Improved responsiveness to change in joint space width over 24-month follow-up: comparison of 3D JSW on weight-bearing CT vs 2D JSW on radiographs in the MOST study

OBJECTIVE

Radiographic joint space width (JSW) has been a standard for measuring knee osteoarthritis (OA) structural change. Limitations in the responsiveness of this approach might be overcome by instead measuring 3D JSW on weight-bearing CT (WBCT). This study compared the responsiveness of 3D JSW measurements using WBCT with the responsiveness of radiographic 2D JSW.

DESIGN

Standing, fixed-flexion knee radiographs (XR) and WBCT were acquired ancillary to the 144- and 168-month Multicenter Osteoarthritis Study visits. Tibiofemoral JSW was measured on both XR and WBCT. Responsiveness to change was defined by the standardized response mean (SRM) for change in JSW (1) at predetermined mediolateral locations (JSWx) on both modalities and (2) in the following subregions measured on WBCT images: central medial and lateral femur (CMF/CLF) and tibia (CMT/CLT), and anterior and posterior tibia (AMT/ALT, PMT/MLT).

RESULTS

Baseline and 24-month follow-up JSWx measurements were completed for 265 participants (58.1% women). Responsiveness of 3D JSWx for medial tibiofemoral compartment on coronal WBCT (SRM range: -0.18, -0.24) exceeded that for 2D JSWx (-0.10, -0.16). Responsiveness of 3D JSW subregional mean (-0.06, -0.36) and maximal (-1.14, -1.75) CMF and CMT and maximal CLF/CLT 3D JSW changes were statistically significantly greater in comparison with respective medial and lateral 2D JSWx (P ≤ 0.002).

CONCLUSIONS

Subregional 3D JSW on WBCT is substantially more responsive to 24-month changes in tibiofemoral joint structure compared to radiographic measurements. Use of subregional 3D JSW on WBCT could enable improved detection of OA structural progression over a 24-month duration in comparison with measurements made on XR.

A Regulatory Perspective on Manufacturing Processes Pertaining to Lyophilized Injectable Products

Freeze-drying, also known as lyophilization, is a dehydration process designed to prolong the shelf life of injectable drug products. Here, we provide regulatory considerations for manufacturing processes specific to lyophilized injectable products. Specifically, a general discussion on each unit operation, including compounding, filtration, filling, and lyophilization, is provided to help the pharmaceutical industry establish reliable manufacturing processes from a regulatory perspective. In addition, a list of manufacturing-related deficiencies identified from a total of 263 new drug applications (NDAs) and abbreviated new drug applications (ANDAs) submitted for lyophilized injectable products is provided. We hope that the information presented in this report may help applicants avoid some common manufacturing-related deficiencies in regulatory submissions, thereby making high-quality lyophilized pharmaceuticals expeditiously available to the American public.

Correlations of Medial Joint Space Width on Fixed-Flexed Standing Computed Tomography and Radiographs With Cartilage and Meniscal Morphology on Magnetic Resonance Imaging

OBJECTIVE

To assess whether medial tibiofemoral joint space width (JSW) on 3-dimensional (3-D) standing computed tomography (SCT) correlates more closely with magnetic resonance imaging cartilage morphology (CM) and meniscal scores than does radiographic 2-D JSW.

METHODS

Participants in the Multicenter Osteoarthritis Study, who had standing fixed-flexion posteroanterior knee radiographs, were recruited. Medial tibiofemoral 3-D JSW on SCT and 2-D JSW on fixed-flexion radiographs were compared with medial tibiofemoral cartilage and meniscal morphology using the Whole-Organ Magnetic Resonance Imaging Score (WORMS). Associations between the area of the articular surface with 3-D JSW <2.5 mm on SCT, radiographic minimal 2-D JSW, and the WORMS-CM and meniscal scores were assessed using Spearman's rho.

RESULTS

For the 19 participants included (33 knees), mean ± SD age was 66.9 ± 5.4 years, body mass index was 29.5 ± 4.4 kg/m(2) , 42.1% of participants were female, and the Kellgren/Lawrence grades were 0 (21.2%), 1 (36.4%), 2 (18.2%), and 3 (24.2%). The articular surface area with 3-D JSW <2.5 mm on SCT correlated with WORMS-CM scores for the central medial tibia (rs  = 0.84, P < 0.001), central medial femur (rs  = 0.60, P < 0.007), and posterior medial meniscal tear (rs  = 0.39, P < 0.026), as did other cut points for 3-D JSW. Correlations with radiographic minimal 2-D JSW were -0.66, -0.52, and -0.40, respectively, differing from SCT only for tibial cartilage (P = 0.001).

