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Takahashi I, Takeda K, Toyama T, Matsuzaki T, Kuroki H, Hoso M. Histological and immunohistochemical analyses of articular cartilage during onset and progression of pre- and early-stage osteoarthritis in a rodent model. Sci Rep 2024; 14:10568. [PMID: 38719877 PMCID: PMC11079058 DOI: 10.1038/s41598-024-61502-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/07/2024] [Indexed: 05/12/2024] Open
Abstract
Early diagnosis and treatment of pre- and early-stage osteoarthritis (OA) is important. However, the cellular and cartilaginous changes occurring during these stages remain unclear. We investigated the histological and immunohistochemical changes over time between pre- and early-stage OA in a rat model of traumatic injury. Thirty-six male rats were divided into two groups, control and OA groups, based on destabilization of the medial meniscus. Histological and immunohistochemical analyses of articular cartilage were performed on days 1, 3, 7, 10, and 14 postoperatively. Cell density of proteins associated with cartilage degradation increased from postoperative day one. On postoperative day three, histological changes, including chondrocyte death, reduced matrix staining, and superficial fibrillation, were observed. Simultaneously, a compensatory increase in matrix staining was observed. The Osteoarthritis Research Society International score increased from postoperative day seven, indicating thinner cartilage. On postoperative day 10, the positive cell density decreased, whereas histological changes progressed with fissuring and matrix loss. The proteoglycan 4-positive cell density increased on postoperative day seven. These findings will help establish an experimental model and clarify the mechanism of the onset and progression of pre- and early-stage traumatic OA.
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Affiliation(s)
- Ikufumi Takahashi
- Section of Rehabilitation, Kanazawa University Hospital, 13-1, Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
- Department of Motor Function Analysis, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Keisuke Takeda
- Section of Rehabilitation, Kanazawa University Hospital, 13-1, Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tadashi Toyama
- Division of Biostatistics, Innovative Clinical Research Center, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Taro Matsuzaki
- Division of Health Sciences, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hiroshi Kuroki
- Department of Motor Function Analysis, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahiro Hoso
- Division of Health Sciences, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
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Bank NC, Sanghvi P, Hecht CJ, Mistovich RJ. The Epidemiology of Posttraumatic Osteoarthritis of the Knee in the United States: An Analysis of 948,853 Patients From 2000 to 2022. J Am Acad Orthop Surg 2024; 32:e313-e320. [PMID: 38236910 DOI: 10.5435/jaaos-d-23-00662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/27/2023] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION Posttraumatic osteoarthritis of the knee (PTOAK) is a known sequela of bony and soft-tissue articular knee injuries, although its historically reported prevalence is highly variable with no recent population-based studies. METHODS The TriNetX/US Collaborative Network database was queried to identify adult patients diagnosed with a history of knee trauma using ICD-10-CM coding. Primary outcomes measured were yearly incidence proportion (IP), incidence rate (IR), and prevalence of knee osteoarthritis in the United States from 2000 to 2022. Chi square analyses were conducted to compare outcomes across categorical data. Regression modeling was performed to project PTOAK epidemiology to 2030. Statistical significance was held at P < 0.05 for all analyses. RESULTS Nine hundred forty-eight thousand eight hundred fifty-three patients meeting criteria were identified. As of 2022, the IP of PTOAK was 5.93%, IR was 2.26 × 10 -4 cases/person-day, and prevalence was 21.1%. By strata in 2022, posttraumatic knee OA is most prevalent among the 54 to 59-year-old age group (50.9%), 60 to 64-year-old age group (50.3%), 50 to 54-year-old age group (49.7%), female patients (24.2%), and White patients (23.1%). Regression analyses revealed that the IP, IR, and prevalence of PTOAK have increased exponentially from 2000 to 2022. By 2030, the model predicts that the IP will further increase to 10.7% (95% PI = 9.79% to 11.7%), IR will be 3.79 × 10 -4 cases/person-day (95% PI = 3.28 × 10 -4 to 4.29 × 10 -4 ), and prevalence of PTOAK in the United States will be 40.6% (95% PI = 39.1% to 42.0%). DISCUSSION These findings echo earlier, smaller scale studies but reveal an alarming rise in PTOAK prevalence, potentially doubling by 2030. The financial burden of knee OA treatment in the United States is already substantial, costing between $5.7 and $15 billion USD annually. This projected increase in prevalence could further increase healthcare expenditures by $1 to 3 billion by 2030. These results emphasize the need for additional research into factors contributing to PTOAK, evidence-based preventive public health interventions, and the development of multidisciplinary system-based care delivery optimization pathways.
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Affiliation(s)
- Nicholas C Bank
- From the Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH (Bank, Sanghvi, Hecht II, and Mistovich), the Department of Orthopaedics, University of North Carolina, Chapel Hill, NC (Bank), and the MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH (Mistovich)
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Lowe T, Dong XN, Griffin L. Hamstrings vibration reduces tibiofemoral compressive force following anterior cruciate ligament reconstruction. J Orthop Res 2023. [PMID: 37975273 DOI: 10.1002/jor.25736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 10/11/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023]
Abstract
Individuals who have undergone anterior cruciate ligament reconstruction (ACLR) are at greater risk of developing knee osteoarthritis (OA). This elevated risk of knee OA is associated with high tibiofemoral (TF) compressive force, due to a combination of low knee flexion angles and increased co-contraction of the hamstrings and quadriceps during limb loading. Prolonged vibration of the hamstrings fatigues the intrafusal muscle fibers, which reduces autonomic reflexive excitation of the hamstrings and alleviates reciprocal inhibition to the quadriceps. The aim of this study was to examine the effect of prolonged hamstrings vibration on TF compressive force in individuals who have undergone ACL reconstruction. Fourteen participants with unilateral ACLR and 14 participants without knee injury performed a single-leg drop-land task before and after prolonged (20 min) vibration of the hamstrings. Peak TF compressive force, knee flexion angle, and hamstrings/quadriceps co-contraction were calculated during the deceleration phase of the drop-land task before and after vibration. The ACLR group experienced an 18% decrease in TF compressive force, a 32% increase in knee flexion angle, and a 38% decrease in hamstrings/quadriceps co-contraction after hamstrings vibration. There was no difference in any of the parameters in the noninjured group after vibration. These data suggest that acute prolonged hamstrings vibration has the potential to mitigate TF compressive force, which may protect the knee joint in the long term. Clinical significance: The results of this research are expected to lead to improved clinical care for ACLR patients because it holds promise for mitigating altered joint mechanics and perhaps slowing down the onset of posttraumatic knee osteoarthritis.
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Affiliation(s)
- Timothy Lowe
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, Colorado, USA
| | - Xuanliang Neil Dong
- Department of Health and Kinesiology, The University of Texas at Tyler, Tyler, Texas, USA
| | - Lisa Griffin
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas, USA
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Evans-Pickett A, Davis-Wilson HC, Johnston CD, Blackburn JT, Hackney AC, Pietrosimone B. Immediate Effects of Walking With a Knee Brace After Anterior Cruciate Ligament Reconstruction: A Biomechanical, Biochemical, and Structural Approach. J Athl Train 2023; 58:542-553. [PMID: 35119477 PMCID: PMC10496450 DOI: 10.4085/1062-6050-0700.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Individuals who undergo anterior cruciate ligament reconstruction (ACLR) are at higher risk of posttraumatic osteoarthritis. Altered joint tissue loading caused by aberrant gait biomechanics leads to deleterious changes in joint health linked to the onset of posttraumatic osteoarthritis. Knee braces have been used to modify joint tissue loading in individuals with joint injury, yet the effects of walking with a brace after ACLR on biomechanical, biochemical, and structural cartilage outcomes are unknown. OBJECTIVE To compare biomechanical, biochemical, and structural outcomes between braced and nonbraced walking in individuals with ACLR. DESIGN Crossover study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 34 individuals with unilateral ACLR (18 females, 16 males; time since ACLR = 50.1 ± 36.8 months). INTERVENTION(S) Gait biomechanics were assessed during braced and unbraced conditions on separate days. MAIN OUTCOME MEASURE(S) Vertical ground reaction force, knee-flexion angle, and internal knee-extension moment waveforms were evaluated throughout the stance phase and compared between conditions. Percentage changes in serum cartilage oligomeric matrix protein (%ΔCOMP) and femoral cartilage cross-sectional area (%ΔCSA) measured via ultrasound were calculated after a 3000-step walking protocol. RESULTS Braced walking increased the knee-flexion angle (largest difference = 3.56°; Cohen d effect size = 1.72) and knee-extension moment (largest difference = -0.48% body weight × height; Cohen d effect size = -1.14) compared with nonbraced walking but did not influence vertical ground reaction force. Whereas no difference (P = .20) in %ΔCOMP existed between the braced and nonbraced conditions in the entire cohort (n = 30 with complete blood data), a larger increase (P = .04) in %ΔCOMP was seen during nonbraced than braced walking in individuals who demonstrated increased COMP during nonbraced walking. No difference (P = .86) in %ΔCSA was present between the braced and nonbraced conditions. CONCLUSIONS Braced walking may improve sagittal-plane gait biomechanics and %ΔCOMP in a subset of individuals who demonstrate a typical increased COMP response to load (ie, increase in COMP) after nonbraced walking.
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Affiliation(s)
- Alyssa Evans-Pickett
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
| | - Hope C. Davis-Wilson
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
- Physical Therapy Department, School of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora
| | - Christopher D. Johnston
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
- Department of Athletic Training, High Point University, NC
| | - J. Troy Blackburn
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill
| | - Anthony C. Hackney
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
- Department of Nutrition, School of Public Health, University of North Carolina at Chapel Hill
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill
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Shultz SP, Buck AN, Fink PW, Kung SM, Ward MJ, Antal Z, Backus SI, Kraszewski AP, Hillstrom HJ. Body mass affects kinetic symmetry and inflammatory markers in adolescent knees during gait. Clin Biomech (Bristol, Avon) 2023; 102:105887. [PMID: 36657189 PMCID: PMC9975061 DOI: 10.1016/j.clinbiomech.2023.105887] [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: 05/18/2022] [Revised: 12/20/2022] [Accepted: 01/09/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND Early-onset osteoarthritis has been attributed to pro-inflammatory factors and biomechanical changes in obesity. However, research has yet to explore whether knee joint moments are asymmetrical in children with obesity and could precede the onset of knee osteoarthritis. The present study compares knee moment asymmetry between adolescents with and without obesity and examines the relationship between asymmetries and inflammatory biomarkers. METHODS Twenty-eight adolescents (13-16 years) were classified as with (n = 12) or without (n = 16) obesity. Lower extremity kinetics were measured using three-dimensional motion analysis. Bilateral knee joint moments were analyzed in the sagittal, frontal, and transverse planes across stance phase. Kinetic asymmetry was calculated between the right and left sides and represented by the R2 value. Enzyme-linked immunosorbent assays analyzed serum 25-hydroxy vitamin D, interferon gamma, tumor nercrosis factor alpha, interleukin-6, and C-reactive protein levels. Parametric and non-parametric tests determined significant group differences in asymmetries and biomarkers, respectively. Spearman's correlations identified relationships between biomarkers and asymmetries with statistically significant group differences. FINDINGS Adolescents with obesity had greater sagittal (loading, midstance) and frontal (midstance, pre-swing) plane kinetic knee asymmetry and higher concentrations of interleukin-6 and C-reactive protein. A moderately negative correlation existed between C-reactive protein and sagittal (loading, midstance) plane asymmetry, and also between interleukin-6 and frontal (pre-swing) plane asymmetry. INTERPRETATION Inflammatory response increases with greater knee joint asymmetry, suggesting knee joint damage and altered joint loading co-exist in adolescents with obesity. Increased risk to joint health may exist in sub-phases where knee joints are improperly loaded.
