Regional variations of indentation stiffness and thickness of normal rabbit knee articular cartilage

Comparison of 3 Cell-Free Matrix Scaffolds Used to Treat Osteochondral Lesions in a Rabbit Model

BACKGROUND

Various cell-free scaffolds are already in use for the treatment of osteochondral defects (OCDs); however, a gold standard material has not yet been defined.

PURPOSE

This study compared the macroscopic, histological, and scanning electron microscopy (SEM) characteristics of Chondro-Gide (CG), MaioRegen (MA), and poly-d,l-lactide-co-caprolactone (PLCL) cell-free scaffolds enhanced with small-diameter microfractures (SDMs) for OCDs in a rabbit model.

STUDY DESIGN

Controlled laboratory study.

METHODS

In total, 54 knees from 27 rabbits were used in this study. Three rabbits were sacrificed at the beginning of the study to form an intact cartilage control group (group IC). An OCD model was created at the center of the trochlea, and SDMs were generated in 24 rabbits. Rabbits with OCDs were divided into 4 groups (n = 12 knees per group) according to the cell-free scaffold applied: CG (group CG), MA (group MA), PLCL (group PLCL), and a control group (group SDM). Half of the rabbits were sacrificed at 1 month after treatment, while the other half were sacrificed at 3 months after treatment. Healed cartilage was evaluated macroscopically (using International Cartilage Regeneration & Joint Preservation Society [ICRS] classification criteria) and histopathologically (using modified O'Driscoll scores and collagen staining). Additionally, cell-free scaffold morphologies were compared using SEM analysis.

RESULTS

ICRS and modified O'Driscoll classification and staining with collagen type 1 and type 2 demonstrated significant differences among groups at both 1 and 3 months after treatment (P < .05). The histological characteristics of the group IC samples were superior to those of all other groups, except group PLCL, at 3 months after treatment (P < .05). In addition, the histological properties of group PLCL samples were superior to those of group SDM samples at both 1 and 3 months after treatment in terms of the modified O'Driscoll scores and type 1 collagen staining (P < .05). Concerning type 2 collagen staining intensity, the groups were ranked from highest to lowest at 3 months after treatment as follows: group PLCL (30.3 ± 2.6) > group MA (26.6 ± 1.2) > group CG (23.3 ± 2.3) > group SDM (18.9 ± 0.9).

CONCLUSION

OCDs treated with enhanced SDM using cell-free PLCL scaffolds had superior histopathological and microenvironmental properties, more hyaline cartilage, and more type 2 collagen compared with those treated using CG or MA scaffolds.

CLINICAL RELEVANCE

OCDs treated with PLCL cell-free scaffolds may have superior histopathological properties and contain more type 2 collagen than do OCDs treated with CG or MA cell-free scaffolds.

Cartilage Tissue Engineering Approaches Need to Assess Fibrocartilage When Hydrogel Constructs Are Mechanically Loaded

Chondrocytes that are impregnated within hydrogel constructs sense applied mechanical force and can respond by expressing collagens, which are deposited into the extracellular matrix (ECM). The intention of most cartilage tissue engineering is to form hyaline cartilage, but if mechanical stimulation pushes the ratio of collagen type I (Col1) to collagen type II (Col2) in the ECM too high, then fibrocartilage can form instead. With a focus on Col1 and Col2 expression, the first part of this article reviews the latest studies on hyaline cartilage regeneration within hydrogel constructs that are subjected to compression forces (one of the major types of the forces within joints) in vitro. Since the mechanical loading conditions involving compression and other forces in joints are difficult to reproduce in vitro, implantation of hydrogel constructs in vivo is also reviewed, again with a focus on Col1 and Col2 production within the newly formed cartilage. Furthermore, mechanotransduction pathways that may be related to the expression of Col1 and Col2 within chondrocytes are reviewed and examined. Also, two recently-emerged, novel approaches of load-shielding and synchrotron radiation (SR)–based imaging techniques are discussed and highlighted for future applications to the regeneration of hyaline cartilage. Going forward, all cartilage tissue engineering experiments should assess thoroughly whether fibrocartilage or hyaline cartilage is formed.

A Rabbit Femoral Condyle Defect Model for Assessment of Osteochondral Tissue Regeneration

Osteochondral tissue repair represents a common clinical need, with multiple approaches in tissue engineering and regenerative medicine being investigated for the repair of defects of articular cartilage and subchondral bone. A full thickness rabbit femoral condyle defect is a clinically relevant model of an articulating and load bearing joint surface for the investigation of osteochondral tissue repair by various cell-, biomolecule-, and biomaterial-based implants. In this protocol, we describe the methodology and 1.5- to 2-h surgical procedure for the generation of a reproducible, full thickness defect for construct implantation in the rabbit medial femoral condyle. Furthermore, we describe a step-by-step procedure for osteochondral tissue collection and the assessment of tissue formation using standardized histological, radiological, mechanical, and biochemical analytical techniques. This protocol illustrates the critical steps for reproducibility and minimally invasive surgery as well as applications to evaluate the efficacy of cartilage and bone tissue engineering implants, with emphasis on the usage of histological and radiological measures of tissue growth. Impact statement Although multiple surgical techniques have been developed for the treatment of osteochondral defects, repairing the tissues to their original state remains an unmet need. Such limitations have thus prompted the development of various constructs for osteochondral tissue regeneration. An in vivo model that is both clinically relevant and economically practical is necessary to evaluate the efficacy of different tissue engineered constructs. In this article, we present a full thickness rabbit femoral condyle defect model and describe the analytical techniques to assess the regeneration of osteochondral tissue.

Comparative anatomy and morphology of the knee in translational models for articular cartilage disorders. Part II: Small animals

BACKGROUND

Small animal models are critical to model the complex disease mechanisms affecting a functional joint leading to articular cartilage disorders. They are advantageous for several reasons and significantly contributed to the understanding of the mechanisms of cartilage diseases among which osteoarthritis.

METHODS

Literature search in Pubmed.

RESULTS AND DISCUSSION

This narrative review summarizes the most relevant anatomical structural and functional characteristics of the knee (stifle) joints of the major small animal species, including mice, rats, guinea pigs, and rabbits compared with humans. Specific characteristics of each species, including kinematical gait parameters are provided and compared with the human situation. When placed in a proper context respecting their challenges and limitations, small animal models are important and appropriate models for articular cartilage disorders.

Animal Models of Osteochondral Defect for Testing Biomaterials

The treatment of osteochondral defects (OCD) remains a great challenge in orthopaedics. Tissue engineering holds a good promise for regeneration of OCD. In the light of tissue engineering, it is critical to establish an appropriate animal model to evaluate the degradability, biocompatibility, and interaction of implanted biomaterials with host bone/cartilage tissues for OCD repair in vivo. Currently, model animals that are commonly deployed to create osteochondral lesions range from rats, rabbits, dogs, pigs, goats, and sheep horses to nonhuman primates. It is essential to understand the advantages and disadvantages of each animal model in terms of the accuracy and effectiveness of the experiment. Therefore, this review aims to introduce the common animal models of OCD for testing biomaterials and to discuss their applications in translational research. In addition, we have reviewed surgical protocols for establishing OCD models and biomaterials that promote osteochondral regeneration. For small animals, the non-load-bearing region such as the groove of femoral condyle is commonly chosen for testing degradation, biocompatibility, and interaction of implanted biomaterials with host tissues. For large animals, closer to clinical application, the load-bearing region (medial femoral condyle) is chosen for testing the durability and healing outcome of biomaterials. This review provides an important reference for selecting a suitable animal model for the development of new strategies for osteochondral regeneration.

Evaluation of an Autologous Bone Mesenchymal Stem Cell-Derived Extracellular Matrix Scaffold in a Rabbit and Minipig Model of Cartilage Repair

Background

This study aimed to evaluate an autologous bone mesenchymal stem cell (MSC)-derived extracellular matrix (ECM) scaffold in two animal models of cartilage repair.

