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Roseren F, Roffino S, Pithioux M. Mechanical Characterization at the Microscale of Mineralized Bone Callus after Bone Lengthening. Materials (Basel) 2022; 15:6207. [PMID: 36143518 PMCID: PMC9501547 DOI: 10.3390/ma15186207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 06/16/2023]
Abstract
Distraction osteogenesis (DO) involves several processes to form an organized distracted callus. While bone regeneration during DO has been widely described, no study has yet focused on the evolution profile of mechanical properties of mineralized tissues in the distracted callus. The aim of this study was therefore to measure the elastic modulus and hardness of calcified cartilage and trabecular and cortical bone within the distracted callus during the consolidation phase. We used a microindentation assay to measure the mechanical properties of periosteal and endosteal calluses; each was subdivided into two regions. Histological sections were used to localize the tissues. The results revealed that the mechanical properties of calcified cartilage did not evolve over time. However, trabecular bone showed temporal variation. For elastic modulus, in three out of four regions, a similar evolution profile was observed with an increase and decrease over time. Concerning hardness, this evolves differently depending on the location in the distracted callus. We also observed spatial changes in between regions. A first duality was apparent between regions close to the native cortices and the central area, while latter differences were seen between periosteal and endosteal calluses. Data showed a heterogeneity of mechanical properties in the distracted callus with a specific mineralization profile.
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Affiliation(s)
- Flavy Roseren
- Aix Marseille Univ, CNRS, ISM, 13009 Marseille, France
- Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, 13009 Marseille, France
- Aix Marseille Univ, APHM, CNRS, ISM, Mecabio Platform, Anatomy Laboratory, 13009 Marseille, France
| | - Sandrine Roffino
- Aix Marseille Univ, CNRS, ISM, 13009 Marseille, France
- Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, 13009 Marseille, France
- Aix Marseille Univ, APHM, CNRS, ISM, Mecabio Platform, Anatomy Laboratory, 13009 Marseille, France
| | - Martine Pithioux
- Aix Marseille Univ, CNRS, ISM, 13009 Marseille, France
- Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, 13009 Marseille, France
- Aix Marseille Univ, APHM, CNRS, ISM, Mecabio Platform, Anatomy Laboratory, 13009 Marseille, France
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Kumabe Y, Fukui T, Takahara S, Kuroiwa Y, Arakura M, Oe K, Oda T, Sawauchi K, Matsushita T, Matsumoto T, Hayashi S, Kuroda R, Niikura T. Percutaneous CO2 Treatment Accelerates Bone Generation During Distraction Osteogenesis in Rabbits. Clin Orthop Relat Res 2020; 478:1922-1935. [PMID: 32732577 PMCID: PMC7371043 DOI: 10.1097/corr.0000000000001288] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 04/14/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Distraction osteogenesis has been broadly used to treat various structural bone deformities and defects. However, prolonged healing time remains a major problem. Various approaches including the use of low-intensity pulsed ultrasound, parathyroid hormone, and bone morphogenetic proteins (BMPs) have been studied to shorten the treatment period with limited success. Our previous studies of rats have reported that the transcutaneous application of CO2 accelerates fracture repair and bone-defect healing in rats by promoting angiogenesis, blood flow, and endochondral ossification. This therapy may also accelerate bone generation during distraction osteogenesis, but, to our knowledge, no study investigating CO2 therapy on distraction osteogenesis has been reported. QUESTIONS/PURPOSES We aimed to investigate the effect of transcutaneous CO2 during distraction osteogenesis in rabbits, which are the most suitable animal as a distraction osteogenesis model for a lengthener in terms of limb size. We asked: Does transcutaneous CO2 during distraction osteogenesis alter (1) radiographic bone density in the distraction gap during healing; (2) callus parameters, including callus bone mineral content, volumetric bone mineral density, and bone volume fraction; (3) the newly formed bone area, cartilage area, and angiogenesis, as well as the expression of interleukin-6 (IL-6), BMP-2, BMP-7, hypoxia-inducible factor (HIF) -1α, and vascular endothelial growth factor (VEGF); and (4) three-point bend biomechanical strength, stiffness, and energy? METHODS Forty 24-week-old female New Zealand white rabbits were used according to a research protocol approved by our institutional ethical committee. A distraction osteogenesis rabbit tibia model was created as previously described. Briefly, an external lengthener was applied to the right tibia, and a transverse osteotomy was performed at the mid-shaft. The osteotomy stumps were connected by adjusting the fixator to