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Affiliation(s)
- Sarah P Shultz
- Kinesiology Department, Seattle University, Seattle, WA, USA.
| | - Ashley N Buck
- Kinesiology Department, Seattle University, Seattle, WA, USA.
| | - Philip W Fink
- STAPS, Université Sorbonne Paris Nord, Bobigny, France; Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France.
| | - Stacey M Kung
- Sports Medicine Department, Sports Surgery Clinic, Dublin, Ireland.
| | - Mary J Ward
- Weill Cornell Medicine, Department of Pediatrics, New York, NY, USA.
| | - Zoltan Antal
- Weill Cornell Medicine, Department of Pediatrics, New York, NY, USA.
| | - Sherry I Backus
- Leon Root, MD Motion Analysis Laboratory, Rehabilitation Department, Hospital for Special Surgery (HSS), New York, NY, USA.
| | - Andrew P Kraszewski
- Leon Root, MD Motion Analysis Laboratory, Rehabilitation Department, Hospital for Special Surgery (HSS), New York, NY, USA.
| | - Howard J Hillstrom
- Leon Root, MD Motion Analysis Laboratory, Rehabilitation Department, Hospital for Special Surgery (HSS), New York, NY, USA.
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Williams JR, Neal K, Alfayyadh A, Capin JJ, Khandha A, Manal K, Snyder-Mackler L, Buchanan TS. Patellofemoral contact forces and knee gait mechanics 3 months after ACL reconstruction are associated with cartilage degradation 24 months after surgery. Osteoarthritis Cartilage 2023; 31:96-105. [PMID: 36252943 PMCID: PMC9771964 DOI: 10.1016/j.joca.2022.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/26/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Evaluate patellofemoral cartilage health, as assessed by quantitative magnetic resonance imaging (qMRI) T2 relaxation times, 24-months after ACL reconstruction (ACLR) and determine if they were associated with patellofemoral contact forces and knee mechanics during gait 3 months after surgery. DESIGN Thirty individuals completed motion analysis during overground walking at a self-selected speed 3 months after ACLR. An EMG-driven neuromusculoskeletal model was used to determine muscle forces, which were then used in a previously described model to estimate patellofemoral contact forces. Biomechanical variables of interest included peak patellofemoral contact force, peak knee flexion angle and moment, and walking speed. These same participants underwent a sagittal bilateral T2 mapping qMRI scan 24-months after surgery. T2 relaxation times were estimated for both patellar and trochlear cartilage. Paired t-tests were used to compare T2 relaxation times between limbs while Pearson correlations and linear regressions were utilized to assess the association between the biomechanical variables of interest and T2 relaxation times. RESULTS Prolonged involved limb trochlear T2 relaxation times (vs uninvolved) were present 24-months after surgery, indicating worse cartilage health. No differences were detected in patellar cartilage. Significant negative associations were present within the involved limb for all the biomechanical variables of interest 3 months after ACLR and trochlear T2 relaxation times at 24-months. No associations were found in patellar cartilage or within the uninvolved limb. CONCLUSIONS Altered involved limb trochlear cartilage health is present 24-months after ACLR and may be related to patellofemoral loading and other walking gait mechanics 3 months after surgery.
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Affiliation(s)
- J R Williams
- Department of Mechanical Engineering, University of Delaware, Newark, DE, USA.
| | - K Neal
- Department of Mechanical Engineering, University of Delaware, Newark, DE, USA.
| | - A Alfayyadh
- Biomechanics and Movement Science, University of Delaware, Newark, DE, USA; Physical Therapy and Rehabilitation Department, Jouf University, Jouf, Saudi Arabia.
| | - J J Capin
- Department of Physical Therapy, Marquette University, Milwaukee, WI, USA.
| | - A Khandha
- Department of Biomedical Engineering, University of Delaware, Newark, DE, USA.
| | - K Manal
- Biomechanics and Movement Science, University of Delaware, Newark, DE, USA; Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA.
| | - L Snyder-Mackler
- Biomechanics and Movement Science, University of Delaware, Newark, DE, USA; Department of Biomedical Engineering, University of Delaware, Newark, DE, USA; Department of Physical Therapy, University of Delaware, Newark, DE, USA.
| | - T S Buchanan
- Department of Mechanical Engineering, University of Delaware, Newark, DE, USA; Biomechanics and Movement Science, University of Delaware, Newark, DE, USA; Department of Biomedical Engineering, University of Delaware, Newark, DE, USA.
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Neal K, Williams JR, Alfayyadh A, Capin JJ, Khandha A, Manal K, Snyder-Mackler L, Buchanan TS. Knee joint biomechanics during gait improve from 3 to 6 months after anterior cruciate ligament reconstruction. J Orthop Res 2022; 40:2025-2038. [PMID: 34989019 PMCID: PMC9256843 DOI: 10.1002/jor.25250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/08/2021] [Accepted: 12/19/2021] [Indexed: 02/04/2023]
Abstract
Gait alterations after anterior cruciate ligament reconstruction (ACLR) are commonly reported and have been linked to posttraumatic osteoarthritis development. While knee gait alterations have been studied at several time points after ACLR, little is known about how these biomechanical variables change earlier than 6 months after surgery, nor is much known about how they differ over the entire stance phase of gait. The purpose of this study was to examine knee gait biomechanical variables over their entire movement pattern through stance at both 3 and 6 months after ACLR and to study the progression of interlimb asymmetry between the two postoperative time points. Thirty-five individuals underwent motion analysis during overground walking 3 (3.2 ± 0.5) and 6 (6.4 ± 0.7) months after ACLR. Knee biomechanical variables were compared between limbs and across time points through 100% of stance using statistical parametric mapping; this included a 2 × 2 (Limb × Time) repeated measures analysis of variance and two-tailed t-tests. Smaller knee joint angles, moments, extensor forces, and medial compartment forces were present in the involved versus uninvolved limb. Interlimb asymmetries were present at both time points but were less prevalent at 6 months. The uninvolved limb's biomechanical variables stayed relatively consistent over time, while the involved limb's trended toward that of the uninvolved limb. Statement of Clinical Significance: Interventions to correct asymmetrical gait patterns after ACLR may need to occur early after surgery and may need to focus on multiple parts of stance phase.
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Affiliation(s)
- Kelsey Neal
- Department of Mechanical Engineering, University of Delaware, Newark, DE
| | - Jack R. Williams
- Department of Mechanical Engineering, University of Delaware, Newark, DE
| | | | - Jacob J. Capin
- Biomechanics and Movement Science, University of Delaware, Newark, DE
- Department of Physical Therapy, University of Delaware, Newark, DE
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- Eastern Colorado VA Geriatric Research Education and Clinical Center (GRECC), Aurora, CO
- Department of Physical Therapy, Marquette University, Milwaukee, WI
| | - Ashutosh Khandha
- Department of Biomedical Engineering, University of Delaware, Newark, DE
| | - Kurt Manal
- Kinesiology and Applied Physiology, University of Delaware, Newark, DE
| | - Lynn Snyder-Mackler
- Biomechanics and Movement Science, University of Delaware, Newark, DE
- Department of Physical Therapy, University of Delaware, Newark, DE
- Department of Biomedical Engineering, University of Delaware, Newark, DE
| | - Thomas S. Buchanan
- Department of Mechanical Engineering, University of Delaware, Newark, DE
- Biomechanics and Movement Science, University of Delaware, Newark, DE
- Department of Biomedical Engineering, University of Delaware, Newark, DE
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Progress in osteoarthritis research by the National Natural Science Foundation of China. Bone Res 2022; 10:41. [PMID: 35610209 PMCID: PMC9130253 DOI: 10.1038/s41413-022-00207-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/24/2021] [Accepted: 02/17/2022] [Indexed: 01/10/2023] Open
Abstract
Osteoarthritis (OA) in China is gradually becoming an important scientific research area that has had a significant impact on research and development (R&D) activities in the OA field worldwide. This article summarizes the R&D progress related to OA in China in recent years. The National Natural Science Foundation of China (NSFC) is a national funding institution for basic research and plays a critical role in promoting and supporting Chinese scholars' R&D activities. We collected and analyzed information on NSFC funding in the field of OA from 2010 to 2019, including the amount, the level and the program categories of the funded projects. The data fully demonstrate the important and positive role of the NSFC in supporting free exploration, cultivating research teams and young talent, and boosting OA R&D. In this article, we outline and discuss hot topics in focused areas, key advances in this field and the prospects for progress in OA research in China.
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Lisee C, Davis-Wilson H, Evans-Pickett A, Horton WZ, Blackburn T, Franz JR, Thoma L, Spang JT, Pietrosimone B. Linking Gait Biomechanics and Daily Steps After ACL Reconstruction. Med Sci Sports Exerc 2022; 54:709-716. [PMID: 35072659 PMCID: PMC9255696 DOI: 10.1249/mss.0000000000002860] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Aberrant biomechanics and altered loading frequency are associated with poor knee joint health in osteoarthritis development. After anterior cruciate ligament reconstruction (ACLR), individuals demonstrate underloading (lesser vertical ground reaction force (vGRF)) with stiffened knee gait biomechanics (lesser knee extension moment (KEM) and knee flexion angle) and take fewer daily steps as early as 6 months after surgery. The purpose of this cross-sectional laboratory study is to compare gait biomechanics throughout stance between individuals 6-12 months after ACLR who take the lowest, moderate, and highest daily steps. METHODS Individuals with primary, unilateral history of ACLR between the ages of 16 and 35 yr were included (n = 36, 47% females; age, 21 ± 5 yr; months since ACLR, 8 ± 2). Barefoot gait biomechanics of vGRF (body weight), KEM (body weight × height), and knee flexion angle during stance were collected and time normalized. Average daily steps were collected via a waist-mounted accelerometer in free-living settings over 7 d. Participants were separated into tertiles based on lowest daily steps (3326-6042 daily steps), moderate (6043-8198 daily steps), and highest (8199-12,680 daily steps). Biomechanical outcomes of the ACLR limb during stance were compared between daily step groups using functional waveform gait analyses. RESULTS There were no significant differences in sex, body mass index, age, or gait speed between daily step groups. Individuals with the lowest daily steps walk with lesser vGRF and lesser KEM during weight acceptance, and lesser knee flexion angle throughout stance in the ACLR limb compared with individuals with highest and moderate daily steps. CONCLUSIONS After ACLR, individuals who take the fewest daily steps also walk with lesser vGRF during weight acceptance and a stiffened knee strategy throughout stance. These results highlight complex interactions between joint loading parameters after ACLR.