Material/Methods

A rabbit model (n=16) and a minipig model (n=8) of cartilage repair were created with cartilage defects of the knee joints treated with bone marrow stimulation (BMS). In the ECM group, autologous bone MSC-derived ECM scaffolds were implanted into the cartilage defects after bone marrow stimulation. In the BMS group, the cartilage defects were treated by bone marrow stimulation only. The renewal capacity of bone MSCs was measured with a colony-forming unit fibroblast (CFU-F) in vitro assay. The extent of cartilage repair was as-sessed at 6 months after surgery.

Results

In the rabbit model, the macroscopic appearance of the exudate of the healing wounds in the ECM group showed less fibrosis, and the histology showed more evenly distributed chondrocytes compared with the BMS group. The CFU-F assay showed that the number of bone MSCs in the ECM group was approximately was twice that of the BMS group. In the minipig model, the macroscopic appearance and magnetic resonance imaging (MRI) findings of the ECM group were improved when compared with the BMS group. The repaired tissue in ECM group had similar histological characteristics and biochemical content to normal hyaline cartilage.

Conclusions

In two animal models of knee joint cartilage repair, the use of an ECM scaffold increased the number of bone MSCs and improved the extent of cartilage repair.

Optimization of photocrosslinked gelatin/hyaluronic acid hybrid scaffold for the repair of cartilage defect

There is no therapy currently available for fully repairing articular cartilage lesions. Our laboratory has recently developed a visible light-activatable methacrylated gelatin (mGL) hydrogel, with the potential for cartilage regeneration. In this study, we further optimized mGL scaffolds by supplementing methacrylated hyaluronic acid (mHA), which has been shown to stimulate chondrogenesis via activation of critical cellular signalling pathways. We hypothesized that the introduction of an optimal ratio of mHA would enhance the biological properties of mGL scaffolds and augment chondrogenesis of human bone marrow-derived mesenchymal stem cells (hBMSCs). To test this hypothesis, hybrid scaffolds consisting of mGL and mHA at different weight ratios were fabricated with hBMSCs encapsulated at 20 × 106  cells/ml and maintained in a chondrogenesis-promoting medium. The chondrogenenic differentiation of hBMSCs, within different scaffolds, was estimated after 8 weeks of culture. Our results showed that mGL/mHA at a 9:1 (%, w/v) ratio resulted in the lowest hBMSC hypertrophy and highest glycosaminoglycan production, with a slightly increased volume of the entire construct. The applicability of this optimally designed mGL/mHA hybrid scaffold for cartilage repair was then examined in vivo. A full-thickness cylindrical osteochondral defect was surgically created in the rabbit femoral condyle, and a three-dimensional cell-biomaterial construct was fabricated by in situ photocrosslinking to fully fill the lesion site. The results showed that implantation of the mGL/mHA (9:1) construct resulted in both cartilage and subchondral bone regeneration after 12 weeks, supporting its use as a promising scaffold for repair and resurfacing of articular cartilage defects, in the clinical setting.

A Scaffold-Free Allogeneic Construct From Adipose-Derived Stem Cells Regenerates an Osteochondral Defect in a Rabbit Model

PURPOSE

To determine whether an osteochondral defect could be healed histologically by implanting allogeneic 3-dimensionally formed adipose-derived stem cells (ADSCs) in a rabbit model.

METHODS

Thirty Japanese white rabbits (aged 15-17 weeks) were assigned to 1 of 2 groups. An osteochondral defect (diameter, 4.8 mm; depth, 3 mm) was created in the trochlear groove of the knee using a drill. The defects were left empty in the control group and were filled with cylindrical plugs of allogeneic ADSCs extracted from adipose tissue in the experimental group. Macroscopic scoring, histologic scoring, and immunohistologic stainability of type II collagen were evaluated at 4, 8, and 12 weeks postoperatively.

RESULTS

The macroscopic scores of the healing tissue in the experimental group were significantly greater than those in the control group at 12 weeks (P = .031). Histologically, safranin O staining was noted at 4 weeks and increased gradually over time in the experimental group. The modified International Cartilage Repair Society histologic score in the experimental group was significantly higher than that in the controls at 8 and 12 weeks (14 vs 9 at 8 weeks [P = .008], 18 vs 10 at 12 weeks [P = .007]). The implanted tissue was positive for type II collagen, and stainability increased gradually over time.

CONCLUSIONS

The 3-dimensional scaffold-free allogeneic ADSCs implanted into the osteochondral defect survived, adhered to the defect, increased the stainability of type II collagen gradually over time, and promoted histologic healing in a rabbit model.

CLINICAL RELEVANCE

ADSC implantation designed to promote osteochondral healing may play an important role in osteochondral healing.

Mesenchymal Stem Cells in Oriented PLGA/ACECM Composite Scaffolds Enhance Structure-Specific Regeneration of Hyaline Cartilage in a Rabbit Model

Articular cartilage lacks a blood supply and nerves. Hence, articular cartilage regeneration remains a major challenge in orthopedics. Decellularized extracellular matrix- (ECM-) based strategies have recently received particular attention. The structure of native cartilage exhibits complex zonal heterogeneity. Specifically, the development of a tissue-engineered scaffold mimicking the aligned structure of native cartilage would be of great utility in terms of cartilage regeneration. Previously, we fabricated oriented PLGA/ACECM (natural, nanofibrous, articular cartilage ECM) composite scaffolds. In vitro, we found that the scaffolds not only guided seeded cells to proliferate in an aligned manner but also exhibited high biomechanical strength. To detect whether oriented cartilage regeneration was possible in vivo, we used mesenchymal stem cell (MSC)/scaffold constructs to repair cartilage defects. The results showed that cartilage defects could be completely regenerated. Histologically, these became filled with hyaline cartilage and subchondral bone. Moreover, the aligned structure of cartilage was regenerated and was similar to that of native tissue. In conclusion, the MSC/scaffold constructs enhanced the structure-specific regeneration of hyaline cartilage in a rabbit model and may be a promising treatment strategy for the repair of human cartilage defects.

Repair of osteochondral defects in a rabbit model with artificial cartilage particulates derived from cultured collagen-chondrocyte microspheres

Sketch of fabrication, filling up and repair of rabbit osteochondral defects using artificial cartilage particulates (ACPs) based on collagen I hydrogel microspheres with chondrocytes.

Fresh Osteochondral Allograft Versus Autograft: Twelve-Month Results in Isolated Canine Knee Defects

BACKGROUND

Osteochondral autografts and allografts have been widely used in the treatment of isolated grade 4 articular cartilage lesions of the knee. However, there is a paucity of literature regarding the basic science investigating the direct comparison between fresh osteochondral allografts to autografts.

HYPOTHESIS

At 12 months, fresh osteochondral allografts are equal to autografts with respect to function, bony incorporation into host bone, and chondrocyte viability.

STUDY DESIGN

Controlled laboratory study.

METHODS

Eight adult mongrel dogs underwent bilateral hindlimb osteochondral graft implantation in the knee after creation of an acute Outerbridge grade 4 cartilage defect. One hindlimb of each dog knee received an autograft, and the contralateral knee received an allograft. All dogs were sacrificed at 12 months. Graft analysis included gross examination, radiographs, magnetic resonance imaging (MRI), biomechanical testing, and histology.

RESULTS

MRI demonstrated excellent bony incorporation of both autografts and allografts, except for 1 allograft that revealed partial incorporation. Histologic examination of cartilage showed intact hyaline appearance for both autografts and allografts, with fibrocartilage at the host-graft interface of both. Biomechanical testing demonstrated no significant difference between allografts and autografts (P = .76). Furthermore, no significant difference was observed between allografts and the native cartilage with biomechanical testing (P = .84).

CONCLUSION

After 12 months from time of implantation, fresh osteochondral allograft tissue and autograft tissue in this study were not statistically different with respect to biomechanical properties, gross morphology, bony incorporation, or overall histologic characteristics. When compared with the previously reported 6-month incorporation rates, there was improved allograft and autograft incorporation at 12 months.

