Impact of Selective Posterior Cruciate Ligament Fiber Release on Femoral Rollback in Cruciate-Retaining Total Knee Arthroplasty: A Computational Study

BACKGROUND

Partial or total release of the posterior cruciate ligament (PCL) is often performed intraoperatively in cruciate-retaining total knee arthroplasty (CR-TKA) to alleviate excessive femoral rollback. However, the effect of the release of selected fibers of the PCL on femoral rollback in CR-TKA is not well understood. Therefore, we used a computational model to quantify the effect of selective PCL fiber releases on femoral rollback in CR-TKA.

METHODS

Computational models of 9 cadaveric knees (age: 63 years, range 47 to 79) were virtually implanted with a CR-TKA. Passive flexion was simulated with the PCL retained and after serially releasing each individual fiber of the PCL, starting with the one located most anteriorly and laterally on the femoral notch and finishing with the one located most posteriorly on the medial femoral condyle. The experiment was repeated after releasing only the central PCL fiber. The femoral rollback of each condyle was defined as the anterior-posterior distance between tibiofemoral contact points at 0° and 90° of flexion.

RESULTS

Release of the central PCL fiber in combination with the anterolateral (AL) fibers, reduced femoral rollback a median of 1.5 [0.8, 2.1] mm (P = .01) medially and by 2.0 [1.2, 2.5] mm (P = .04) laterally. Releasing the central fiber alone reduced the rollback by 0.7 [0.4, 1.1] mm (P < .01) medially and by 1.0 [0.5, 1.1] mm (P < .01) laterally, accounting for 47 and 50% of the reduction when released in combination with the AL fibers.

CONCLUSIONS

Releasing the central fibers of the PCL had the largest impact on reducing femoral rollback, either alone or in combination with the release of the entire AL bundle. Thus, our findings provide clinical guidance regarding the regions of the PCL that surgeons should target to reduce femoral rollback in CR-TKA.

Temperature-Responsive Pickering Double Emulsions Stabilized by Binary Microgels

Microgels are excellent emulsifiers that can self-assemble to reduce interfacial tension and form a steric barrier at an oil-water interface. Herein, we report a two-step emulsification approach to prepare oil-in-water-in-oil (O/W/O) Pickering double emulsions through the dispersion of microgels in two immiscible phases. The stabilization mechanism depends on the uneven distribution and adsorption of hydrophilic water-swollen microgels and hydrophobic octanol-swollen microgels on either outer water droplets or inner oil droplets. Our results reveal that binary microgels outperformed single microgels in terms of interfacial tension reduction and emulsion stabilization. Notably, the binary microgel-stabilized Pickering double emulsions show excellent temperature responsiveness owing to the intrinsic thermal sensitivity of microgels. Consequently, the selective and rapid release of encapsulated substances in different phases can be achieved through the adjustment of the ambient temperature.

Selective Anticancer Therapy Based on a HA-CD44 Interaction Inhibitor Loaded on Polymeric Nanoparticles

Hyaluronic acid (HA), through its interactions with the cluster of differentiation 44 (CD44), acts as a potent modulator of the tumor microenvironment, creating a wide range of extracellular stimuli for tumor growth, angiogenesis, invasion, and metastasis. An innovative antitumor treatment strategy based on the development of a nanodevice for selective release of an inhibitor of the HA-CD44 interaction is presented. Computational analysis was performed to evaluate the interaction of the designed tetrahydroisoquinoline-ketone derivative (JE22) with CD44 binding site. Cell viability, efficiency, and selectivity of drug release under acidic conditions together with CD44 binding capacity, effect on cell migration, and apoptotic activity were successfully evaluated. Remarkably, the conjugation of this CD44 inhibitor to the nanodevice generated a reduction of the dosis required to achieve a significant therapeutic effect.

Photoactivated Selective Release of Droplets from Microwell Arrays

Droplet microfluidics has enabled a significant reduction in reaction volume and analysis time, which in turn has led to transformative advances in high-capacity screening and assays. By arranging droplets into a static array, it is possible to monitor dynamic events that occur within these microchambers over an extended period of time, facilitating the identification of rare events and cell types. In many instances, it is highly desirable to recover a small number of droplets that contain unique analytes or cells for further analyses; however, few techniques allow for selective recovery of droplets from such an array without using a complex network of physical valves, which also require a large number of control units external to the microfluidic device. In this report, we present photoactivated selective release of droplets from a static microwell array enabled by a photoresponsive polymer layer integrated into the microfluidic device. This photoresponsive layer is placed in between a microwell array that traps a large number of droplets and a PDMS slab with or without a top flow channel that can be used for recovery. By using focused light, the photoresponsive layer can either be punctured for release-up recovery or induced to create a bubble by local heating to selectively push-down release droplets. We show that the photoresponsive layer is optically transparent within the visible spectrum and thus does not interfere with optical observation of droplets. The type of photoacoustic dye and the physical properties of the photoresponsive layer can be engineered to induce either puncture of the photoresponsive layer or pushing of droplets out of the microwell arrays with low thermal impact on the droplets. We believe that the photoresponsive layer will have a broad impact in the field of soft lithography-based microfluidic devices for various applications including photoresponsive valves as well as high-throughput single-cell sequencing.

