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Nixon J, Tadros BJ, Moreno-Suarez I, Pretty W, Collopy D, Clark G. Functionally aligned total knee arthroplasty: A lateral flexion laxity up to 6 mm is safe! Knee Surg Sports Traumatol Arthrosc 2024; 32:1317-1323. [PMID: 38515265 DOI: 10.1002/ksa.12087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/03/2024] [Accepted: 02/05/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE Loose flexion gaps are associated with poor functional outcomes and instability in total knee arthroplasty (TKA). The effect of a trapezoidal flexion gap in a functionally aligned TKA remains unknown. The aim of this study was to investigate the effect of a larger lateral flexion gap in a robotic-assisted (RA), functionally aligned (FA) and cruciate-retaining (CR) TKA on clinical outcomes. METHODS Data from 527 TKA in 478 patients from 2018 to 2020 were collected. All patients underwent an RA (MAKO, Stryker), FA and CR TKA. Gap measurements were collected intraoperatively. Patient-reported outcome measures (PROMs), pain Visual analogue score (VAS) and range of motion were collected postoperatively. Patients were also asked about the ease of stair ascent and descent and kneeling on a 5-point scale. The minimum follow-up was 2 years. Patients were stratified into three groups based on lateral flexion laxity. RESULTS At 2 years postoperatively, the group with a looser gap (3-6 mm) had higher mean PROMs when compared with the group with a gap of 2-3 mm. There were no differences detected in any other outcomes at 2 years. A total of 70.9% of patients in the group with a 3-6 mm gap reported being able to walk down a flight of stairs 'easily', compared with 56.7% in the 2-3 mm group and 54% in the <2 mm group (p = 0.04). CONCLUSION The study shows that a loose lateral flexion gap in functionally aligned CR TKA does not adversely affect outcomes in the short term. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Jeremy Nixon
- St John of God Hospital Subiaco and Midland Hospitals, Subiaco, Western Australia, Australia
| | - Baha John Tadros
- St John of God Hospital Subiaco and Midland Hospitals, Subiaco, Western Australia, Australia
- Perth Hip and Knee Clinic, Subiaco, Western Australia, Australia
| | | | - William Pretty
- Perth Hip and Knee Clinic, Subiaco, Western Australia, Australia
| | - Dermot Collopy
- St John of God Hospital Subiaco and Midland Hospitals, Subiaco, Western Australia, Australia
- Perth Hip and Knee Clinic, Subiaco, Western Australia, Australia
| | - Gavin Clark
- St John of God Hospital Subiaco and Midland Hospitals, Subiaco, Western Australia, Australia
- Perth Hip and Knee Clinic, Subiaco, Western Australia, Australia
- University of Western Australia, Crawley, Western Australia, Australia
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Okada S, Taniguchi M, Yagi M, Motomura Y, Okada S, Nakazato K, Fukumoto Y, Kobayashi M, Kanemitsu K, Ichihashi N. Characteristics of Acute Cartilage Response After Mechanical Loading in Patients with Early-Mild Knee Osteoarthritis. Ann Biomed Eng 2024; 52:1326-1334. [PMID: 38329562 DOI: 10.1007/s10439-024-03456-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/17/2024] [Indexed: 02/09/2024]
Abstract
This study determined whether the acute cartilage response, assessed by cartilage thickness and echo intensity, differs between patients with early-mild knee osteoarthritis (OA) and healthy controls. We recruited 56 women aged ≥ 50 years with Kellgren-Lawrence (KL) grade ≤ 2 (age, 70.6 ± 7.4 years; height, 153.7 ± 5.2 cm; weight, 51.9 ± 8.2 kg). Based on KL grades and knee symptoms, the participants were classified into control (KL ≤ 1, asymptomatic, n = 27) and early-mild knee OA groups (KL 1 and symptomatic, KL 2, n = 29). Medial femoral cartilage thickness and echo intensity were assessed using ultrasonographic B-mode images before and after treadmill walking (15 min, 3.3 km/h). To investigate the acute cartilage response, repeated-measures analysis of covariance (groups × time) with adjusted age, external knee moment impulse, steps during treadmill walking, and cartilage thickness at pre-walking was performed. A significant interaction was found at the tibiofemoral joint; after walking, the cartilage thickness was significantly decreased in the early-mild knee OA group compared to the control group (p = 0.002). At the patellofemoral joint, a significant main effect of time was observed, but no interaction was detected (p = 0.802). No changes in cartilage echo intensity at either the tibiofemoral or patellofemoral joints, and no interactions were noted (p = 0.295 and p = 0.063). As acute cartilage response after walking, the thickness of the medial tibiofemoral joint in the early-mild knee OA was significantly reduced than that in the control group. Thus, greater acute deformation after walking might be a feature found in patients with early-mild knee OA.
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Affiliation(s)
- Shogo Okada
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
- Research Fellow of the Japan Society for the Promotion of Science, Tokyo, Japan
| | - Masashi Taniguchi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Masahide Yagi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshiki Motomura
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
- Kobayashi Orthopaedic Clinic, Kyoto, Japan
| | - Sayaka Okada
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kaede Nakazato
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshihiro Fukumoto
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
- Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan
| | | | | | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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Huppertz MS, Lemainque T, Yüksel C, Siepmann R, Kuhl C, Roemer F, Truhn D, Nebelung S. [Current MR imaging of cartilage in the context of knee osteoarthritis (part 2) : Cartilage pathologies and their assessment]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:304-311. [PMID: 38170243 DOI: 10.1007/s00117-023-01253-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 01/05/2024]
Abstract
High-quality magnetic resonance (MR) imaging is essential for the precise assessment of the knee joint and plays a key role in the diagnostics, treatment and prognosis. Intact cartilage tissue is characterized by a smooth surface, uniform tissue thickness and an organized zonal structure, which are manifested as depth-dependent signal intensity variations. Cartilage pathologies are identifiable through alterations in signal intensity and morphology and should be communicated based on a precise terminology. Cartilage pathologies can show hyperintense and hypointense signal alterations. Cartilage defects are assessed based on their depth and should be described in terms of their location and extent. The following symptom constellations are of overarching clinical relevance in image reading and interpretation: symptom constellations associated with rapidly progressive forms of joint degeneration and unfavorable prognosis, accompanying symptom constellations mostly in connection with destabilizing meniscal lesions and subchondral insufficiency fractures (accelerated osteoarthritis) as well as symptoms beyond the "typical" degeneration, especially when a discrepancy is observed between (minor) structural changes and (major) synovitis and effusion (inflammatory arthropathy).
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Affiliation(s)
- Marc Sebastian Huppertz
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Teresa Lemainque
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Can Yüksel
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Robert Siepmann
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Christiane Kuhl
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Frank Roemer
- Radiologisches Institut, Universitätsklinikum Erlangen & Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen-Nürnberg, Deutschland
- Department of Radiology, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA
| | - Daniel Truhn
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Sven Nebelung
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
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Eckstein F, Wluka AE, Wirth W, Cicuttini F. 30 Years of MRI-based cartilage & bone morphometry in knee osteoarthritis: From correlation to clinical trials. Osteoarthritis Cartilage 2024; 32:439-451. [PMID: 38331162 DOI: 10.1016/j.joca.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/20/2023] [Accepted: 02/01/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE The first publication on morphometric analysis of articular cartilage using magnetic resonance imaging (MRI) in 1994 set the scene for a game change in osteoarthritis (OA) research. The current review highlights milestones in cartilage and bone morphometry, summarizing the rapid progress made in imaging, its application to understanding joint (patho-)physiology, and its use in interventional clinical trials. METHODS Based on a Pubmed search of articles from 1994 to 2023, the authors subjectively selected representative work illustrating important steps in the development or application of magnetic resonance-based cartilage and bone morphometry, with a focus on studies in humans, and on the knee. Research on OA-pathophysiology is addressed only briefly, given length constraints. Compositional and semi-quantitative assessment are not covered here. RESULTS The selected articles are presented in historical order as well as by content. We review progress in the technical aspects of image acquisition, segmentation and analysis, advances in understanding tissue growth, physiology, function, and adaptation, and a selection of clinical trials examining the efficacy of interventions on knee cartilage and bone. A perspective is provided of how lessons learned may be applied to future research and clinical management. CONCLUSIONS Over the past 30 years, MRI-based morphometry of cartilage and bone has contributed to a paradigm shift in understanding articular tissue physiology and OA pathophysiology, and to the development of new treatment strategies. It is likely that these technologies will continue to play a key role in the development and (accelerated) approval of therapy, potentially targeted to different OA phenotypes.
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Affiliation(s)
- Felix Eckstein
- Department of Imaging & Functional Musculoskeletal Research, Center of Anatomy and Cell Biology, Paracelsus Medical University (PMU), Salzburg, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation (LBIAR), Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Freilassing, Bavaria, Germany.
| | - Anita E Wluka
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Wolfgang Wirth
- Department of Imaging & Functional Musculoskeletal Research, Center of Anatomy and Cell Biology, Paracelsus Medical University (PMU), Salzburg, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation (LBIAR), Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Freilassing, Bavaria, Germany
| | - Flavia Cicuttini
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Liu H, Gong H, Chen P, Zhang L, Cen H, Fan Y. Biomechanical effects of typical lower limb movements of Chen-style Tai Chi on knee joint. Med Biol Eng Comput 2023; 61:3087-3101. [PMID: 37624535 DOI: 10.1007/s11517-023-02906-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023]
Abstract
The load and stress distribution on cartilage and meniscus of the knee joint in typical lower limb movements of Chen-style Tai Chi (TC) and deep squat (DS) were analyzed using finite element (FE) analysis. The loadings for this analysis consisted of muscle forces and ground reaction force (GRF), which were calculated through the inverse dynamic approach based on kinematics and force plate measurements obtained from motion capture experiments. Thirteen experienced practitioners performed four typical TC movements, namely, single whip (SW), brush knee and twist step (BKTS), stretch down (SD), and part the wild horse's mane (PWHM), which exhibit lower posture and greater lower limb force compared to other TC styles. The results indicated that TC required greater lower limb muscle strength than DS, resulting in greater knee joint forces. The stress on the medial cartilage in SW and BKTS fell within a range conductive to maintaining the balance between anabolism and catabolism of cartilage matrix. This was due to the fact that SW and BKTS reduce the medial to total tibiofemoral contact force ratios through knee abduction, which may effectively alleviate mild medial knee osteoarthritis (KOA). However, the greater medial contact force ratios observed in SD and PWHM resulted in great contact stresses that may aggravate the pain of patients with KOA. To mitigate these effects, practitioners should consider elevating their postures appropriately to reduce knee flexion angles, especially during the single-leg support phase. This adjustment can decrease the required muscle strength, load and stress on the knee joint.
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Affiliation(s)
- Haibo Liu
- Key Laboratory for Biomechanics and Mechanobiology (Beihang University) of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, No.37, Xueyuan Road, Haidian District, Beijing, 100083, People's Republic of China
| | - He Gong
- Key Laboratory for Biomechanics and Mechanobiology (Beihang University) of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, No.37, Xueyuan Road, Haidian District, Beijing, 100083, People's Republic of China.
| | - Peng Chen
- Key Laboratory for Biomechanics and Mechanobiology (Beihang University) of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, No.37, Xueyuan Road, Haidian District, Beijing, 100083, People's Republic of China
| | - Le Zhang
- Key Laboratory for Biomechanics and Mechanobiology (Beihang University) of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, No.37, Xueyuan Road, Haidian District, Beijing, 100083, People's Republic of China
| | - Haipeng Cen
- Key Laboratory for Biomechanics and Mechanobiology (Beihang University) of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, No.37, Xueyuan Road, Haidian District, Beijing, 100083, People's Republic of China
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology (Beihang University) of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, No.37, Xueyuan Road, Haidian District, Beijing, 100083, People's Republic of China
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Küpper JC, Kline A, Felfeliyan B, Jaremko J, Ronsky JL. Comparison of Dynamic Knee Contact Mechanics with T 2 Imaging in Different Ages of Healthy Participants. Ann Biomed Eng 2023; 51:2465-2478. [PMID: 37340276 DOI: 10.1007/s10439-023-03277-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/07/2023] [Indexed: 06/22/2023]
Abstract
Aging is a known risk factor for Osteoarthritis (OA), however, relations between cartilage composition and aging remain largely unknown in understanding human OA. T2 imaging provides an approach to assess cartilage composition. Whether these T2 relaxation times in the joint contact region change with time during gait remain unexplored. The study purpose was to demonstrate a methodology for linking dynamic joint contact mechanics to cartilage composition as measured by T2 relaxometry. T2 relaxation times for unloaded cartilage were measured in a 3T General Electric magnetic resonance (MR) scanner in this preliminary study. High-speed biplanar video-radiography (HSBV) was captured for five 20-30-year-old and five 50-60-year-old participants with asymptomatic knees. By mapping the T2 cartilages to the dynamic contact regions, T2 values were averaged over the contact area at each measurement within the gait cycle. T2 values demonstrated a functional relationship across the gait cycle. There were no statistically significant differences between 20- and 30-year-old and 50-60-year-old participant T2 values at first force peak of the gait cycle in the medial femur (p = 1.00, U = 12) or in the medial tibia (p = 0.31, U = 7). In the medial and lateral femur in swing phase, the joint moved from a region of high T2 values at 75% of gait to a minimum at 85-95% of swing. The lateral femur and tibia demonstrated similar patterns to the medial compartments but were less pronounced. This research advances understanding of the linkage between cartilage contact and cartilage composition. The change from a high T2 value at ~ 75% of gait to a lower value near the initiation of terminal swing (90% gait) indicates that there are changes to T2 averages corresponding to changes in the contact region across the gait cycle. No differences were found between age groups for healthy participants. These preliminary findings provide interesting insights into the cartilage composition corresponding to dynamic cyclic motion and inform mechanisms of osteoarthritis.