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Affiliation(s)
- Caroline Lisee
- MOTION Science Institute, Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, NC
| | - Hope Davis-Wilson
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
| | - Alyssa Evans-Pickett
- MOTION Science Institute, Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, NC
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, NC
| | - W. Zachary Horton
- Department of Statistics, University of California Santa Cruz, Santa Cruz, California
| | - Troy Blackburn
- MOTION Science Institute, Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, NC
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, NC
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jason R. Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC
| | - Louise Thoma
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, NC
| | - Jeffrey T. Spang
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, NC
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, NC
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Erhart-Hledik JC, Titchenal MR, Migliore E, Asay JL, Andriacchi TP, Chu CR. Cartilage oligomeric matrix protein responses to a mechanical stimulus associate with ambulatory loading in individuals with anterior cruciate ligament reconstruction. J Orthop Res 2022; 40:791-798. [PMID: 34185322 DOI: 10.1002/jor.25121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 01/07/2021] [Accepted: 06/09/2021] [Indexed: 02/04/2023]
Abstract
Mechanical factors have been implicated in the development of osteoarthritis after anterior cruciate ligament (ACL) reconstruction. This study tested for associations between ambulatory joint loading (total joint moment [TJM] and vertical ground reaction force [vGRF]) and changes in serum levels of cartilage oligomeric matrix protein (COMP) in response to a mechanical stimulus (30-min walk) in individuals with ACL reconstruction. Twenty-five subjects (mean age: 34.5 ± 9.8 years; 2.2 ± 0.2 years post-surgery) with primary unilateral ACL reconstruction underwent gait analysis for assessment of peak vGRF and TJM first (TJM1) and second (TJM2) peaks. Serum COMP concentrations were measured by enzyme-linked immunosorbent assay immediately before, 3.5 h, and 5.5 h after a 30-min walk. Pearson correlation coefficients and backward stepwise multiple linear regression analysis, with adjustments for age, sex, body mass index, and between-limb speed difference, assessed associations between changes in COMP and between-limb differences in joint loading parameters. Greater TJM1 (R = 0.542, p = 0.005), TJM2 (R = 0.460, p = 0.021), and vGRF (R = 0.577, p = 0.003) in the ACL-reconstructed limb as compared to the contralateral limb were associated with higher COMP values 3.5 h following the 30-min walk. Change in COMP at 5.5 h became a significant predictor of the between-limb difference in TJM1 and vGRF in multivariate analyses after accounting for the between-limb speed difference. These results demonstrate that higher TJM and vGRF in the ACLR limb as compared to the contralateral limb are associated with higher relative COMP levels 3.5 and 5.5 h after a 30-min walk. Future work should investigate the effect of therapies to alter joint loading on the biological response in individuals after ACL reconstruction.
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Affiliation(s)
- Jennifer C Erhart-Hledik
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California, USA.,Palo Alto Veterans Hospital, Palo Alto, California, USA
| | - Matthew R Titchenal
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California, USA.,Palo Alto Veterans Hospital, Palo Alto, California, USA.,Department of Mechanical Engineering, Stanford University, Stanford, California, USA
| | - Eleonora Migliore
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California, USA.,Palo Alto Veterans Hospital, Palo Alto, California, USA
| | - Jessica L Asay
- Palo Alto Veterans Hospital, Palo Alto, California, USA.,Department of Mechanical Engineering, Stanford University, Stanford, California, USA
| | - Thomas P Andriacchi
- Department of Mechanical Engineering, Stanford University, Stanford, California, USA
| | - Constance R Chu
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California, USA.,Palo Alto Veterans Hospital, Palo Alto, California, USA
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11
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The effect of an ankle-foot orthosis on tibiofemoral motion during step-up and step-down in healthy adults. Prosthet Orthot Int 2022; 46:148-154. [PMID: 35412522 DOI: 10.1097/pxr.0000000000000073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 08/09/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Solid ankle-foot orthoses (SAFOs) are frequently prescribed in conditions such as cerebral palsy and stroke. Although gait is improved in the short term, long-term effects of limiting ankle and foot motion during functional activities on joints such as the knee have not been investigated. Our study purpose was to compare tibiofemoral (TF) motion in shoe and SAFO conditions in healthy adults to inform future studies in clinical populations. METHODS A custom-made device using electromagnetic sensors was used to collect three-dimensional TF rotation data while 29 healthy adult participants (female participants = 19, age = 24.4 ± 4.5 years) performed step-up/step-down in shoe and SAFO conditions. RESULTS In the SAFO condition during step-up, extent of motion was greater in frontal and transverse planes and less in the sagittal plane. Discrete values at 0%-10% of the cycle in sagittal, 50%-100% in frontal, and 40%-100% in transverse planes were statistically different, producing more abduction and external rotation. In the SAFO condition during step-down, extent of motion was significantly greater in the frontal and transverse planes. Discrete values were statistically different in 40%-60% of the cycle in sagittal, 0%-30% and 70%-90% in frontal, and 0%-30% and 70%-90% in transverse planes, producing more abduction and external rotation in the first half of the cycle and more adduction and internal rotation in the second half of the cycle. CONCLUSIONS An SAFO affects triplanar TF kinematics in healthy adults during step-up/step-down. Future investigations into ankle-foot orthosis prescription and TF motion in clinical populations will facilitate optimal ankle-foot orthosis prescription and knee function in the long term.
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12
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Williams JR, Neal K, Alfayyadh A, Khandha A, Manal K, Snyder-Mackler L, Buchanan TS. Patellofemoral contact forces after ACL reconstruction: A longitudinal study. J Biomech 2022; 134:110993. [PMID: 35182902 PMCID: PMC8976762 DOI: 10.1016/j.jbiomech.2022.110993] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/13/2021] [Accepted: 02/07/2022] [Indexed: 11/17/2022]
Abstract
Osteoarthritis (OA) development after ACL reconstruction (ACLR) is common. Patellofemoral OA after ACLR is as prevalent as tibiofemoral OA; however, few have explored the mechanisms leading to disease development in this compartment. Biomechanical alterations may be one mechanism responsible for post-traumatic knee OA. Patellofemoral contact forces during dynamic tasks, such as running and single leg hops, have been assessed at return to sport and later time points. The results of these studies, however, contradict each other, are only cross-sectional in nature, and are limited to specific points in time within the movement pattern. The purpose of this study was to assess patellofemoral contact forces 3, 6, and 24 months after ACLR during level walking over the entirety of the movement pattern. Patellofemoral contact forces were calculated after determination of muscle forces from a validated, subject-specific, EMG-driven neuromusculoskeletal model. Statistical parametric mapping was used to compare patellofemoral contact forces between limbs and across time points. Patellofemoral underloading of the involved limb (vs. uninvolved) was present at 3 months (p < 0.001 from 7 to 30% of stance) and 6 months (p = 0.001 from 11 to 23% of stance and p = 0.025 from 27 to 32%) after ACLR but was resolved by 24 months. Both limbs' load increased from 3 to 6 months. The involved limb displayed relatively consistent loads from 6 months onward, while the uninvolved limb's decreased back down towards their 3-month values. Overall, these results suggest that early patellofemoral underloading exists after ACLR and may be leading to patellofemoral OA development.
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Affiliation(s)
- Jack R Williams
- Department of Mechanical Engineering, University of Delaware, Newark, DE, United States.
| | - Kelsey Neal
- Department of Mechanical Engineering, University of Delaware, Newark, DE, United States
| | - Abdulmajeed Alfayyadh
- Biomechanics and Movement Science, University of Delaware, Newark, DE, United States
| | - Ashutosh Khandha
- Biomechanics and Movement Science, University of Delaware, Newark, DE, United States; Department of Biomedical Engineering, University of Delaware, Newark, DE, United States
| | - Kurt Manal
- Biomechanics and Movement Science, University of Delaware, Newark, DE, United States; Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - Lynn Snyder-Mackler
- Biomechanics and Movement Science, University of Delaware, Newark, DE, United States; Department of Biomedical Engineering, University of Delaware, Newark, DE, United States; Department of Physical Therapy, University of Delaware, Newark, DE, United States
| | - Thomas S Buchanan
- Department of Mechanical Engineering, University of Delaware, Newark, DE, United States; Biomechanics and Movement Science, University of Delaware, Newark, DE, United States; Department of Biomedical Engineering, University of Delaware, Newark, DE, United States
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13
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Williams JR, Neal K, Alfayyadh A, Lennon K, Capin JJ, Khandha A, Manal K, Potter HG, Snyder-Mackler L, Buchanan TS. Knee cartilage T 2 relaxation times 3 months after ACL reconstruction are associated with knee gait variables linked to knee osteoarthritis. J Orthop Res 2022; 40:252-259. [PMID: 33783867 PMCID: PMC8481340 DOI: 10.1002/jor.25043] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/05/2021] [Accepted: 03/24/2021] [Indexed: 02/04/2023]
Abstract
Osteoarthritis development after ACL reconstruction (ACLR) is not well understood. Investigators have examined associations between knee biomechanical alterations and quantitative MRI (qMRI) variables, reflective of cartilage health, 12-60 months following ACLR; however, none have done so early after surgery. As part of an exploratory study, 45 individuals (age, 23 ± 7 years) underwent motion analysis during walking and qMRI 3 months after ACLR. For each limb, peak knee adduction moment (pKAM) and peak knee flexion moment (pKFM) were determined using inverse dynamics and peak medial compartment force was calculated using a neuromusculoskeletal model. T2 relaxation times in the medial compartment and linear regressions were used to determine the associations between gait variables and deep and superficial cartilage T2 relaxation times in six regions. pKAM was positively associated with deep layer T2 relaxation times within the femoral central and posterior regions when examined in the involved limb and from an interlimb difference perspective (involved limb - uninvolved limb). After adjusting for age, the association between interlimb difference of pKAM and interlimb difference of deep layer T2 relaxation times in the tibial central region became significant (p = .043). Interlimb difference of pKFM was negatively associated with interlimb difference of deep layer T2 relaxation times within the femoral central and posterior regions. These associations suggest that degenerative pathways leading to osteoarthritis may be detectable as early as 3 months after reconstruction. Preventative therapeutic techniques may need to be employed early in the rehabilitation process to prevent cartilage degradation.
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Affiliation(s)
- Jack R. Williams
- Department of Mechanical Engineering, University of
Delaware, Newark, DE
| | - Kelsey Neal
- Department of Mechanical Engineering, University of
Delaware, Newark, DE
| | | | - Kendra Lennon
- Department of Physical Therapy, University of Delaware,
Newark, DE
| | - Jacob J. Capin
- Biomechanics and Movement Science, University of Delaware,
Newark, DE,Department of Physical Therapy, University of Delaware,
Newark, DE,Physical Therapy Program, Department of Physical Medicine
and Rehabilitation, University of Colorado, Aurora, CO,Eastern Colorado VA Geriatric Research Education and
Clinical Center (GRECC), Aurora, CO
| | - Ashutosh Khandha
- Department of Biomedical Engineering, University of
Delaware, Newark, DE
| | - Kurt Manal
- Kinesiology and Applied Physiology, University of Delaware,
Newark, DE
| | - Hollis G. Potter
- Department of Radiology and Imaging, Hospital for Special
Surgery, New York, NY
| | - Lynn Snyder-Mackler
- Biomechanics and Movement Science, University of Delaware,
Newark, DE,Department of Physical Therapy, University of Delaware,
Newark, DE,Department of Biomedical Engineering, University of
Delaware, Newark, DE
| | - Thomas S. Buchanan
- Department of Mechanical Engineering, University of
Delaware, Newark, DE,Biomechanics and Movement Science, University of Delaware,
Newark, DE,Department of Biomedical Engineering, University of
Delaware, Newark, DE
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14
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Chu CR. Can we afford to ignore the biology of joint healing and graft incorporation after ACL reconstruction? J Orthop Res 2022; 40:55-64. [PMID: 34314066 DOI: 10.1002/jor.25145] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/23/2021] [Accepted: 07/01/2021] [Indexed: 02/04/2023]
Abstract
Anterior cruciate ligament (ACL) reconstruction is successful at restoring stability to return ACL injured patients to high-demand work, sports, and recreational activities. The development of posttraumatic osteoarthritis (OA) in roughly half of patients just 10-15 years after ACLR highlight the need to improve clinical care pathways. Graft failure and reinjury rates, which further increase OA risk, also remain high for younger and more active patients. The biological components of joint recovery and graft incorporation, therefore, impact short- and long-term clinical outcomes. Biochemical and magnetic resonance imaging (MRI) data show substantial compromise of articular cartilage metabolism and matrix composition after ACL injury and reconstructive surgery suggesting a potential need for activity modulation in early recovery. Furthermore, joint recovery is variable with compositional MRI studies showing progressive cartilage degeneration 1 and 2 years after ACLR. Biopsy and MRI studies also show high variability in ACL graft characteristics within the 1st year after ACLR followed by continued graft maturation into the 2nd year and beyond. To improve the care of ACL injured patients, there is a critical need for clinical attention and scientific inquiry into timing the reintroduction of higher load activities in relationship to neuromuscular recovery, joint biology, and graft maturation. In addition to symptomatic and mechanical recovery, development and validation of biological markers for joint and cartilage homeostasis as well as ACL graft healing are needed for personalized decision making on rehabilitation needs, reduction of OA risk, and resumption of athletic, recreational, and vocational activities.