Electrical Potential Specified Release of BSA/Hep/Polypyrrole Composite Film and Its Cellular Responses

A facile strategy is needed for accurate time-space supply of suitable growth factors or drugs. Polypyrrole (PPy) was able to carry almost all kinds of negatively charged biomolecules through anodizing method, which made it an appropriate way for codeposition of multiple molecules. The difference in the conjugation between different molecules and PPy makes it possible for selective release when the redox state of PPy changes. In this work, bovine serum albumin (BSA) and heparin (Hep) were chosen to be the model molecules in view of their differences in the level of electronegativity and molecular weight. Double-layer deposition method was used to improve the biocompatibility of PPy/BSA/Hep film. It was found the content of BSA and Hep in the film can be controlled by regulating deposition current and time. BSA release was facilitated under positive voltage and then promote the proliferation of preosteoblasts, while Hep release was promoted under negative voltage and enhance cell differentiation. Our work provides a dual-molecule model in PPy for selective release and further explores the mechanism of release selectivity, this discovery has potential applications in tissue engineering and regenerative medicine.

An injectable scaffold based on temperature-responsive hydrogel and factor-loaded nanoparticles for application in vascularization in tissue engineering

Controlled release of functional factors contributes to target migration of therapeutic cells and plays a crucial role in the in situ vascularization of tissue repair and regeneration. A biomedical application requires the selective release of multiple factors which will guide the synergy of the cells. Here, we developed an injectable system based on a temperature-responsive hydrogel and stromal cell-derived factor-1 (SDF-1)/vascular endothelial growth factor (VEGF) loaded into two types of nanoparticles to induce migration and rapid proliferation of mesenchymal stem cells (MSCs) and endothelial cells (ECs) via selective SDF-1/VEGF release. Series of in vitro and in vivo experiments demonstrate that our composited system can accurately guide MSCs and ECs for vascularization. In addition, the properties of the nanoparticles and hydrogel, including micro/nanoscales, characteristic of charge, and biocompatibility, played crucial roles for the selective release and cells behavior (target migration and rapid proliferation).

Selective Release of Hydrophobic and Hydrophilic Cargos from Multi-Stimuli-Responsive Nanogels

Highly stable multi-stimuli-responsive nanogels for selective release of simultaneously encapsulated hydrophobic and hydrophilic cargos in a spatiotemporally controlled manner are demonstrated here. The nanogel is composed of hydrophilic pH- and thermoresponsive poly(2-(dimethylamino)ethyl methacrylate) (PDMAEMA) and hydrophobic photocleavable o-nitrobenzyl (ONB) linkage. The hydrophobic cargos were noncovalently encapsulated into lipophilic interiors of the nanogels, while the hydrophilic cargos were chemically linked to the nanogel precursor polymer PDMAEMA through a redox-cleavable disulfide junction. For these dual-loaded nanogels, hydrophobic cargos can be released in response to temperature, pH, and UV light, while the hydrophilic cargos can be released in response to redox reagent. The stimuli-selective release of hydrophobic and hydrophilic cargos affords the system with great potential applications in combination chemotherapy, tissue engineering, anticorrosion, and smart nanoreactors.

Selective Medial Release Technique Using the Pie-Crusting Method for Medial Tightness During Primary Total Knee Arthroplasty

BACKGROUND

The pie-crusting method is popular in releasing lateral tightness during primary total knee arthroplasty (TKA) but is not well described for medial release. We established a selective medial release technique using the pie-crusting technique and investigated the effectiveness and safety of the technique during primary TKA.

METHODS

We retrospectively reviewed 729 primary TKAs with varus deformity between October 2009 and June 2012. Medial tightness in flexion was released by traditional subperiosteal stripping for the anterior portion of the medial collateral ligament (aMCL). Medial tightness in extension was released by the pie crusting for the tight fibers in the posterior portion of the MCL and/or posteromedial corner structures (pMCL/PMCS). Clinical outcomes were evaluated by Knee Society (KS) scores and the Western Ontario and McMaster Universities Osteoarthritis Index. Any complications, including late medial instability that may be related to our surgical technique, were carefully inspected.

RESULTS

Among the 729 knees, 170 (23.3%) required subperiosteal stripping for balancing in flexion only, 186 (25.5%) required the pie-crusting for balancing in extension only and 142 (19.5%) required subperiosteal stripping and the pie-crusting for balancing in flexion and extension. The KS knee score was improved from 52.5 to 83.4, KS function score from 58.2 to 91.9, and Western Ontario and McMaster Universities Osteoarthritis Index from 42.7 to 21.8 (P < .001, all). No specific complications related to our technique were identified.

CONCLUSIONS

The selective medial release technique appears to be an effective and safe method to obtain a balanced mediolateral gap in primary TKA.

Mast cells and inflammation

Mast cells are well known for their role in allergic and anaphylactic reactions, as well as their involvement in acquired and innate immunity. Increasing evidence now implicates mast cells in inflammatory diseases where they are activated by non-allergic triggers, such as neuropeptides and cytokines, often exerting synergistic effects as in the case of IL-33 and neurotensin. Mast cells can also release pro-inflammatory mediators selectively without degranulation. In particular, IL-1 induces selective release of IL-6, while corticotropin-releasing hormone secreted under stress induces the release of vascular endothelial growth factor. Many inflammatory diseases involve mast cells in cross-talk with T cells, such as atopic dermatitis, psoriasis and multiple sclerosis, which all worsen by stress. How mast cell differential responses are regulated is still unresolved. Preliminary evidence suggests that mitochondrial function and dynamics control mast cell degranulation, but not selective release. Recent findings also indicate that mast cells have immunomodulatory properties. Understanding selective release of mediators could explain how mast cells participate in numerous diverse biologic processes, and how they exert both immunostimulatory and immunosuppressive actions. Unraveling selective mast cell secretion could also help develop unique mast cell inhibitors with novel therapeutic applications. This article is part of a Special Issue entitled: Mast cells in inflammation.