MM. Hydrogel treatment for idiopathic osteoarthritis in a Dunkin Hartley Guinea pig model. PLoS One 2022; 17:e0278338. [PMID: 36449506 PMCID: PMC9710799 DOI: 10.1371/journal.pone.0278338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 10/13/2022] [Indexed: 12/02/2022] Open
Abstract
The study objective was to determine if intraarticular injections of an extracellular matrix (ECM) powder and blood composite (ECM-B) would have a significant impact on post-operative gait parameters without eliciting adverse cartilage changes or severe lymphatic reactions in an idiopathic osteoarthritis (OA) model. Twenty-one Dunkin Hartley Guinea pigs received an intraarticular injection of ECM-B in each knee and were split into sub-groups for gait assessment and post-harvest knee evaluations at 1 week (n = 5), 2 weeks (n = 5), 4 weeks (n = 5), or 8 weeks (n = 6). The results were compared with a control group (n = 5), which underwent bilateral injections of phosphate-buffered saline (PBS), gait measurements at 1, 2, 4, and 8 weeks, and post-mortem knee evaluation at 8 weeks post-injection. Hind limbs and popliteal lymph nodes were collected at the Week 8 endpoint and underwent histological analysis by a veterinary pathologist. Significant improvement in hind limb base of support was observed in the ECM-B group compared to the control group at Week 4 but was no longer significant by Week 8. No significant differences were observed between control and ECM-B groups in hind limb cartilage, synovium, or popliteal lymph node histology at Week 8. In conclusion, administration of an ECM-B material may improve gait for a limited time without significant adverse effects on the cartilage, synovium, or local lymph nodes.
Collapse
Affiliation(s)
- Lauren R. Parola
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/ Rhode Island Hospital, Providence, RI, United States of America
| | - Megan P. Pinette
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/ Rhode Island Hospital, Providence, RI, United States of America
| | - Benedikt L. Proffen
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Nicholas J. Sant
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - N. Padmini Karamchedu
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/ Rhode Island Hospital, Providence, RI, United States of America
| | - Meggin Q. Costa
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/ Rhode Island Hospital, Providence, RI, United States of America
| | - Janine Molino
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/ Rhode Island Hospital, Providence, RI, United States of America
| | - Braden C. Fleming
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/ Rhode Island Hospital, Providence, RI, United States of America
- * E-mail:
| | - Martha M. Murray
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States of America
| |
Collapse
|
3
|
Zandiyeh P, Parola LR, Fleming BC, Beveridge JE. Wavelet analysis reveals differential lower limb muscle activity patterns long after anterior cruciate ligament reconstruction. J Biomech 2022; 133:110957. [PMID: 35114581 PMCID: PMC8893161 DOI: 10.1016/j.jbiomech.2022.110957] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to test whether differences in muscle activity patterns between anterior cruciate ligament-reconstructed patients (ACLR) and healthy controls could be detected 10 to 15 years post-surgery using a machine learning classification approach. Eleven ACLR subjects and 12 healthy controls were recruited from an ongoing prospective randomized clinical trial. Surface electromyography (EMG) signals were recorded from gastrocnemius medialis and lateralis, tibialis anterior, vastus medialis, rectus femoris, biceps femoris, and semitendinosus muscles. Muscle activity was analyzed using wavelet analysis and examined within four sub-phases of the hop test, as well as an average of the task as a whole. K-nearest neighbor machine learning combined with a leave-one-out validation was used to classify the muscle activity patterns as either ACLR or Control. When muscle activity was averaged across the whole hop task, activity patterns for all muscles except the tibialis anterior were identified as being different between the study cohorts. ACLR patients demonstrated continuous muscle activities that spanned take-off, airborne, and landing hop phases versus healthy controls who displayed timed and regulated islets of muscle activities specific to each hop phase. The most striking features were 25-50% greater relative quadriceps intensity and approximately 66% diminished biceps femoris intensity in ACLR patients. The current findings are in contrast to previous work using conventional co-contraction and muscle activation onset EMG measures of the same dataset, underscoring the sensitivity and potential of the wavelet approach coupled with machine learning to reveal meaningful adaptation strategies in this at-risk population.
Collapse
Affiliation(s)
- Payam Zandiyeh
- Department of Orthopaedic Surgery, University of Texas Health Sciences Center at Houston, TX, USA.