CONCLUSION

Greater surface area with a low JSW, measured by SCT, correlates more strongly with the severity of tibial cartilage lesions, while correlating with medial femoral cartilage and meniscal damage to a similar extent as radiographic minimal JSW. SCT may enable valid stratification of participants in clinical trials, through quickly and inexpensively characterizing osteoarthritis features.

Coherence between cellular responses and in vitro splicing inhibition for the anti-tumor drug pladienolide B and its analogs

Pladienolide B (PB) is a potent cancer cell growth inhibitor that targets the SF3B1 subunit of the spliceosome. There is considerable interest in the compound as a potential chemotherapeutic, as well as a tool to study SF3B1 function in splicing and cancer development. The molecular structure of PB, a bacterial natural product, contains a 12-member macrolide ring with an extended epoxide-containing side chain. Using a novel concise enantioselective synthesis, we created a series of PB structural analogs and the structurally related compound herboxidiene. We show that two methyl groups in the PB side chain, as well as a feature of the macrolide ring shared with herboxidiene, are required for splicing inhibition in vitro. Unexpectedly, we find that the epoxy group contributes only modestly to PB potency and is not absolutely necessary for activity. The orientations of at least two chiral centers off the macrolide ring have no effect on PB activity. Importantly, the ability of analogs to inhibit splicing in vitro directly correlated with their effects in a series of cellular assays. Those effects likely arise from inhibition of some, but not all, endogenous splicing events in cells, as previously reported for the structurally distinct SF3B1 inhibitor spliceostatin A. Together, our data support the idea that the impact of PB on cells is derived from its ability to impair the function of SF3B1 in splicing and also demonstrate that simplification of the PB scaffold is feasible.

Elevated tibiofemoral articular contact stress predicts risk for bone marrow lesions and cartilage damage at 30 months

OBJECTIVE

As cartilage loss and bone marrow lesions (BMLs) are associated with knee joint pain and structural worsening, this study assessed whether non-invasive estimates of articular contact stress may longitudinally predict risk for worsening of knee cartilage morphology and BMLs.

DESIGN

This was a longitudinal cohort study of adults aged 50-79 years with risk factors for knee osteoarthritis. Baseline and follow-up measures included whole-organ magnetic resonance imaging score (WORMS) classification of knee cartilage morphology and BMLs. Tibiofemoral geometry was manually segmented on baseline magnetic resonance imaging (MRI), and three-dimensional (3D) tibiofemoral point clouds were registered into subject-specific loaded apposition using fixed-flexion knee radiographs. Discrete element analysis (DEA) was used to estimate mean and peak contact stresses for the medial and lateral compartments. The association of baseline contact stress with worsening cartilage and BMLs in the same subregion over 30 months was assessed using conditional logistic regression.

RESULTS

Subjects (N = 38, 60.5% female) had a mean ± standard deviation (SD) age and body mass index (BMI) of 63.5 ± 8.4 years and 30.5 ± 3.7 kg/m2 respectively. Elevated mean articular contact stress at baseline was associated with worsening cartilage morphology and worsening BMLs by 30 months, with odds ratio (OR) [95% confidence interval (CI)] of 4.0 (2.5, 6.4) and 6.6 (2.7, 16.5) respectively. Peak contact stress also was significantly associated with worsening cartilage morphology and BMLs {1.9 (1.5, 2.3) and 2.3 (1.5, 3.6)}(all P < 0.0001).

CONCLUSIONS

Detection of higher contact stress 30 months prior to structural worsening suggests an etiological role for mechanical loading. Estimation of articular contact stress with DEA is an efficient and accurate means of predicting subregion-specific knee joint worsening and may be useful in guiding prognosis and treatment.

Structure-based design of highly selective β-secretase inhibitors: synthesis, biological evaluation, and protein-ligand X-ray crystal structure

The structure-based design, synthesis, and X-ray structure of protein-ligand complexes of exceptionally potent and selective β-secretase inhibitors are described. The inhibitors are designed specifically to interact with S(1)' active site residues to provide selectivity over memapsin 1 and cathepsin D. Inhibitor 5 has exhibited exceedingly potent inhibitory activity (K(i) = 17 pM) and high selectivity over BACE 2 (>7000-fold) and cathepsin D (>250000-fold). A protein-ligand crystal structure revealed important molecular insight into these selectivities. These interactions may serve as an important guide to design selectivity over the physiologically important aspartic acid proteases.

