An in vivo determination of patellofemoral contact positions

OBJECTIVE

To determine patellofemoral contact patterns in two-dimensions for normal and implanted patients.

DESIGN

An in vivo, weightbearing fluoroscopy analysis of 14 subjects with normal knees, 12 with anterior cruciate ligament deficient knees, 14 with a posterior cruciate retaining implant, and 25 with a posterior cruciate substituting implant.

BACKGROUND

Most previous experimental studies involving the knee joint have been either in vitro or under nonweightbearing conditions.

METHODS

Subjects were studied under fluoroscopic surveillance performing deep knee bends to maximum flexion. Video images were analyzed on a computer with a two-dimensional technique of digitizing discrete points on the patella, femur, and tibia.

RESULTS

The contact position, measured from the patella mass center, was inferior on the patella at extension and moved superior during flexion. Average contact positions of the implanted knee groups were more superior than the normal knee group throughout the flexion cycle. Analysis of patellar tilt angle demonstrated a flexed posture of the patella relative to the tibia. Increase in patellar tilt angle with increasing femorotibial flexion was substantially greater in implanted knees versus normal knees. Separation of the patella from the femur in full extension was absent in normal knees, but present in 86% and 44% of posterior cruciate retaining and posterior cruciate substituting total knee arthroplasties, respectively.

CONCLUSIONS

The patellofemoral kinematics of the total knee arthroplasties analyzed in the study was statistically different than the normal and anterior cruciate ligament-deficient knees. The kinematic variations observed between normal and implanted knees may be related to disturbed femorotibial kinematics previously observed to occur following total knee arthroplasty.

RELEVANCE

Patellofemoral complications, including polyethylene wear, are a major concern in total knee arthroplasty. Since the causes of polyethylene wear are multi-factorial, abnormal patellofemoral kinematics may play a role in patellar failure.

[In vivo determination of patello-femoral separation and linear impulse forces]

Problems associated with the patellofemoral joint account for nearly half of all total knee arthroplasty (TKA) revisions. Under in vivo conditions, we previously determined that TKA subjects experience patellofemoral separation while performing dynamic, weight-bearing activities. This study investigates the impulse loading conditions that may exist at the time the patella impacts the femur during knee flexion. Fifty-seven subjects (68 knees) performed three successive deep knee bends under fluoroscopic surveillance. Eleven subjects (14 knees) had a posterior cruciate retaining (PCR) TKA, 19 subjects (25 knees) had a posterior cruciate substituting (PS) TKA, 15 subjects (17 knees) had a normal knee, and 12 subjects (12 knees) had an anterior cruciate ligament deficient (ACLD) knee. Velocities of each subjects' patella relative to a fixed point on the tibia were used as input to a mathematical model incorporating the impulse-momentum equation. At full extension, 12 of 14 PCR knees, 11 of 25 PS knees, 1 of 12 ACLD knees, and none of the 17 normal knees exhibited patellofemoral joint separation. The maximum separation, detected in a PCR knee, was 12 mm. The relative force determined upon patellofemoral impact was minimal (1.0 N). Simulated walking conditions for each subject were then entered into the mathematical model at a rate of 100 Hz and the calculated patellofemoral impact forces ranged from 78 N to 213 N. Since impulse loading conditions occur over a very small period of time, it was concluded that capturing fluoroscopy images at a rate of 30 Hz was too slow. Under simulated walking conditions, the impact forces due to impulse loading could contribute to polyethylene failure if these conditions induce fatigue of the polyethylene.

pFJ265, a new cloning vehicle for Streptomyces

A 9.3-kb plasmid, pNM100, was isolated from Streptomyces virginiae (NRRL 15156) and characterized. Streptomyces genes for thiostrepton and neomycin resistance were cloned into pNM100 to yield a small plasmid derivative, pFJ265, that is suitable for Streptomyces gene cloning. pFJ265 is a 9.2-kb nonconjugative plasmid and has a copy number of several hundred per chromosome.