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Affiliation(s)
- Jessica Christine Küpper
- Department of Mechanical and Manufacturing Engineering, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
- McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| | - Adrienne Kline
- McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Department of Biomedical Engineering, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Banafshe Felfeliyan
- McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Department of Biomedical Engineering, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Jacob Jaremko
- Department of Radiology & Diagnostic Imaging, Faculty of Medicine, University of Alberta, Walter C MacKenzie Health Sciences Centre, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada
| | - Janet L Ronsky
- Department of Mechanical and Manufacturing Engineering, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Department of Biomedical Engineering, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
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Cance N, Erard J, Shatrov J, Fournier G, Gunst S, Martin GL, Lustig S, Servien E. Delaying anterior cruciate ligament reconstruction increases the rate and severity of medial chondral injuries. Bone Joint J 2023; 105-B:953-960. [PMID: 37652445 DOI: 10.1302/0301-620x.105b9.bjj-2022-1437.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Aims The aim of this study was to evaluate the association between chondral injury and interval from anterior cruciate ligament (ACL) tear to surgical reconstruction (ACLr). Methods Between January 2012 and January 2022, 1,840 consecutive ACLrs were performed and included in a single-centre retrospective cohort. Exclusion criteria were partial tears, multiligament knee injuries, prior ipsilateral knee surgery, concomitant unicompartmental knee arthroplasty or high tibial osteotomy, ACL agenesis, and unknown date of tear. A total of 1,317 patients were included in the final analysis, with a median age of 29 years (interquartile range (IQR) 23 to 38). The median preoperative Tegner Activity Score (TAS) was 6 (IQR 6 to 7). Patients were categorized into four groups according to the delay to ACLr: < three months (427; 32%), three to six months (388; 29%), > six to 12 months (248; 19%), and > 12 months (254; 19%). Chondral injury was assessed during arthroscopy using the International Cartilage Regeneration and Joint Preservation Society classification, and its association with delay to ACLr was analyzed using multivariable analysis. Results In the medial compartment, delaying ACLr for more than 12 months was associated with an increased rate (odds ratio (OR) 1.93 (95% confidence interval (CI) 1.27 to 2.95); p = 0.002) and severity (OR 1.23 (95% CI 1.08 to 1.40); p = 0.002) of chondral injuries, compared with < three months, with no association in patients aged > 50 years old. No association was found for shorter delays, but the overall dose-effect analysis was significant for the rate (p = 0.015) and severity (p = 0.026) of medial chondral injuries. Increased TAS was associated with a significantly reduced rate (OR 0.88 (95% CI 0.78 to 0.99); p = 0.036) and severity (OR 0.96 (95% CI 0.92 to 0.99); p = 0.017) of medial chondral injuries. In the lateral compartment, no association was found between delay and chondral injuries. Conclusion Delay was associated with an increased rate and severity of medial chondral injuries in a dose-effect fashion, in particular for delays > 12 months. Younger patients seem to be at higher risk of chondral injury when delaying surgery. The timing of ACLr should be optimally reduced in this population.
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Affiliation(s)
- Nicolas Cance
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Julien Erard
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Jobe Shatrov
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
- Sydney Orthopaedic Research Institute, University of Notre Dame Australia, Hornsby and Ku-Ring Hospital, Sydney, Australia
| | - Gaspard Fournier
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Stanislas Gunst
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Guillaume L Martin
- Département de Santé Publique, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Sébastien Lustig
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
- IFSTTAR, LBMC, Université Claude Bernard Lyon 1, Lyon, France
| | - Elvire Servien
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
- Interuniversity Laboratory of Human Movement Science, Université Claude Bernard Lyon 1, Lyon, France
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Coburn SL, Crossley KM, Kemp JL, Warden SJ, West TJ, Bruder AM, Mentiplay BF, Culvenor AG. Immediate and Delayed Effects of Joint Loading Activities on Knee and Hip Cartilage: A Systematic Review and Meta-analysis. SPORTS MEDICINE - OPEN 2023; 9:56. [PMID: 37450202 PMCID: PMC10348990 DOI: 10.1186/s40798-023-00602-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 06/19/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The impact of activity-related joint loading on cartilage is not clear. Abnormal loading is considered to be a mechanical driver of osteoarthritis (OA), yet moderate amounts of physical activity and rehabilitation exercise can have positive effects on articular cartilage. Our aim was to investigate the immediate effects of joint loading activities on knee and hip cartilage in healthy adults, as assessed using magnetic resonance imaging. We also investigated delayed effects of activities on healthy cartilage and the effects of activities on cartilage in adults with, or at risk of, OA. We explored the association of sex, age and loading duration with cartilage changes. METHODS A systematic review of six databases identified studies assessing change in adult hip and knee cartilage using MRI within 48 h before and after application of a joint loading intervention/activity. Studies included adults with healthy cartilage or those with, or at risk of, OA. Joint loading activities included walking, hopping, cycling, weightbearing knee bends and simulated standing within the scanner. Risk of bias was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analysis estimated the percentage change in compartment-specific cartilage thickness or volume and composition (T2 relaxation time) outcomes. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system evaluated certainty of evidence. RESULTS Forty studies of 653 participants were included after screening 5159 retrieved studies. Knee cartilage thickness or volume decreased immediately following all loading activities investigating healthy adults; however, GRADE assessment indicated very low certainty evidence. Patellar cartilage thickness and volume reduced 5.0% (95% CI 3.5, 6.4, I2 = 89.3%) after body weight knee bends, and tibial cartilage composition (T2 relaxation time) decreased 5.1% (95% CI 3.7, 6.5, I2 = 0.0%) after simulated standing within the scanner. Hip cartilage data were insufficient for pooling. Secondary outcomes synthesised narratively suggest knee cartilage recovers within 30 min of walking and 90 min of 100 knee bends. We found contrasting effects of simulated standing and walking in adults with, or at risk of, OA. An increase of 10 knee bend repetitions was associated with 2% greater reduction in patellar thickness or volume. CONCLUSION There is very low certainty evidence that minimal knee cartilage thickness and volume and composition (T2 relaxation time) reductions (0-5%) occur after weightbearing knee bends, simulated standing, walking, hopping/jumping and cycling, and the impact of knee bends may be dose dependent. Our findings provide a framework of cartilage responses to loading in healthy adults which may have utility for clinicians when designing and prescribing rehabilitation programs and providing exercise advice.
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Affiliation(s)
- Sally L. Coburn
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
| | - Kay M. Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
| | - Joanne L. Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
| | - Stuart J. Warden
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
- Department of Physical Therapy, School of Health & Human Sciences, Indiana University, Indianapolis, IN USA
| | - Tom J. West
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
| | - Andrea M. Bruder
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
| | - Benjamin F. Mentiplay
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
| | - Adam G. Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
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Khokhlova L, Komaris DS, O'Flynn B, Tedesco S. Acoustic emissions and age-related changes of the knee. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38082763 DOI: 10.1109/embc40787.2023.10340224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Acoustic emission (AE) monitoring is currently being widely investigated as a diagnostic tool in orthopedics, in particular for osteoarthritis (OA) diagnostics. Considering that age is one of the main risk factors for OA, investigating age-related changes in joint AEs might provide an additional incentive for further studies and consequent translation to clinical practice. The aim of this study is to investigate age-related changes in knee AE and determine AE hit definition modes as well as AE hit parameters that allow for improved age group differentiation. Knee AEs were recorded from 51 participants in two age groups (18-35 and 50-75 years old) whilst cycling with 30 and 60 rpm cadence. Two AE sensors with 15-40 kHz and 100-450 kHz frequency ranges were used, and three AE event detection modes investigated. Additionally, participants' Knee Osteoarthritis Outcome Scores (KOOS) were recorded. Low frequency sensors (15-40kHz) and hit modes with shortened hit and peak definition times showed the potential to distinguish between age groups. Moreover, a weak correlation was found between only three parameters (AE event median duration, rise time, and signal strength) and age, indicating that changes in joint AE are most likely associated with pathological changes rather than physiological ageing within the healthy norm.Clinical Relevance- the use of AE monitoring was examined in the context of age-related changes in knee health. The study indicates the potential for knee AE monitoring to be used as a quantitative measure of pathological changes in the knee status.
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10
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Clark G, Steer R, Khan RN, Collopy D, Wood D. Maintaining joint line obliquity optimizes outcomes of functional alignment in total knee arthroplasty in patients with constitutionally varus knees. J Arthroplasty 2023:S0883-5403(23)00349-2. [PMID: 37061140 DOI: 10.1016/j.arth.2023.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/18/2023] [Accepted: 04/03/2023] [Indexed: 04/17/2023] Open
Abstract
INTRODUCTION Functional alignment (FA) strives to balance the knee soft-tissue envelope during total knee arthroplasty (TKA) using implant alignment adjustments rather than soft-tissue releases. There is debate on how best to achieve FA. We compared minimum two-year outcomes between FA with a mechanical alignment plan [FA(m)] and FA with a kinematic alignment plan [FA(k)]. The null hypothesis was that there would be no difference in outcomes between FA(m) and FA(k). METHODS Prospective data was collected from 300 consecutive robotic assisted (RA) FA TKAs [135 FA(m) and 165 FA(k)]. Patient reported outcomes were obtained pre-operatively and two years post-operatively. The coronal plane alignment of the knee (CPAK) classification was used to classify knee alignment phenotypes. RESULTS Overall limb alignment was equivalent between groups. Final implant alignment was different between FA(m) and FA(k) groups, with FA(k) TKAs having higher tibial varus (P<0.01), higher femoral valgus (P<0.01), and higher joint line obliquity (P<0.01). Patients reported higher FJS-12 scores with FA(k) TKAs (79.4 versus 71.6, P=0.018), and greater range of motion (125 versus 121°; P=0.003). Patients who had constitutional varus reported the greatest improvement with FA(k) technique (FJS at minimum two years of 89 versus 65; P<0.001). CONCLUSION Utilizing an individualized alignment plan (FA(k)) led to a final implant position with greater joint line obliquity, yet the same overall limb alignment. This was associated with improved outcomes at two years post TKA in patients who had constitutional varus. Three-dimensional component position and joint line obliquity affect outcomes following TKA independent of coronal limb alignment.
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Affiliation(s)
- Gavin Clark
- St John of God Hospital, Salvado Rd, Subiaco, Western Australia, Australia; Perth Hip and Knee Clinic, 1 Wexford St, Subiaco, Western Australia, Australia; University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia, Australia.
| | - Richard Steer
- Gold Coast University Hospital, Department of Orthopaedic Surgery, 1 Hospital Boulevard, Southport, Queensland, Australia; University of Queensland, School of Medicine, St Lucia, Queensland, Australia
| | - R Nazim Khan
- University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia, Australia
| | - Dermot Collopy
- St John of God Hospital, Salvado Rd, Subiaco, Western Australia, Australia; Perth Hip and Knee Clinic, 1 Wexford St, Subiaco, Western Australia, Australia
| | - David Wood
- University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia, Australia
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11
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Brenneman Wilson EC, Quenneville CE, Maly MR. Integrating MR imaging with full-surface indentation mapping of femoral cartilage in an ex vivo porcine stifle. J Mech Behav Biomed Mater 2023; 139:105651. [PMID: 36640543 DOI: 10.1016/j.jmbbm.2023.105651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 11/22/2022] [Accepted: 01/01/2023] [Indexed: 01/08/2023]
Abstract
The potential of MRI to predict cartilage mechanical properties across an entire cartilage surface in an ex vivo model would enable novel perspectives in modeling cartilage tolerance and predicting disease progression. The purpose of this study was to integrate MR imaging with full-surface indentation mapping to determine the relationship between femoral cartilage thickness and T2 relaxation change following loading, and cartilage mechanical properties in an ex vivo porcine stifle model. Matched-pairs of stifle joints from the same pig were randomized into either 1) an imaging protocol where stifles were imaged at baseline and after 35 min of static axial loading; and 2) full surface mapping of the instantaneous modulus (IM) and an electromechanical property named quantitative parameter (QP). The femur and femoral cartilage were segmented from baseline and post-intervention scans, then meshes were generated. Coordinate locations of the indentation mapping points were rigidly registered to the femur. Multiple linear regressions were performed at each voxel testing the relationship between cartilage outcomes (thickness change, T2 change) and mechanical properties (IM, QP) after accounting for covariates. Statistical Parametric Mapping was used to determine significance of clusters. No significant clusters were identified; however, this integrative method shows promise for future work in ex vivo modeling by identifying spatial relationships among variables.
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Affiliation(s)
| | - Cheryl E Quenneville
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada; School of Biomedical Engineering, Hamilton, ON, Canada
| | - Monica R Maly
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada; Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada.
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12
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Yokoe T, Tajima T, Yamaguchi N, Morita Y, Chosa E. Fixation of an Osteochondral Lesion of the Femoral Intercondylar Groove Using Autogenous Osteochondral Grafts and Bioabsorbable Pins in a Patient with Open Physes: A Case Report. Medicina (B Aires) 2022; 58:medicina58111528. [PMID: 36363485 PMCID: PMC9695273 DOI: 10.3390/medicina58111528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/17/2022] [Accepted: 10/24/2022] [Indexed: 11/05/2022] Open
Abstract
Osteochondral lesion (OCL) of the patellofemoral (PF) joint is not an uncommon cause of knee pain, and surgery is needed when conservative treatment fails. However, there is a lack of evidence regarding the optimal surgical treatment for OCL of the PF joint. Fixation of OCLs using autogenous osteochondral grafts has been reported to be effective for OCL of the knee. However, in this surgical technique, the biomechanical strength of osteochondral grafts may not be sufficient in patients with open physes due to the specific quality of the cartilage and subchondral bone given their age. There is a lack of studies reporting fixation of the OCL located in the PF joint using autogenous osteochondral grafts. We herein report a case of OCL of the femoral intercondylar groove where autogenous osteochondral grafts augmented with bioabsorbable pins were used to fix the lesion in a 14-year-old patient with open physes. Preoperative MRI revealed a completely detached OCL of the intercondylar groove (36 mm × 20 mm). Although a total of four osteochondral grafts were harvested from the non-weightbearing area of the lateral femoral condyle, cartilage detached from one of the grafts. The quality of the osteochondral grafts was considered to be insufficient for stabilization of the OCL; thus, two bioabsorbable pins were additionally inserted following fixation of the lesion using three osteochondral grafts. After two years of follow-up, postoperative functional scores were favorable without knee pain. The present case suggests that fixation of the OCL using autogenous osteochondral grafts may not be appropriate for young patients with open physes.