Enantioselective total synthesis of pladienolide B: a potent spliceosome inhibitor

An enantioselective and convergent total synthesis of pladienolide B (1) is described. Pladienolide B binds to the SF3b complex of a spliceosome and inhibits mRNA splicing activity. The synthesis features an epoxide opening reaction, an asymmetric reduction of a β-keto ester, and a cross metathesis strategy for the side chain synthesis.

Enhancing protein backbone binding--a fruitful concept for combating drug-resistant HIV

The evolution of drug resistance is one of the most fundamental problems in medicine. In HIV/AIDS, the rapid emergence of drug-resistant HIV-1 variants is a major obstacle to current treatments. HIV-1 protease inhibitors are essential components of present antiretroviral therapies. However, with these protease inhibitors, resistance occurs through viral mutations that alter inhibitor binding, resulting in a loss of efficacy. This loss of potency has raised serious questions with regard to effective long-term antiretroviral therapy for HIV/AIDS. In this context, our research has focused on designing inhibitors that form extensive hydrogen-bonding interactions with the enzyme's backbone in the active site. In doing so, we limit the protease's ability to acquire drug resistance as the geometry of the catalytic site must be conserved to maintain functionality. In this Review, we examine the underlying principles of enzyme structure that support our backbone-binding concept as an effective means to combat drug resistance and highlight their application in our recent work on antiviral HIV-1 protease inhibitors.

Tetrahydrofuran, tetrahydropyran, triazoles and related heterocyclic derivatives as HIV protease inhibitors

HIV/AIDS remains a formidable disease with millions of individuals inflicted worldwide. Although treatment regimens have improved considerably, drug resistance brought on by viral mutation continues to erode their effectiveness. Intense research efforts are currently underway in search of new and improved therapies. This review is concerned with the design of novel HIV-1 protease inhibitors that incorporate heterocyclic scaffolds and which have been reported within the recent literature (2005-2010). Various examples in this review showcase the essential role heterocycles play as scaffolds and bioisosteres in HIV-1 protease inhibitor drug development. This review will hopefully stimulate the widespread application of these heterocycles in the design of other therapeutic agents.

Acute articular fracture severity and chronic cartilage stress challenge as quantitative risk factors for post-traumatic osteoarthritis: illustrative cases

Novel biomechanical methods have been developed to objectively measure acute fracture severity (from inter-fragmentary surface area) and chronic contact stress challenge (from patient-specific finite element analysis) in articular fractures. These new methods help clarify the pathomechanics of the development of post-traumatic osteoarthritis, and can contribute directly to the clinical care of patients. In this manuscript, the value of these two new measures is demonstrated in three illustrative tibial plafond fracture cases, in which both metrics are correlated with cartilage status and with patient outcomes at a minimum of two years after injury. These clinical cases demonstrate the utility of new biomechanical variables to advance clinical research and patient care, by providing a basis to predict outcome and select treatment.

Design, synthesis, protein-ligand X-ray structure, and biological evaluation of a series of novel macrocyclic human immunodeficiency virus-1 protease inhibitors to combat drug resistance

The structure-based design, synthesis, and biological evaluation of a series of nonpeptidic macrocyclic HIV protease inhibitors are described. The inhibitors are designed to effectively fill in the hydrophobic pocket in the S1'-S2' subsites and retain all major hydrogen bonding interactions with the protein backbone similar to darunavir (1) or inhibitor 2. The ring size, the effect of methyl substitution, and unsaturation within the macrocyclic ring structure were assessed. In general, cyclic inhibitors were significantly more potent than their acyclic homologues, saturated rings were less active than their unsaturated analogues and a preference for 10- and 13-membered macrocylic rings was revealed. The addition of methyl substituents resulted in a reduction of potency. Both inhibitors 14b and 14c exhibited marked enzyme inhibitory and antiviral activity, and they exerted potent activity against multidrug-resistant HIV-1 variants. Protein-ligand X-ray structures of inhibitors 2 and 14c provided critical molecular insights into the ligand-binding site interactions.