CLINICAL RELEVANCE

With no significant differences in gross examination, radiographs, MRI, biomechanical testing, or histology in the canine model, the use of allograft tissue to treat osteochondral defects may eliminate the morbidity associated with autograft harvest.

Can chondral healing be improved following microfracture? The effect of adipocyte tissue derived stem cell therapy

BACKGROUND

We aimed to investigate the effect of adipose tissue-derived mesenchymal stem cells (ADSCs) on chondral healing using the microfracture (MF) technique.

METHODS

Thirty male rabbits were randomly divided into three groups. Standard cylindrical osteochondral defects (OCDs) were created in the weight-bearing areas of the medial condyles of all the right knees; the defects were four millimeters in diameter and two millimeters in depth. The control group (group A) was restricted to spontaneous healing. For group B, we performed MF with a 1.5-mm drill. For group C, we applied MF using the same method and then applied 3×10(6) ADSCs to the defect area. At eight weeks post-operation, the subjects were sacrificed, and the distal femoral joint surfaces were evaluated histopathologically for chondral healing. The samples were scored according to the International Cartilage Repair Society (ICRS) scale.

RESULTS

The results for group C were significantly better than those for group A in terms of the surface properties (p=0.003). The matrix evaluation was better for group A than for group C (p=0.01). The cell distribution, cell viability and subchondral bone parameters were similar between the groups (p=0.198, p=0.387 and p=0.699). The cartilage mineralization parameter was better for group C than for group A (p=0.001). The signs of healing were better for group C than for group B, but the differences were not significant (p=0.185).

CONCLUSIONS

Improvements with additional ADSC treatments were not statistically significant in cases in which ADSC treatment was compared with isolated MF treatment.

CLINICAL RELEVANCE

Additional ADSCs treatment may have positive effect on chondral healing but it doesn't seem significant.

Site-dependent biomechanical responses of chondrocytes in the rabbit knee joint

Biomechanical responses of chondrocytes were determined in specific locations within the superficial zone of patellar, femoral groove, femoral condyle and tibial plateau cartilages obtained from female New Zealand White rabbits. A confocal laser scanning microscope combined with a custom indentation system was utilized for experimentation. Changes in cell volumes and dimensions (i.e. cell height, width and depth) due to loading, global, local axial and transverse strains were determined for each site. Tissue composition and structure was analysed at each indentation site with digital densitometry, polarized light microscopy and Fourier transform infrared imaging spectroscopy. Patellar cells underwent greater volume decreases (compared to femoral groove cells; p<0.05) primarily due to greater decreases in cell height (p<0.05), consistent with greater levels of both global and local axial strains (p<0.05). Lateral condyle cells underwent greater volume decreases (compared to lateral plateau cells; p<0.05) primarily due to greater decreases in cell height, consistent with greater levels of tissue strains (p<0.05). Medial condyle cells underwent smaller volume decreases (compared to medial plateau cells; p<0.05) primarily due to elevated cell expansions in the depth direction, which was consistent with greater levels of minor transverse strains (p<0.05). Site-dependent differences in collagen orientation angles agreed conceptually with the observed cell dimensional changes. Chondrocyte biomechanical responses were highly site-dependent and corresponded primarily with the orientation of the collagen fibrils. The observed differences were thought to be due to the different biomechanical loading conditions at each site.

Very early osteoarthritis changes sensitively fluid flow properties of articular cartilage

In this study, fibril-reinforced poroelastic (FRPE) modeling was used for rabbit knee after anterior cruciate ligament transection (ACLT) to assess how the mechanical properties of collagen, proteoglycans, and fluid in articular cartilage change in early osteoarthritis, and how site-specific these changes are. Unilateral ACLT was performed in eight skeletally mature, female New Zealand white rabbits. A separate control (CTRL) group consisted of knee joints of five non-operated rabbits. Animals were sacrificed at four weeks after ACLT and cartilage-on-bone samples from femoral groove, medial and lateral femoral condyles, and tibial plateaus were harvested. A stress-relaxation protocol in indentation geometry was applied and the FRPE model was fitted to the experimental force-time curve by minimizing the mean absolute error between experiment and simulation. The optimized parameters were: fibril network modulus (Ef), representing the collagen network; non-fibrillar matrix modulus (Enf), representing the PG matrix; and permeability (k), representing fluid flow. Permeability was increased significantly in the ACLT group compared to the CTRL group knees at all sites except for the medial tibial plateau. ACLT also caused a decrease in the Ef at all sites except for the medial and lateral tibial plateaus. The Enf of the ACLT group knees was altered only for the lateral femoral condyle. The results of this study suggest that early osteoarthritis primarily affects cartilage permeability and impairs the collagen network stiffness in a site-specific manner. These findings from early osteoarthritis indicate that fluid flow velocity in articular cartilage may change prior to quantifiable structural alterations in the tissue.

Stem cell therapies for knee cartilage repair: the current status of preclinical and clinical studies

BACKGROUND

Articular cartilage damage of the knee is common, causing significant morbidity worldwide. Many adult tissues contain cells that are able to differentiate into multiple cell types, including chondrocytes. These stem cells have gained significant attention over the past decade and may become frontline management for cartilage defects in the very near future.

PURPOSE

The role of stem cells in the treatment of knee osteochondral defects was reviewed. Recent animal and clinical studies were reviewed to determine the benefits and potential outcomes of using stem cells for cartilage defects.

STUDY DESIGN

Literature review.

METHODS

A PubMed search was undertaken. The key phrase "stem cells and knee" was used. The search included reviews and original articles over an unlimited time period. From this search, articles outlining animal and clinical trials were selected. A search of current clinical trials in progress was performed on the clinicaltrials.gov website, and "stem cells and knee" was used as the search phrase.

RESULTS

Stem cells have been used in many recent in vitro and animal studies. A number of cell-based approaches for cartilage repair have progressed from preclinical animal studies into clinical trials.

CONCLUSION

The use of stem cells for the treatment of cartilage defects is increasing in animal and clinical studies. Methods of delivery of stem cells to the knee's cartilage vary from direct injection to implantation with scaffolds. While these approaches are highly promising, there is currently limited evidence of a direct clinical benefit, and further research is required to assess the overall outcome of stem cell therapies for knee cartilage repair.

An ultrasound biomicroscopic and water jet ultrasound indentation method for detecting the degenerative changes of articular cartilage in a rabbit model of progressive osteoarthritis

It is important to assess the early degeneration of articular cartilage associated with osteoarthritis (OA) for early intervention and treatment planning. Previously, we have developed a high frequency ultrasound and water jet indentation method for the morphologic, acoustic and mechanical assessment of articular cartilage, using the enzymatic digestion as a model of osteoarthritic degeneration. No naturally degenerated articular cartilage has been tested with the developed method. In this study, we aimed to determine the usefulness of the developed method for detecting the natural degeneration of articular cartilage in a standard surgical model of OA in rabbits. Forty adult New Zealand white female rabbits were used in this study, which included 30 experimental rabbits undergoing the right anterior cruciate ligament transection surgery and 10 control rabbits. At the 3rd, 6th, and 9th week post-surgery, 10 experimental rabbits were sacrificed, respectively, for assessment of the knee cartilage quality. The cartilage at the medial and lateral femoral condyles and tibial plateaus (four points) was measured by the high frequency ultrasound biomicroscopy, the water jet ultrasound indentation and a contact mechanical indentation test before a histopathologic analysis for grading of degeneration severity. Measured parameters were compared among different groups classified either by post-surgery time or by histopathologic grade. The results showed a general trend of increase for ultrasound roughness index and a general trend of decrease for integrated reflection coefficient, stiffness coefficient from water-jet indentation and Young's modulus (E) from the mechanical indentation with the increase of post-surgery time. Comparisons among groups with different histopathologic grades showed similar trend with the increase of degeneration severity. The water jet ultrasound indentation method was demonstrated to be an effective method to measure the mechanical properties of the articular cartilage and with further development of arthroscopic ultrasound probe; it has the ability to assess the early degeneration of articular cartilage with measurement of morphologic, acoustic and mechanical properties of the cartilage in vivo.