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Affiliation(s)
- Constance R Chu
- Department Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Veterans Affairs Palo Alto Healthcare System, Livermore, California, USA
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15
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Williams AA, Deadwiler BC, Dragoo JL, Chu CR. Cartilage Matrix Degeneration Occurs within the First Year after ACLR and Is Associated with Impaired Clinical Outcome. Cartilage 2021; 13:1809S-1818S. [PMID: 34894770 PMCID: PMC8804799 DOI: 10.1177/19476035211063856] [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: 05/17/2021] [Revised: 11/02/2021] [Accepted: 11/02/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Anterior cruciate ligament reconstruction (ACLR) has not been shown to decrease the risk for development of post-traumatic osteoarthritis. Magnetic resonance imaging (MRI) T2 mapping can be used to assess cartilage compositional changes. This study tests whether (1) worse cartilage arthroscopic status at ACLR is reflected by higher cartilage T2 values in matched study regions 6 weeks and 1 year after ACLR, and (2) increasing cartilage T2 values between 6 weeks and 1 year after ACLR are associated with worsening patient-reported outcomes. DESIGN Twenty-two participants with ACLR and 26 controls underwent 3T MRI. T2 values in medial and lateral femoral and tibial cartilage were measured at 6 weeks and 1 year after ACLR and compared with arthroscopic grades, Knee injury and Osteoarthritis Outcome Scores (KOOS), and control T2 values. RESULTS Most (59%-86%) cartilage study regions examined by arthroscopy demonstrated intact articular surfaces. Average T2 value increased in 3 of 4 study regions between 6 weeks and 1 year after ACLR (P = .001-.011). T2 value increased (P < .013) even for participants whose cartilage had intact articular surfaces at ACLR. Participants with ACLR who showed greater increases in cartilage T2 values had less improvement to KOOS Quality of Life (P = .009, ρ = -0.62). DISCUSSION Cartilage status assessed arthroscopically at ACLR and by MRI T2 maps 6 weeks later was healthier than cartilage status assessed by MRI T2 maps at 1-year follow-up. Progressive T2 elevations were observed over the first year after ACLR even in patients with arthroscopically intact cartilage at the time of surgery and were associated with reduced improvement in knee quality of life suggesting preosteoarthritis.
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Affiliation(s)
- Ashley A. Williams
- Department of Orthopaedic Surgery,
Stanford University, Stanford, CA, USA
- Veterans Affairs Palo Alto Healthcare
System, Palo Alto, CA, USA
| | | | - Jason L. Dragoo
- Department of Orthopaedics, University
of Colorado, Denver, CO, USA
| | - Constance R. Chu
- Department of Orthopaedic Surgery,
Stanford University, Stanford, CA, USA
- Veterans Affairs Palo Alto Healthcare
System, Palo Alto, CA, USA
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16
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Harkey MS, Blackburn JT, Hackney AC, Lewek MD, Schmitz RJ, Pietrosimone B. Sex-Specific Associations between Cartilage Structure and Metabolism at Rest and Acutely Following Walking and Drop-Landing. Cartilage 2021; 13:1772S-1781S. [PMID: 32954820 PMCID: PMC8808927 DOI: 10.1177/1947603520959386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Cartilage health is thought to be dependent on the relationship between mechanics, structure, and metabolism, rather than these individual components in isolation. Due to sex differences in cartilage health, there is need to determine if the relationships between these cartilage components separately for males and females. Therefore, we sought to determine the sex-specific associations between cartilage structure and metabolism at rest and their acute response following walking and drop-landing in healthy individuals. DESIGN A cartilage ultrasound assessment and an ante-cubital blood draw were performed before and after walking and drop-landing conditions in 20 males and 20 females. Cartilage structure was assessed via medial and lateral femoral cartilage cross-sectional area. Cartilage metabolism was quantified with serum cartilage oligomeric matrix protein (COMP) concentration. Percent change scores from pre- to postloading were used to calculate acute alterations in cross-sectional area and COMP. Correlational analyses were used to assess the association between cartilage structure and metabolism measures separately for males and females. RESULTS In females, greater resting COMP concentration was associated with less cartilage cross-sectional area in the medial(ρ = -0.50, P = 0.03) and lateral (ρ = -0.69, P = 0.001) femur. Resting cartilage measures were not associated among males. Following walking and drop-landing, percent change scores in cartilage structure and metabolism were not associated. CONCLUSIONS This study highlights that, in females, thinner anterior femoral cartilage is associated with greater resting serum COMP concentrations, a biomarker often linked to cartilage breakdown. Future studies into the relationships between various cartilage components should consider sex-specific analyses as these relationships are sex dependent.
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Affiliation(s)
- Matthew S. Harkey
- Department of Kinesiology, Michigan
State University, East Lansing, MI, USA,Matthew S. Harkey, Department of
Kinesiology, Michigan State University, 308 W. Circle Drive #112, East Lansing,
MI 48824, USA.
| | - J. Troy Blackburn
- Department of Exercise and Sports
Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anthony C. Hackney
- Department of Exercise and Sports
Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Department of Nutrition, School of
Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC,
USA
| | - Michael D. Lewek
- Division of Physical Therapy, University
of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Randy J. Schmitz
- Department of Kinesiology, University of
North Carolina at Greensboro, Greensboro, NC, USA
| | - Brian Pietrosimone
- Department of Exercise and Sports
Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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17
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Chu CR, Williams AA, Erhart-Hledik JC, Titchenal MR, Qian Y, Andriacchi TP. Visualizing pre-osteoarthritis: Integrating MRI UTE-T2* with mechanics and biology to combat osteoarthritis-The 2019 Elizabeth Winston Lanier Kappa Delta Award. J Orthop Res 2021; 39:1585-1595. [PMID: 33788306 DOI: 10.1002/jor.25045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/03/2021] [Accepted: 03/24/2021] [Indexed: 02/04/2023]
Abstract
Osteoarthritis (OA) is a leading cause of pain and disability for which disease-modifying treatments remain lacking. This is because the symptoms and radiographic changes of OA occur after the onset of likely irreversible changes. Defining and treating earlier disease states are therefore needed to delay or to halt OA progression. Taking this concept a step further, studying OA pathogenesis before disease onset by characterizing potentially reversible markers of increased OA risk to identify a state of "pre-osteoarthritis (pre-OA)" shifts the paradigm towards OA prevention. The purpose of this review is to summarize the 42 studies comprising the 2019 Kappa Delta Elizabeth Lanier Award where conceptualization of a systems-based definition for "pre-osteoarthritis (pre-OA)" was followed by demonstration of potentially reversible markers of heightened OA risk in patients after anterior cruciate ligament (ACL) injury and reconstruction. In the process, these efforts contributed a new magnetic resonance imaging method of ultrashort echo time (UTE) enhanced T2* mapping to visualize joint tissue damage before the development of irreversible changes. The studies presented here support a transformative approach to OA that accounts for interactions between mechanical, biological, and structural markers of OA risk to develop and evaluate new treatment strategies that can delay or prevent the onset of clinical disease. This body of work was inspired by and performed for patients. Shifting the paradigm from attempting to modify symptomatic radiographic OA towards monitoring and reversing markers of "pre-OA" opens the door for transforming the clinical approach to OA from palliation to prevention.
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Affiliation(s)
- Constance R Chu
- Department Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Surgery, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | - Ashley A Williams
- Department Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Surgery, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | - Jennifer C Erhart-Hledik
- Department Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Surgery, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | | | - Yongxian Qian
- Center for Biomedical Imaging, New York University, New York, New York, USA
| | - Thomas P Andriacchi
- Department Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Mechanical Engineering, Stanford University, Stanford, California, USA
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18
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Hori M, Terada M, Suga T, Isaka T. Changes in anterior femoral articular cartilage structure in collegiate rugby athletes with and without a history of traumatic knee joint injury following a five-month competitive season. Sci Rep 2021; 11:15186. [PMID: 34312456 PMCID: PMC8313691 DOI: 10.1038/s41598-021-94462-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/12/2021] [Indexed: 11/21/2022] Open
Abstract
This study aimed to examine anterior femoral cartilage morphology before (pre-season) and after (post-season) a 5-month competitive season in collegiate ruby players with and without a previous history of traumatic injury to ligamentous, meniscus, and/or cartilage structures at the knee joint. Using a prospective cohort design, 42 male collegiate rugby players with a previous history of traumatic intracapsular knee joint injury and 124 players without knee injury history were included in this study. Ultrasonography assessments of anterior femoral cartilage were performed before (pre-season) and following a 5-month athletic season (post-season). Rugby players with a history of traumatic knee joint injury had greater lateral condylar thickness (2.37 ± 0.35 mm, p = 0.03), intercondylar thickness (2.51 ± 0.47 mm, p = 0.03), and partial area (44.67 ± 7.28mm2, p = 0.02) compared to control players (lateral = 2.23 ± 0.35 mm, intercondylar = 2.32 ± 0.47 mm, partial area = 41.60 ± 7.26 mm2), regardless of pre-and post-season assessment time points. Pre-season ultrasonography assessment of lateral condylar thickness (2.34 ± 0.47 mm, p = 0.02), medial condylar thickness (2.05 ± 0.43 mm, p = 0.03), and partial area (44.10 ± 9.23 mm2, p = 0.001) were significantly greater than the post-season ultrasonography assessment time point (lateral = 2.26 ± 0.43 mm, medial = 1.98 ± 0.43 mm, partial area = 42.17 ± 8.82 mm2), regardless of group membership. Rugby players with a history of intracapsular knee joint injury displayed altered anterior femoral cartilage size via ultrasonography assessments. Regardless of a presence of injury history, collegiate rugby players showed a decrease in cartilage thickness and partial area following a 5-month competitive season.