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Affiliation(s)
- Takuji Yokoe
- Correspondence: ; Tel.: +81-985-85-0986; Fax: 81-985-84-2931
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13
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Markhardt BK, Huang BK, Spiker AM, Chang EY. Interpretation of Cartilage Damage at Routine Clinical MRI: How to Match Arthroscopic Findings. Radiographics 2022; 42:1457-1473. [PMID: 35984752 PMCID: PMC9453290 DOI: 10.1148/rg.220051] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/19/2022] [Accepted: 04/25/2022] [Indexed: 11/11/2022]
Abstract
This review is intended to aid in the interpretation of damage to the articular cartilage at routine clinical MRI to improve clinical management. Relevant facets of the histologic and biochemical characteristics and clinical management of cartilage are discussed, as is MRI physics. Characterization of damage to the articular cartilage with MRI demands a detailed understanding of the normal and damaged appearance of the osteochondral unit in the context of different sequence parameters. Understanding the location of the subchondral bone plate is key to determining the depth of the cartilage lesion. Defining the bone plate at MRI is challenging because of the anisotropic fibrous organization of articular cartilage, which is susceptible to the "magic angle" phenomenon and chemical shift artifacts at the interface with the fat-containing medullary cavity. These artifacts may cause overestimation of the thickness of the subchondral bone plate and, therefore, overestimation of the depth of a cartilage lesion. In areas of normal cartilage morphology, isolated hyperintense and hypointense lesions often represent degeneration of cartilage at arthroscopy. Changes in the subchondral bone marrow at MRI also increase the likelihood that cartilage damage will be visualized at arthroscopy, even when a morphologic lesion cannot be resolved, and larger subchondral lesions are associated with higher grades at arthroscopy. The clinical significance of other secondary features of cartilage damage are also reviewed, including osteophytes, intra-articular bodies, and synovitis. Online supplemental material is available for this article. Work of the U.S. Government published under an exclusive license with the RSNA.
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Affiliation(s)
- B. Keegan Markhardt
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention (B.K.M.), and Department of Orthopedic Surgery (A.M.S.),
University of Wisconsin-Madison, Clinical Science Center, 600 Highland Ave,
E3/311, Madison, WI 53792; Department of Radiology, Division of Musculoskeletal
Imaging, University of California, San Diego, La Jolla, Calif (B.K.H., E.Y.C.);
and Radiology Services, Veterans Affairs San Diego Healthcare System
(E.Y.C.)
| | - Brady K. Huang
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention (B.K.M.), and Department of Orthopedic Surgery (A.M.S.),
University of Wisconsin-Madison, Clinical Science Center, 600 Highland Ave,
E3/311, Madison, WI 53792; Department of Radiology, Division of Musculoskeletal
Imaging, University of California, San Diego, La Jolla, Calif (B.K.H., E.Y.C.);
and Radiology Services, Veterans Affairs San Diego Healthcare System
(E.Y.C.)
| | - Andrea M. Spiker
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention (B.K.M.), and Department of Orthopedic Surgery (A.M.S.),
University of Wisconsin-Madison, Clinical Science Center, 600 Highland Ave,
E3/311, Madison, WI 53792; Department of Radiology, Division of Musculoskeletal
Imaging, University of California, San Diego, La Jolla, Calif (B.K.H., E.Y.C.);
and Radiology Services, Veterans Affairs San Diego Healthcare System
(E.Y.C.)
| | - Eric Y. Chang
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention (B.K.M.), and Department of Orthopedic Surgery (A.M.S.),
University of Wisconsin-Madison, Clinical Science Center, 600 Highland Ave,
E3/311, Madison, WI 53792; Department of Radiology, Division of Musculoskeletal
Imaging, University of California, San Diego, La Jolla, Calif (B.K.H., E.Y.C.);
and Radiology Services, Veterans Affairs San Diego Healthcare System
(E.Y.C.)
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Batool S, Hammami M, Mantebea H, Badar F, Xia Y. Location-Specific Study of Young Rabbit Femoral Cartilage by Quantitative µMRI and Polarized Light Microscopy. Cartilage 2022; 13:19476035221085143. [PMID: 35306861 PMCID: PMC9137317 DOI: 10.1177/19476035221085143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Microscopic magnetic resonance imaging (µMRI) and polarized light microscopy (PLM) are used to characterize the structural variations at different anatomical locations of femoral cartilage in young rabbits (12-14 weeks old). DESIGN Four intact knees were imaged by µMRI at 86 µm resolution. Three small cartilage-bone specimens were harvested from each of 2 femoral medial condyles and imaged by quantitative µMRI (T2 anisotropy) at 9.75 µm resolution (N = 6). These specimens, as well as the other 2 intact femoral condyles, were used for histology and imaged by quantitative PLM (retardation and angle) at 0.25 µm to 4 µm resolutions. RESULTS Quantitative MRI relaxation data and PLM fibril data revealed collaboratively distinct topographical variations in both cartilage thickness and its collagen organization in the juvenile joint. Cartilage characteristics from the central location have a 3-zone arcade-like fibril structure and a distinct magic angle effect, commonly seen in mature articular cartilage, while cartilage at the anterior location lacks these characteristics. Overall, the lowest retardation values and isotropic T2 values have been found in the distal femur (trochlear ridge), with predominant parallel fibers with respect to the articular surface. Central cartilage is the thickest (~550 µm), approximately twice as thick as the anterior and posterior locations. CONCLUSION Distinctly different characteristics of tissue properties were found in cartilage at different topographical locations on femoral condyle in rabbits. Knowledge of location-specific structural differences in the collagen network over the joint surface can improve the understanding of local mechanobiology and provide insights to tissue engineering and degradation repairs.
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Affiliation(s)
- Syeda Batool
- Department of Physics, Center for Biomedical Research, Oakland University, Rochester, MI, USA
| | - Mouhamad Hammami
- Department of Physics, Center for Biomedical Research, Oakland University, Rochester, MI, USA
| | - Hannah Mantebea
- Department of Physics, Center for Biomedical Research, Oakland University, Rochester, MI, USA
| | - Farid Badar
- Department of Physics, Center for Biomedical Research, Oakland University, Rochester, MI, USA
| | - Yang Xia
- Department of Physics, Center for Biomedical Research, Oakland University, Rochester, MI, USA,Yang Xia, Department of Physics, Center for Biomedical Research, Oakland University, 244 Meadow Brook Road, Rochester, MI 48309, USA.
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15
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Kwon DG, Kim MK, Jeon YS, Nam YC, Park JS, Ryu DJ. State of the Art: The Immunomodulatory Role of MSCs for Osteoarthritis. Int J Mol Sci 2022; 23:1618. [PMID: 35163541 PMCID: PMC8835711 DOI: 10.3390/ijms23031618] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/21/2022] [Accepted: 01/27/2022] [Indexed: 01/15/2023] Open
Abstract
Osteoarthritis (OA) has generally been introduced as a degenerative disease; however, it has recently been understood as a low-grade chronic inflammatory process that could promote symptoms and accelerate the progression of OA. Current treatment strategies, including corticosteroid injections, have no impact on the OA disease progression. Mesenchymal stem cells (MSCs) based therapy seem to be in the spotlight as a disease-modifying treatment because this strategy provides enlarged anti-inflammatory and chondroprotective effects. Currently, bone marrow, adipose derived, synovium-derived, and Wharton's jelly-derived MSCs are the most widely used types of MSCs in the cartilage engineering. MSCs exert immunomodulatory, immunosuppressive, antiapoptotic, and chondrogenic effects mainly by paracrine effect. Because MSCs disappear from the tissue quickly after administration, recently, MSCs-derived exosomes received the focus for the next-generation treatment strategy for OA. MSCs-derived exosomes contain a variety of miRNAs. Exosomal miRNAs have a critical role in cartilage regeneration by immunomodulatory function such as promoting chondrocyte proliferation, matrix secretion, and subsiding inflammation. In the future, a personalized exosome can be packaged with ideal miRNA and proteins for chondrogenesis by enriching techniques. In addition, the target specific exosomes could be a gamechanger for OA. However, we should consider the off-target side effects due to multiple gene targets of miRNA.
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Affiliation(s)
| | | | | | | | | | - Dong Jin Ryu
- Orthopedic Surgery, Inha University Hospital, 22332 Inhang-ro 27, Jung-gu, Incheon 22332, Korea; (D.G.K.); (M.K.K.); (Y.S.J.); (Y.C.N.); (J.S.P.)
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16
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Logerstedt DS, Ebert JR, MacLeod TD, Heiderscheit BC, Gabbett TJ, Eckenrode BJ. Effects of and Response to Mechanical Loading on the Knee. Sports Med 2021; 52:201-235. [PMID: 34669175 DOI: 10.1007/s40279-021-01579-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 11/30/2022]
Abstract
Mechanical loading to the knee joint results in a differential response based on the local capacity of the tissues (ligament, tendon, meniscus, cartilage, and bone) and how those tissues subsequently adapt to that load at the molecular and cellular level. Participation in cutting, pivoting, and jumping sports predisposes the knee to the risk of injury. In this narrative review, we describe different mechanisms of loading that can result in excessive loads to the knee, leading to ligamentous, musculotendinous, meniscal, and chondral injuries or maladaptations. Following injury (or surgery) to structures around the knee, the primary goal of rehabilitation is to maximize the patient's response to exercise at the current level of function, while minimizing the risk of re-injury to the healing tissue. Clinicians should have a clear understanding of the specific injured tissue(s), and rehabilitation should be driven by knowledge of tissue-healing constraints, knee complex and lower extremity biomechanics, neuromuscular physiology, task-specific activities involving weight-bearing and non-weight-bearing conditions, and training principles. We provide a practical application for prescribing loading progressions of exercises, functional activities, and mobility tasks based on their mechanical load profile to knee-specific structures during the rehabilitation process. Various loading interventions can be used by clinicians to produce physical stress to address body function, physical impairments, activity limitations, and participation restrictions. By modifying the mechanical load elements, clinicians can alter the tissue adaptations, facilitate motor learning, and resolve corresponding physical impairments. Providing different loads that create variable tensile, compressive, and shear deformation on the tissue through mechanotransduction and specificity can promote the appropriate stress adaptations to increase tissue capacity and injury tolerance. Tools for monitoring rehabilitation training loads to the knee are proposed to assess the reactivity of the knee joint to mechanical loading to monitor excessive mechanical loads and facilitate optimal rehabilitation.
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Affiliation(s)
- David S Logerstedt
- Department of Physical Therapy, University of the Sciences in Philadelphia, Philadelphia, PA, USA.
| | - Jay R Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, WA, Australia.,Orthopaedic Research Foundation of Western Australia, Perth, WA, Australia.,Perth Orthopaedic and Sports Medicine Research Institute, Perth, WA, Australia
| | - Toran D MacLeod
- Department of Physical Therapy, Sacramento State University, Sacramento, CA, USA
| | - Bryan C Heiderscheit
- Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
| | - Tim J Gabbett
- Gabbett Performance Solutions, Brisbane, QLD, Australia.,Centre for Health Research, University of Southern Queensland, Ipswich, QLD, Australia
| | - Brian J Eckenrode
- Department of Physical Therapy, Arcadia University, Glenside, PA, USA
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17
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Vibroarthrographic signals for the low-cost and computationally efficient classification of aging and healthy knees. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.103003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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18
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Roberts HM, Griffith-McGeever CL, Owen JA, Angell L, Moore JP, Thom JM. An exploratory study to investigate the association between age, physical activity, femoral trochlear cartilage thickness and biomarkers of tissue metabolism in adult males. Eur J Appl Physiol 2021; 121:1871-1880. [PMID: 33713200 PMCID: PMC8192398 DOI: 10.1007/s00421-021-04655-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 02/25/2021] [Indexed: 11/27/2022]
Abstract
Purpose To investigate the association between age, physical activity, femoral trochlear cartilage thickness and biomarkers of tissue metabolism in a cross-sectional sample of adult males. This study utilizes several emerging biomarkers that have been associated with early joint degenerative changes; serum COMP (cartilage oligomeric matrix protein), HA (hyaluronan) and lubricin. Methods Eighty-one males (age: mean (range): 43(18–70) years; body mass index: 25.2 (21.0–30.6) kg/m2) volunteered. Resting serum COMP, HA and lubricin concentrations were determined via commercially available enzyme-linked immunosorbent assay (ELISA) and femoral trochlear cartilage thickness via supra-patellar ultrasound imaging. Physical activity levels were assessed using questionnaires. Statistical analyses were performed using correlation and regression analyses. Results Age was correlated with lateral trochlear cartilage thickness (r = − 0.372; p < 0.01) and serum COMP (r = 0.342; p < 0.01). 7-day physical activity was correlated with serum COMP (r = 0.357, p < 0.01), and 12-month physical activity with both lateral trochlear cartilage thickness (r = 0.340, p = 0.01) and serum HA (r = 0.296, p < 0.05). Regression analyses revealed that age significantly accounted for the variability in lateral cartilage thickness and serum COMP, following the adjustment for potential cofounders. However, the association between age and lateral trochlear cartilage thickness was not moderated by physical activity levels (all p > 0.05). Conclusion This study indicates that older age may be associated with thinner lateral trochlear cartilage and higher cartilage turnover. Being physically active may also be positive for lateral trochlear cartilage thickness. However, overall, both age and physical activity level only account for a small amount of the variability in cartilage thickness and serum biomarkers.