[Possibilities for the biomechanical characterization of cartilage: a brief update]

The quantitative description of the biomechanical function of diarthrodial joint cartilage is a particularly challenging task due to the unique load bearing, load distribution and tribological properties of the tissue,which have their origin in the unique structure and biochemical composition. In the course of recent decades,different material models and testing methods have been published which claim to meet this challenge in one way or another. The goal of this paper is to provide an overview of the basic principles involved in the most important of these material models and testing methods. The relationship between the material models and the relevant testing methods will be illustrated in a comprehensible manner. As practical use of these methods is also associated with the amount of time required to perform them, particular attention will be paid to experimental approaches requiring only one test modality to be performed.

[Defect models for the regeneration of articular cartilage in large animals]

BACKGROUND

Several animal models are available for the analysis of regeneration of articular cartilage in large animals, such as sheep, pigs, goats, dogs and horses. The subchondral bone lamella must be considered when ACT and MACT techniques are examined in order to protect the implant against migration of cells from the bone marrow, although recruitment of cells is often desirable in the regeneration of human cartilage.

MATERIAL AND METHODS

The defects are mainly positioned at the condyles and the trochlea often bilaterally and spontaneous healing should be excluded. The follow-up period for assessment of the effectiveness of cartilage regeneration is 6-12 months. Shorter observation times up to 12 weeks can be used for pilot studies. Scores based on histological, immunohistological and biochemical staining are mostly used for assessing the regenerated tissue. Biomechanical tests with destructive features need isolated specimens from the animal but modern slice imaging techniques can reflect the progression of the healing processes over the time span of the study in vivo.

CONCLUSION

Approaches to standardize the evaluation of the regeneration of articular cartilage have been sporadically described whereas they are required from the point of view of the approval of new concepts for therapy and the protection of animals.

Of mice, men and elephants: the relation between articular cartilage thickness and body mass

Mammalian articular cartilage serves diverse functions, including shock absorption, force transmission and enabling low-friction joint motion. These challenging requirements are met by the tissue’s thickness combined with its highly specific extracellular matrix, consisting of a glycosaminoglycan-interspersed collagen fiber network that provides a unique combination of resilience and high compressive and shear resistance. It is unknown how this critical tissue deals with the challenges posed by increases in body mass. For this study, osteochondral cores were harvested post-mortem from the central sites of both medial and lateral femoral condyles of 58 different mammalian species ranging from 25 g (mouse) to 4000 kg (African elephant). Joint size and cartilage thickness were measured and biochemical composition (glycosaminoclycan, collagen and DNA content) and collagen cross-links densities were analyzed. Here, we show that cartilage thickness at the femoral condyle in the mammalian species investigated varies between 90 µm and 3000 µm and bears a negative allometric relationship to body mass, unlike the isometric scaling of the skeleton. Cellular density (as determined by DNA content) decreases with increasing body mass, but gross biochemical composition is remarkably constant. This however need not affect life-long performance of the tissue in heavier mammals, due to relatively constant static compressive stresses, the zonal organization of the tissue and additional compensation by joint congruence, posture and activity pattern of larger mammals. These findings provide insight in the scaling of articular cartilage thickness with body weight, as well as in cartilage biochemical composition and cellularity across mammalian species. They underscore the need for the use of appropriate in vivo models in translational research aiming at human applications.

Effect of different running modes on the morphological, biochemical, and mechanical properties of articular cartilage

Mechanical loading plays an important role not solely in cartilage development, but also in cartilage degeneration. Its adaptation behavior to mechanical loading has not been clearly delineated. The aim of the study was to examine the effect of different running modes (with different muscle contraction types) on morphological, biochemical, and mechanical properties of articular cartilage in the knee of growing rats. Thirty-six female Sprague-Dawley rats were randomly assigned into a nonactive age-matched control (AMC), level (LEVEL), and 20° downhill (DOWN) running group (n = 12 each). Running groups were trained on a treadmill for 30 min/day, 5 days/week for 6 weeks. Immunohistochemical staining and analysis of expression for collagen II, collagen IX, cartilage oligomeric matrix protein (COMP), and matrilin-3, histomorphometry of femoral cartilage height and femoral COMP staining height, and indentation testing of tibial articular cartilage were performed. Rats subjected to downhill running showed a significantly (P = 0.015) higher COMP staining height and a tendentially (P = 0.084) higher cartilage height in the high-weight bearing area of femoral articular cartilage. Cartilage thickness, mechanical properties, and expression of cartilage network proteins in tibial cartilage remained unaffected by different running modes. Our data suggest that joint loading induced by eccentric muscle contractions during downhill running may lead to a site-specific adaptation.

The effect of level and downhill running on cortical and trabecular bone in growing rats

Mechanical loading is essential for bone development and prevention of age-related bone diseases. Muscular contractions during physical activity and the generated strain magnitude are primary determinants for the osteogenic response. However, the adaptation capacity of bones, especially due to different muscle contraction types, is largely unknown. In the present study we examined the effect of different running modes characterized by different muscle contraction types and loading patterns on the morphological, structural, and mechanical properties of different sites in the femur of growing rats. Thirty-six female Sprague-Dawley rats were randomly assigned to a nonactive age-matched control (AMC), a level running (LEVEL), and a 20° decline downhill running (DOWN) group (n = 12 each). Running groups were trained on a treadmill for 30 min/day, 5 days/week for 6 weeks. After death, pQCT analysis of the meta- and diaphyses, micro-CT analysis of the epiphysis, and mechanical testing of the femur were performed. The Tb.BMD in the metaphysis was significantly (P < 0.05) increased in the DOWN compared to the AMC group, whereas level running had no effect on Tb.BMD. While Young's modulus was significantly different (P < 0.05) between the DOWN and LEVEL groups, no structural alterations were found in the diaphysis between the groups. Further, subchondral trabecular bone did not show exercise-induced changes caused by the different running modes but displayed a remarkably high intraepiphyseal variability. Downhill running seems to be a potent osteogenic stimulus in the femoral metaphysis.

Animal models for cartilage regeneration and repair

Articular cartilage injury and degeneration are leading causes of disability. Animal studies are critically important to developing effective treatments for cartilage injuries. This review focuses on the use of animal models for the study of the repair and regeneration of focal cartilage defects. Animals commonly used in cartilage repair studies include murine, lapine, canine, caprine, porcine, and equine models. There are advantages and disadvantages to each model. Small animal rodent and lapine models are cost effective, easy to house, and useful for pilot and proof-of-concept studies. The availability of transgenic and knockout mice provide opportunities for mechanistic in vivo study. Athymic mice and rats are additionally useful for evaluating the cartilage repair potential of human cells and tissues. Their small joint size, thin cartilage, and greater potential for intrinsic healing than humans, however, limit the translational value of small animal models. Large animal models with thicker articular cartilage permit study of both partial thickness and full thickness chondral repair, as well as osteochondral repair. Joint size and cartilage thickness for canine, caprine, and mini-pig models remain significantly smaller than that of humans. The repair and regeneration of chondral and osteochondral defects of size and volume comparable to that of clinically significant human lesions can be reliably studied primarily in equine models. While larger animals may more closely approximate the human clinical situation, they carry greater logistical, financial, and ethical considerations. A multifactorial analysis of each animal model should be carried out when planning in vivo studies. Ultimately, the scientific goals of the study will be critical in determining the appropriate animal model.

Muscle weakness causes joint degeneration in rabbits

OBJECTIVE

The objective of this study was to investigate the effects of botulinum toxin type-A (BTX-A) induced quadriceps weakness on micro-structural changes in knee cartilage of New Zealand White (NZW) rabbits.