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Affiliation(s)
- Miyuki Hori
- Graduate School of Sport and Health Science, Ritsumeikan University, 1-1-1 Noji-higashi, Kusatsu, Shiga, 525-8577, Japan
| | - Masafumi Terada
- College of Sport and Health Science, Ritsumeikan University, 1-1-1 Noji-higashi, Kusatsu, Shiga, 525-8577, Japan.
| | - Tadashi Suga
- Research Organization of Science and Technology, Ritsumeikan University, 1-1-1 Noji-higashi, Kusatsu, Shiga, 525-8577, Japan
| | - Tadao Isaka
- Graduate School of Sport and Health Science, Ritsumeikan University, 1-1-1 Noji-higashi, Kusatsu, Shiga, 525-8577, Japan.,College of Sport and Health Science, Ritsumeikan University, 1-1-1 Noji-higashi, Kusatsu, Shiga, 525-8577, Japan
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19
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Evans-Pickett A, Longobardi L, Spang JT, Creighton RA, Kamath G, Davis-Wilson HC, Loeser R, Blackburn JT, Pietrosimone B. Synovial fluid concentrations of matrix Metalloproteinase-3 and Interluekin-6 following anterior cruciate ligament injury associate with gait biomechanics 6 months following reconstruction. Osteoarthritis Cartilage 2021; 29:1006-1019. [PMID: 33781899 PMCID: PMC8658576 DOI: 10.1016/j.joca.2021.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare gait biomechanics 6 months following anterior cruciate ligament (ACL) reconstruction (ACLR) between patients with the highest and lowest concentrations of synovial fluid (SF) interleukin-6 (IL-6) and matrix metalloproteinase-3 (MMP-3), as well as compared to uninjured controls. DESIGN SF concentrations of IL-6 and MMP-3 were collected 7 ± 4 days post injury in 38 ACL injured patients (55% female, 21±4yrs, 25.3 ± 5.2BMI). ACL injured individuals were stratified into the lowest and highest quartiles based on IL-6 (IL-6Lowest and IL-6Highest) and MMP-3 (MMP-3Lowest and MMP-3Highest) concentrations. Gait biomechanics were collected on the injured limb 6 months post-ACLR and in 38 uninjured controls (50% female, 21±3yrs, 23.8 ± 2.8BMI). Functional analyses of variance were used to compare vertical ground reaction force (vGRF), knee flexion angle (KFA), and internal knee extension moment (KEM) waveforms throughout stance phase of gait to determine the proportions of stance differing between limbs and groups. RESULTS Compared to uninjured controls, IL-6High and MMP-3High ACL subgroups demonstrated lesser vGRF (largest differences: IL-6, 7.88%BW; MMP-3, 11.05%BW) during early-stance and greater vGRF (largest differences: IL-6, 6.21%BW; MMP-3, 5.85%BW) in mid-stance, lesser KFA (largest differences: IL-6, 3.11°; MMP-3, 3.72°) and lesser KEM (largest differences: IL-6, 0.96%BW•m; MMP-3, 1.07%BW•m) in early-stance, as well as greater KFA in mid-stance (largest differences: IL-6, 1.5°; MMP-3, 2.95°). CONCLUSIONS High SF concentrations of a proinflammatory cytokine and a degradative enzyme early post-ACL injury are associated with aberrant gait biomechanics in the injured limb at 6 months post-ACLR (i.e., lesser vGRF, KFA and KEM) linked to posttraumatic osteoarthritis development.
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Affiliation(s)
- Alyssa Evans-Pickett
- MOTION Science Institute, Department of Exercise and
Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United
States,Human Movement Science Curriculum, University of
North Carolina at Chapel Hill, Chapel Hill, NC, United States,Corresponding Author: Alyssa Evans-Pickett, Ph.D.
Student, Department of Exercise and Sport Science, University of North Carolina
at Chapel Hill, 210 South Road Fetzer Hall, Chapel Hill, NC, 27599, United
States,
| | - Lara Longobardi
- Thurston Arthritis Research Center, University of
North Carolina at Chapel Hill, 27599, United States
| | - Jeffrey T. Spang
- Department of Orthopaedics, School of Medicine,
University of North Carolina at Chapel Hill, 27599, NC, United States
| | - R. Alexander Creighton
- Department of Orthopaedics, School of Medicine,
University of North Carolina at Chapel Hill, 27599, NC, United States
| | - Ganesh Kamath
- Department of Orthopaedics, School of Medicine,
University of North Carolina at Chapel Hill, 27599, NC, United States
| | - Hope C. Davis-Wilson
- MOTION Science Institute, Department of Exercise and
Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United
States,Human Movement Science Curriculum, University of
North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Richard Loeser
- Thurston Arthritis Research Center, University of
North Carolina at Chapel Hill, 27599, United States
| | - J. Troy Blackburn
- MOTION Science Institute, Department of Exercise and
Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United
States,Human Movement Science Curriculum, University of
North Carolina at Chapel Hill, Chapel Hill, NC, United States,Department of Orthopaedics, School of Medicine,
University of North Carolina at Chapel Hill, 27599, NC, United States
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and
Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United
States,Human Movement Science Curriculum, University of
North Carolina at Chapel Hill, Chapel Hill, NC, United States,Department of Orthopaedics, School of Medicine,
University of North Carolina at Chapel Hill, 27599, NC, United States
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20
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Blackburn T, Padua DA, Pietrosimone B, Schwartz TA, Spang JT, Goodwin JS, Dewig DR, Johnston CD. Vibration improves gait biomechanics linked to posttraumatic knee osteoarthritis following anterior cruciate ligament injury. J Orthop Res 2021; 39:1113-1122. [PMID: 32757272 DOI: 10.1002/jor.24821] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/24/2020] [Accepted: 07/13/2020] [Indexed: 02/04/2023]
Abstract
Anterior cruciate ligament reconstruction (ACLR) incurs a high risk of posttraumatic knee osteoarthritis (PTOA). Aberrant gait biomechanics contribute to PTOA and are attributable in part to quadriceps dysfunction. Vibration improves quadriceps function following ACLR, but its effects on gait biomechanics are unknown. The purpose of this study was to evaluate the effects of whole-body vibration (WBV) and local muscle vibration (LMV) on gait biomechanics in individuals with ACLR. Seventy-five volunteers (time since ACLR 27 ± 16 months) were randomized to WBV, LMV, or Control interventions. Walking biomechanics were assessed prior to and following a single exposure to the interventions. Outcomes included pre-post change scores in the ACLR limb for the peak vertical ground reaction force (vGRF) and its loading rate, peak internal knee extension (KEM) and abduction moments, and peak knee flexion and varus angles. LMV produced a significant decrease in the vGRF loading rate (-3.6 BW/s) that was greater than the changes in the WBV (-0.3 BW/s) and Control (0.5 BW/s) groups. Additionally, WBV produced an increase in the peak KEM (0.27% BW × Ht) that was greater than the change in the Control group (-0.17% BW × Ht) but not the LMV group (0.01% BW × Ht). Lower KEM and greater loading rates have been linked to declines in joint health following ACLR. WBV acutely increased the peak KEM and LMV decreased loading rates. These data suggest that vibration has the potential to mitigate aberrant gait biomechanics, and may represent an effective approach for reducing PTOA risk following ACLR.
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Affiliation(s)
- Troy Blackburn
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Allied Health Sciences, Program in Human Movement Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Darin A Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Allied Health Sciences, Program in Human Movement Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Allied Health Sciences, Program in Human Movement Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Todd A Schwartz
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jeffrey T Spang
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Derek R Dewig
- Department of Allied Health Sciences, Program in Human Movement Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Chris D Johnston
- Department of Athletic Training, High Point University, North Carolina
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Harkey MS, Little E, Thompson M, Zhang M, Driban JB, Salzler MJ. Femoral Cartilage Ultrasound Echo Intensity Associates with Arthroscopic Cartilage Damage. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:43-50. [PMID: 33082054 PMCID: PMC7568485 DOI: 10.1016/j.ultrasmedbio.2020.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/03/2020] [Accepted: 09/07/2020] [Indexed: 05/21/2023]
Abstract
This study compared quantitative cartilage ultrasound metrics between people with (n = 12) and without (n = 12) arthroscopic cartilage damage after anterior cruciate ligament injury (age, 24.9 ± 3.7 y; sex, 33% female, 67% male; days since injury = 50 ± 52). A transverse suprapatellar ultrasound assessment imaged the femoral cartilage in participants' injured knees before a clinical arthroscopy. A custom program automatically separated a manual cartilage segmentation into standardized medial and lateral femoral regions and calculated mean thickness (i.e., cross-sectional area/length of cartilage-bone interface), mean echo intensity and echo-intensity heterogeneity. An orthopedic surgeon assessed arthroscopic cartilage damage in the medial and lateral femoral condyles using the Outerbridge grading system (cartilage damage = Outerbridge ≥ 1). Separate logistic regressions for medial and lateral femoral cartilage were used to determine the association between each ultrasound metric and arthroscopic cartilage damage. In medial femoral cartilage, for every 1 standard deviation decrease in echo-intensity mean and heterogeneity, there is, respectively, a 91% (adjusted odds ratio, 0.09; 95% confidence interval, 0.01-0.69) and 97% (adjusted odds ratio, 0.03; 95% confidence interval, 0.002-0.50) increase in the odds of having arthroscopic cartilage damage. Lateral cartilage ultrasound metrics are not associated with lateral arthroscopic cartilage damage. This study provides preliminary evidence that femoral cartilage ultrasound echo intensity is a non-invasive measure associated with medial femoral cartilage health after anterior cruciate ligament injury.
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Affiliation(s)
- Matthew S Harkey
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA; Division of Rheumatology, Allergy, & Immunology, Tufts Medical Center, Boston, Massachusetts, USA; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
| | - Erin Little
- Division of Rheumatology, Allergy, & Immunology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Mikaela Thompson
- Department of Orthopaedics, Tufts Medical Center, Boston, Massachusetts, USA
| | - Ming Zhang
- Division of Rheumatology, Allergy, & Immunology, Tufts Medical Center, Boston, Massachusetts, USA; Department of Computer Science & Networking, Wentworth Institute of Technology, Boston, Massachusetts, USA
| | - Jeffrey B Driban
- Division of Rheumatology, Allergy, & Immunology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Matthew J Salzler
- Department of Orthopaedics, Tufts Medical Center, Boston, Massachusetts, USA
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22
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Kaur M, Ribeiro DC, Webster KE, Sole G. Knee biomechanics while navigating steps in participants with anterior cruciate ligament reconstruction, between 2 and 10 years following surgery. Phys Ther Sport 2020; 46:70-76. [DOI: 10.1016/j.ptsp.2020.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 01/13/2023]
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23
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Luc-Harkey BA, Franz J, Hackney AC, Blackburn JT, Padua DA, Schwartz T, Davis-Wilson H, Spang J, Pietrosimone B. Immediate Biochemical Changes After Gait Biofeedback in Individuals With Anterior Cruciate Ligament Reconstruction. J Athl Train 2020; 55:1106-1115. [PMID: 32966563 DOI: 10.4085/1062-6050-0372.19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Gait biomechanics are linked to biochemical changes that contribute to the development of posttraumatic knee osteoarthritis in individuals with anterior cruciate ligament reconstruction (ACLR). It remains unknown if modifying peak loading during gait using real-time biofeedback will result in acute biochemical changes related to cartilage metabolism. OBJECTIVE To determine if acutely manipulating peak vertical ground reaction force (vGRF) during gait influences acute changes in serum cartilage oligomeric matrix protein concentration (sCOMP) among individuals with ACLR. DESIGN Crossover study. PATIENTS OR OTHER PARTICIPANTS Thirty individuals with unilateral ACLR participated (70% female, age = 20.43 ± 2.91 years old, body mass index = 24.42 ± 4.25, months post-ACLR = 47.83 ± 26.97). Additionally, we identified a subgroup of participants who demonstrated an increase in sCOMP after the control or natural loading condition (sCOMPCHANGE > 0 ng/mL, n = 22, 70% female, age = 20.32 ± 3.00 years old, body mass index = 24.73 ± 4.33, months post-ACLR = 47.27 ± 29.32). MAIN OUTCOME MEASURE(S) Serum was collected both prior to and immediately after each condition to determine sCOMPchange. INTERVENTION(S) All participants attended 4 sessions that involved 20 minutes of walking on a force-measuring treadmill consisting of a control condition (natural loading) followed by random ordering of 3 loading conditions with real-time biofeedback: (1) symmetric vGRF between limbs, (2) a 5% increase in vGRF (high loading) and (3) a 5% decrease in vGRF (low loading). A general linear mixed model was used to determine differences in sCOMPCHANGE between altered loading conditions and the control group in the entire cohort and the subgroup. RESULTS The sCOMPCHANGE was not different across loading conditions for the entire cohort (F3,29 = 1.34, P = .282). Within the subgroup, sCOMPCHANGE was less during high loading (1.95 ± 24.22 ng/mL, t21 = -3.53, P = .005) and symmetric loading (9.93 ± 21.45 ng/mL, t21 = -2.86, P = .025) compared with the control condition (25.79 ± 21.40 ng/mL). CONCLUSIONS Increasing peak vGRF during gait decreased sCOMP in individuals with ACLR who naturally demonstrated an increase in sCOMP after 20 minutes of walking. TRIAL REGISTRY ClinicalTrials.gov (NCT03035994).