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Affiliation(s)
- Harry M Roberts
- School of Sport, Health and Exercise Sciences, Physical Activity for Health and Well Being (PAWB) Research Group, Bangor University, Bangor, UK. .,School of Biosciences and Medicine, University of Surrey, The Leggett Building, Daphne Jackson Road, Guildford, GU2 7WG, UK.
| | - Claire L Griffith-McGeever
- School of Sport, Health and Exercise Sciences, Physical Activity for Health and Well Being (PAWB) Research Group, Bangor University, Bangor, UK
| | - Julian A Owen
- School of Sport, Health and Exercise Sciences, Physical Activity for Health and Well Being (PAWB) Research Group, Bangor University, Bangor, UK
| | - Lewis Angell
- School of Sport, Health and Exercise Sciences, Physical Activity for Health and Well Being (PAWB) Research Group, Bangor University, Bangor, UK
| | - Jonathan P Moore
- School of Sport, Health and Exercise Sciences, Physical Activity for Health and Well Being (PAWB) Research Group, Bangor University, Bangor, UK
| | - Jeanette M Thom
- School of Sport, Health and Exercise Sciences, Physical Activity for Health and Well Being (PAWB) Research Group, Bangor University, Bangor, UK.,School of Medical Sciences, University of New South Wales, Sydney, Australia
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19
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Brenneman Wilson EC, Gatti AA, Maly MR. A new technique to evaluate the impact of running on knee cartilage deformation by region. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2021; 34:593-603. [PMID: 33387105 DOI: 10.1007/s10334-020-00896-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/16/2020] [Accepted: 11/08/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES When measuring changes in knee cartilage thickness in vivo after loading, mean values may not reflect local changes. The objectives of this investigation were: (1) use statistical parametric mapping (SPM) to determine regional deformation patterns of tibiofemoral cartilage in response to running; (2) quantify regional differences in cartilage thickness between males and females; and (3) explore the influence of sex on deformation. MATERIALS AND METHODS Asymptomatic males (n = 15) and females (n = 15) had MRI imaging of their right knee before and after 15 min of treadmill running. Medial and lateral tibial, and medial and lateral weight-bearing femoral cartilage were segmented. SPM was completed on cartilage thickness maps to test the main effects of Running and Sex, and their interaction. F-statistic maps were thresholded; clusters above this threshold indicated significant differences. RESULTS Deformation was observed in all four compartments; the lateral tibia had the largest area of deformation (p < 0.0001). Thickness differences between sexes were observed in all four compartments, showing females have thinner cartilage (p ≤ 0.009). The lateral tibia had small clusters indicating an interaction of sex on deformation (p ≤ 0.012). DISCUSSION SPM identified detailed spatial information on tibiofemoral cartilage thickness differences observed after running, and between sexes and their interaction.
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Affiliation(s)
| | - Anthony A Gatti
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.,NeuralSeg, Ltd., Hamilton, ON, Canada
| | - Monica R Maly
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada. .,School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada. .,Department of Kinesiology, University of Waterloo, 200 University Avenue West, Burt Matthews Hall, Rm 1036, Waterloo, ON, N2G3G1, Canada.
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20
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Özel D. The relationship between early-onset chondromalacia and the position of the patella. Acta Radiol 2020; 61:370-375. [PMID: 31319691 DOI: 10.1177/0284185119861901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background There are many underlying accelerator factors for chondromalacia and one of the well-known factors is patellar malalignment. Purpose To evaluate the relationship between early-onset chondromalacia and patellar position; and, second, to evaluate the value of patellar malalignment criteria. Material and Methods Patients aged 18–40 years with advanced chondromalacia were included. For comparison, a control group was defined with the same number of individuals of the same mean age. The magnetic resonance imaging (MRI) sagittal view with the greatest patellar length was used to obtain the patellar height measurement with the Insall-Salvati index. For the remaining three indices—modified Insall-Salvati, Caton-Deschamps, and Blackburne-Pell—a sagittal view with the greatest patellar articular surface was used. Discordance was defined as contradiction with the measured index and the other three indices. Results Both patella alta and baja were found to be predisposing factors for chondromalacia. Modified Insall-Salvati index was the most concordant measurement to define patella alta. Conclusion Both patella alta and patella baja were found to predispose to chondromalacia. Patella baja is rare, which may explain why it is not often mentioned as a predisposing factor. The modified Insall-Salvati index ratio was the best patella alta indicator that showed chondral status, more than patellar placement, and was more concordant with the other indices. Blackburne-Pell had the second highest number and ratio of discordance. BP cannot be optimally calculated because deciding the location of the tibial plateau seems to be problematic since it is a three-dimensional and complicated structure.
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Affiliation(s)
- Deniz Özel
- Sağlık Bilimleri University, Okmeydanı Research and Education Hospital, Radiology Clinic, Istanbul, Turkey
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21
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Comparison of Cartilage Mechanical Properties Measured During Creep and Recovery. Sci Rep 2020; 10:1547. [PMID: 32005844 PMCID: PMC6994684 DOI: 10.1038/s41598-020-58220-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 01/02/2020] [Indexed: 12/23/2022] Open
Abstract
The diagnosis of osteoarthritis (OA) currently depends on the presence of pain and radiographic imaging findings, which generally do not present until later stages of the disease when the condition is difficult to treat. Therefore, earlier detection of OA pathology is needed for improved disease management. Ex vivo cartilage studies indicate that changes in the mechanical function of cartilage occur as degeneration progresses during OA. Thus, measurement of the in vivo cartilage mechanical response may serve as an earlier indicator of OA pathology. Though mechanical characterization is classically performed during loading, the unloading (recovery) response of cartilage may also enable determination of mechanical response. Therefore, the purpose of this study was to validate the use of the recovery response for mechanical characterization of cartilage in a controlled, ex vivo environment. To do so, confined compression creep and recovery tests were conducted on cartilage explants (N = 10), and the resulting mechanical properties from both the creep and recovery phases were compared. No statistically significant differences were found in the mechanical properties between the two phases, reinforcing the hypothesis that unloading (recovery) may be a good surrogate for loading.
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Variation in the Thickness of Knee Cartilage. The Use of a Novel Machine Learning Algorithm for Cartilage Segmentation of Magnetic Resonance Images. J Arthroplasty 2019; 34:2210-2215. [PMID: 31445869 PMCID: PMC7251923 DOI: 10.1016/j.arth.2019.07.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/15/2019] [Accepted: 07/17/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The variation in articular cartilage thickness (ACT) in healthy knees is difficult to quantify and therefore poorly documented. Our aims are to (1) define how machine learning (ML) algorithms can automate the segmentation and measurement of ACT on magnetic resonance imaging (MRI) (2) use ML to provide reference data on ACT in healthy knees, and (3) identify whether demographic variables impact these results. METHODS Patients recruited into the Osteoarthritis Initiative with a radiographic Kellgren-Lawrence grade of 0 or 1 with 3D double-echo steady-state MRIs were included and their gender, age, and body mass index were collected. Using a validated ML algorithm, 2 orthogonal points on each femoral condyle were identified (distal and posterior) and ACT was measured on each MRI. Site-specific ACT was compared using paired t-tests, and multivariate regression was used to investigate the risk-adjusted effect of each demographic variable on ACT. RESULTS A total of 3910 MRI were included. The average femoral ACT was 2.34 mm (standard deviation, 0.71; 95% confidence interval, 0.95-3.73). In multivariate analysis, distal-medial (-0.17 mm) and distal-lateral cartilage (-0.32 mm) were found to be thinner than posterior-lateral cartilage, while posterior-medial cartilage was found to be thicker (0.21 mm). In addition, female sex was found to negatively impact cartilage thickness (OR, -0.36; all values: P < .001). CONCLUSION ML was effectively used to automate the segmentation and measurement of cartilage thickness on a large number of MRIs of healthy knees to provide normative data on the variation in ACT in this population. We further report patient variables that can influence ACT. Further validation will determine whether this technique represents a powerful new tool for tracking the impact of medical intervention on the progression of articular cartilage degeneration.
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23
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Roberts HM, Moore JP, Thom JM. The Reliability of Suprapatellar Transverse Sonographic Assessment of Femoral Trochlear Cartilage Thickness in Healthy Adults. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:935-946. [PMID: 30208236 DOI: 10.1002/jum.14775] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 06/21/2018] [Accepted: 07/04/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To determine the intrasession reliability of femoral cartilage thickness measurements using sonography and extend the pool of normative data for cartilage thickness measurements assessed by sonography. METHODS A total of 77 healthy participants (55 men, 22 women), with an average age of 43 ± 18 (mean ± standard deviation) years, volunteered. Resting suprapatellar sonography was used to image trochlear cartilage thickness on 2 separate occasions a maximum of 7 days apart. Reliability was evaluated with intraclass correlation coefficients, Bland-Altman analysis, standard error of measurement, and the smallest real difference. Normative data was assessed using linear, multiple regression models and independent group t tests. RESULTS The test-retest level of agreement at all locations was high (intraclass correlation coefficient, 0.779-0.843), which increased to high-very high in young adults (intraclass correlation coefficient, 0.884-0.920). The standard error of measurement was 8.2% to 8.3% at all locations and reduced further to 5.4% to 6.3% in younger adults. The smallest real difference was between 22.8% and 23.1% for the full sample and 14.9% and 17.5% in young adults only. Multiple regression analyses demonstrated that age, weight, female sex, and a high physical activity frequency could significantly predict cartilage thickness at all locations (P < .05); however, female sex was the only significant independent predictor in all models (all P < .01). Females also had thinner cartilage at all locations (P < .01). CONCLUSION Suprapatellar sonography demonstrates high intratester reliability and measurement precision and is a promising method to assess trochlear cartilage thickness. Being female may impact femoral cartilage thickness more than other potential risk factors for knee osteoarthritis such as age, weight, and high physical activity frequency.
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Affiliation(s)
- Harry M Roberts
- the School of Sport, Health & Exercise Sciences, Bangor University, Bangor, Gwynedd, Wales
- School of Biosciences and Medicine, University of Surrey, Guildford, Surrey, England
| | - Jonathan P Moore
- the School of Sport, Health & Exercise Sciences, Bangor University, Bangor, Gwynedd, Wales
| | - Jeanette M Thom
- School of Medical Sciences, University of New South Wales, Australia
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24
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Kim C, Keating A. Cell Therapy for Knee Osteoarthritis: Mesenchymal Stromal Cells. Gerontology 2019; 65:294-298. [PMID: 30897578 DOI: 10.1159/000496605] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 01/07/2019] [Indexed: 11/19/2022] Open
Abstract
Osteoarthritis (OA) is designated the 11th highest contributor of 291 diseases of global disability and the most common cause of chronic disability in elderly people. OA has a devastating impact on quality of life and represents an enormous socio-economic burden. Currently, OA is incurable, and no approved medications, biological therapy, or procedure prevents the progressive destruction of the osteoarthritic knee joint. All current treatments provide symptomatic relief rather than preventative or regenerative results. There is an urgent and compelling need to find, validate, and test new biological therapeutics. Cell-based therapies involving the delivery of mesenchymal stromal cells (MSCs) to the os-teoarthritic knee joint have emerged as a potential solution to overcome this clinical shortcoming. In this review, we address the clinical evidence, challenges, and recent advances surrounding MSC treatment in knee OA.
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Affiliation(s)
- Christopher Kim
- Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada,
| | - Armand Keating
- Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada.,Cell Therapy Translational Research Laboratory, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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25
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Endisha H, Rockel J, Jurisica I, Kapoor M. The complex landscape of microRNAs in articular cartilage: biology, pathology, and therapeutic targets. JCI Insight 2018; 3:121630. [PMID: 30185670 DOI: 10.1172/jci.insight.121630] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The disabling degenerative disease osteoarthritis (OA) is prevalent among the global population. Articular cartilage degeneration is a central feature of OA; therefore, a better understanding of the mechanisms that maintain cartilage homeostasis is vital for developing effective therapeutic interventions. MicroRNAs (miRs) modulate cell signaling pathways and various processes in articular cartilage via posttranscriptional repression of target genes. As dysregulated miRs frequently alter the homeostasis of articular cartilage, modulating select miRs presents a potential therapeutic opportunity for OA. Here, we review key miRs that have been shown to modulate cartilage-protective or -destructive mechanisms and signaling pathways. Additionally, we use an integrative computational biology approach to provide insight into predicted miR gene targets that may contribute to OA pathogenesis, and highlight the complexity of miR signaling in OA by generating both unique and overlapping gene targets of miRs that mediate protective or destructive effects. Early OA detection would enable effective prevention; thus, miRs are being explored as diagnostic biomarkers. We discuss these ongoing efforts and the applicability of miR mimics and antisense inhibitors as potential OA therapeutics.