DESIGN

Fifteen rabbits were divided randomly into an experimental and a sham control group. Each group received a unilateral single quadriceps muscle injection either with saline (sham control; n=4) or BTX-A (experimental; n=11).

RESULTS

BTX-A injection produced significant quadriceps muscle weakness (P<0.05) and loss of quadriceps muscle mass (P<0.05). Degenerative changes of the knee cartilage, assessed with the Mankin grading system, were the same for the injected and non-injected hind limbs of the experimental group animals. Sham injection had no effect on joint degeneration but all control animals showed some degenerative changes in the knee. Degenerative changes of the retro-patellar cartilage were more severe in the experimental compared to sham control group rabbits (P<0.05). The distal region of the retro-patellar cartilage was more degenerated than the proximal part in the experimental and control group rabbits (P<0.05). The Mankin grades for the tibiofemoral region were not significantly different between experimental and control group rabbits (P>0.05).

CONCLUSION

Quadriceps muscle weakness caused increased degeneration in the retro-patellar cartilage of NZW rabbits, providing evidence that muscle weakness might be a risk factor for the onset and progression of osteoarthritis (OA). Future work needs to delineate whether muscle weakness directly affects joint degeneration, or if changes in function and movement execution associated with muscle weakness are responsible for the increased rate of OA onset and progression observed here.

PEOT/PBT based scaffolds with low mechanical properties improve cartilage repair tissue formation in osteochondral defects

The aim of our study was to compare the healing response of biomechanically and biochemically different scaffolds in osteochondral defects created in rabbit medial femoral condyles. A block copolymer comprised of poly(ethylene oxide terephthalate) and poly(butylene terephthalate) was used to prepare porous scaffolds. The 70/30 scaffold (70 wt % poly(ethylene oxide terephthalate)) was compared to the stiffer 55/45 (55 wt % poly(ethylene oxide terephthalate)) scaffold. Nine 6-month-old rabbits were used. Osteochondral defects were filled with 55/45 scaffolds (n = 6); 70/30 scaffolds (n = 6); or left empty (n = 6). Defect sites were allowed to heal for 12 weeks. Condyles were macroscopically evaluated and analysed histologically using the O'Driscoll score for evaluating repair of osteochondral defects. Repair tissue in 70/30 scaffolds consisted of cartilage-like tissue on top of trabecular bone, whereas the tissue within the 55/45 scaffolds consisted predominantly of trabecular bone. O'Driscoll scores for 70/30 scaffolds were significantly better (p = 0.024) in comparison to untreated osteochondral defects and 55/45 scaffolds. This study reveals that the biomechanical and biochemical properties of the scaffold play an important role by themselves, and can affect the healing response of osteochondral defects. Scaffolds with low mechanical properties were superior in cartilage repair tissue formation.

A simple measuring device for laboratory indentation tests on cartilage

Mechanical testing of articular cartilage and repair tissue enables judgment of their capacity in withstanding mechanical loading. In the past, different methods have been developed requiring a complex technical setup and extensive data analysis. Therefore, the aim of the present project was to build up a simple measuring apparatus for laboratory indentation tests. The device consists of an incremental optical displacement transducer with a sleeve bearing guided plunger and a spherical tip made of polished steel (radius: 0.75 or 1.5 mm), a sensitive load cell and a stiff frame. The indentation force results from the plunger's gravity plus the force of the spring inside the displacement transducer and levels at 0.170 N or 0.765 N. The displacement transducer is fixed to the frame via the load cell that enables one to detect the initial contact of the tip with the tissue. The load cell has a standard uncertainty of 2 mN and the displacement transducer of 1 microm. From indentation-creep tests, a "0.25-s elastic modulus" is calculated. Measurements on thin rubber sheets were carried out to determine the quality of the measuring device. Compression tests on cylinders made of these rubber sheets yielded control data, and a good agreement with the "0.25-s elastic modulus" was found. Indentation tests on cartilage at different sites of sheep femoral condyles yielded a very good repeatability of the measurement results (+/-7.5%).

In vivo magnetic resonance imaging of animal models of knee osteoarthritis

Recent technical developments in high-field magnetic resonance (MR) scanners, improvement in radio frequency coil design and gradient performance along with the development of efficient pulse sequences and new methods of enhancing contrast have made high-quality imaging of animal arthritis models feasible. MR can provide high-resolution structural information about the osteoarthritic changes in animal models, and also information about the biophysical properties of cartilage. This paper reviews the MR techniques available for animal knee imaging, and the various MR-derived readouts of knee osteoarthritis in animal models. Pitfalls in interpreting animal joint anatomy and joint composition are highlighted.

Bone marrow mesenchymal stem cells in a hyaluronan scaffold for treatment of an osteochondral defect in a rabbit model

The purpose of this study was to evaluate the efficiency of using mesenchymal stem cells (MSC) in a hyaluronan scaffold for repair of an osteochondral defect in rabbit knee. Bone marrow was harvested from the posterior iliac crest in 11 New Zealand White rabbits. MSC were isolated and cultured in autologous serum for 28 days and transferred to a hyaluronan scaffold 24 h prior to implantation. A 4 mm diameter and 1.5 mm deep defect was created in the medial femoral condyle of both knees and the scaffold with MSC was implanted in one knee while an empty scaffold was implanted in the contra-lateral knee. After 24 weeks the rabbits were killed and histological sections were subjected to semiquantitative and quantitative evaluation by observers blinded regarding treatment modality. High degree of filling was obtained, but there was no statistically significant difference between the two treatments. However, there was a tendency for a better quality of repair in the MSC treated knees. No hypertrophy was observed by either method. MSC in a hyaluronan scaffold may be a promising treatment approach, but further studies are needed to determine the best combination of scaffold and cells.

The minipig model for experimental chondral and osteochondral defect repair in tissue engineering: retrospective analysis of 180 defects

Articular cartilage repair is still a challenge in orthopaedic surgery. Although many treatment options have been developed in the last decade, true regeneration of hyaline articular cartilage is yet to be accomplished. In vitro experiments are useful for evaluating cell-matrix interactions under controlled parameters. When introducing new treatment options into clinical routine, adequate animal models are capable of closing the gap between in vitro experiments and the clinical use in human beings. We developed an animal model in the Göttingen minipig (GMP) to evaluate the healing of osteochondral or full-thickness cartilage defects. The defects were located in the middle third of the medial portion of the patellofemoral joint at both distal femurs. Chondral defects were 6.3 mm, osteochondral defects either 5.4 or 6.3 mm in diameter and 8 or 10 mm deep. In both defects the endogenous repair response showed incomplete repair tissue formation up to 12 months postoperatively. Based on its limited capability for endogenous repair of chondral and osteochondral defects, the GMP is a useful model for critical assessment of new treatment strategies in articular cartilage tissue engineering.

Measuring fixed charge density of goat articular cartilage using indentation methods and biochemical analysis

An important indicator of osteoarthritis (OA) progression is the loss of proteoglycan (PG) aggregates from the cartilage tissue. Using the indentation creep test, two analytical methods, as previously developed by Lu et al. [Lu, X. L., Miller, C., Chen, F. H., Guo, X. E., Mow, V. C., 2007. The generalized triphasic correspondence principle for simultaneous determination of the mechanical properties and proteoglycan content of articular cartilage by indentation. Journal of Biomechanics 40, 2434-2441 (EPub).], for predicting the fixed charge density (FCD) of goat knee articular cartilage in the normal (control) and degenerated states were compared: (1) a "dual-stage" method to calculate FCD from the mechanical properties of the tissue when tested in isotonic and hypertonic solutions; and (2) a "single-stage" method to predict FCD (as in (1)) assuming an intrinsic Poisson's ratio of 0.05 in the hypertonic state. A biochemical analysis using 1,9-dimethylmethylene blue (DMMB) assay was conducted to directly measure PG content, and hence FCD. The association between the FCD and the aggregate modulus of the tissue was also explored. The mean (+/-S.D.) FCD values measured using the dual-stage method were the closest (control: 0.129+/-0.039, degenerated: 0.046+/-029) to the DMMB results (control: 0.125+/-0.034, degenerated: 0.057+/-0.024) as compared to those of the single-stage method (control: 0.147+/-0.035, degenerated: 0.063+/-0.026). The single-stage method was more reliable (r(2)=0.81) when compared to the dual-stage method (r(2)=0.79). A prediction of FCD from the aggregate modulus generated the least reliable FCD prediction (r(2)=0.68). Because both the dual- and single-stage methods provided reliable FCD estimates for normal and degenerated tissue, the less time-consuming single-stage method was concluded to be the ideal technique for predicting FCD and hence PG content of the tissue.