Development of cloning vehicles from the Streptomyces plasmid pFJ103

A 20-kb plasmid, pFJ103, was isolated from a strain of Streptomyces granuloruber. A restriction endonuclease map of the plasmid was constructed. A Streptomyces gene that specifies resistance to the antibiotic thiostrepton was subcloned into Escherichia coli plasmid pBR322, inserted into pFJ103 and transformed into Streptomyces ambofaciens protoplasts. Two classes of transformants were obtained. One carries the pFJ104 plasmid consisting of the entire pFJ103 with the 1.8-kb thiostrepton resistance gene insert. The other carries the pFJ105 plasmid consisting of the 2.9-kb replicon segment of pFJ103 with the same thiostrepton resistance insert. A gene for neomycin resistance together with the entire E. coli pBR322 plasmid were cloned into pFJ105. The resulting E. coli-Streptomyces bifunctional vector, pFJ123, transformed both E. coli and Streptomyces. The small size of pFJ105, its ease of isolation, and efficient transformation of Streptomyces protoplasts establishes it, and its derivatives, as useful plasmid cloning vehicles for fundamental and applied studies.

The biosynthesis of the antibiotic pyrrolnitrin by Pseudomonas aureofaciens

Feeding experiments with tryptophan samples labeled specifically with radioactive and stable isotopes have shown that Pseudomonas aureofaciens converts this amino acid into pyrrolnitrin in such a way that the indole nitrogen gives rise to the nitro group, the amino group becomes the pyrrole nitrogen, C-3 of the precursor side chain becomes C-3 of the antibiotic, and H-2 of the indole ring and H-alpha of the side chain give rise to H-5 and H-2 of pyrrolnitrin, respectively. Only the L-isomer of tryptophan is incorporated with retention of the alpha-hydrogen and the amino nitrogen. From the D-isomer the labels from these two positions are lost. The obvious conclusion that L-tryptophan is the more immediate precursor is, however, contradicted by the better incorporation of D- than L-tryptophan into the antibiotic. Several potential pathway intermediates were evaluated for incorporation and 4-(0-aminophenyl)-pyrrole was found to be a good precursor. The results area discussed in terms of a plausible pathway for pyrrolnitrin biosynthesis.

De-esterification of cephalosporin para-nitrobenzyl esters by microbial enzymes

Bacteria and actinomycetes were screened for esterase enzymes capable of removing the para-nitrobenzyl ester from cephalosporins. An esterase preparation from Bacillus subtilis was used to prepare cephalexin and 7-ADCA from the corresponding para-nitrobenzyl esters.

Origin of glycine from acid hydrolysis of the -lactam antibiotic A16886B

Structural analysis of two new beta-lactam antibiotics, A16884A and A16886B, indicated that they, like cephalosporin C, were composed of modified valine and cysteine residues, and alpha-aminoadipic acid. However, acid hydrolysis of A16886B and A16884A produced three times as much glycine as did hydrolysis of cephalosporin C under the same conditions. Samples of A16886B-(14)C-6 and A16886B-(14)C-8 were prepared by the addition of cysteine-(14)C-3 and cystine-(14)C-1 to fermentations of Streptomyces clavuligerus. The specific activity of glycine obtained from hydrolysis of A16886B-(14)C-6 was considerably higher than that from hydrolysis of A16886B-(14)C-8. An explanation for the difference in amounts of glycine obtained from hydrolysis of these antibiotics is discussed.

Incorporation of labeled precursors into A16886B, a novel -lactam antibiotic produced by Streptomyces clavuligerus

The incorporation of C-14 from amino acids into A16886B, 7-(5-amino-5-carboxyvaleramido)-7-methoxy-3-carbamoyloxymethyl-3-cephem-4- carboxylic acid, by Streptomyces clavuligerus is reported. As with cephalosporin C biosynthesis by the mold Cephalosporium acremonium, labels from cysteine, valine, and alpha-amino-adipic acid were incorporated. Unlike cephalosporin C, in A16886B label from lysine was incorporated into the alpha-aminoadipic acid side chain. Label from methionine-(14)C-methyl was incorporated into the methoxyl group. The relative percentage of incorporation of (3)H and (14)C from doubly labeled cystine suggests the improbability of the C-7 methoxyl group arising from an intermediate containing a double bond between C-6 and C-7.