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Affiliation(s)
- Helal Endisha
- Arthritis Program, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Division of Genetics and Development, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Department of Surgery and Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada
| | - Jason Rockel
- Arthritis Program, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Division of Genetics and Development, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Igor Jurisica
- Arthritis Program, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Division of Genetics and Development, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Departments of Medical Biophysics and Computer Science, University of Toronto, Toronto, Ontario, Canada.,Institute of Neuroimmunology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Mohit Kapoor
- Arthritis Program, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Division of Genetics and Development, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Department of Surgery and Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada
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26
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Xiao ZF, Su GY, Hou Y, Chen SD, Lin DK. Cartilage degradation in osteoarthritis: A process of osteochondral remodeling resembles the endochondral ossification in growth plate? Med Hypotheses 2018; 121:183-187. [PMID: 30396477 DOI: 10.1016/j.mehy.2018.08.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 08/17/2018] [Accepted: 08/25/2018] [Indexed: 12/15/2022]
Abstract
Osteoarthritis (OA) is one of the most common degenerative disease which causes pain and disability of joint and brings heavy socioeconomic burden in the world. However, the pathogenesis of OA has not been fully understood. Articular cartilage degradation or loss was often regarded as the characteristic of osteoarthritis. But we believe that there may had a illusion that OA was simply considered to be a process of wear and tear because evidences have supported all joint tissues remodeling including cartilage, subchondral bone, synovium, ligament, fat pad, and etc, were engaged in OA, in particular the cartilage and subchondral bone. Many factors such as mechanics, inflammation and immunological abnormality could drive the joint tissues metabolic and disturb the steady state of cartilage and bone, which further devoted to a serial pathological manifestations, consisting of hypertrophy and apoptosis of articular chondrocytes, degradation of cartilage matrix, angiogenesis and calcification of hyaline cartilage, replication of tidemark, formation of osteophytes, degeneration of ligaments and, in the knee, the menisci, hypertrophy of the joint capsule and remodeling of subchondral bone along with increased permeability of the osteochondral interface. The thickening of calcified cartilage, the thinning of superficial hyaline cartilage and the remodeling of subchondral bone indicated that the cartilage degradation could be a procedure of enchondral ossification similar to the growth plate, of driven by a host of cytokines within the affected joint. Articular cartilage loses stable state from normal resting to a high turnover in the stimulation of abnormal mechanical stresses and cytokines would subsequently contributed to slowly sustained remodeling and calcification, which might be the key features of the initiation and development of OA. In this article, the development and structural comparison of articular cartilage and growth plate as well as the major pathologic features of OA will be discussed to explain that cartilage degeneration in OA might be a process of enchondral ossification similar to growth plate. This would provide a new perspective for understanding OA's pathogenesis and the treatment in the future.
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Affiliation(s)
- Zhi-Feng Xiao
- The Department of Spinal Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 111, Dade Road, Yuexiu District, Guangzhou 510120, China; The Laboratory Affiliated to Orthopaedics and Traumatology of Chinese Medicine of Linnan Medical Research Center of Guangzhou University of Chinese Medicine, No. 12, Jichang Road, Baiyun District, Guangzhou 510405, China.
| | - Guo-Yi Su
- The Department of Spinal Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 111, Dade Road, Yuexiu District, Guangzhou 510120, China; Guangzhou University of Chinese Medicine, No. 12, Jichang Road, Baiyun District, Guangzhou 510405, China
| | - Yu Hou
- The Department of Spinal Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 111, Dade Road, Yuexiu District, Guangzhou 510120, China; Guangzhou University of Chinese Medicine, No. 12, Jichang Road, Baiyun District, Guangzhou 510405, China
| | - Shu-Dong Chen
- The Department of Spinal Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 111, Dade Road, Yuexiu District, Guangzhou 510120, China; Guangzhou University of Chinese Medicine, No. 12, Jichang Road, Baiyun District, Guangzhou 510405, China
| | - Ding-Kun Lin
- The Department of Spinal Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 111, Dade Road, Yuexiu District, Guangzhou 510120, China; Guangzhou University of Chinese Medicine, No. 12, Jichang Road, Baiyun District, Guangzhou 510405, China.
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27
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Roberts HM, Moore JP, Thom JM. The effect of aerobic walking and lower body resistance exercise on serum COMP and hyaluronan, in both males and females. Eur J Appl Physiol 2018. [PMID: 29536174 DOI: 10.1007/s00421-018-3837-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the serum cartilage oligomeric matrix protein (COMP) and hyaluronan (HA) response to walking (high-repetition loading) and resistance training exercise (low-repetition loading) in males and females. METHODS 15 males (age: 28 ± 6 years; BMI: 24 ± 2; mean ± SD) and 15 females (age: 26 ± 4 years; BMI: 23 ± 2) completed both a 40-min walk at 80% of maximum heart rate and a 40-min lower body resistance training protocol, separated by a minimum of 48 h. Serum COMP and HA were determined at rest, immediately post, and 30-min post exercise. Resting femoral cartilage thickness was also measured using ultrasonography. RESULTS COMP increased following walking (28.9%; P < 0.001) and resistance training exercise (26.0%; P < 0.001), remaining above baseline post-exercise following walking (mean difference: +28.3 ng/ml; 95% CI 3.8-52.8 ng/ml; P = 0.02). Although the exercise response did not differ for gender, COMP concentrations were higher in males than in females at all time points (all, P < 0.001). In contrast, HA concentrations did not change following either modality of exercise. However, females demonstrated higher HA pre-exercise (37.7 ± 17.8 vs 26.2 ± 12.8 ng/ml; P = 0.006) and immediately post exercise (38.0 ± 19.0 vs 28.2 ± 15.5 ng/ml; P = 0.033) compared to men. Finally, following adjustment for body size, femoral cartilage thickness was greater in men compared to women (notch: 2.66 vs 1.74 mm, P < 0.001). CONCLUSION The effect of a single bout of lower body exercise on serum COMP and HA is independent of exercise modality in healthy men and women. Furthermore, having thicker femoral cartilage and higher baseline COMP in males does not appear to influence how the cartilage responds to exercise.
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Affiliation(s)
- Harry M Roberts
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK.
- School of Biosciences and Medicine, University of Surrey, The Leggett Building, Daphne Jackson Road, Guildford, GU2 7WG, UK.
| | - Jonathan P Moore
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | - Jeanette M Thom
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
- School of Medical Sciences, University of New South Wales, Sydney, Australia
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28
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Ho KY, McClaren J, Sudweeks S. Acute Effects of Walking on the Deformation of Femoral Articular Cartilage in Older Adults. J Geriatr Phys Ther 2018. [PMID: 29533282 DOI: 10.1519/jpt.0000000000000185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Although discomfort during walking is a common complaint in individuals with knee osteoarthritis (OA), how an acute bout of walking affects femoral cartilage remains unclear. Current literature has suggested that frontal plane knee malalignment (ie, varus and valgus) is associated with the initiation and/or progression of knee OA. However, the association between knee alignment and femoral cartilage deformation after an acute bout of loading has not yet been investigated. This study was aimed to compare the acute effects of walking on femoral cartilage deformation between older adults with and without knee OA. We also examined the association between frontal plane knee alignment and loading-induced femoral cartilage deformation. METHODS Ten persons without OA (Kellgren Lawrence grading = 0 or 1; 5 females and 5 males; 55.0 [1.8] years of age; 78.8 [14.1] kg; 1.8 [0.2] m) and 9 persons with OA (Kellgren Lawrence grading ≥2; 4 females and 5 males; 55.6 [4.5] years of age; 97.4 [15.0] kg; 1.7 [0.1] m) participated. Each participant underwent magnetic resonance imaging before and immediately after 30 minutes of fast walking at 3 to 4 miles per hour. To obtain cartilage deformation postwalking, the medial and lateral femoral cartilage of the weight-bearing areas was segmented on participants' magnetic resonance imaging. Cartilage thickness was quantified by computing the average perpendicular distance between opposing voxels defining the edges of the femoral cartilage. Cartilage deformation of the medial and lateral femurs was defined as the percent changes in cartilage thickness after walking. Frontal plane knee alignment was obtained by measuring the angle between the long axes of femur and tibia. Independent t tests were used to compare cartilage deformation between the 2 groups. Pearson correlation coefficients were used to assess the association between cartilage deformation and knee alignment. RESULTS AND DISCUSSION There was no significant difference in cartilage deformation between the OA and control groups in lateral (P = .69) or medial (P = .87) femur. A significant correlation was found between lateral femoral cartilage deformation and increased knee valgus alignment (r = 0.497; P = .03). No difference was found between medial femoral cartilage deformation and frontal plane knee alignment (r = 273; P = .26). CONCLUSIONS This is the first study comparing the acute effects of walking on femoral cartilage deformation between older adults with and without knee OA. Although there was not a difference in walking-induced femoral cartilage deformation between the OA and control groups, knee valgus was related to lateral femoral cartilage deformation after walking. Our findings suggested that walking exercises may be used safely in older adults without knee malalignment.
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Affiliation(s)
- Kai-Yu Ho
- Department of Physical Therapy, University of Nevada, Las Vegas
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29
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Ren P, Niu H, Gong H, Zhang R, Fan Y. Morphological, biochemical and mechanical properties of articular cartilage and subchondral bone in rat tibial plateau are age related. J Anat 2018; 232:457-471. [PMID: 29266211 PMCID: PMC5807934 DOI: 10.1111/joa.12756] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2017] [Indexed: 12/30/2022] Open
Abstract
The purpose of this study was to investigate age-related changes in the morphological, biochemical and mechanical properties of articular cartilage (AC) and subchondral bone in the rat tibial plateau. Female Wistar rats were grouped according to age (1, 3, 5, 7, 9, 11, 13, 15, 16 and 17 months, with 10 rats in each group). The ultrastructures, surface topographies, and biochemical and mechanical properties of the AC and subchondral bone in the knee joints of the rats were determined through X-ray micro-tomography, histology, immunohistochemistry, scanning electron microscopy (SEM), atomic force microscopy and nanoindentation. We found that cartilage thickness decreased with age. This decrease was accompanied by functional condensation of the underlying subchondral bone. Increased thickness and bone mineral density and decreased porosity were observed in the subchondral plate (SP). Growth decreased collagen II expression in the tibial cartilage. The arrangement of trabeculae in the subchondral trabecular bone became disordered. The thickness and strength of the fibers decreased with age, as detected by SEM. The SP and trabeculae in the tibial plateau increased in roughness in the first phase (1-9 months of age), and then were constant in the second phase (11-17 months of age). Meanwhile, the roughness of the AC changed significantly in the first phase (1-9 months of age), but the changes were independent of age thereafter. This study gives a comprehensive insight into the growth-related structural, biochemical and mechanical changes in the AC and subchondral bone. The results presented herein may contribute to a new understanding of the pathogenesis of age-related bone diseases.
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Affiliation(s)
- Pengling Ren
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of EducationSchool of Biological Science and Medical EngineeringBeihang UniversityBeijingChina
| | - Haijun Niu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of EducationSchool of Biological Science and Medical EngineeringBeihang UniversityBeijingChina
| | - He Gong
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of EducationSchool of Biological Science and Medical EngineeringBeihang UniversityBeijingChina
| | - Rui Zhang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of EducationSchool of Biological Science and Medical EngineeringBeihang UniversityBeijingChina
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of EducationSchool of Biological Science and Medical EngineeringBeihang UniversityBeijingChina
- National Research Center for Rehabilitation Technical AidsBeijingChina
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30
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Vibroarthrography for early detection of knee osteoarthritis using normalized frequency features. Med Biol Eng Comput 2018; 56:1499-1514. [DOI: 10.1007/s11517-018-1785-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 01/01/2018] [Indexed: 10/18/2022]
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31
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Sex estimation from the patella in an African American population. J Forensic Leg Med 2018; 54:1-7. [DOI: 10.1016/j.jflm.2017.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 09/03/2017] [Accepted: 12/18/2017] [Indexed: 11/19/2022]
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32
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Favre J, Erhart-Hledik JC, Blazek K, Fasel B, Gold GE, Andriacchi TP. Anatomically Standardized Maps Reveal Distinct Patterns of Cartilage Thickness With Increasing Severity of Medial Compartment Knee Osteoarthritis. J Orthop Res 2017; 35:2442-2451. [PMID: 28233332 DOI: 10.1002/jor.23548] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 02/10/2017] [Indexed: 02/04/2023]
Abstract
While cartilage thickness alterations are a central element of knee osteoarthritis (OA), differences among disease stages are still incompletely understood. This study aimed to quantify the spatial-variations in cartilage thickness using anatomically standardized thickness maps and test if there are characteristic patterns in patients with different stages of medial compartment knee OA. Magnetic resonance images were acquired for 75 non-OA and 100 OA knees of varying severities (Kellgren and Lawrence (KL) scores 1-4). Three-dimensional cartilage models were reconstructed and a shape matching technique was applied to convert the models into two-dimensional anatomically standardized thickness maps. Difference thickness maps and statistical parametric mapping were used to compare the four OA and the non-OA subgroups. This analysis showed distinct thickness patterns for each clinical stage that formed a coherent succession from the non-OA to the KL 4 subgroups. Interestingly, the only significant difference for early stage (KL 1) was thicker femoral cartilage. With increase in disease severity, typical patterns developed, including thinner cartilage in the anterior area of the medial condyle (significant for KL 3 and 4) and thicker cartilage in the posterior area of the medial and lateral condyles (significant for all OA subgroups). The tibial patterns mainly consisted of thinner cartilage for both medial and lateral compartments (significant for KL 2-4). Comparing anatomically standardized maps allowed identifying patterns of thickening and thinning over the entire cartilage surface, consequently improving the characterization of thickness differences associated with OA. The results also highlighted the value of anatomically standardized maps to analyze spatial variations in cartilage thickness. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2442-2451, 2017.