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Affiliation(s)
| | - Jason Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh
| | - Anthony C Hackney
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - J Troy Blackburn
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Darin A Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Todd Schwartz
- Department of Biostatistics, University of North Carolina at Chapel Hill
| | - Hope Davis-Wilson
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Jeffrey Spang
- Department of Orthopaedics, MOTION Science Institute, University of North Carolina at Chapel Hill
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
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24
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Andriacchi TP, Griffin TM, Loeser RF, Chu CR, Roos EM, Hawker GA, Erhart-Hledik JC, Fischer AG. Bridging Disciplines as a pathway to Finding New Solutions for Osteoarthritis a collaborative program presented at the 2019 Orthopaedic Research Society and the Osteoarthritis Research Society International. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 2:100026. [DOI: 10.1016/j.ocarto.2020.100026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/18/2019] [Accepted: 01/07/2020] [Indexed: 01/18/2023] Open
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25
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Blackburn JT, Pietrosimone B, Spang JT, Goodwin JS, Johnston CD. Somatosensory Function Influences Aberrant Gait Biomechanics Following Anterior Cruciate Ligament Reconstruction. J Orthop Res 2020; 38:620-628. [PMID: 31608488 DOI: 10.1002/jor.24495] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 10/04/2019] [Indexed: 02/04/2023]
Abstract
Osteoarthritis is common following anterior cruciate ligament reconstruction (ALCR), and aberrant gait biomechanics are considered a primary contributor. Somatosensory dysfunction potentially alters gait biomechanics, but this association is unclear. Therefore, the purposes of this investigation were to compare somatosensory function between limbs and evaluate associations between somatosensory function and gait biomechanics linked to osteoarthritis development in individuals with ALCR. Seventy-three volunteers with ALCR participated. Gait biomechanics (peak vertical ground reaction force magnitude and loading rate, peak internal knee extension and valgus moments, peak knee flexion and varus angles, and quadriceps/hamstrings co-activation) were assessed as subjects walked at their preferred speed. The somatosensory function was assessed via joint position sense error (knee flexion) and vibratory perception threshold (femoral epicondyles, malleoli, and first metatarsal). Though somatosensory function did not differ between the ACLR and contralateral limbs, poorer joint position sense in the ACLR limb was associated with lower loading rates and internal knee extension moments, and greater co-activation. Poorer vibratory perception at the medial and lateral malleoli and first metatarsal head in the ACLR limb was associated with lower loading rates, greater internal knee valgus moments and varus angles, and greater co-activation. Poorer vibratory perception at the medial malleolus and first metatarsal head in the contralateral limb was associated with greater peak knee varus angles and internal knee valgus moments. These results suggest that future research evaluating rehabilitation approaches for improving somatosensory function is warranted as a potential approach for restoring normal gait biomechanics and reducing osteoarthritis risk. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:620-628, 2020.
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Affiliation(s)
- Jonathan T Blackburn
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, 210 South Rd., CB#8700, Chapel Hill, North Carolina, 27599-8700.,Program in Human Movement Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, 210 South Rd., CB#8700, Chapel Hill, North Carolina, 27599-8700.,Program in Human Movement Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jeffrey T Spang
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Chris D Johnston
- Program in Human Movement Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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26
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Evans A, Ibrahim M, Pope R, Mwangi J, Botros M, Johnson SP, Al Kassis S. Treating hand and foot osteoarthritis using a patient's own blood: A systematic review and meta-analysis of platelet-rich plasma. J Orthop 2020; 18:226-236. [PMID: 32071509 DOI: 10.1016/j.jor.2020.01.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/25/2020] [Indexed: 02/07/2023] Open
Abstract
Background This study summarizes all literature investigating platelet-rich plasma (PRP) in the treatment of osteoarthritis of the hands and feet. Materials & methods This is a PRISMA compliant systematic review of 7 databases and includes a meta-analysis of randomized controlled trial (RCT) data on pain and function. Results Nine articles were included in the review. Meta-analysis of 4 RCTs shows PRP significantly improves pain and function versus control. More results are significant at longer duration follow-up. Conclusions PRP improves pain and function of osteoarthritis. Heterogeneity and risk-of-bias limit current data, requiring more RCTs to determine any regenerative potential of PRP. Prospero Systematic Review Registration Number 136582.
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Affiliation(s)
- Adam Evans
- Meharry Medical College, 1005 Dr DB Todd Jr Blvd, Nashville, TN, 37208, USA
| | - Maryo Ibrahim
- Meharry Medical College, 1005 Dr DB Todd Jr Blvd, Nashville, TN, 37208, USA
| | - Rand Pope
- Vanderbilt University School of Medicine, 1161 21st Ave South, Nashville, TN, 37232, USA
| | - James Mwangi
- Meharry Medical College, 1005 Dr DB Todd Jr Blvd, Nashville, TN, 37208, USA
| | - Mina Botros
- Meharry Medical College, 1005 Dr DB Todd Jr Blvd, Nashville, TN, 37208, USA
| | - Shepard P Johnson
- Vanderbilt University Medical Center Department of Plastic Surgery, D-4207 Medical Center North, 1211 Medical Center Drive, Nashville, TN, 37212, USA
| | - Salam Al Kassis
- Vanderbilt University Medical Center Department of Plastic Surgery, D-4207 Medical Center North, 1211 Medical Center Drive, Nashville, TN, 37212, USA
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27
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Shultz SJ, Schmitz RJ, Cameron KL, Ford KR, Grooms DR, Lepley LK, Myer GD, Pietrosimone B. Anterior Cruciate Ligament Research Retreat VIII Summary Statement: An Update on Injury Risk Identification and Prevention Across the Anterior Cruciate Ligament Injury Continuum, March 14-16, 2019, Greensboro, NC. J Athl Train 2019; 54:970-984. [PMID: 31461312 PMCID: PMC6795093 DOI: 10.4085/1062-6050-54.084] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Sandra J. Shultz
- Applied Neuromechanics Research Laboratory, University of North Carolina at Greensboro
| | - Randy J. Schmitz
- Applied Neuromechanics Research Laboratory, University of North Carolina at Greensboro
| | - Kenneth L. Cameron
- John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, NY
| | - Kevin R. Ford
- Human Biomechanics and Physiology Laboratory, Department of Physical Therapy, High Point University, NC
| | - Dustin R. Grooms
- Ohio Musculoskeletal & Neurological Institute and Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens
| | | | - Gregory D. Myer
- The SPORT Center, Division of Sports Medicine, and Departments of Pediatrics and Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, OH
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
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28
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Chu CR. Concepts Important to Secondary Prevention of Posttraumatic Osteoarthritis. J Athl Train 2019; 54:987-988. [PMID: 31437015 DOI: 10.4085/1062-6050-54.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Constance R Chu
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA
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29
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O’Donnell C, Migliore E, Grandi FC, Koltsov J, Lingampalli N, Cisar C, Indelli PF, Sebastiano V, Robinson WH, Bhutani N, Chu CR. Platelet-Rich Plasma (PRP) From Older Males With Knee Osteoarthritis Depresses Chondrocyte Metabolism and Upregulates Inflammation. J Orthop Res 2019; 37:1760-1770. [PMID: 31042308 PMCID: PMC6824920 DOI: 10.1002/jor.24322] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 04/04/2019] [Indexed: 02/04/2023]
Abstract
There is intense clinical interest in the potential effects of platelet-rich plasma (PRP) for the treatment of osteoarthritis (OA). This study tested the hypotheses that (i) "lower" levels of the inflammatory mediators (IMs), interleukin-1β, and tumor necrosis factor α (TNF-α) and (ii) "higher" levels of the growth factors (GFs), insulin-like growth factor 1, and transforming growth factor β1 within leukocyte-poor PRP correlate with more favorable chondrocyte and macrophage responses in vitro. Samples were collected from 10 "healthy" young male (23-33 years old) human subjects (H-PRP) and nine older (62-85 years old) male patients with severe knee OA (OA-PRP). The samples were separated into groups of "high" or "low" levels of IM and GF based on multiplex cytokine and enzyme-linked immunosorbent assay data. Three-dimensional (3D) alginate bead chondrocyte cultures and monocyte-derived macrophage cultures were treated with 10% PRP from donors in different groups. Gene expression was analyzed by quantitative polymerase chain reaction. Contrary to our hypotheses, the effect of PRP on chondrocytes and macrophages was mainly influenced by the age and disease status of the PRP donor as opposed to the IM or GF groupings. While H-PRP showed similar effects on expression of chondrogenic markers (Col2a1 and Sox9) as the negative control group (p > 0.05), OA-PRP decreased chondrocyte expression of Col2a1 and Sox-9 messenger RNA by 40% and 30%, respectively (Col2a1, p = 0.015; Sox9, p = 0.037). OA-PRP also upregulated TNF-α and matrix metallopeptidase 9 (p < 0.001) gene expression in macrophages while H-PRP did not. This data suggests that PRP from older individuals with OA contain factors that may suppress chondrocyte matrix synthesis and promote macrophage inflammation in vitro. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1760-1770, 2019.
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Affiliation(s)
- Christian O’Donnell
- Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Eleonora Migliore
- Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, CA,VA Palo Alto Health Care System, Palo Alto, CA
| | - Fiorella Carla Grandi
- Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Jayme Koltsov
- Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Nithya Lingampalli
- Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, CA,VA Palo Alto Health Care System, Palo Alto, CA
| | - Cecilia Cisar
- Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, CA,VA Palo Alto Health Care System, Palo Alto, CA
| | - Pier F. Indelli
- Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, CA,VA Palo Alto Health Care System, Palo Alto, CA
| | | | - William H. Robinson
- Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, CA,VA Palo Alto Health Care System, Palo Alto, CA
| | - Nidhi Bhutani
- Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Constance R. Chu
- Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, CA,VA Palo Alto Health Care System, Palo Alto, CA
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30
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Kobsar D, Charlton JM, Hunt MA. Individuals with knee osteoarthritis present increased gait pattern deviations as measured by a knee-specific gait deviation index. Gait Posture 2019; 72:82-88. [PMID: 31173950 DOI: 10.1016/j.gaitpost.2019.05.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/10/2019] [Accepted: 05/17/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND A biomechanical analysis can provide valuable information on osteoarthritis (OA) gait, but important multidimensional interactions are often ignored. The Gait Deviation Index (GDI) was designed to address the issue of data complexity in gait analyses by providing a single, encompassing, value for one's deviation from a normative reference group. RESEARCH QUESTION The primary aim of this study was to examine differences in a knee-specific GDI among young adults, and older individuals with and without knee OA. Secondarily, we aimed to examine these differences while controlling for gait speed. METHOD Sagittal and frontal plane knee joint angles and moments were used in the computation of a GDI among young adults, and older individuals with and without knee OA. The GDI was calculated such that scores ≥100% were considered typical young-healthy gait and a 10% decrease below 100 equated to 1 standard deviation from typical gait. Scores were first examined using a one-way analysis of variance, and examined again after correcting for gait speed. RESULTS The GDI was calculated for three groups: young-healthy adults (n = 52), older individuals without knee OA (n = 56), and individuals with knee OA (n = 191). Those with knee osteoarthritis exhibited a mean GDI of 87.2 (11.1), which was significantly lower than young adults (99.6 (10.6); p < 0.001) and older individuals without knee OA (94.3 (11.0); p < 0.001). Differences in GDI remained consistent after controlling for gait speed. Knee OA gait waveforms displayed significant variability across similar GDIs, specifically in frontal plane patterns. CONCLUSION Those with knee osteoarthritis exhibited lower (worse) GDIs compared to those without knee osteoarthritis and young, healthy individuals. After correcting for gait speed, these findings did not change. The GDI highlighted the significant variability in gait waveforms within individuals with knee OA, but the clinical utility of the GDI score itself remains limited.