Intra-articular delivery of chondroitin sulfate for the treatment of joint defects in rabbit model

Chondroitin sulfate (CS) is considered as a possible candidate for the treatment of joint defect. This study is to evaluate the efficacy of intra-articular injection of CS carried by hydrogel in the treatment of chondral defects in adult rabbit models. Inclusion of CS (0-50 microg/ml) in in vitro chondrocyte culture exerts a dose-dependent increase in cell proliferation. To select for optimal carrier for in vivo study, the release kinetic of CS embedded in five types of hydrogel was studied using fluorescence technique and their biocompatibilities in vivo were investigated by injecting the CS-hydrogel into rabbit knees. alpha-CD-EG 4400 hydrogel was chosen as the carrier based on progressively released CS from the hydrogel, with 80% released by in one week while the remaining 20% was retained for 30 days. In vivo studies showed high biocompatibility of CS-hydrogel. To evaluate the efficacy of CS in the treatment of cartilage injury, chondral defects were created in femoral medial condyle (punch diameter 2.7 mm) or trochlea (punch diameter 3.5 mm) of the rabbits without damaging subchondral bone. CS (100 mg/ml) in 0.5 ml alpha-CD-EG 4400 hydrogel was then injected into the knee joint. Hydrogel and saline served as controls. On day 50 the chondral defect in the saline group showed no signs of healing and defect treated with hydrogel alone was covered with a thin and slightly irregular layer of fibrous tissue. The CS-hydrogel group showed a thicker layer composed of both hyaline and fibrocartilage. The modulus of elasticity was the highest in the CS-hydrogel group and lowest in the group injected with saline only. Our results suggest that intra-articular delivery of CS by alpha-CD-EG 4400 improved the biomechanical and histological properties of the repaired cartilage. It may be an effective treatment for cartilage injury.

Musculoskeletal disorders associated with obesity: a biomechanical perspective

Despite the multifactorial nature of musculoskeletal disease, obesity consistently emerges as a key and potentially modifiable risk factor in the onset and progression of musculoskeletal conditions of the hip, knee, ankle, foot and shoulder. To date, the majority of research has focused on the impact of obesity on bone and joint disorders, such as the risk of fracture and osteoarthritis. However, emerging evidence indicates that obesity may also have a profound effect on soft-tissue structures, such as tendon, fascia and cartilage. Although the mechanism remains unclear, the functional and structural limitations imposed by the additional loading of the locomotor system in obesity have been almost universally accepted to produce aberrant mechanics during locomotor tasks, thereby unduly raising stress within connective-tissue structures and the potential for musculoskeletal injury. While such mechanical theories abound, there is surprisingly little scientific evidence directly linking musculoskeletal injury to altered biomechanics in the obese. For the most part, even the biomechanical effects of obesity on the locomotor system remain unknown. Given the global increase in obesity and the rapid rise in musculoskeletal disorders, there is a need to determine the physical consequences of continued repetitive loading of major structures of the locomotor system in the obese and to establish how obesity may interact with other factors to potentially increase the risk of musculoskeletal disease.

Maturation-dependent change and regional variations in acoustic stiffness of rabbit articular cartilage: an examination of the superficial collagen-rich zone of cartilage

OBJECTIVE

The purpose of the study was to investigate maturation-dependent changes of acoustic (ultrasound) stiffness and other ultrasound features of articular cartilage in healthy rabbit knees.

METHODS

Five groups of rabbits of various ages (3 weeks, 8 weeks, 6 months, 1 year, 2.5 years) consisting of five rabbits per group were examined. Signal intensity (index of stiffness), signal duration (index of surface irregularity) and interval between signals (index of thickness) of the ultrasound reflection from articular cartilage were examined at four sites: posterior lateral femoral condyle, posterior medial femoral condyle, lateral tibial plateau, and medial tibial plateau. The sites were observed macroscopically and microscopically with a light microscope and a polarized light microscope.

RESULTS

At the lateral and medial condyles and the lateral tibial plateau, signal intensity was least in 3-week-old specimens. The intensity increased until 6 months or 1 year of age. At these sites, the signal durations and intervals between signals were least at the ages of 6 months or 1 year. At the medial tibial plateau, the intensity was the least at 2.5 years of age and the interval between signals was least at 3 weeks of age; there was no effect of age on signal duration. Cartilage surfaces of all specimens were smooth and no degenerative changes were macroscopically or microscopically evident. The surface brightness of cartilage under the polarized light microscope was consistent with signal intensity values.

CONCLUSIONS

The response of articular cartilage to ultrasound was maturation-dependent. Acoustic properties differed from mechanical stiffness properties, which were determined using indentation. Ultrasound may detect properties of the surface collagen of the articular cartilage.

Comparison of fresh osteochondral autografts and allografts: a canine model

BACKGROUND

Osteochondral autografts and allografts have been widely used in the treatment of isolated grade IV articular cartilage lesions of the knee. However, the authors are not aware of any study that has prospectively compared fresh osteochondral autografts to fresh allografts with regard to imaging, biomechanical testing, and histology.

HYPOTHESIS

The imaging, biomechanical properties, and histologic appearance of fresh osteochondral autograft and fresh allograft are similar with respect to bony incorporation into host bone, articular cartilage composition, and biomechanical properties.

STUDY DESIGN

Controlled laboratory study.

METHODS

Eighteen adult dogs underwent bilateral knee osteochondral graft implantation after creation of an Outerbridge grade IV cartilage defect. One knee received an autograft, and the contralateral knee received a fresh allograft. Nine dogs were sacrificed at 3 months, and 9 dogs were sacrificed at 6 months. Graft analysis included gross examination, radiographs, magnetic resonance imaging, biomechanical testing, and histology.

RESULTS

Magnetic resonance imaging demonstrated excellent bony incorporation of both autografts and allografts. Biomechanical testing demonstrated no significant difference between autografts versus allografts versus control at 3 or 6 months (P = .36-.91). A post hoc calculation showed 80% power to detect a 30% difference between allograft and control. Histologic examination showed normal cartilage structure for both autografts and allografts.

CONCLUSION

Fresh osteochondral autograft and fresh allograft tissues are not statistically different with respect to bony incorporation, articular cartilage composition, or biomechanical properties up to 6 months after implantation.

CLINICAL RELEVANCE

The use of fresh allograft tissue to treat osteochondral defects eliminates morbidity associated with harvesting autograft tissue without compromising the results of the surgical procedure.

Measurement of articular cartilage stiffness of the femoropatellar, tarsocrural, and metatarsophalangeal joints in horses and comparison with biochemical data

OBJECTIVE

To determine normal cartilage stiffness values in different weight-bearing and non-weight-bearing areas of 3 different equine joints, and to evaluate the relationship between cartilage stiffness and glycosaminoglycan (GAG) and collagen content.

STUDY DESIGN

Compressive stiffness of the articular cartilage was measured in 8 horse cadaver femoropatellar (FP), tarsocrural (TC), and metatarsophalangeal (MT) joints. Gross evaluation, collagen content, GAG content, and histologic appearance were assessed for each measurement location.