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Affiliation(s)
- Julien Favre
- Department of Musculoskeletal Medicine, Centre Hospitalier Universiatire Vaudois, University of Lausanne, Lausanne, Switzerland.,Department of Mechanical Engineering, Stanford University, Stanford, California
| | - Jennifer C Erhart-Hledik
- Department of Mechanical Engineering, Stanford University, Stanford, California.,Palo Alto VA, Palo Alto, California
| | - Katerina Blazek
- Department of Mechanical Engineering, Stanford University, Stanford, California.,Palo Alto VA, Palo Alto, California
| | - Benedikt Fasel
- Department of Mechanical Engineering, Stanford University, Stanford, California
| | - Garry E Gold
- Department of Radiology, Stanford University, Stanford, California.,Department of Bioengineering, Stanford University, Stanford, California.,Department of Orthopaedic Surgery, Stanford University, Stanford, California
| | - Thomas P Andriacchi
- Department of Mechanical Engineering, Stanford University, Stanford, California.,Palo Alto VA, Palo Alto, California.,Department of Orthopaedic Surgery, Stanford University, Stanford, California
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33
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Mavrogonatou E, Pratsinis H, Papadopoulou A, Karamanos NK, Kletsas D. Extracellular matrix alterations in senescent cells and their significance in tissue homeostasis. Matrix Biol 2017; 75-76:27-42. [PMID: 29066153 DOI: 10.1016/j.matbio.2017.10.004] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 10/13/2017] [Accepted: 10/14/2017] [Indexed: 12/16/2022]
Abstract
Normal cells after a defined number of successive divisions or after exposure to genotoxic stresses are becoming senescent, characterized by a permanent growth arrest. In addition, they secrete increased levels of pro-inflammatory and catabolic mediators, collectively termed "senescence-associated secretory phenotype". Furthermore, senescent cells exhibit an altered expression and organization of many extracellular matrix components, leading to specific remodeling of their microenvironment. In this review we present the current knowledge on extracellular matrix alterations associated with cellular senescence and critically discuss certain characteristic examples, highlighting the ambiguous role of senescent cells in the homeostasis of various tissues under both normal and pathologic conditions.
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Affiliation(s)
- Eleni Mavrogonatou
- Laboratory of Cell Proliferation and Ageing, Institute of Biosciences and Applications, National Centre for Scientific Research "Demokritos", Athens, Greece
| | - Harris Pratsinis
- Laboratory of Cell Proliferation and Ageing, Institute of Biosciences and Applications, National Centre for Scientific Research "Demokritos", Athens, Greece
| | - Adamantia Papadopoulou
- Laboratory of Cell Proliferation and Ageing, Institute of Biosciences and Applications, National Centre for Scientific Research "Demokritos", Athens, Greece
| | - Nikos K Karamanos
- Biochemistry, Biochemical Analysis & Matrix Pathobiology Research Group, Laboratory of Biochemistry, Department of Chemistry, University of Patras, Patras, Greece
| | - Dimitris Kletsas
- Laboratory of Cell Proliferation and Ageing, Institute of Biosciences and Applications, National Centre for Scientific Research "Demokritos", Athens, Greece.
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34
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Liu B, Lad NK, Collins AT, Ganapathy PK, Utturkar GM, McNulty AL, Spritzer CE, Moorman CT, Sutter EG, Garrett WE, DeFrate LE. In Vivo Tibial Cartilage Strains in Regions of Cartilage-to-Cartilage Contact and Cartilage-to-Meniscus Contact in Response to Walking. Am J Sports Med 2017; 45:2817-2823. [PMID: 28671850 PMCID: PMC5629119 DOI: 10.1177/0363546517712506] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There are currently limited human in vivo data characterizing the role of the meniscus in load distribution within the tibiofemoral joint. Purpose/Hypothesis: The purpose was to compare the strains experienced in regions of articular cartilage covered by the meniscus to regions of cartilage not covered by the meniscus. It was hypothesized that in response to walking, tibial cartilage covered by the meniscus would experience lower strains than uncovered tibial cartilage. STUDY DESIGN Descriptive laboratory study. METHODS Magnetic resonance imaging (MRI) of the knees of 8 healthy volunteers was performed before and after walking on a treadmill. Using MRI-generated 3-dimensional models of the tibia, cartilage, and menisci, cartilage thickness was measured in 4 different regions based on meniscal coverage and compartment: covered medial, uncovered medial, covered lateral, and uncovered lateral. Strain was defined as the normalized change in cartilage thickness before and after activity. RESULTS Within each compartment, covered cartilage before activity was significantly thinner than uncovered cartilage before activity ( P < .001). After 20 minutes of walking, all 4 regions experienced significant cartilage thickness decreases ( P < .01). The covered medial region experienced significantly less strain than the uncovered medial region ( P = .04). No difference in strain was detected between the covered and uncovered regions in the lateral compartment ( P = .40). CONCLUSION In response to walking, cartilage that is covered by the meniscus experiences lower strains than uncovered cartilage in the medial compartment. These findings provide important baseline information on the relationship between in vivo tibial compressive strain responses and meniscal coverage, which is critical to understanding normal meniscal function.
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Affiliation(s)
- Betty Liu
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC USA,Department of Biomedical Engineering, Duke University School of Medicine, Durham, NC USA
| | - Nimit K. Lad
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC USA
| | - Amber T. Collins
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC USA
| | - Pramodh K. Ganapathy
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC USA
| | - Gangadhar M. Utturkar
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC USA
| | - Amy L. McNulty
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC USA,Department of Pathology, Duke University School of Medicine, Durham, NC USA
| | | | - Claude T. Moorman
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC USA
| | - E. Grant Sutter
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC USA
| | - William E. Garrett
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC USA
| | - Louis E. DeFrate
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC USA,Department of Biomedical Engineering, Duke University School of Medicine, Durham, NC USA
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Fontinele RG, Krause Neto W, Gama EF, Brito Mari RD, de Souza RR, Conrado A, Mochizuki L, Kfoury Junior JR. Caloric restriction minimizes aging effects on the femoral medial condyle. Aging Male 2017; 20:161-167. [PMID: 28332902 DOI: 10.1080/13685538.2017.1301418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
This study aimed to analyze the effects of caloric restriction on aged femoral articular cartilage of Wistar rats. Three groups of eight animals each were considered: young (YC) and old (OC) control groups fed with a normal diet and old caloric restriction group (OCR) composed of 18-month-old animals fed with a 31% less caloric diet from 6-months of age. Articular cartilage was studied through morphometry and immunohistochemistry. Body mass was 12% less in the OCR group than in the OC group. The articular cartilage from OC rats show thinner medial condyles, fewer chondrocytes, smaller chondrocytes nuclear volume and, in both condyles, a predominance of collagen type II and less collagen density compared to both YC and OCR groups (p < .001). In contrast, OCR articular cartilage show thicker medial condyles, larger chondrocytes nuclear volume and increased collagen density compared to OC group (p < 0.001). We concluded that caloric restriction minimizes the effects of aging on medial condyles of the femoral articular cartilage.
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Affiliation(s)
- Renata Gabriel Fontinele
- a Department of Surgery, Faculty of Veterinary Medicine and Zootecny , São Paulo University , São Paulo , Brazil
| | - Walter Krause Neto
- b Department of Physical Education, Laboratory of Morphoquantitative Studies and Immunohistochemistry , São Judas Tadeu University , São Paulo , Brazil
| | - Eliane Florencio Gama
- b Department of Physical Education, Laboratory of Morphoquantitative Studies and Immunohistochemistry , São Judas Tadeu University , São Paulo , Brazil
| | - Renata de Brito Mari
- c Department of Morphological Sciences , Maringá State University , Maringá , Brazil
| | - Romeu Rodrigues de Souza
- b Department of Physical Education, Laboratory of Morphoquantitative Studies and Immunohistochemistry , São Judas Tadeu University , São Paulo , Brazil
- d Department of Anatomy , São Judas Tadeu University , São Paulo , Brazil
| | - André Conrado
- a Department of Surgery, Faculty of Veterinary Medicine and Zootecny , São Paulo University , São Paulo , Brazil
| | - Luis Mochizuki
- e School of Arts, Sciences and Humanities , São Paulo University , São Paulo , Brazil
| | - José Roberto Kfoury Junior
- a Department of Surgery, Faculty of Veterinary Medicine and Zootecny , São Paulo University , São Paulo , Brazil
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Pain prediction by serum biomarkers of bone turnover in people with knee osteoarthritis: an observational study of TRAcP5b and cathepsin K in OA. Osteoarthritis Cartilage 2017; 25:858-865. [PMID: 28087412 DOI: 10.1016/j.joca.2017.01.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/16/2016] [Accepted: 01/04/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To investigate serum biomarkers, tartrate resistant acid phosphatase 5b (TRAcP5b) and cathepsin K (cath-K), indicative of osteoclastic bone resorption, and their relationship to pain and pain change in knee osteoarthritis (OA). METHODS Sera and clinical data were collected from 129 people (97 with 3-year follow-up) with knee OA from the Prediction of Osteoarthritis Progression (POP) cohort. Knee OA-related outcomes in POP included: WOMAC pain, National Health and Nutrition Examination Survey (NHANES) I (pain, aching and stiffness), subchondral sclerosis, and radiographically determined tibiofemoral and patellofemoral OA. Two putative osteoclast biomarkers were measured in sera: TRAcP5b and cath-K. Medial tibia plateaux were donated at knee arthroplasty for symptomatic OA (n = 84) or from 16 post mortem (PM) controls from the Arthritis Research UK (ARUK) Pain Centre joint tissue repository. Osteoclasts were stained for tartrate resistant acid phosphatase (TRAcP) within the subchondral bone of the medial tibia plateaux. RESULTS Serum TRAcP5b activity, but not cath-K-immunoreactivity, was associated with density of TRAcP-positive osteoclasts in the subchondral bone of medial tibia plateaux. TRAcP-positive osteoclasts were more abundant in people with symptomatic OA compared to controls. Serum TRAcP5b activity was associated with baseline pain and pain change. CONCLUSIONS Our observations support a role for subchondral osteoclast activity in the generation of OA pain. Serum TRAcP5b might be a clinically relevant biomarker of disease activity in OA.
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Jørgensen AEM, Kjær M, Heinemeier KM. The Effect of Aging and Mechanical Loading on the Metabolism of Articular Cartilage. J Rheumatol 2017; 44:410-417. [PMID: 28250141 DOI: 10.3899/jrheum.160226] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The morphology of articular cartilage (AC) enables painless movement. Aging and mechanical loading are believed to influence development of osteoarthritis (OA), yet the connection remains unclear. METHODS This narrative review describes the current knowledge regarding this area, with the literature search made on PubMed using appropriate keywords regarding AC, age, and mechanical loading. RESULTS Following skeletal maturation, chondrocyte numbers decline while increasing senescence occurs. Lower cartilage turnover causes diminished maintenance capacity, which produces accumulation of fibrillar crosslinks by advanced glycation end products, resulting in increased stiffness and thereby destruction susceptibility. CONCLUSION Mechanical loading changes proteoglycan content. Moderate mechanical loading causes hypertrophy and reduced mechanical loading causes atrophy. Overloading produces collagen network damage and proteoglycan loss, leading to irreversible cartilage destruction because of lack of regenerative capacity. Catabolic pathways involve inflammation and the transcription factor nuclear factor-κB. Thus, age seems to be a predisposing factor for OA, with mechanical overload being the likely triggering cause.
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Affiliation(s)
- Adam El Mongy Jørgensen
- From the Institute of Sports Medicine, Department of Orthopedic Surgery M, Bispebjerg Hospital, and the Department of Biomedical Sciences, Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. .,A.E. Jørgensen, MD, Institute of Sports Medicine, Department of Orthopedic Surgery M, Bispebjerg Hospital, Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen; M. Kjær, MD, DMSc, Institute of Sports Medicine, Department of Orthopedic Surgery M, Bispebjerg Hospital, Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen; K.M. Heinemeier, MSc, PhD, Institute of Sports Medicine, Department of Orthopedic Surgery M, Bispebjerg Hospital, and Department of Biomedical Sciences, Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen.
| | - Michael Kjær
- From the Institute of Sports Medicine, Department of Orthopedic Surgery M, Bispebjerg Hospital, and the Department of Biomedical Sciences, Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,A.E. Jørgensen, MD, Institute of Sports Medicine, Department of Orthopedic Surgery M, Bispebjerg Hospital, Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen; M. Kjær, MD, DMSc, Institute of Sports Medicine, Department of Orthopedic Surgery M, Bispebjerg Hospital, Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen; K.M. Heinemeier, MSc, PhD, Institute of Sports Medicine, Department of Orthopedic Surgery M, Bispebjerg Hospital, and Department of Biomedical Sciences, Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Katja Maria Heinemeier
- From the Institute of Sports Medicine, Department of Orthopedic Surgery M, Bispebjerg Hospital, and the Department of Biomedical Sciences, Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,A.E. Jørgensen, MD, Institute of Sports Medicine, Department of Orthopedic Surgery M, Bispebjerg Hospital, Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen; M. Kjær, MD, DMSc, Institute of Sports Medicine, Department of Orthopedic Surgery M, Bispebjerg Hospital, Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen; K.M. Heinemeier, MSc, PhD, Institute of Sports Medicine, Department of Orthopedic Surgery M, Bispebjerg Hospital, and Department of Biomedical Sciences, Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen
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Schmitz RJ, Wang HM, Polprasert DR, Kraft RA, Pietrosimone BG. Evaluation of knee cartilage thickness: A comparison between ultrasound and magnetic resonance imaging methods. Knee 2017; 24:217-223. [PMID: 27914723 DOI: 10.1016/j.knee.2016.10.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 08/31/2016] [Accepted: 10/11/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Establishing clinically accessible measures of cartilage health is critical for assessing effectiveness of protocols to reduce risk of osteoarthritis (OA) development and progression. Cartilage thickness is one important measure in describing both OA development and progression. The objective was to determine the relationship between ultrasound and MRI measures of cartilage thickness in the medial femoral condyle. METHODS Mean cartilage thicknesses of the left medial femoral cartilage were measured via T1 weighted MRI and ultrasound imaging from transverse, anterior, middle, and posterior medial femoral regions in 10 healthy females (Mean±Std Dev) (1.66±0.08m, 59.5±8.3kg, 21.6±1.4years) and nine healthy males (1.80±0.08m, 79.1±6.2kg, 21.7±1.5years). Pearson correlations examined relationships between MRI and ultrasound measures. Bland-Altman plots evaluated agreement between the imaging modalities. RESULTS Transverse ultrasound thickness measures were significantly positively correlated with MRI middle (r=.67, P≤.05) and posterior thicknesses (r=.49, P≤.05) while the middle and posterior longitudinal ultrasound measures were significantly correlated to their respective MRI regions (r=.67, P≤.05 & r=.59 P≤.05, respectively). There was poor absolute agreement between correlated measures with ultrasound thickness measures being between 1.9 and 2.8mm smaller than MRI measures. CONCLUSIONS These results suggest that ultrasound may be a viable clinical tool to assess relative cartilage thickness in the middle and posterior medial femoral regions. However, the absolute validity of the ultrasound measure is called into question due to the larger MRI-based thickness measures. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Randy J Schmitz
- The University of North Carolina at Greensboro, Greensboro, NC, United States.