Design of HIV-1 protease inhibitors with pyrrolidinones and oxazolidinones as novel P1'-ligands to enhance backbone-binding interactions with protease: synthesis, biological evaluation, and protein-ligand X-ray studies

Structure-based design, synthesis, and biological evaluation of a series of novel HIV-1 protease inhibitors are described. In an effort to enhance interactions with protease backbone atoms, we have incorporated stereochemically defined methyl-2-pyrrolidinone and methyl oxazolidinone as the P1'-ligands. These ligands are designed to interact with Gly-27' carbonyl and Arg-8 side chain in the S1'-subsite of the HIV protease. We have investigated the potential of these ligands in combination with our previously developed bis-tetrahydrofuran (bis-THF) and cyclopentanyltetrahydrofuran (Cp-THF) as the P2-ligands. Inhibitor 19b with a (R)-aminomethyl-2-pyrrolidinone and a Cp-THF was shown to be the most potent compound. This inhibitor maintained near full potency against multi-PI-resistant clinical HIV-1 variants. A high resolution protein-ligand X-ray crystal structure of 19b-bound HIV-1 protease revealed that the P1'-pyrrolidinone heterocycle and the P2-Cp-ligand are involved in several critical interactions with the backbone atoms in the S1' and S2 subsites of HIV-1 protease.

L-selectride-mediated highly diastereoselective asymmetric reductive aldol reaction: access to an important subunit for bioactive molecules

L-selectride reduction of a chiral or achiral enone followed by reaction of the resulting enolate with optically active alpha-alkoxy aldehydes proceeded with excellent diastereoselectivity. The resulting alpha,alpha-dimethyl-beta-hydroxy ketones are inherent to a variety of biologically active natural products.

Quantification of ankle articular cartilage topography and thickness using a high resolution stereophotography system

OBJECTIVE

To describe the topography and to measure thicknesses, surface areas and volumes in the cartilage layers of the ankle.

METHODS

Twelve cadaveric ankle joints were disarticulated and the cartilage surfaces of each bone were imaged with a highly accurate (+/-2 microm) stereophotography system (ATOS). The cartilage was then dissolved and the subchondral bone imaged. The geometric data were then used to measure the quantitative parameters in each cartilage layer.

RESULTS

The mean cartilage volume across the 12 specimens ranged from 0.32+/-0.08 ml for the fibula to 2.44+/-0.48 ml for the talus. The mean thickness of both the talar (1.1+/-0.18 mm) and tibial (1.16+/-0.14 mm) cartilage was significantly thicker than the fibula (0.85+/-0.13 mm). The talus had the greatest mean maximum cartilage thickness (2.38+/-0.4 mm).

CONCLUSIONS

The reported stereophotographic technique may be used as an independent gold standard for validation of the accuracy of quantitative cartilage measurements made using magnetic resonance imaging. The thickness distribution maps show that the thickest articular cartilage occurs over the talar shoulders where osteochondral lesions commonly occur and not in the centre of the talar dome as commonly believed.

Structure-based optimization of MurF inhibitors

The D-Ala-D-Ala adding enzyme (MurF) from Streptococcus pneumoniae catalyzes the ATP-dependent formation of the UDP-MurNAc-pentapeptide, a critical component of the bacterial cell wall. MurF is a potential target for antibacterial design because it is unique to bacteria and performs an essential non-redundant function in the bacterial cell. The recent discovery and subsequent cocrystal structure determination of MurF in complex with a new class of inhibitors served as a catalyst to begin a medicinal chemistry program aimed at improving their potency. We report here a multidisciplinary approach to this effort that allowed for rapid generation of cocrystal structures, thereby providing the crystallographic information critical for driving the inhibitor optimization process. This effort resulted in the discovery of low-nanomolar inhibitors of this bacterial enzyme.

Differentiation of in vitro transcriptional repression and activation profiles of selective glucocorticoid modulators

The SAR at C-5 of the 10-methoxy-2,2,4-trimethylbenzopyrano[3,4-f]quinoline core leading to identification of (-) anti 1-methylcyclohexen-3-yl as the optimum substituent that imparts minimal GR mediated in vitro transcriptional activation while maintaining full transcriptional repression is described. The in vitro profile of these candidates in human cell assays relevant to the therapeutic window of glucocorticoid modulators is outlined.

Structure-activity relationships of novel potent MurF inhibitors

A novel class of MurF inhibitors was discovered and structure-activity relationship studies have led to several potent compounds with IC(50)=22 approximately 70 nM. Unfortunately, none of these potent MurF inhibitors exhibited significant antibacterial activity even in the presence of bacterial cell permeabilizers.