make no gap. After a 7-day latency phase, distraction was continued at 1 mm per day for 10 days. Beginning the day after the osteotomy, a 20-minute transcutaneous application of CO2 on the operated leg using a CO2 absorption-enhancing hydrogel was performed five times per week in the CO2 group (n = 20). Sham treatment with air was administered in the control group (n = 20). Animals were euthanized immediately after the distraction period (n = 10), 2 weeks (n = 10), and 4 weeks (n = 20) after completion of distraction. We performed bone density quantification on the plain radiographs to evaluate consolidation in the distraction gap with image analyzing software. Callus parameters were measured with micro-CT to assess callus microstructure. The newly formed bone area and cartilage area were measured histologically with safranin O/fast green staining to assess the progress of ossification. We also performed immunohistochemical staining of endothelial cells with fluorescein-labeled isolectin B4 and examined capillary density to evaluate angiogenesis. Gene expressions in newly generated callus were analyzed by real-time polymerase chain reaction. Biomechanical strength, stiffness, and energy were determined from a three-point bend test to assess the mechanical strength of the callus. RESULTS Radiographs showed higher pixel values in the distracted area in the CO2 group than the control group at Week 4 of the consolidation phase (0.98 ± 0.11 [95% confidence interval 0.89 to 1.06] versus 1.19 ± 0.23 [95% CI 1.05 to 1.34]; p = 0.013). Micro-CT demonstrated that bone volume fraction in the CO2 group was higher than that in the control group at Week 4 (5.56 ± 3.21 % [95% CI 4.32 to 6.12 %] versus 11.90 ± 3.33 % [95% CI 9.63 to 14.25 %]; p = 0.035). There were no differences in any other parameters (that is, callus bone mineral content at Weeks 2 and 4; volumetric bone mineral density at Weeks 2 and 4; bone volume fraction at Week 2). At Week 2, rabbits in the CO2 group had a larger cartilage area compared with those in the control group (2.09 ± 1.34 mm [95% CI 1.26 to 2.92 mm] versus 5.10 ± 3.91 mm [95% CI 2.68 to 7.52 mm]; p = 0.011). More newly formed bone was observed in the CO2 group than the control group at Week 4 (68.31 ± 16.32 mm [95% CI 58.19 to 78.44 mm] versus 96.26 ± 19.37 mm [95% CI 84.25 to 108.26 mm]; p < 0.001). There were no differences in any other parameters (cartilage area at Weeks 0 and 4; newly formed bone area at Weeks 0 and 2). Immunohistochemical isolectin B4 staining showed greater capillary densities in rabbits in the CO2 group than the control group in the distraction area at Week 0 and surrounding tissue at Weeks 0 and 2 (distraction area at Week 0, 286.54 ± 61.55 /mm [95% CI 232.58 to 340.49] versus 410.24 ± 55.29 /mm [95% CI 361.78 to 458.71]; p < 0.001; surrounding tissue at Week 0 395.09 ± 68.16/mm [95% CI 335.34 to 454.83] versus 589.75 ± 174.42/mm [95% CI 436.86 to 742.64]; p = 0.003; at Week 2 271.22 ± 169.42 /mm [95% CI 122.71 to 419.73] versus 508.46 ± 49.06/mm [95% CI 465.45 to 551.47]; p < 0.001 respectively). There was no difference in the distraction area at Week 2. The expressions of BMP -2 at Week 2, HIF1-α at Week 2 and VEGF at Week 0 and 2 were greater in the CO2 group than in the control group (BMP -2 at Week 2 3.84 ± 0.83 fold [95% CI 3.11 to 4.58] versus 7.32 ± 1.63 fold [95% CI 5.88 to 8.75]; p < 0.001; HIF1-α at Week 2, 10.49 ± 2.93 fold [95% CI 7.91 to 13.06] versus 20.74 ± 11.01 fold [95% CI 11.09 to 30.40]; p < 0.001; VEGF at Week 0 4.80 ± 1.56 fold [95% CI 3.43 to 6.18] versus 11.36 ± 4.82 fold [95% CI 7.13 to 15.59]; p < 0.001; at Week 2 31.52 ± 8.26 fold [95% CI 24.27 to 38.76] versus 51.05 ± 15.52 fold [95% CI 37.44 to 64.66]; p = 0.034, respectively). There were no differences in any other parameters (BMP-2 at Week 0 and 4; BMP -7 at Weeks 0, 2 and 4; HIF-1α at Weeks 0 and 4; IL-6 at Weeks 0, 2 and 4; VEGF at Week 4). In the biomechanical assessment, ultimate stress and failure energy were greater in the CO2 group than in the control group at Week 4 (ultimate stress 259.96 ± 74.33 N [95% CI 167.66 to 352.25] versus 422.45 ± 99.32 N [95% CI 299.13 to 545.77]; p < 0.001, failure energy 311.32 ± 99.01 Nmm [95% CI 188.37 to 434.25] versus 954.97 ± 484.39 Nmm [95% CI 353.51 to 1556.42]; p = 0.003, respectively). There was no difference in stiffness (216.77 ± 143.39 N/mm [95% CI 38.73 to 394.81] versus 223.68 ± 122.17 N/mm [95% CI 71.99 to 375.37]; p = 0.92). CONCLUSION Transcutaneous application of CO2 accelerated bone generation in a distraction osteogenesis model of rabbit tibias. As demonstrated in previous studies, CO2 treatment might affect bone regeneration in distraction osteogenesis by promoting angiogenesis, blood flow, and endochondral ossification. CLINICAL RELEVANCE The use of the transcutaneous application of CO2 may open new possibilities for shortening healing time in patients with distraction osteogenesis. However, a deeper insight into the mechanism of CO2 in the local tissue is required before it can be used in future clinical practice.