| | | | - Daniel R Polprasert
- The University of North Carolina at Greensboro, Greensboro, NC, United States
| | - Robert A Kraft
- Wake Forest University, Winston-Salem, NC, United States
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Wyatt LA, Moreton BJ, Mapp PI, Wilson D, Hill R, Ferguson E, Scammell BE, Walsh DA. Histopathological subgroups in knee osteoarthritis. Osteoarthritis Cartilage 2017; 25:14-22. [PMID: 27720884 DOI: 10.1016/j.joca.2016.09.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 09/01/2016] [Accepted: 09/28/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Osteoarthritis (OA) is a heterogeneous, multi-tissue disease. We hypothesised that different histopathological features characterise different stages during knee OA progression, and that discrete subgroups can be defined based on validated measures of OA histopathological features. DESIGN Medial tibial plateaux and synovium were from 343 post-mortem (PM) and 143 OA arthroplasty donations. A 'chondropathy/osteophyte' group (n = 217) was classified as PM cases with osteophytes or macroscopic medial tibiofemoral chondropathy lesions ≥grade 3 to represent pre-surgical (early) OA. 'Non-arthritic' controls (n = 48) were identified from the remaining PM cases. Mankin histopathological scores were subjected to Rasch analysis and supplemented with histopathological scores for subchondral bone marrow replacement and synovitis. Item weightings were derived by principle components analysis (PCA). Histopathological subgroups were sought using latent class analysis (LCA). RESULTS Chondropathy, synovitis and osteochondral pathology were each associated with OA at arthroplasty, but each was also identified in some 'non-arthritic' controls. Tidemark breaching in the chondropathy/osteophyte group was greater than in non-arthritic controls. Three histopathological subgroups were identified, characterised as 'mild OA', or 'severe OA' with mild or moderate/severe synovitis. CONCLUSIONS Presence and severity of synovitis helps define distinct histopathological OA subgroups. The absence of a discrete 'normal' subgroup indicates a pathological continuum between normality and OA status. Identifying specific pathological processes and their clinical correlates in OA subgroups has potential to accelerate the development of more effective therapies.
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Affiliation(s)
- L A Wyatt
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, UK; Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK.
| | - B J Moreton
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, UK; Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - P I Mapp
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, UK; Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK
| | - D Wilson
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, UK; Department of Rheumatology, Sherwood Forest Hospitals NHS Foundation Trust, Mansfield Road, Sutton in Ashfield, NG17 4JL, UK
| | - R Hill
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, UK; Department of Rheumatology, Sherwood Forest Hospitals NHS Foundation Trust, Mansfield Road, Sutton in Ashfield, NG17 4JL, UK
| | - E Ferguson
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, UK; School of Psychology, University of Nottingham, Nottingham, UK
| | - B E Scammell
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, UK; Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK
| | - D A Walsh
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, UK; Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK; Department of Rheumatology, Sherwood Forest Hospitals NHS Foundation Trust, Mansfield Road, Sutton in Ashfield, NG17 4JL, UK
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Peckmann TR, Meek S, Dilkie N, Rozendaal A. Determination of sex from the patella in a contemporary Spanish population. J Forensic Leg Med 2016; 44:84-91. [DOI: 10.1016/j.jflm.2016.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 09/04/2016] [Accepted: 09/21/2016] [Indexed: 10/20/2022]
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Menopause is associated with articular cartilage degeneration: a clinical study of knee joint in 860 women. Menopause 2016; 23:1239-1246. [DOI: 10.1097/gme.0000000000000697] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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42
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Lad NK, Liu B, Ganapathy PK, Utturkar GM, Sutter EG, Moorman CT, Garrett WE, Spritzer CE, DeFrate LE. Effect of normal gait on in vivo tibiofemoral cartilage strains. J Biomech 2016; 49:2870-2876. [PMID: 27421206 DOI: 10.1016/j.jbiomech.2016.06.025] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 06/10/2016] [Accepted: 06/23/2016] [Indexed: 11/17/2022]
Abstract
Altered cartilage loading is believed to be associated with osteoarthritis development. However, there are limited data regarding the influence of normal gait, an essential daily loading activity, on cartilage strains. In this study, 8 healthy subjects with no history of knee surgery or injury underwent magnetic resonance imaging of a single knee prior to and following a 20-min walking activity at approximately 1.1m/s. Bone and cartilage surfaces were segmented from these images and compiled into 3-dimensional models of the tibia, femur, and associated cartilage. Thickness changes were measured across a grid of evenly spaced points spanning the models of the articular surfaces. Averaged compartmental strains and local strains were then calculated. Overall compartmental strains after the walking activity were found to be significantly different from zero in all four tibiofemoral compartments, with tibial cartilage strain being significantly larger than femoral cartilage strain. These results provide baseline data regarding the normal tibiofemoral cartilage strain response to gait. Additionally, the technique employed in this study has potential to be used as a "stress test" to understand how factors including age, weight, and injury influence tibiofemoral cartilage strain response, essential information in the development of potential treatment strategies for the prevention of osteoarthritis.
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Affiliation(s)
- Nimit K Lad
- Duke Sports Medicine Center, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Betty Liu
- Duke Sports Medicine Center, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Pramodh K Ganapathy
- Duke Sports Medicine Center, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Gangadhar M Utturkar
- Duke Sports Medicine Center, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - E Grant Sutter
- Duke Sports Medicine Center, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Claude T Moorman
- Duke Sports Medicine Center, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - William E Garrett
- Duke Sports Medicine Center, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Charles E Spritzer
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Louis E DeFrate
- Duke Sports Medicine Center, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA.
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Hudelmaier M, Wirth W. Differences in subchondral bone size after one year in osteoarthritic and healthy knees. Osteoarthritis Cartilage 2016; 24:623-30. [PMID: 26564574 PMCID: PMC5572564 DOI: 10.1016/j.joca.2015.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 09/25/2015] [Accepted: 11/02/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Increase of subchondral bone area (tAB) in OA has been reported, but it remains unclear if this is specific to OA. We investigated differences in knee tAB after one year in healthy subjects and in those with radiographic OA (rOA). METHOD MR images of 899 right knees from the OA Initiative were acquired at baseline and one year follow-up (year-1). Medial and lateral tibial cartilage (MT and LT) and weight-bearing femoral cartilage (cMF and cLF) were segmented and tAB computed. Subjects were stratified into: healthy controls, pre-rOA (K&L grades 0 and 1, with OA risk factors), established rOA (K&L grades 2-4), and independently with regards to joint space narrowing (without, with medial, lateral and bilateral JSN). Primary analysis tested if tAB was different between baseline and year-1 in rOA. Exploratory analyses investigated whether: (1) tAB changes differed between healthy controls and those with rOA; (2) tAB differences were greater in higher K&L grades; and (3) tAB was different between baseline and year-1 in JSN. Significance was set at P < 0.0125. RESULTS Differences in tAB were found in rOA in MT, cMF and cLF (ranging from +0.2% to +0.4%; P < 0.001), but not in healthy controls or pre-rOA. Rates of change did not differ between groups. Within the JSN groups differences of 0.2-0.4% were found in the femur (P < 0.05). CONCLUSION We find that knee tABs differ in rOA between baseline and year-1, but the change was not greater than in healthy knees, and is restricted to the femur in JSN.
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Affiliation(s)
- Martin Hudelmaier
- Institute of Anatomy & Musculoskeletal Research, Paracelsus Medical University (PMU) Salzburg, Austria,Chondrometrics GmbH, Ainring, Germany
| | - Wolfgang Wirth
- Institute of Anatomy & Musculoskeletal Research, Paracelsus Medical University (PMU) Salzburg, Austria,Chondrometrics GmbH, Ainring, Germany
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Yahara Y, Takemori H, Okada M, Kosai A, Yamashita A, Kobayashi T, Fujita K, Itoh Y, Nakamura M, Fuchino H, Kawahara N, Fukui N, Watanabe A, Kimura T, Tsumaki N. Pterosin B prevents chondrocyte hypertrophy and osteoarthritis in mice by inhibiting Sik3. Nat Commun 2016; 7:10959. [PMID: 27009967 PMCID: PMC4820810 DOI: 10.1038/ncomms10959] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/05/2016] [Indexed: 01/09/2023] Open
Abstract
Osteoarthritis is a common debilitating joint disorder. Risk factors for osteoarthritis include age, which is associated with thinning of articular cartilage. Here we generate chondrocyte-specific salt-inducible kinase 3 (Sik3) conditional knockout mice that are resistant to osteoarthritis with thickened articular cartilage owing to a larger chondrocyte population. We also identify an edible Pteridium aquilinum compound, pterosin B, as a Sik3 pathway inhibitor. We show that either Sik3 deletion or intraarticular injection of mice with pterosin B inhibits chondrocyte hypertrophy and protects cartilage from osteoarthritis. Collectively, our results suggest Sik3 regulates the homeostasis of articular cartilage and is a target for the treatment of osteoarthritis, with pterosin B as a candidate therapeutic.
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Affiliation(s)
- Yasuhito Yahara
- Department of Cell Growth and Differentiation, Center for iPS Cell Research and Application, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.,Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630, Sugitani, Toyama 930-0194, Japan
| | - Hiroshi Takemori
- Laboratory of Cell Signaling and Metabolic Disease, National Institutes of Biomedical Innovation, Health and Nutrition, 7-6-8, Asagi, Saito, Ibaraki, Osaka 567-0085, Japan
| | - Minoru Okada
- Department of Cell Growth and Differentiation, Center for iPS Cell Research and Application, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Azuma Kosai
- Department of Cell Growth and Differentiation, Center for iPS Cell Research and Application, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Akihiro Yamashita
- Department of Cell Growth and Differentiation, Center for iPS Cell Research and Application, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Tomohito Kobayashi
- Department of Cell Growth and Differentiation, Center for iPS Cell Research and Application, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Kaori Fujita
- Department of Cell Growth and Differentiation, Center for iPS Cell Research and Application, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yumi Itoh
- Laboratory of Cell Signaling and Metabolic Disease, National Institutes of Biomedical Innovation, Health and Nutrition, 7-6-8, Asagi, Saito, Ibaraki, Osaka 567-0085, Japan
| | - Masahiro Nakamura
- Genome/Epigenome Analysis Core Facility, Center for iPS Cell Research and Application, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Hiroyuki Fuchino
- Research Center for Medicinal Plant Resources, Tsukuba Division, National Institutes of Biomedical Innovation, Health and Nutrition, 1-2, Hachimandai, Tsukuba, Ibaraki 305-0843, Japan
| | - Nobuo Kawahara
- Research Center for Medicinal Plant Resources, Tsukuba Division, National Institutes of Biomedical Innovation, Health and Nutrition, 1-2, Hachimandai, Tsukuba, Ibaraki 305-0843, Japan
| | - Naoshi Fukui
- Graduate School of Arts and Sciences, Department of Life Sciences, The University of Tokyo, Komaba 3-8-1, Meguro-ku, Tokyo 153-8902, Japan
| | - Akira Watanabe
- Genome/Epigenome Analysis Core Facility, Center for iPS Cell Research and Application, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Tomoatsu Kimura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630, Sugitani, Toyama 930-0194, Japan
| | - Noriyuki Tsumaki
- Department of Cell Growth and Differentiation, Center for iPS Cell Research and Application, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
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Laureano PEDS, Oliveira KDS, de Aro AA, Gomes L, Pimentel ER, Esquisatto MAM. Structure and composition of arytenoid cartilage of the bullfrog (Lithobates catesbeianus) during maturation and aging. Micron 2015; 77:16-24. [PMID: 26093475 DOI: 10.1016/j.micron.2015.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 05/24/2015] [Accepted: 05/28/2015] [Indexed: 01/23/2023]
Abstract
The aging process induces progressive and irreversible changes in the structural and functional organization of animals. The objective of this study was to evaluate the effects of aging on the structure and composition of the extracellular matrix of the arytenoid cartilage found in the larynx of male bullfrogs (Lithobates catesbeianus) kept in captivity for commercial purposes. Animals at 7, 180 and 1080 days post-metamorphosis (n=10/age) were euthanized and the cartilage was removed and processed for structural and biochemical analysis. For the structural analyses, cartilage sections were stained with picrosirius, toluidine blue, Weigert's resorcin-fuchsin and Von Kossa stain. The sections were also submitted to immunohistochemistry for detection of collagen types I and II. Other samples were processed for the ultrastructural and cytochemical analysis of proteoglycans. Histological sections were used to chondrocyte count. The number of positive stainings for proteoglycans was quantified by ultrastructural analysis. For quantification and analysis of glycosaminoglycans were used the dimethyl methylene blue and agarose gel electrophoresis methods. The chloramine T method was used for hydroxyproline quantification. At 7 days, basophilia was observed in the pericellular and territorial matrix, which decreased in the latter over the period studied. Collagen fibers were arranged perpendicular to the major axis of the cartilaginous plate and were thicker in older animals. Few calcification areas were observed at the periphery of the cartilage specimens in 1080-day-old animals. Type II collagen was present throughout the stroma at the different ages. Elastic fibers were found in the stroma and perichondrium and increased with age in the two regions. Proteoglycan staining significantly increased from 7 to 180 days and reduced at 1080 days. The amount of total glycosaminoglycans was higher in 180-day-old animals compared to the other ages, with marked presence of chondroitin- and dermatan-sulfate especially in this age. The content of hydroxyproline, which infers the total collagen concentration, was higher in 1080-day-old animals compared to the other ages. The results demonstrated the elastic nature of the arytenoid cartilage of L. catesbeianus and the occurrence of age-related changes in the structural organization and composition of the extracellular matrix. These changes may contribute to alter the function of the larynx in the animal during aging.