Nonsteroidal selective glucocorticoid modulators: the effect of C-5 alkyl substitution on the transcriptional activation/repression profile of 2,5-dihydro-10-methoxy-2,2,4-trimethyl-1H-[1]benzopyrano[3,4-f]quinolines

The preparation and characterization of a series of selective glucocorticoid receptor modulators are described. The preliminary structure-activity relationship of nonaromatic C-5 substitution on the tetracyclic quinoline core showed a preference for small lipophilic side chains. Proper substitution at this position maintained the transcriptional repression of proinflammatory transcription factors while diminishing the transcriptional activation activity of the ligand/glucocorticoid receptor complex. The optimal compounds described in this study were the allyl analogue 18 and cyclopentyl analogue 32. These candidates showed slightly less potent, highly efficacious E-selectin repression with significantly reduced levels of glucocorticoid response element activation in reporter gene assays vs prednisolone. Allyl analogue 18 was evaluated in vivo. An oral dose of 18 showed an ED(50) = 1.7 mg/kg as compared to 1.2 mg/kg for prednisolone in the Sephadex-induced pulmonary eosinophilia model and an ED(50) = 15 mg/kg vs 4 mg/kg for prednisolone in the carrageenan-induced paw edema model.

Impact of exercise on bone health and contraindication of oral contraceptive use in young women

PURPOSE

The effect of quantified resistance and high impact exercise training on bone mass as modified by age and oral contraceptive (OCont) use in young women was studied.

METHODS

Women were categorized by age (18-23 vs 24-31 yr) and OCont use, and were then randomized into either three sessions of resistance exercise plus 60 min.wk-1 of jumping rope or a control group for 24 months. Total body, spine, femoral neck, greater trochanter, Ward's area, and radial bone mineral density (BMD) and/or content (BMC), biochemical markers of bone turnover, dietary intake of calcium, lean body mass, maximal oxygen uptake, and strength were determined at baseline and every 6 months.

RESULTS

Total body (TB) BMC percent change from baseline was higher in exercisers compared with nonexercisers at 6 and 24 months. OCont users had lower bone turnover at baseline and a decrease in TBBMC from baseline compared with non-OCont users at 24 months. Spine BMC and BMD decreased in the exercise and OCont group at 6 months and remained significantly below nonexercisers who used oral contraceptives at 2 yr. Femoral neck BMD also decreased in the exercise and oral contraceptive group at 6 months.

CONCLUSIONS

Exercise prevented a decline in TBBMC seen in the nonexercisers. On the other hand, exercise in oral contraceptive users prevented the increase observed in the spine of the nonexercise plus OCont group.

Insulin-like growth factor I accelerates functional recovery from Achilles tendon injury in a rat model

We studied the effects of insulin-like growth factor I on Achilles tendon healing in a rat model. Rats were randomized into groups of six each: sham surgery, transection alone, and transection plus growth factor. Postoperatively, rats treated with growth factor had a significantly smaller maximum functional deficit and a decreased time to functional recovery than rats in the untreated groups. Biomechanical testing revealed no significant differences in the measured parameters between the treated and the untreated groups after transection. To study the mechanism of action, six additional animals received an Achilles tendon injection of the inflammatory agent carrageenan alone and six received carrageenan plus growth factor. Rats treated with growth factor did not show the inflammation-induced functional deficit experienced by the control rats. Spectrometric myeloperoxidase assays on the remaining eight rats after Achilles tendon transection demonstrated no significant difference between the untreated and the growth factor-treated groups, indicating a mechanism other than neutrophil recruitment by which the growth factor limits inflammation. Histologic studies were performed on carrageenan-injected rats at postinjection day 2 and on surgically treated rats at postoperative day 15. No gross histologic differences were seen between untreated and growth factor-treated groups. This study demonstrated that via a possible antiinflammatory mechanism, insulin-like growth factor I reduces maximum functional deficit and accelerates recovery after Achilles tendon injury.

Correlation of wrist ligamentotaxis with carpal distraction: implications for external fixation

Cadaver forearms were tested to measure carpal bone separation and wrist ligament tension in response to MTS-based incremental wrist distraction. Distraction of 2 mm separated the proximal carpal row from the radius and transmitted an average tension of 8 N. The mid-carpal joint also began to widen at this level of distraction. Distraction of 4 mm resulted in an average tension of 20 N. At this level of distraction, radioscaphoid separation started to exceed radiolunate separation. A transition from low- to high-stiffness response was observed over a range of 4-8 mm distraction for the 12 specimens tested, with an average tension of 80 N associated with 8 mm distraction. Average values of carpal height ratio, revised carpal height ratio, and carpal height index were found to be poor indicators of distraction, owing to their high variability between specimens.