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Affiliation(s)
- Yohei Kumabe
- Y. Kumabe, T. Fukui, S. Takahara, Y. Kuroiwa, M. Arakura, K. Oe, T. Oda, K. Sawauchi, T. Matsushita, T. Matsumoto, S. Hayashi, R. Kuroda, T. Niikura, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoaki Fukui
- Y. Kumabe, T. Fukui, S. Takahara, Y. Kuroiwa, M. Arakura, K. Oe, T. Oda, K. Sawauchi, T. Matsushita, T. Matsumoto, S. Hayashi, R. Kuroda, T. Niikura, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shunsuke Takahara
- Y. Kumabe, T. Fukui, S. Takahara, Y. Kuroiwa, M. Arakura, K. Oe, T. Oda, K. Sawauchi, T. Matsushita, T. Matsumoto, S. Hayashi, R. Kuroda, T. Niikura, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yu Kuroiwa
- Y. Kumabe, T. Fukui, S. Takahara, Y. Kuroiwa, M. Arakura, K. Oe, T. Oda, K. Sawauchi, T. Matsushita, T. Matsumoto, S. Hayashi, R. Kuroda, T. Niikura, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Michio Arakura
- Y. Kumabe, T. Fukui, S. Takahara, Y. Kuroiwa, M. Arakura, K. Oe, T. Oda, K. Sawauchi, T. Matsushita, T. Matsumoto, S. Hayashi, R. Kuroda, T. Niikura, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Keisuke Oe
- Y. Kumabe, T. Fukui, S. Takahara, Y. Kuroiwa, M. Arakura, K. Oe, T. Oda, K. Sawauchi, T. Matsushita, T. Matsumoto, S. Hayashi, R. Kuroda, T. Niikura, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Oda
- Y. Kumabe, T. Fukui, S. Takahara, Y. Kuroiwa, M. Arakura, K. Oe, T. Oda, K. Sawauchi, T. Matsushita, T. Matsumoto, S. Hayashi, R. Kuroda, T. Niikura, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenichi Sawauchi
- Y. Kumabe, T. Fukui, S. Takahara, Y. Kuroiwa, M. Arakura, K. Oe, T. Oda, K. Sawauchi, T. Matsushita, T. Matsumoto, S. Hayashi, R. Kuroda, T. Niikura, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takehiko Matsushita
- Y. Kumabe, T. Fukui, S. Takahara, Y. Kuroiwa, M. Arakura, K. Oe, T. Oda, K. Sawauchi, T. Matsushita, T. Matsumoto, S. Hayashi, R. Kuroda, T. Niikura, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Y. Kumabe, T. Fukui, S. Takahara, Y. Kuroiwa, M. Arakura, K. Oe, T. Oda, K. Sawauchi, T. Matsushita, T. Matsumoto, S. Hayashi, R. Kuroda, T. Niikura, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinya Hayashi
- Y. Kumabe, T. Fukui, S. Takahara, Y. Kuroiwa, M. Arakura, K. Oe, T. Oda, K. Sawauchi, T. Matsushita, T. Matsumoto, S. Hayashi, R. Kuroda, T. Niikura, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Y. Kumabe, T. Fukui, S. Takahara, Y. Kuroiwa, M. Arakura, K. Oe, T. Oda, K. Sawauchi, T. Matsushita, T. Matsumoto, S. Hayashi, R. Kuroda, T. Niikura, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Niikura
- Y. Kumabe, T. Fukui, S. Takahara, Y. Kuroiwa, M. Arakura, K. Oe, T. Oda, K. Sawauchi, T. Matsushita, T. Matsumoto, S. Hayashi, R. Kuroda, T. Niikura, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Pithioux M, Roseren F, Jalain C, Launay F, Charpiot P, Chabrand P, Roffino S, Lamy E. An Efficient and Reproducible Protocol for Distraction Osteogenesis in a Rat Model Leading to a Functional Regenerated Femur. J Vis Exp 2017. [PMID: 29155725 DOI: 10.3791/56433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
This protocol describes the use of a newly developed external fixator for distraction osteogenesis in a rat femoral model. Distraction osteogenesis (DO) is a surgical technique leading to bone regeneration after an osteotomy. The osteotomized extremities are moved away from each other by gradual distraction to reach the desired elongation. This procedure is widely used in humans for lower and upper limb lengthening, treatment after a bone nonunion, or the regeneration of a bone defect following surgery for bone tumor excision, as well as in maxillofacial reconstruction. Only a few studies clearly demonstrate the efficiency of their protocol in obtaining a functional regenerated bone, i.e., bone that will support physiological weight-bearing without fracture after removal of the external fixator. Moreover, protocols for DO vary and reproducibility is limited by lack of information, making comparison between studies difficult. The aim of this study was to develop a reproducible protocol comprising an appropriate external fixator design for rat limb lengthening, with a detailed surgical technique that permits physiological weight-bearing by the animal after removal of the external fixator.