| | - Lauren R. Parola
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Braden C. Fleming
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Jillian E. Beveridge
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA.,Cleveland Clinic Biomedical Engineering Department, Cleveland, OH, USA.,Corresponding Author: Dr. Jillian Beveridge, Cleveland Clinic Biomedical Engineering Department, 9500 Euclid Avenue/ND20, Cleveland, OH, 44195, USA; ; P: (216) 299-3993
| |
Collapse
|
4
|
Karamchedu NP, Fleming BC, Proffen BL, Sant NJ, Portilla G, Parola LR, Molino J, Murray MM. Terminal sterilization influences the efficacy of an extracellular matrix-blood composite for treating posttraumatic osteoarthritis in the rat model. J Orthop Res 2022; 40:573-583. [PMID: 33913543 PMCID: PMC8553815 DOI: 10.1002/jor.25056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 01/21/2021] [Accepted: 04/12/2021] [Indexed: 02/04/2023]
Abstract
The objective was to determine if an intra-articular injection of an extracellular matrix (ECM) powder and blood composite (ECM-B) after anterior cruciate ligament (ACL) injury would have a mitigating effect on posttraumatic osteoarthritis and if that effect would be different with terminal sterilization of the ECM powder before use. Eighty Lewis rats underwent ACL transection and were divided into four groups: (1) intra-articular injection with phosphate-buffered saline (PBS; n = 20), (2) intra-articular injection of ECM-B using aseptically processed ECM (ASEPTIC; n = 20), (3) intra-articular injection of the ECM-busing ECM powder sterilized with 15 kGy electron beam irradiation (EBEAM; n = 20), and (4) intra-articular injection of the ECM-B using ECM powder sterilized with ethylene oxide (EO; n = 20). Twenty additional animals received capsulotomy only (SHAM). The animals were followed for 6 weeks and evaluations of gait, radiographs, and joint cartilage histology were performed. At 6 weeks, when compared to the SHAM group, the group treated with PBS had significantly worse gait and histologic changes, while the ASEPTIC group was not different from SHAM for either of these outcomes. When compared to the SHAM group, the EO group had similar gait outcomes, but greater histologic damage, and the EBEAM group had significantly worse gait and histological outcomes. The ECM-B composite produced using aseptically processed ECM powder mitigated the gait and histologic changes associated with osteoarthritis after ACL transection in the rat; however, care must be taken when selecting a terminal sterilization method as this may affect the effectiveness of treatment.
Collapse
Affiliation(s)
- Naga Padmini Karamchedu
- Department of Orthopaedics, Warren Alpert Medical School of
Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Braden C. Fleming
- Department of Orthopaedics, Warren Alpert Medical School of
Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Benedikt L. Proffen
- Department of Orthopaedic Surgery, Boston Children’s
Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicholas J. Sant
- Department of Orthopaedic Surgery, Boston Children’s
Hospital, Harvard Medical School, Boston, MA, USA
| | - Gabriela Portilla
- Department of Orthopaedic Surgery, Boston Children’s
Hospital, Harvard Medical School, Boston, MA, USA
| | - Lauren R. Parola
- Department of Orthopaedics, Warren Alpert Medical School of
Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Janine Molino
- Department of Orthopaedics, Warren Alpert Medical School of
Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Martha M. Murray
- Department of Orthopaedic Surgery, Boston Children’s
Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
5
|
Behnke AL, Parola LR, Karamchedu NP, Badger GJ, Fleming BC, Beveridge JE. Neuromuscular function in anterior cruciate ligament reconstructed patients at long-term follow-up. Clin Biomech (Bristol, Avon) 2021; 81:105231. [PMID: 33246796 PMCID: PMC7855572 DOI: 10.1016/j.clinbiomech.2020.105231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/11/2020] [Accepted: 11/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The permanence of neuromuscular adaptations following anterior cruciate ligament reconstruction is not known. The aim of this study was to compare bilateral muscle co-contraction indices, time to peak ground reaction force, and timing of muscle onset between anterior cruciate ligament reconstruction subjects 10-15 years post reconstruction with those of matched uninjured controls during a one-leg hop landing. METHODS Nine healthy controls and 9 reconstruction subjects were recruited. Clinical and functional knee exams were administered. Lower limb co-contraction indices, time to peak ground reaction force, and muscle onset times were measured bilaterally. Differences in clinical and functional outcomes were assessed with unpaired t-tests, and mixed model repeated measures were used to examine effects of group, limb and interaction terms in electromyography measures. FINDINGS 89% of control knees were clinically "normal", whereas only 33% of reconstructed knees were "normal". Anterior cruciate ligament-reconstructed subjects tended to achieve shorter functional hop distances but demonstrated symmetrical lower limb electromyography measures that were no different from those of controls' with the exception that biceps femoris activation was delayed bilaterally prior to ground contact but was greater during the injury risk phase of landing. INTERPRETATION With the exception of hamstring activation, lower limb electromyography measures were largely similar between ligament-reconstructed and matched control subjects, which was in contrast to the clinical findings. This result brings into question the significance of neuromuscular function at this long-term follow-up but raises new questions regarding the role of symmetry and pre-injury risk.
Collapse
Affiliation(s)
- Analicia L Behnke
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA.
| | - Lauren R Parola
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA.
| | - Naga Padmini Karamchedu
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA.
| | - Gary J Badger
- Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA.
| | - Braden C Fleming
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA.
| | - Jillian E Beveridge
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA; Cleveland Clinic Biomedical Engineering Department, Cleveland, OH, USA.
| |
Collapse
|
6
|
Abstract
Vinylcyclohexene (VCH) is an industrial byproduct that is known to cause the destruction of ovarian follicles in mice. Its analog, 4-phenylcyclohexene (4PC), is a volatile product from latex-backed carpeting. These studies were undertaken to assess the structure-activity relationships of these compounds and the potential for 4PC to cause ovotoxicity. Female B6C3F1 mice were dosed with VCH (6 mmol/kg/day, ip) or 4PC (3 or 6 mmol/kg/day, ip) daily for 30 days. Treatment with VCH caused dramatic reductions in small and growing follicles as compared to those of vehicle controls. No treatment-related ovarian lesions were associated with 4PC administration. Plasma FSH concentrations were unaltered by treatment with either compound. These results indicate that in mice, the substitution of the phenyl for the vinyl group in the 4 position eliminates the ovotoxicity caused by this class of compounds. Presumably, the ability of the vinyl group to form an epoxide (or dihydrodiol) and/or its smaller size accounts for this difference in ovarian toxicity.
Collapse
Affiliation(s)
- S B Hooser
- Department of Pharmacology and Toxicology, University of Arizona, Tucson 85721
| | | | | | | |
Collapse
|