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Affiliation(s)
- Priscila Eliane dos Santos Laureano
- Programa de Pós-graduação em Ciências Biomédicas, Centro Universitário Hermínio Ometto, Av. Dr. Maximiliano Baruto, 500 Jd. Universitário, 13607-339, Araras, SP, Brazil
| | - Kris Daiana Silva Oliveira
- Programa de Pós-graduação em Ciências Biomédicas, Centro Universitário Hermínio Ometto, Av. Dr. Maximiliano Baruto, 500 Jd. Universitário, 13607-339, Araras, SP, Brazil
| | - Andrea Aparecida de Aro
- Departamento de Biologia Estrutural e Funcional, Instituto de Biologia, Universidade Estadual de Campinas, Rua Charles Darwin, s/n, CxP 6109, 13083-863, Campinas, SP, Brazil
| | - Laurecir Gomes
- Departamento de Biologia Estrutural e Funcional, Instituto de Biologia, Universidade Estadual de Campinas, Rua Charles Darwin, s/n, CxP 6109, 13083-863, Campinas, SP, Brazil
| | - Edson Rosa Pimentel
- Departamento de Biologia Estrutural e Funcional, Instituto de Biologia, Universidade Estadual de Campinas, Rua Charles Darwin, s/n, CxP 6109, 13083-863, Campinas, SP, Brazil
| | - Marcelo Augusto Marretto Esquisatto
- Programa de Pós-graduação em Ciências Biomédicas, Centro Universitário Hermínio Ometto, Av. Dr. Maximiliano Baruto, 500 Jd. Universitário, 13607-339, Araras, SP, Brazil.
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Erdemir A, Bennetts C, Davis S, Reddy A, Sibole S. Multiscale cartilage biomechanics: technical challenges in realizing a high-throughput modelling and simulation workflow. Interface Focus 2015; 5:20140081. [PMID: 25844153 DOI: 10.1098/rsfs.2014.0081] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Understanding the mechanical environment of articular cartilage and chondrocytes is of the utmost importance in evaluating tissue damage which is often related to failure of the fibre architecture and mechanical injury to the cells. This knowledge also has significant implications for understanding the mechanobiological response in healthy and diseased cartilage and can drive the development of intervention strategies, ranging from the design of tissue-engineered constructs to the establishment of rehabilitation protocols. Spanning multiple spatial scales, a wide range of biomechanical factors dictate this mechanical environment. Computational modelling and simulation provide descriptive and predictive tools to identify multiscale interactions, and can lead towards a greater comprehension of healthy and diseased cartilage function, possibly in an individualized manner. Cartilage and chondrocyte mechanics can be examined in silico, through post-processing or feed-forward approaches. First, joint-tissue level simulations, typically using the finite-element method, solve boundary value problems representing the joint articulation and underlying tissue, which can differentiate the role of compartmental joint loading in cartilage contact mechanics and macroscale cartilage field mechanics. Subsequently, tissue-cell scale simulations, driven by the macroscale cartilage mechanical field information, can predict chondrocyte deformation metrics along with the mechanics of the surrounding pericellular and extracellular matrices. A high-throughput modelling and simulation framework is necessary to develop models representative of regional and population-wide variations in cartilage and chondrocyte anatomy and mechanical properties, and to conduct large-scale analysis accommodating a multitude of loading scenarios. However, realization of such a framework is a daunting task, with technical difficulties hindering the processes of model development, scale coupling, simulation and interpretation of the results. This study aims to summarize various strategies to address the technical challenges of post-processing-based simulations of cartilage and chondrocyte mechanics with the ultimate goal of establishing the foundations of a high-throughput multiscale analysis framework. At the joint-tissue scale, rapid development of regional models of articular contact is possible by automating the process of generating parametric representations of cartilage boundaries and depth-dependent zonal delineation with associated constitutive relationships. At the tissue-cell scale, models descriptive of multicellular and fibrillar architecture of cartilage zones can also be generated in an automated fashion. Through post-processing, scripts can extract biphasic mechanical metrics at a desired point in the cartilage to assign loading and boundary conditions to models at the lower spatial scale of cells. Cell deformation metrics can be extracted from simulation results to provide a simplified description of individual chondrocyte responses. Simulations at the tissue-cell scale can be parallelized owing to the loosely coupled nature of the feed-forward approach. Verification studies illustrated the necessity of a second-order data passing scheme between scales and evaluated the role that the microscale representative volume size plays in appropriately predicting the mechanical response of the chondrocytes. The tools summarized in this study collectively provide a framework for high-throughput exploration of cartilage biomechanics, which includes minimally supervised model generation, and prediction of multiscale biomechanical metrics across a range of spatial scales, from joint regions and cartilage zones, down to that of the chondrocytes.
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Affiliation(s)
- Ahmet Erdemir
- Computational Biomodeling (CoBi) Core , Lerner Research Institute, Cleveland Clinic , Cleveland, OH 44195 , USA ; Department of Biomedical Engineering , Lerner Research Institute, Cleveland Clinic , Cleveland, OH 44195 , USA
| | - Craig Bennetts
- Computational Biomodeling (CoBi) Core , Lerner Research Institute, Cleveland Clinic , Cleveland, OH 44195 , USA ; Department of Biomedical Engineering , Lerner Research Institute, Cleveland Clinic , Cleveland, OH 44195 , USA
| | - Sean Davis
- Computational Biomodeling (CoBi) Core , Lerner Research Institute, Cleveland Clinic , Cleveland, OH 44195 , USA ; Department of Biomedical Engineering , Lerner Research Institute, Cleveland Clinic , Cleveland, OH 44195 , USA ; Department of Mechanical Engineering , University of Akron , Akron, OH 44325 , USA
| | - Akhil Reddy
- Computational Biomodeling (CoBi) Core , Lerner Research Institute, Cleveland Clinic , Cleveland, OH 44195 , USA ; Department of Biomedical Engineering , Lerner Research Institute, Cleveland Clinic , Cleveland, OH 44195 , USA ; Weill Cornell Medical College , New York, NY 10065 , USA
| | - Scott Sibole
- Computational Biomodeling (CoBi) Core , Lerner Research Institute, Cleveland Clinic , Cleveland, OH 44195 , USA ; Department of Biomedical Engineering , Lerner Research Institute, Cleveland Clinic , Cleveland, OH 44195 , USA ; Human Performance Laboratory, Faculty of Kinesiology , University of Calgary , Calgary, Alberta , Canada T2N 1N4
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Peng Z, Baena JC, Wang M. Investigations of micron and submicron wear features of diseased human cartilage surfaces. Proc Inst Mech Eng H 2015; 229:164-74. [PMID: 25767152 DOI: 10.1177/0954411915572496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Osteoarthritis is a common disease. However, its causes and morphological features of diseased cartilage surfaces are not well understood. The purposes of this research were (a) to develop quantitative surface characterization techniques to study human cartilages at a micron and submicron scale and (b) to investigate distinctive changes in the surface morphologies and biomechanical properties of the cartilages in different osteoarthritis grades. Diseased cartilage samples collected from osteoarthritis patients were prepared for image acquisition using two different techniques, that is, laser scanning microscopy at a micrometer scale and atomic force microscopy at a nanometer scale. Three-dimensional, digital images of human cartilages were processed and analyzed quantitatively. This study has demonstrated that high-quality three-dimensional images of human cartilage surfaces could be obtained in a hydrated condition using laser scanning microscopy and atomic force microscopy. Based on the numerical data extracted from improved image quality and quantity, it has been found that osteoarthritis evolution can be identified by specific surface features at the micrometer scale, and these features are amplitude and functional property related. At the submicron level, the spatial features of the surfaces were revealed to differ between early and advanced osteoarthritis grades. The effective indentation moduli of human cartilages effectively revealed the cartilage deterioration. The imaging acquisition and numerical analysis methods established allow quantitative studies of distinctive changes in cartilage surface characteristics and better understanding of the cartilage degradation process.
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Affiliation(s)
- Zhongxiao Peng
- School of Mechanical and Manufacturing Engineering, The University of New South Wales, Sydney, NSW, Australia
| | - Juan C Baena
- School of Mechanical and Manufacturing Engineering, The University of New South Wales, Sydney, NSW, Australia
| | - Meiling Wang
- School of Mechanical and Manufacturing Engineering, The University of New South Wales, Sydney, NSW, Australia College of Mechanical and Electrical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
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Omoumi P, Michoux N, Roemer FW, Thienpont E, Vande Berg BC. Cartilage thickness at the posterior medial femoral condyle is increased in femorotibial knee osteoarthritis: a cross-sectional CT arthrography study (Part 2). Osteoarthritis Cartilage 2015; 23:224-31. [PMID: 25450850 DOI: 10.1016/j.joca.2014.08.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 06/26/2014] [Accepted: 08/15/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the thickness of cartilage at the posterior aspect of the medial and lateral condyle in Osteoarthritis (OA) knees compared to non-OA knees using computed tomography arthrography (CTA). DESIGN 535 consecutive knee CTAs (mean patient age = 48.7 ± 16.0; 286 males), were retrospectively analyzed. Knees were radiographically classified into OA or non-OA knees according to a modified Kellgren/Lawrence (K/L) grading scheme. Cartilage thickness at the posterior aspect of the medial and lateral femoral condyles was measured on sagittal reformations, and compared between matched OA and non-OA knees in the whole sample population and in subgroups defined by gender and age. RESULTS The cartilage of the posterior aspect of medial condyle was statistically significantly thicker in OA knees (2.43 mm (95% confidence interval (CI) = 2.36, 2.51)) compared to non-OA knees (2.13 mm (95%CI = 2.02, 2.17)) in the entire sample population (P < 0.001), as well as for all subgroups of patients over 40 years old (all P ≤ 0.01), except for females above 60 years old (P = 0.07). Increase in cartilage thickness at the posterior aspect of the medial condyle was associated with increasing K/L grade in the entire sample population, as well as for males and females separately (regression coefficient = 0.10-0.12, all P < 0.001). For the lateral condyle, there was no statistically significant association between cartilage thickness and OA (either presence of OA or K/L grade). CONCLUSIONS Cartilage thickness at the non-weight-bearing posterior aspect of the medial condyle, but not of the lateral condyle, was increased in OA knees compared to non-OA knees. Furthermore, cartilage thickness at the posterior aspect of the medial condyle increased with increasing K/L grade.
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Affiliation(s)
- P Omoumi
- Department of Radiology, Cliniques Universitaires St Luc - UC Louvain, Hippocrate Avenue 10/2942, B-1200 Brussels, Belgium; Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Bugnon 46, CH-1011 Lausanne, Switzerland.
| | - N Michoux
- Department of Radiology, Cliniques Universitaires St Luc - UC Louvain, Hippocrate Avenue 10/2942, B-1200 Brussels, Belgium
| | - F W Roemer
- Department of Radiology, Klinikum Augsburg, Augsburg, Germany
| | - E Thienpont
- Department of Orthopedic Surgery, Cliniques Universitaires St Luc - UC Louvain, Hippocrate Avenue 10/2942, B-1200 Brussels, Belgium
| | - B C Vande Berg
- Department of Radiology, Cliniques Universitaires St Luc - UC Louvain, Hippocrate Avenue 10/2942, B-1200 Brussels, Belgium
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Kuszel L, Trzeciak T, Richter M, Czarny-Ratajczak M. Osteoarthritis and telomere shortening. J Appl Genet 2014; 56:169-76. [PMID: 25366419 PMCID: PMC4412548 DOI: 10.1007/s13353-014-0251-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 10/04/2014] [Accepted: 10/08/2014] [Indexed: 11/16/2022]
Abstract
Osteoarthritis is the most common disease of joints caused by degradation of articular cartilage and subchondral bone. It is classified as primary form with unknown cause and as secondary form with known etiology. Genetic and epigenetic factors interact with environmental factors and contribute to the development of primary osteoarthritis. Thus far, many polymorphisms associated with osteoarthritis have been identified and recent studies also indicate the involvement of epigenetic factors (e.g., telomere shortening) in the initiation of this disorder. Accelerated shortening of telomeres was detected in osteoarthritis and other age-related diseases. Studies revealed that telomere length is severely reduced in blood leukocytes and chondrocytes of patients with osteoarthritis, and this may contribute to the initiation and development of osteoarthritis, whose major cause is still unknown.
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Affiliation(s)
- Lukasz Kuszel
- Department of Medical Genetics, Poznan University of Medical Sciences, Rokietnicka 8, 60-806, Poznan, Poland
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Francuski J, Radovanović A, Andrić N, Krstić V, Bogdanović D, Hadžić V, Todorović V, Macanović ML, Petit SS, Beck-Cormier S, Guicheux J, Gauthier O, Filipović MK. Age-related Changes in the Articular Cartilage of the Stifle Joint in Non-working and Working German Shepherd Dogs. J Comp Pathol 2014; 151:363-74. [DOI: 10.1016/j.jcpa.2014.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/22/2014] [Accepted: 09/18/2014] [Indexed: 11/28/2022]
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