The effect of intercondylar notchplasty on the patellofemoral articulation

Using pressure-sensitive film, we measured the patellofemoral contact areas and pressures after increasing degrees of notchplasty in eight fresh-frozen cadaveric knee specimens. Each specimen was stabilized on an axial loading frame with physiologic loads applied through the quadriceps tendon at varying flexion angles. The patellofemoral joint was loaded at 90 degrees, 105 degrees and 120 degrees of knee flexion. The same measurements were then obtained after serial notchplasties of 3, 6, and 9 mm. The film was analyzed for contact areas and for contact pressures by densitometry. There was no statistical significance between contact area or pressure after notchplasties of 3, 6, or 9 mm at 90 degrees, 105 degrees, and 120 degrees of knee flexion. These data suggest that routine notchplasty does not affect the patellofemoral articulation.

Contact stress distributions in malreduced intraarticular distal radius fractures

Residual articular incongruity of the distal radius following intraarticular fracture has been correlated with early osteoarthritis (OA) and a poor clinical outcome. We developed a simple in vitro fracture model of the distal radius to investigate the relationship between degree of articular incongruity and the resulting distribution of radiocarpal contact stress. Twelve fresh-frozen cadaver arms were dissected, packets of Fuji Pressensor film were inserted into the wrist, and the wrist was loaded through its flexor and extensor tendons. We created a simple intraarticular fracture that allowed controlled distal radius articular incongruity. Loading trials were performed for the intact distal radius, for a fully reduced case, and for step-offs of 0.4, 1, 2, and 3 mm. Mean contact stress was significantly greater than the anatomically reduced case at only 3 mm of step-off. Contact area was greater than the anatomically reduced case at 0.4, 1, and 2 mm of step-off. The elevations in contact stress that we observed were only modest, suggesting that other factors may be involved in the pathogenesis of radiocarpal OA in the presence of residual articular incongruity.

Displaced intra-articular fractures of the distal radius: the effect of fracture displacement on contact stresses in a cadaver model

Contact stresses in the wrist were measured after simulating displaced fractures of the lunate fossa in the distal radius of eight human cadaver arms. Osteotomies created displaced lunate fossa fractures of 0, 1, 2, and 3 mm. Contact stresses were measured with Fuji pressure-sensitive film after loads of 100 N were applied to the wrist through wrist flexor and extensor tendons. Mean contact stresses were significantly increased with step-offs of 1 mm or more. Maximum stresses and overloaded areas were significantly increased with step-offs of 2 mm or more. As the magnitude of the fracture displacement increased, there was a shift in the focus of the maximum stresses toward the fracture line. In this model, simulated displaced die-punch fractures created alterations in both the magnitude and location of contact stresses in the wrist joint.

Physical modelling of hip joint forces in stair climbing

A test device has been developed and validated to simulate physiologic loading of the hip during stair climbing. Forces about the hip joint were measured in static simulations of stair climbing using simulated extensor, abductor and adductor muscle groups to support the joint. Femoral flexion angle (to model step length and height) and applied hip flexion moment (to model trunk lean) were varied to examine the effects of different loading conditions on the hip. In stair climbing the maximum total joint force was six times body weight at 34 degrees of femoral flexion and 60 N m of hip flexion moment. Joint forces increased with hip flexion moment and varied little with femoral flexion angle, except for the posteriorly directed force. This component, which twists implants about the femoral shaft, increased with femoral flexion angle but changed little with hip flexion moment.

Biomechanical evaluation of cervical spine stabilization methods using a porcine model

STUDY DESIGN

The biomechanical stability of three different methods of cervical spine stabilization was evaluated in a porcine model. Specimens were tested in flexion, extension, and axial rotation.

OBJECTIVES

Our goal was to determine if posterior lateral mass plating after anterior reconstruction provided more stability compared with unicortical or bicortical anterior plate fixation after a simulated corpectomy.

SUMMARY OF BACKGROUND DATA

Previous implant biomechanical evaluations use ligamentous and intervertebral disc disruption models under constrained and nonrepetitive loading. This study examines implant performance using a corpectomy model loaded for multiple cycles, allowing for unconstrained motion.

METHODS

Twenty-one porcine cervical spines were destabilized with a one-level cervical corpectomy and reconstructed with an anterior methacrylate graft. Each construct was stabilized with either an AO Morscher plate system with unicortical, self-locking screws; a Caspar plate with biocortical screws; or two posterior lateral mass plates. Testing with cyclic loads was performed on an MTS machine in flexion, extension, and axial rotation.

RESULTS

There was no statistical difference between the two anterior forms of fixation in flexion, extension, or axial rotation. Posterior lateral mass plating was significantly more stable than either anterior construct. Screw loosening was seen more frequently with bicortical Caspar plating.

CONCLUSIONS

After a single-level cervical corpectomy and idealized grafting, all three surgical constructs provided stability equal to or greater than the intact condition in flexion, extension, and axial rotation. In unstable cervical spine injury patterns involving anterior disruption, this study supports the use of anterior grafting combined with posterior lateral mass plating to achieve maximum stability.