Detection of a cephalosporin C acetyl esterase in the carbamate cephalosporin antibiotic-producing culture, Streptomyces clavuligerus

The possible role of a cephalosporin C acetyl esterase in the formation of the beta-lactam antibiotic A16886A, 7-(5-amino-5-carboxyvaleramido)-3-carbamoyloxy-methyl-3-cephem-4-carboxylic acid, by Streptomyces clavuligerus was studied. Addition of dl-valine-(14)C-1 to a fermentation of Cephalosporium acremonium gave cephalosporin C-(14)C-9 (I). The formation of deacetylcephalosporin C-(14)C-9 from I occurred at a greater rate in broths of S. clavuligerus than in the broths of C. acremonium, or in the autoclaved broths of S. clavuligerus. Diisopropylfluorophosphate partially inhibited the deacetylation of I in S. clavuligerus broth. An intracellular cephalosporin C esterase in S. clavuligerus could not be demonstrated. Although A16886A has been chemically synthesized from deacetylcephalosporin C, this reaction could not be demonstrated with S. clavuligerus.

Production of substituted L-tryptophans by fermentation

Claviceps purpurea has been shown to produce extracellular l-tryptophan from indole in stirred fermentors. The substrate specificity of this conversion was investigated by using substituted indoles, anthranilic acid, and 4-chloro-anthranilic acid. Addition of 2-, 4-, 5-, 6-, and 7-methyl indole or 6-chloroindole to C. purpurea C1M produced the corresponding substituted l-tryptophan. In contrast, addition of l-methyl, 6-trifluoromethyl, 6-nitro-, or 4-benzyloxy-substituted indoles, or anthranilic and 4-chloroanthranilic acids did not produce detectable amounts of the corresponding tryptophan.

Metabolism of tryptophan by Pseudomonas aureofaciens. 3. Production of substituted pyrrolnitrins from tryptophan analogues

Exogenous tryptophan is metabolized by Pseudomonas aureofaciens to yield pyrrolnitrin [3-chloro-4-(2'-nitro-3'-chlorophenyl)-pyrrole], an antifungal agent. The ability of this culture to metabolize tryptophan analogues in a similar manner was investigated by addition of the appropriate compound to the fermentation. Tryptophan precursors and metabolites or nonphenyl-substituted tryptophans had little effect on pyrrolnitrin biosynthesis, but simple derivatives of indole inhibited the production of pyrrolnitrin. Tryptophans substituted at the 4 position decreased pyrrolnitrin production and were converted into the corresponding substituted indoles. Tryptophans substituted at the 5, 6, and 7 position with fluorine or at the 5 and 7 position with methyl yielded new pyrrolnitrin derivatives. Substitution of larger groups (such as chloro, bromo, trifluoromethyl, and methoxy) at these positions led to the formation of the intermediate, amino pyrrolnitrin [3-chloro-4-(2'-amino-3'-chlorophenyl)-pyrrole], with the appropriate new substituent. The trifluoromethyl group at the 6 position of tryptophan prevented chlorination at the 3 position of pyrrolnitrin.

Metabolism of tryptophans by Pseudomonas aureofaciens. VI. Production of pyrrolnitrin by selected Pseudomonas species

Twenty-nine strains of Pseudomonas, classified as P. fluorescens biotype D or E or as P. multivorans, were examined for the production of pyrrolnitrin, an antifungal agent synthesized in P. aureofaciens. Eight strains were shown to produce pyrrolnitrin in shake-flask fermentation. Four cultures were from the multivorans taxon, and the remaining four were members of the fluorescens group. The antifungal agent produced in these strains was isolated and shown to be pyrrolnitrin by comparison with an authentic sample. The strains differed markedly with respect to the amount of pyrrolnitrin produced and in their utilization of exogenous tryptophan. Secondary metabolites, not related to pyrrolnitrin, were also examined and compared with those synthesized in P. aureofaciens. Marked differences were noted in both phenazine pigments and phenolic metabolites. The results of the study suggest that the production of pyrrolnitrin may be widespread in selected taxonomic groups of Pseudomonas.