ANIMALS

Eight equine cadavers (4 intact females, 4 castrated males; 7 Quarter Horse or Quarter Horse type, 1 Arabian; aged 4-12 years, weighing 400-550 kg).

METHODS

The articular surfaces of 8 equine cadaver FP, TC, and MT joints were grossly evaluated for signs of articular cartilage pathology. Stiffness at preselected sites (FP joint-6 sites; TC joint-3 sites; MT joint-4 sites) was determined using an arthroscopic indentation instrument. Biochemical composition (collagen, GAG content) and histologic evaluation (modified Mankin score) were assessed for each measurement site.

RESULTS

All cartilage from all sites evaluated was determined to be normal based on macroscopic and histologic assessments. No significant correlation between Mankin scores and cartilage stiffness values was observed. Site differences in cartilage stiffness were measured in all 3 joints (P<.001). GAG or collagen content had a significant positive correlation with stiffness values in 6 of 13 sites (P<.05, r>0.622, r2>0.387).

CONCLUSION

Relative cartilage stiffness values measured in healthy equine joints are site dependent and can be measured using an indentation device intended for arthroscopic application.

CLINICAL RELEVANCE

An indentation instrument provided an objective means of determining relative compressive stiffness of articular cartilage. Further research needs to be performed to confirm the site and joint differences observed in this study in clinically normal horses and to determine if the tester can be used clinically to predict articular cartilage pathology.

Evaluation of Cartilage Reconstruction by Means of Autologous Chondrocyte Versus Periosteal Graft Transplantation: An Animal Study

BACKGROUND

Autologous chondrocyte transplantation (ACT) has been shown to heal cartilage defects under experimental and clinical conditions. However, the evaluation of successful transplantation still remains arbitrary and further research is required to establish objective criteria of treatment. The aim of the present study was to evaluate the criteria of successful ACT and to compare the results with those obtained following periosteal grafting (PG).

MATERIALS AND METHODS

Articular cartilage specimens were taken from the distal femur of 30 adolescent New Zealand rabbits and chondrocytes were obtained by collagenase digestion. The chondrocytes were identified by a functional assay, based on estimating procollagen type II mRNA by reverse-transcribed polymerase chain reaction. The cells cultured in vitro were transplanted under a periosteal flap into a full thickness defect (ICRS III(0)). The quality of the repaired tissue was evaluated macroscopically according to a modified scale of Brittberg et al, and microscopically according to O'Driscoll et al. For comparative purposes animals treated with PG were used.

RESULTS

Cultured chondrocytes expressed procollagen type II and, upon transplantation into the defect, produced hyaline cartilage. To evaluate the results of transplantation, two categories of criteria were adopted-macroscopic analysis and microscopic examination. By all adopted criteria the results were significantly better in the ACT group (P < .05) than in the PG group.

CONCLUSION

Prior to transplantation, assays for specialized functions of chondrocytes required semiquantitative evaluation of macroscopic and microscopic appearance of the repaired tissue, showing the benefit of autologous chondrocyte versus periosteal graft transplantation.

Material properties of articular cartilage in the rabbit tibial plateau

The material properties of articular cartilage in the rabbit tibial plateau were determined using biphasic indentation creep tests. Cartilage specimens from matched-pair hind limbs of rabbits approximately 4 months of age and greater than 12 months of age were tested on two locations within each compartment using a custom built materials testing apparatus. A three-way ANOVA was used to determine the effect of leg, compartment, and test location on the material properties (aggregate modulus, permeability, and Poisson's ratio) and thickness of the cartilage for each set of specimens. While no differences were observed in cartilage properties between the left and right legs, differences between compartments were found in each set of specimens. For cartilage from the adolescent group, values for aggregate modulus were 40% less in the medial compartment compared to the lateral compartment, while values for permeability and thickness were greater in the medial compartment compared to the lateral compartment (57% and 30%, respectively). Values for Poisson's ratio were 19% less in the medial compartment compared to the lateral compartment. There was also a strong trend for thickness to differ between test locations. Similar findings were observed for cartilage from the mature group with values for permeability and thickness being greater in the medial compartment compared to the lateral compartment (66% and 34%, respectively). Values for Poisson's ratio were 22% less in the medial compartment compared to the lateral compartment.

The effects of storage on fresh human osteochondral allografts

Historically, fresh human osteochondral allografts have been stored in lactated Ringer's solution at 4 degrees C and then transplanted as quickly as possible, generally within 2 to 5 days, to ensure delivery of a high level of viable chondrocytes. Recently, allograft distribution companies have begun to provide fresh osteochondral allografts that are stored in a proprietary culture medium usually for at least 2 weeks before delivery to the surgeon for implantation. The effects of such storage on human cartilage have not been well-defined. In the current study the effects of storage in lactated Ringer's solution and in culture media were assessed. After 7 days of storage in lactated Ringer's solution, a significant decline in chondrocyte viability and metabolic activity was seen. Culture media provided significantly better preservation of the cartilage with viability and metabolic activity remaining essentially unchanged from baseline for as many as 14 days. The biochemical and biomechanical properties of the extracellular matrix remained stable with storage in both solutions with time. These data suggest that osteochondral allografts stored under traditional conditions in lactated Ringer's solution should continue to be implanted as quickly as possible and certainly within 7 days of donor death. If kept in culture media, the storage duration may be extended to approximately 2 weeks.

Prolonged storage effects on the articular cartilage of fresh human osteochondral allografts

BACKGROUND

Fresh osteochondral allograft transplantation is a well-established technique for the treatment of cartilage defects of the knee. It is believed that the basic paradigm of the technique is that the transplantation of viable chondrocytes maintains the articular cartilage matrix over time. Allograft tissue is typically transplanted up to forty-two days after the death of the donor, but it is unknown how the conditions and duration of storage affect the properties of fresh human osteochondral allografts. This study examined the quality of human allograft cartilage as a function of storage for a duration of one, seven, fourteen, and twenty-eight days. We hypothesized that chondrocyte viability, chondrocyte metabolic activity, and the biochemical and biomechanical properties of articular cartilage would remain unchanged after storage for twenty-eight days.

METHODS

Sixty osteochondral plugs were harvested from ten fresh human femoral condyles within forty-eight hours after the death of the donor and were stored in culture medium at 4 degrees C. At one, seven, fourteen, and twenty-eight days after harvest, the osteochondral plugs were analyzed for (1) viability and viable cell density by confocal microscopy, (2) proteoglycan synthesis by quantification of (35)SO(4) incorporation, (3) glycosaminoglycan content, (4) indentation stiffness, (5) compressive modulus and hydraulic permeability by static and dynamic compression testing, and (6) tensile modulus by equilibrium tensile testing.

RESULTS

Chondrocyte viability and viable cell density remained unchanged after storage for seven and fourteen days (p > 0.7) and then declined at twenty-eight days (p < 0.001). Proteoglycan synthesis remained unchanged at seven days (p > 0.1) and then declined at fourteen days (p < 0.01) and twenty-eight days (p < 0.001). No significant differences were detected in glycosaminoglycan content (p > 0.8), indentation stiffness (p > 0.4), compressive modulus (p > 0.05), permeability (p > 0.3), or equilibrium tensile modulus after storage for twenty-eight days (p > 0.9).

CONCLUSIONS

These data demonstrate that fresh human osteochondral allograft tissue stored for more than fourteen days undergoes significant decreases in chondrocyte viability, viable cell density, and metabolic activity, with preservation of glycosaminoglycan content and biomechanical properties. The cartilage matrix is preserved during storage for twenty-eight days, but the chondrocytes necessary to maintain the matrix after transplantation decreased over that time-period.