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Affiliation(s)
- Dylan Kobsar
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Jesse M Charlton
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, Canada; Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, Canada
| | - Michael A Hunt
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, Canada.
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31
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Pietrosimone B, Seeley MK, Johnston C, Pfeiffer SJ, Spang JT, Blackburn JT. Walking Ground Reaction Force Post-ACL Reconstruction: Analysis of Time and Symptoms. Med Sci Sports Exerc 2019; 51:246-254. [PMID: 30157111 DOI: 10.1249/mss.0000000000001776] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE The association between lower-extremity loading and clinically relevant knee symptoms at different time points after anterior cruciate ligament reconstruction (ACLR) is unclear. Vertical ground reaction force (vGRF) from walking was compared between individuals with and without clinically relevant knee symptoms in three cohorts: <12 months post-ACLR, 12-24 months post-ACLR, and >24 months post-ACLR. METHODS One hundred twenty-eight individuals with unilateral ACLR were classified as symptomatic or asymptomatic, based on previously defined cutoff values for the Knee Osteoarthritis and Injury Outcome Score (<12 months post-ACLR [symptomatic n = 28, asymptomatic n = 24]; 12-24 months post-ACLR [symptomatic n = 15, asymptomatic n = 15], and >24 months post-ACLR [symptomatic, n = 13; asymptomatic, n = 33]). Vertical ground reaction force exerted on the ACLR limb was collected during walking gait, and functional analyses of variance were used to evaluate the effects of symptoms and time post-ACLR on vGRF throughout stance phase (α = 0.05). RESULTS Symptomatic individuals, <12 months post-ACLR, demonstrated less vGRF during both vGRF peaks (i.e., weight acceptance and propulsion) and greater vGRF during midstance, compared to asymptomatic individuals. Vertical ground reaction force characteristics were not different between symptomatic and asymptomatic individuals for most of stance in individuals between 12 and 24 months post-ACLR. Symptomatic individuals who were >24 months post-ACLR, exhibited greater vGRF during both peaks, but lesser vGRF during midstance, compared to asymptomatic individuals. CONCLUSION Relative to asymptomatic individuals, symptomatic individuals are more likely to underload the ACLR limb early after ACLR (i.e., <12 months) during both vGRF peaks, but overload the ACLR limb, during both vGRF peaks, at later time points (i.e., >24 months). We propose these differences in lower-extremity loading during walking might have implications for long-term knee health, and should be considered when designing therapeutic interventions for individuals with an ACLR.
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Affiliation(s)
- Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Matthew K Seeley
- Department of Exercise Sciences, Brigham Young University, Provo, UT
| | - Christopher Johnston
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Steven J Pfeiffer
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jeffery T Spang
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, NC
| | - J Troy Blackburn
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
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32
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Hardy E, Merrett DC, Zhang H, Zhang Q, Zhu H, Yang DY. Possible case of pressure resorption associated with osteoarthritis in human skeletal remains from ancient China. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2019; 24:1-6. [PMID: 30245227 DOI: 10.1016/j.ijpp.2018.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 07/12/2018] [Accepted: 07/24/2018] [Indexed: 06/08/2023]
Abstract
Osteoarthritis, one of the most common pathological conditions observed in human skeletal remains, is traditionally thought to only affect the structures within the joint capsule. We examined the osteoarthritic distal femora of an individual from Ancient North China, ca. 475-221 BCE. The standard signs of osteoarthritis, marginal lipping and extensive eburnation, were observed in the patellofemoral compartment of the knee joint. In addition however were bilateral pressure-caused fossae on the extra-articular anterior surfaces of the distal femora 10 mm proximal to the large osteophytes at the apex of the patellar surfaces. Anatomy and possible pathogenesis of knee arthritis are explored in order to come to a tentative aetiology of the extra-articular lesions. These lesions are suggested to be a new criterion for identifying severe knee arthritis. The osteological phenomenon is then placed into archaeological context of the Warring States period of ancient China.
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Affiliation(s)
- Evan Hardy
- Department of Archaeology, Simon Fraser University, Burnaby, BC V5A 1S6, Canada; SFU-JLU Joint Centre for Bioarchaeological Research, Department of Archeaology, Simon Fraser University, Burnaby, BC V5A 1S6, Canada.
| | - Deborah C Merrett
- Department of Archaeology, Simon Fraser University, Burnaby, BC V5A 1S6, Canada; SFU-JLU Joint Centre for Bioarchaeological Research, Department of Archeaology, Simon Fraser University, Burnaby, BC V5A 1S6, Canada.
| | - Hua Zhang
- Department of Archaeology, Simon Fraser University, Burnaby, BC V5A 1S6, Canada; SFU-JLU Joint Centre for Bioarchaeological Research, Department of Archeaology, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Quanchao Zhang
- Research Centre for Chinese Frontier Archaeology, Jilin University, Changchun, Jilin 130012, China; SFU-JLU Joint Centre for Bioarchaeological Research, Department of Archeaology, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Hong Zhu
- Research Centre for Chinese Frontier Archaeology, Jilin University, Changchun, Jilin 130012, China; SFU-JLU Joint Centre for Bioarchaeological Research, Department of Archeaology, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Dongya Y Yang
- Department of Archaeology, Simon Fraser University, Burnaby, BC V5A 1S6, Canada; SFU-JLU Joint Centre for Bioarchaeological Research, Department of Archeaology, Simon Fraser University, Burnaby, BC V5A 1S6, Canada.
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Williams AA, Titchenal MR, Do BH, Guha A, Chu CR. MRI UTE-T2* shows high incidence of cartilage subsurface matrix changes 2 years after ACL reconstruction. J Orthop Res 2019; 37:370-377. [PMID: 30030866 DOI: 10.1002/jor.24110] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 07/13/2018] [Indexed: 02/06/2023]
Abstract
Alteration of deep cartilage matrix has been observed following anterior cruciate ligament (ACL) injury, evidenced by elevated MRI UTE-T2* values measured in small, 2-D cartilage regions of interest. This Level I diagnostic study seeks to more thoroughly evaluate deep cartilage matrix changes to medial tibiofemoral UTE-T2* maps 2 years after ACL reconstruction and examine the relative utilities of 3-D compared to 2-D assessments of cartilage UTE-T2* maps. Thirty-eight ACL-reconstructed and 20 uninjured subjects underwent MRI UTE-T2* mapping. "Small" single mid-sagittal 2-D and larger 3-D "tread mark" regions of interest were manually segmented and found to be correlated in medial cartilage (r > 0.58, p < 0.005). 3-D analyses of UTE-T2* maps showed differences to medial tibial cartilage between ACL-reconstructed and uninjured subjects (p = 0.007) that were not detected by smaller 2-D regions (p > 0.46). Quantitative comparisons show 14/38 (37%) ACL-reconstructed subjects have values >2 standard deviations higher than uninjured controls. Among a subset of ACL-reconstructed subjects with no morphologic MRI evidence of medial tibiofemoral cartilage or meniscal pathology (n = 12), elevated UTE-T2* values in "small" 2-D femoral (p = 0.011), but not larger 3-D tread mark regions of interest (p > 0.13), were observed. These data show the utility of 2-D UTE-T2* assessments of mid-sagittal weight-bearing regions of medial femoral cartilage for identifying subclinical deep cartilage matrix changes 2 years after ACLR. Clinical Significance: Mid-sagittal single slice 2-D UTE-T2* mapping may be an efficient means to assess medial femoral cartilage for subsurface matrix changes early after ACL reconstruction while 3-D assessments provide additional sensitivity to changes in the medial tibial plateau. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:370-377, 2019.
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Affiliation(s)
- Ashley A Williams
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street, MC 6342, Redwood City, California 94063
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Matthew R Titchenal
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street, MC 6342, Redwood City, California 94063
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Department of Mechanical Engineering, Stanford University, Stanford, California
| | - Bao H Do
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Department of Radiology, Stanford University, Stanford, California
| | - Aditi Guha
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street, MC 6342, Redwood City, California 94063
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Constance R Chu
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street, MC 6342, Redwood City, California 94063
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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34
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Luc-Harkey BA, Franz JR, Hackney AC, Blackburn JT, Padua DA, Pietrosimone B. Lesser lower extremity mechanical loading associates with a greater increase in serum cartilage oligomeric matrix protein following walking in individuals with anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2018; 60:13-19. [PMID: 30292062 DOI: 10.1016/j.clinbiomech.2018.09.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 09/19/2018] [Accepted: 09/25/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Aberrant mechanical loading during gait is hypothesized to contribute to the development of posttraumatic osteoarthritis following anterior cruciate ligament reconstruction. Our purpose was to determine if peak vertical ground reaction force and instantaneous vertical ground reaction force loading rate associate with the acute change in serum cartilage oligomeric matrix protein following a 20-minute bout of walking. METHODS We enrolled thirty individuals with a unilateral anterior cruciate ligament reconstruction. Peak vertical ground reaction force and instantaneous vertical ground reaction force loading rate were extracted from the first 50% of the stance phase of gait during a 60-second trial. Blood samples were collected immediately before and after 20 min of treadmill walking at self-selected speed. The change in serum cartilage oligomeric matrix protein from pre- to post-walking was calculated. Stepwise linear regression models were used to determine the association between each outcome of loading and the change in serum cartilage oligomeric matrix protein after accounting for sex, gait speed, time since anterior cruciate ligament reconstruction, graft type, and history of concomitant meniscal procedure (ΔR2). FINDINGS Lesser peak vertical ground reaction force (ΔR2 = 0.208; β = -0.561; P = 0.019) and instantaneous vertical ground reaction force loading rate (ΔR2 = 0.168; β = -0.519; P = 0.037) on the anterior cruciate ligament reconstructed limb associated with a greater increase in serum cartilage oligomeric matrix protein following 20 min of walking. INTERPRETATION Mechanical loading may be a future therapeutic target for altering the acute biochemical response to walking in individuals with an anterior cruciate ligament reconstruction.
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Affiliation(s)
- Brittney A Luc-Harkey
- Neurological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America.
| | - Jason R Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, United States of America
| | - Anthony C Hackney
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - J Troy Blackburn
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Darin A Padua
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Brian Pietrosimone
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
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Pietrosimone B, Blackburn JT, Padua DA, Pfeiffer SJ, Davis HC, Luc-Harkey BA, Harkey MS, Stanley Pietrosimone L, Frank BS, Creighton RA, Kamath GM, Spang JT. Walking gait asymmetries 6 months following anterior cruciate ligament reconstruction predict 12-month patient-reported outcomes. J Orthop Res 2018; 36:2932-2940. [PMID: 29781550 DOI: 10.1002/jor.24056] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 02/15/2018] [Indexed: 02/04/2023]
Abstract
The study sought to determine the association between gait biomechanics (vertical ground reaction force [vGRF], vGRF loading rate [vGRF-LR]) collected 6 months following anterior cruciate ligament reconstruction (ACLR) with patient-reported outcomes at 12 months following ACLR. Walking gait biomechanics and all subsections of the Knee Injury and Osteoarthritis Outcomes Score (KOOS) were collected at 6 and 12 months following ACLR, respectively, in 25 individuals with a unilateral ACLR. Peak vGRF and peak instantaneous vGRF-LR were extracted from the first 50% of the stance phase. Limb symmetry indices (LSI) were used to normalize outcomes in the ACLR limb to that of the uninjured limb (ACLR/uninjured). Linear regression analyses were used to determine associations between biomechanical outcomes and KOOS while accounting for walking speed. Receiver operator characteristic curves were used to determine the accuracy of 6-month biomechanical outcomes for identifying individuals with acceptable patient-reported outcomes, using previously defined KOOS cut-off scores, 12 months post-ACLR. Individuals with lower peak vGRF LSI 6 months post-ACLR demonstrated worse patient-reported outcomes (KOOS Pain, Activities of Daily life, Sport and Recreation, Quality of Life) at the 12-month exam. A peak vGRF LSI ≥0.99 6 months following ACLR associated with 13.33× higher odds of reporting acceptable patient-reported outcomes 12 months post-ACLR. Lesser peak vGRF LSI during walking at 6-months post-ACLR may be a critical indicator of worse future patient-reported outcomes. Clinical significance achieving early symmetrical lower extremity loading and minimizing under-loading of the ACLR limb during walking may be a potential therapeutic target for improving patient-reported outcomes post-ACLR. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2932-2940, 2018.