Radial instability of the metacarpophalangeal joint of the thumb. A biomechanical investigation

Human cadaver thumbs were tested to evaluate stability of the radial side of the MP joint. The contributions of the dorsal capsule, radial collateral ligament, accessory collateral ligament, and volar plate were examined with the joint in 0 degrees and 30 degrees of flexion. At 0 degrees flexion, the average joint angulation increased 4 degrees following isolated radial collateral ligament transection and 6 degrees following isolated accessory collateral ligament transection. Release of both the accessory and radial collateral ligaments produced marked instability with joint angulation of at least 46 degrees. The accessory collateral ligament helped to stabilize the extended MP joint. There were no significant contributions to stability from the dorsal capsule and volar plate when the collateral ligaments were intact. In the laboratory setting, radial-side instability of the MP joint of the thumb requires transection of both the proper and accessory radial collateral ligament.

A contact-coupled finite element analysis of the radiocarpal joint

A plane-strain finite element contact model of the radiocarpal joint has been developed to investigate the mechanical relationship between initial intra-articular fracture of the distal radius, subsequent imprecise reduction of articular incongruency, and final onset of osteoarthrosis. The model includes the radius, two carpal bones (the lunate and the scaphoid), and the articulations and ligamentous connections between the bones. The model has been validated through comparisons with previous experimental and computational models of the wrist. The relationship between malreduced intra-articular fracture of the distal radius and the subsequent onset of posttraumatic radiocarpal osteoarthrosis is clinically important but poorly understood. The broad objective of the current research is the development of a well-verified computational model of the radiocarpal joint, which in concert with previously developed experimental models, will be capable of providing guidance toward rigorously grounded improvements in distal radius intra-articular fracture management techniques. This model represents a first step toward this objective as well as a new level of computational simulation of wrist mechanics.

The influence of basal cartilage calcification on dynamic juxtaarticular stress transmission

Dynamic finite element analysis is used to elucidate the manner in which juxtaarticular stress distributions depend on the transitional mechanical properties of the calcified cartilage layer. A finite element model is used to study how these stresses change in response to the thinning of the articular cartilage layer associated with tidemark advancement. The finite element results indicate that shear stress levels within the deepest layer of articular cartilage are increased when tidemark advancement with concomitant cartilage-thinning and calcified cartilage/subchondral plate thickening is modeled. The cartilage-thinning associated with tidemark advancement, observed both clinically and experimentally, may be an explanation for what has previously been considered wear-related thinning.

Stress wave effects in a finite element analysis of an impulsively loaded articular joint

A dynamic contact finite element formulation was used to study transient stresses in the impulsively loaded rabbit knee, an established experimental model of mechanically induced osteoarthrosis. The computations were used to test the hypothesis that stress wave propagation and reflection, from juxtarticular interfaces of material property discontinuity, could be responsible for markedly increased levels of transient local cartilage stress. The finite element results demonstrated intuitively credible stress wave propagation and interfacial reflection phenomena. However, the magnitude of these waves was not nearly large enough to appreciably alter the quasi-static stress distributions otherwise prevailing. Thus, local stress wave reflection from interfaces of modulus discontinuity (for example the cartilage/subchondral plate) probably does not contribute appreciably to the heightened tissue sensitivity to impulsive loading experimentally observed in this animal model.

Open hand fractures: prognosis and classification

Two hundred open fractures distal to the carpus in one hundred twenty-one patients were studied retrospectively. One hundred seventy-three fractures were followed-up to complete bony union, which occurred at a median period of seven weeks. Ninety-seven total complications included nine wound infections in seven patients, eighteen malunions, seventeen delayed or nonunions, twenty-three fixation problems, and two late amputations. Infection rate increased in the presence of wound contamination, delay in treatment greater than twenty-four hours, or systemic illness. It was not increased by presence of internal fixation, immediate wound closure, large wound size, tendon/nerve/vascular injury, or high-energy mechanism. We suggest a classification predictive of infection: type I: Clean wound and no systemic illness; type II: Contaminated wound, delay in treatment greater than twenty-four hours, or significant systemic illness. We recommend choosing fracture stabilization on the basis of the mechanical needs of the fracture, regardless of wound size, injury energy, or contamination. Immediate wound closure is appropriate for type I injuries and delayed closure should be reserved for type II wounds.