Histological evaluation of osteochondral defects: consideration of animal models with emphasis on the rabbit, experimental setup, follow-up and applied methods

Regardless of their etiology, cartilage defects of articular joints remain one of the unsolved problems in medicine. Therefore, numerous techniques to enhance cartilage repair are under clinical or experimental investigation. In any serious approach experimental investigation should precede human application. If the decision is made to implement an animal model, which one should be used? What is a good experimental animal for osteochondral defects? Can chondral defects be evaluated? What is the critical size of the defect? How long should the experiment last? Which histological techniques should be used? What are the pitfalls when evaluating osteochondral defects histologically? What is the best scoring system? All these questions will be addressed to provide concise information on this topic with particular attention being paid to the rabbit as an experimental animal. Biotechnological techniques of investigation are developing rapidly. Hence special emphasis is placed on principles and reliable morphological examination.

Evaluation of Gateshead carbon fibre rod as an implant material for repair of osteochondral defects: a morphological and mechanical study in the rabbit knee

Use of the Gateshead carbon fibre rod system remains controversial. Although it has been shown to enhance the repair of lesions in load bearing areas of convex articular surfaces, there is a lack of evidence to support the claim that it provides an inert scaffold for ingrowth of organised fibrous tissue. and thereby increasing the rate and quality of articular surface regeneration. This study examined osteochondral repair following implantation of a Gateshead rod in the femoral condyles of 25 rabbits for up to 32 weeks. using radiology, histology, scanning electron microscopy and mechanical testing. The repaired fibrocartilaginous surface layer was found to be persistently softer than the normal control and some repaired surfaces were worn, exposing the rod at 32 weeks. Whilst fibrous tissue grew into the outer braided sheath of the rod, the core remained impervious. The rod appeared to act as a space occupier, initially providing better subsurface support than found in natural healing. In the long term, however, it prevented subchondral bone restoration and re-establishment of the normal osteochondral junction, resulting in a quality of repair which did not differ from that found in naturally healing defects.

Autologous chondrocytes used for articular cartilage repair: an update

Articular cartilage in adults has a poor ability to self-repair after a substantial injury; however, it is not known whether there is a cartilage resurfacing technique superior to the existing techniques. It is not satisfactory that at the beginning of the new millennium, there still is a lack of randomized studies comparing different cartilage repair techniques and there still is little knowledge of the natural course of a cartilaginous lesion. To date, various articular cartilage resurfacing techniques have the potential to improve the repair of cartilage defects and reduce the patient's disability. One such cartilage repair technique is autologous chondrocyte transplantation combined with a periosteal graft. Since the first patient was operated on in 1987, much interest in cartilage repair and cell engineering has emerged. The experience with autologous chondrocyte transplantation during the past 13 years with in vitro chondrocyte expansion, cartilage harvest, and postoperative biopsy technique is discussed, and the latest followup of 213 consecutive patients in different subgroups with 2 to 10 years followup is presented. The technique gives stable long-term results with a high percentage of good to excellent results (84%-90%) in patients with different types of single femoral condyle lesions, whereas patients with other types of lesions have a lower degree of success (mean, 74%).

High-resolution MRI detects cartilage swelling at the early stages of experimental osteoarthritis

OBJECTIVE

The progressive early changes in cartilage and subchondral bone in an experimental model of osteoarthritis (OA) were investigated with high-resolution magnetic resonance imaging (MRI) and microradiography.

METHODS

Partial medial meniscectomy was performed in the left knee of 16 rabbits. Four normal and four sham-operated additional rabbits were used as controls. Changes in cartilage and subchondral bone were sequentially assessed after surgery with MRI at 0, 2, 4, 6, 8 and 10 weeks, subchondral bone variations quantified postoperatively on microradiographs of sagittal sections at 6 and 10 weeks and the macroscopic alterations graded according to the severity of joint changes.

RESULTS

MRI demonstrated a progressive increase in the articular cartilage thickness in the weight-bearing area of the femur at weeks 4, 6 and 8 vs basal. Tibial cartilage thickness only showed a significant increment at week 6. No significant abnormalities were detected on X-rays in subchondral bone when compared to controls. Macroscopically, 4 weeks after the operation OA rabbits had only slight cartilage discoloration. Cartilage eburnation, pitting, superficial erosions and osteophytes were detected at week 6. These abnormalities were more evident at 8 and 10 weeks after meniscectomy.

CONCLUSION

The focal increase in cartilage thickness is one of the earliest measurable changes in OA and preceeds subchondral bone remodeling. The measurement of cartilage thickness variations with MRI can be used to follow the course of OA and to evaluate the potential beneficial effect of novel therapies.

Radiographic joint space narrowing and histologic changes in a rabbit meniscectomy model of early knee osteoarthrosis

The purpose of this study was to compare weightbearing radiographs with histologic cartilage evaluation in a rabbit meniscectomy model of the early stage of osteoarthrosis. Fifteen rabbits had a medial meniscectomy performed in one knee and a sham operation in the other knee. Five rabbits each were sacrificed at 13, 25, and 40 weeks after surgery. Radiographic joint space width and histologic cartilage changes of the medial knee compartment were quantified. Five non-operated knees and five knees in which the meniscus had been removed immediately before the evaluations served as control specimens. Overall, the joint space of the peripheral part of the medial knee compartment was narrower in knees operated on for meniscus removal than in sham-operated knees (P < 0.003). In the knees with the meniscus removed, more cartilage changes were seen at the joint surface area of contact on radiographs than in the sham-operated knees (P < 0.0015). Indeed, the area of contact had cartilage changes similar to those in the whole medial compartment. However, there was no correlation between the degree of histologic cartilage change and the corresponding joint space measurements. Joint space width as measured on weightbearing radiographs is reduced after meniscectomy in the rabbit, but it does not reflect the degree of cartilage damage of the loaded joint surfaces in early stages of osteoarthrosis.

In situ compressive properties of the glenoid labrum

The purpose of this study was to measure the structural stiffness (load/displacement response) and elastic modulus (stress-strain response) of the glenoid labrum at different locations throughout the tissue. It was intended that the results of this work would serve to define the properties of the labrum. This in turn may permit a better understanding of labral function and of the mechanics of injury or degeneration and may ultimately contribute to improving the design of future labral reconstruction procedures. In addition, these data may allow incorporation of labral properties into a glenoid arthroplasty component. The testing procedure consisted of rapid compression of the labrum using a flat indentor. Stiffness and modulus results demonstrated differences between the superior and inferior portions of the labrum. The elastic moduli findings for the labrum were 0.18 +/- 0.17, 0.11 +/- 0.16, and 0.23 +/- 0.20 MPa for the inferior anterior, inferior, and inferior posterior sections, respectively. The superior anterior, superior, and superior posterior sections were respectively 0.19 +/- 0.09, 0. 32 +/- 0.22, and 0.41 +/- 0.32 MPa. These results are similar to those of knee menisci. The modulus findings for the substrate cartilage were 1.92 +/- 0.78, 1.99 +/- 0.70, and 2.00 +/- 1.33 MPa for the inferior anterior, inferior, and inferior posterior sections, respectively. The superior anterior, superior, and superior posterior sections were respectively 1.60 +/- 0.79, 1.29 +/- 0.75, and 1.42 +/- 0.54 MPa, which are comparable to previous cartilage findings.

Autologous chondrocyte transplantation

The intrinsic capacity of cartilage to repair chondral injuries is poor. Different techniques to induce cartilage repair with the use of extrinsic chondrogeneic cell sources have been explored in experimental models. Cells can be harvested autologously or as allografts from a healthy part of the donor tissue, isolated, expanded in vitro, and finally implanted into the defect in high densities. Pure chondrocytes, epiphyseal or mature, allogeneic or autologous, and other types of mesenchymal cells have been used. The composition and structure of the extracellular cartilage matrix are maintained through a balance of anabolic and catabolic activities controlled by the unique chondrocytes. They keep the cartilage alive; they alone maintain it and regulate it. It therefore seems important to use true committed chondrocytes to repair a local cartilaginous defect. The rational basis for the use of committed autologous chondrocytes in combination with a covering periosteal membrane in the treatment of deep cartilage defects is presented.