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Affiliation(s)
- Martine Pithioux
- CNRS, ISM, Inst Movement Sci, Aix Marseille Univ; Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, APHM;
| | - Flavy Roseren
- CNRS, ISM, Inst Movement Sci, Aix Marseille Univ; Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, APHM
| | | | - Franck Launay
- CNRS, ISM, Inst Movement Sci, Aix Marseille Univ; Sainte-Marguerite Hospital, Institute for Locomotion, Department of Peadiatric Orthopaedics, APHM
| | | | - Patrick Chabrand
- CNRS, ISM, Inst Movement Sci, Aix Marseille Univ; Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, APHM
| | | | - Edouard Lamy
- CNRS, ISM, Inst Movement Sci, Aix Marseille Univ; Service Central de la Qualité et de l'Information Pharmaceutiques, APHM
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Kim JB, Lee DY, Seo SG, Kim EJ, Kim JH, Yoo WJ, Cho TJ, Choi IH. Demineralized Bone Matrix Injection in Consolidation Phase Enhances Bone Regeneration in Distraction Osteogenesis via Endochondral Bone Formation. Clin Orthop Surg 2015; 7:383-91. [PMID: 26330963 PMCID: PMC4553289 DOI: 10.4055/cios.2015.7.3.383] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 03/23/2015] [Indexed: 11/06/2022] Open
Abstract
Background Distraction osteogenesis (DO) is a promising tool for bone and tissue regeneration. However, prolonged healing time remains a major problem. Various materials including cells, cytokines, and growth factors have been used in an attempt to enhance bone formation. We examined the effect of percutaneous injection of demineralized bone matrix (DBM) during the consolidation phase on bone regeneration after distraction. Methods The immature rabbit tibial DO model (20 mm length-gain) was used. Twenty-eight animals received DBM 100 mg percutaneously at the end of distraction. Another 22 animals were left without further procedure (control). Plain radiographs were taken every week. Postmortem bone dual-energy X-ray absorptiometry and micro-computed tomography (micro-CT) studies were performed at the third and sixth weeks of the consolidation period and histological analysis was performed. Results The regenerate bone mineral density was higher in the DBM group when compared with that in the saline injection control group at the third week postdistraction. Quantitative analysis using micro-CT revealed larger trabecular bone volume, higher trabecular number, and less trabecular separation in the DBM group than in the saline injection control group. Cross-sectional area and cortical thickness at the sixth week postdistraction, assessed using micro-CT, were greater in the regenerates of the DBM group compared with the control group. Histological evaluation revealed higher trabecular bone volume and trabecular number in the regenerate of the DBM group. New bone formation was apparently enhanced, via endochondral ossification, at the site and in the vicinity of the injected DBM. DBM was absorbed slowly, but it remained until the sixth postoperative week after injection. Conclusions DBM administration into the distraction gap at the end of the distraction period resulted in a significantly greater regenerate bone area, trabecular number, and cortical thickness in the rabbit tibial DO model. These data suggest that percutaneous DBM administration at the end of the distraction period or in the early consolidation period may stimulate regenerate bone formation and consolidation in a clinical situation with delayed bone healing during DO.
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Affiliation(s)
- Ji-Beom Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Dong Yeon Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sang Gyo Seo
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Eo Jin Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Ji Hye Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Won Joon Yoo
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Tae-Joon Cho
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - In Ho Choi
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
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