A dynamic finite element analysis of impulsive loading of the extension-splinted rabbit knee

A dynamic nonlinear finite element model was developed to study juxtarticular stresses in the splinted rabbit knee, an established laboratory model for creating osteoarthrosis due to impulsive loading. Plane strain finite element results were validated by comparison with corresponding experimental data. Parametric effects studied included the input tibial displacement speed, the local bone density distribution, and the modulus of cartilage and subchondral bone. While the computed resultant contact force magnitude was sensitive to a number of model parameters, the stress patterns, when normalized to a given resultant force magnitude, were not. Despite comparable force peaks, the finite element results showed approximately six-fold higher effective strain rate levels for a severely impulsive loading protocol known to induce rapid osteoarthrosis, versus those for a mildly impulsive loading protocol not usually associated with cartilage damage. A propensity for elevated shear in the deep cartilage layer near the contact periphery, observed in nearly all computed stress distributions, is consistent with previous experimental findings of fissuring at that level in the impulsively loaded rabbit knee.

Effect of osteochondral defects on articular cartilage. Contact pressures studied in dog knees

Full thickness osteochondral defects 6 mm in diameter were created in the weight-bearing regions of the femoral condyles in 5 adult mongrel dogs to study the contact pressure changes accompanying healing. A digital imaging technique employing Fuji Prescale film mapped contact pressures following 11 months of healing for comparison with contralateral normal knees, and knees with freshly made defects. Although all defects healed uneventfully with subchondral plate reconstitution and with growth restoration of the articular surface, the repair soft tissue appeared histologically to be primarily fibrous tissue, with varying degrees of a fibrocartilaginous component. The mean and peak stresses about fresh defects were not appreciably different from those about healed defects. Neither were there substantial differences in the total cartilage area making contact, except when very low loads were applied. The results suggest that the repair tissue is of poor mechanical quality, and does not contribute appreciably to weight bearing. The cartilage adjacent to the defect did not experience high stresses; neither gross nor light microscopic evidence of degeneration appeared at 11 months. If degeneration does occur following such defects, our data suggest that it is not because of elevated contact stresses.

Contact stress aberrations following imprecise reduction of simple tibial plateau fractures

Despite the well-recognized association between poorly reduced intraarticular fractures and late degenerative changes, current guidelines regarding the reduction precision necessary to avoid excessive cartilage pressures are based largely on anecdotal clinical observations. To gain a quantitative appreciation of the relation between local pressure elevations and fracture reduction imprecision, a simplified laboratory cadaver model of minimally displaced tibial plateau fractures was developed. Cartilage contact stress distributions were measured as a function of depressed fragment malreduction in seven knees, using high-resolution (100 pixels/mm2) digital image scans of Fuji-film stain patterns. The contact stress data showed a general trend of increases of peak local pressure with increasing fracture site incongruity, and in a few isolated instances the effect was very pronounced. Across the whole series, however, statistically significant departures from anatomic pressure levels did not occur until the fragment stepoff was greater than 1.5 mm. Even at the 3-mm stepoff level, for which the depressed fragment usually no longer made contact with the femoral condyle, the peak local pressure values on the intact side of the fracture line averaged only approximately 75% greater than those prevailing anatomically. Given the successful clinical outcomes normally achieved for conservatively managed simple tibial plateau fractures having stepoff magnitudes (5-10 mm) clearly sufficient to insure fragment articular noncontact, the present laboratory results suggest that nominally factor-of-two peak local pressure elevations, provided that they occur over only small portions of the cartilage surface, are probably within the long-term overall tolerance range of an articular joint.

Biological properties of "partial" transformation mutants of Rous sarcoma virus and characterization of their pp60src kinase

We have isolated mutants of Rous sarcoma virus from an unmutagenized stock of the Schmidt-Ruppin strain of Rous sarcoma virus. These mutants induce only a "partial" transformation, and the transformation properties induced show unusual properties or combinations. Cells infected with mutant CU2 have a unique "blebby" morphology, have lost surface fibronectin, form very small colonies in soft agar, and are nearly normal with respect to adhesiveness and hexose transport. Cells infected with mutant tsCU11 have a nearly normal morphology, but grow well in soft agar. Cells infected with mutant CU12 have a fusiform morphology, intermediate levels of hexose transport and fibronectin, and form very large colonies in soft agar. Because the appearance of the different parameters of transformation is dissociated in these mutant-infected cells, these data are interpreted as supporting a model in which the transforming protein pp60src interacts with more than one primary target in generating the transformed phenotype. All of the mutants display levels of pp60src kinase activity less than that of the wild type. In the case of mutant CU12, the lower kinase activity is in part a consequence of a lower steady-state amount of pp60src inside the cell.