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Affiliation(s)
- Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - J Troy Blackburn
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Darin A Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Steven J Pfeiffer
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hope C Davis
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brittney A Luc-Harkey
- Department of Orthopedic Surgery, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, Massachusetts
| | - Matthew S Harkey
- Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts
| | - Laura Stanley Pietrosimone
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Barnett S Frank
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Robert Alexander Creighton
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ganesh M Kamath
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jeffery T Spang
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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36
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Luo Y, Zhang Y, Huang Y. Icariin Reduces Cartilage Degeneration in a Mouse Model of Osteoarthritis and is Associated with the Changes in Expression of Indian Hedgehog and Parathyroid Hormone-Related Protein. Med Sci Monit 2018; 24:6695-6706. [PMID: 30244259 PMCID: PMC6180903 DOI: 10.12659/msm.910983] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background The aim of this study was to determine the role of icariin, a Chinese traditional herbal medicine extracted from Epimedium, in osteoarthritis (OA), using the murine anterior cruciate ligament transection (ACLT)-induced model of OA and micromass culture of murine chondrocytes. Material/Methods Twenty-four three-month-old C57/6J mice were randomly divided into three groups: the sham group (no surgery and joint injection with normal saline) (N=8); the ACLT + ICA group (ACLT surgery and icariin treatment) (N=8); and the ACLT group (ACLT surgery and joint injection with normal saline) (N=8). At 12 weeks after ACLT surgery, murine articular cartilage was harvested from all mice for histological evaluation of any differences in cartilage degeneration. In vitro micromass culture of mouse chondrocytes was used to study the effects of icariin on chondrocyte differentiation and growth from the three mouse groups. Results Icariin treatment (mice in the ACLT + ICA group) significantly reduced degeneration of cartilage in OA with increased cartilage thickness, associated with increased expression of collagen type II alpha 1 (COL2A1), decreased chondrocyte hypertrophy, and decreased expression of collagen type X (ColX) and matrix metalloproteinase 13 (MMP13). In vitro, icariin promoted chondrocyte differentiation by upregulating the expression of agrrecan, Sox9 and parathyroid hormone-related protein (PHrP) and down-regulation of Indian hedgehog (Ihh) and genes regulated by Ihh. Conclusions In a mouse model of OA icariin treatment reduced destruction of cartilage, promoted chondrocyte differentiation, upregulated expression of PHrP and down-regulated the expression of Ihh.
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Affiliation(s)
- Yuan Luo
- Laboratory of Oral Biomedical Science and Translational Medicine, School of Stomatology, Tongji University, Shanghai, China (mainland).,Department of Oral Surgery, Shanghai Stomatology Disease Centre, Shanghai, China (mainland)
| | - Yiwen Zhang
- Laboratory of Oral Biomedical Science and Translational Medicine, School of Stomatology, Tongji University, Shanghai, China (mainland)
| | - Yuanliang Huang
- Laboratory of Oral Biomedical Science and Translational Medicine, School of Stomatology, Tongji University, Shanghai, China (mainland).,Department of Stomatology, Shanghai East Hospital Affiliated with Tongji University, Shanghai, China (mainland)
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Malahias MA, Chytas D, Nakamura K, Raoulis V, Yokota M, Nikolaou VS. A Narrative Review of Four Different New Techniques in Primary Anterior Cruciate Ligament Repair: "Back to the Future" or Another Trend? SPORTS MEDICINE-OPEN 2018; 4:37. [PMID: 30094753 PMCID: PMC6085215 DOI: 10.1186/s40798-018-0145-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/02/2018] [Indexed: 01/28/2023]
Abstract
Recently, four different operative techniques, referring to the primary anterior cruciate ligament (ACL) repair, were described. These are the dynamic intraligamentary stabilization (DIS) with Ligamys™, the Bridge-enhanced repair (BEAR), the use of internal brace, and the refixation with suture anchors. The purpose of this study was to assess the already-published, clinical, and pre-clinical results of those techniques. A literature review was conducted and implemented by three independent researchers. Inclusion criteria were clinical or cadaveric or animal studies about patients suffering from ACL rupture, who were treated with one of those four different arthroscopic techniques of primary ACL repair. There were 10 clinical trials dealing with the different techniques of primary ACL repair and 12 cadaveric or animal studies. The majority of the published clinical trials investigated the dynamic intraligamentary stabilization (DIS), while only four studies referred to the three other surgical techniques. Most of the clinical trials suggested that primary ACL repair should be done during the first 14–21 days after a proximal ACL rupture and not later. Further clinical evidence is needed for the techniques of bridge-enhanced ACL repair, internal brace, and suture anchors ACL refixation in order to support the animal and cadaveric biomechanical studies. Till now, the existing clinical trials were not enough to establish the use of those techniques in the ACL-ruptured patients. On the contrary, the Dynamic intraligamentary stabilization with Ligamys™ device demonstrated very promising results in different types of clinical studies.
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Affiliation(s)
- Michael-Alexander Malahias
- 2nd Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. .,ATOS Hospital, Heidelberg, Germany. .,Orthopaedic Surgeon, ATOS Klinik, Schlossberg 21, 69117, Heidelberg, Germany.
| | - Dimitrios Chytas
- 2nd Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Kaori Nakamura
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.,ATOS Hospital, Heidelberg, Germany
| | - Vasileios Raoulis
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.,ATOS Hospital, Heidelberg, Germany
| | - Masashi Yokota
- Department of Sports Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Vasileios S Nikolaou
- 2nd Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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38
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Real-time biofeedback can increase and decrease vertical ground reaction force, knee flexion excursion, and knee extension moment during walking in individuals with anterior cruciate ligament reconstruction. J Biomech 2018; 76:94-102. [DOI: 10.1016/j.jbiomech.2018.05.043] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 05/17/2018] [Accepted: 05/30/2018] [Indexed: 11/21/2022]
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HARKEY MATTHEWS, BLACKBURN JTROY, HACKNEY ANTHONYC, LEWEK MICHAELD, SCHMITZ RANDYJ, PIETROSIMONE BRIAN. Acute Serum Cartilage Biomarker Response after Walking and Drop Landing. Med Sci Sports Exerc 2018; 50:1465-1471. [DOI: 10.1249/mss.0000000000001585] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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40
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Erhart-Hledik JC, Chu CR, Asay JL, Andriacchi TP. Longitudinal changes in knee gait mechanics between 2 and 8 years after anterior cruciate ligament reconstruction. J Orthop Res 2018; 36:1478-1486. [PMID: 28984381 PMCID: PMC5889359 DOI: 10.1002/jor.23770] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 10/04/2017] [Indexed: 02/06/2023]
Abstract
The purpose of this study was to longitudinally investigate changes in knee joint kinematics and kinetics from 2 to 8 years post-ACLR. Seventeen subjects with primary unilateral transtibial ACLR performed bilateral gait analysis approximately 2 years and 8 years post-ACLR. Seventeen matched healthy control subjects were also analyzed. Kinematic and kinetic comparisons between the ACLR and contralateral limbs over time were completed using a 2 × 2 (time, limb) repeated-measures ANOVA. Unpaired Student's t-tests were used to compare the ACLR and contralateral kinematics and kinetics to the control group. The ACLR and contralateral limbs had similar gait changes over time. Kinetic changes over time included a reduction in first (p = 0.048) and second (p < 0.001) peak extension moments, internal rotation moment (p < 0.001), adduction moment (first peak: p = 0.002, second peak: p = 0.009, impulse: p = 0.004) and an increase in peak knee flexion moment (p = 0.002). Kinematic changes over time included increases in peak knee flexion angle in the first half of stance (p = 0.026), minimum knee flexion angle in the second half of stance (p < 0.001), and average external rotation angle during stance (p = 0.007), and a reduction in average anterior femoral displacement during stance (p = 0.006). Comparison to healthy controls demonstrated improvement in some gait metrics over time. The results demonstrated longitudinal changes from 2 to 8 years after ACLR in knee joint kinetics and kinematics that have been related to clinical outcome after ACLR and the progression of knee OA, and support future larger and comprehensive investigations into long-term changes in joint mechanics in the ACLR population. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1478-1486, 2018.
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Affiliation(s)
| | - Constance R. Chu
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Jessica L. Asay
- Department of Mechanical Engineering, Stanford University, Stanford, CA,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Thomas P. Andriacchi
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA,Department of Mechanical Engineering, Stanford University, Stanford, CA,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
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41
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Williams A, Titchenal M, Andriacchi T, Chu C. MRI UTE-T2* profile characteristics correlate to walking mechanics and patient reported outcomes 2 years after ACL reconstruction. Osteoarthritis Cartilage 2018; 26:569-579. [PMID: 29426012 PMCID: PMC6548437 DOI: 10.1016/j.joca.2018.01.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 01/08/2018] [Accepted: 01/16/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Quantitative magnetic resonance imaging (MRI) ultrashort echo time (UTE) T2* is sensitive to cartilage deep tissue matrix changes after anterior cruciate ligament reconstruction (ACLR). This study was performed to determine whether UTE-T2* profile analysis is a useful clinical metric for assessing cartilage matrix degeneration. This work tests the hypotheses that UTE-T2* depthwise rates of change (profile slopes) correlate with clinical outcome metrics of walking mechanics and patient reported outcomes (PRO) in patients 2 years after ACLR. DESIGN Thirty-six patients 2 years after ACLR completed knee MRI, gait analysis, and PRO. UTE-T2* maps were generated from MRI images and depthwise UTE-T2* profiles were calculated for weight-bearing cartilage in the medial compartment. UTE-T2* profiles from 14 uninjured subjects provided reference values. UTE-T2* profile characteristics, including several different measures of profile slope, were tested for correlation to kinetic and kinematic measures of gait and also to PRO. RESULTS Decreasing UTE-T2* profile slopes in ACLR knees moderately correlated with increasing knee adduction moments (r = 0.41, P < 0.015), greater external tibial rotation (r = 0.44, P = 0.007), and moderately negatively correlated with PRO (r = -0.36, P = 0.032). UTE-T2* profiles from both ACLR and contralateral knees of ACLR subjects differed from that of uninjured controls (P < 0.015). CONCLUSIONS The results of this study suggest that decreasing UTE-T2* profile slopes reflect cartilage deep tissue collagen matrix disruption in a population at increased risk for knee osteoarthritis (OA). That UTE-T2* profiles were associated with mechanical and patient reported measures of clinical outcomes support further study into a potential mechanistic relationship between these factors and OA development.
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Affiliation(s)
- A.A. Williams
- Department of Orthopedic Surgery, Stanford University,
Stanford, CA, USA,Veterans Affairs Palo Alto Health Care System, Palo Alto,
CA, USA
| | - M.R. Titchenal
- Department of Orthopedic Surgery, Stanford University,
Stanford, CA, USA,Mechanical Engineering, Stanford University, Stanford, CA,
USA,Veterans Affairs Palo Alto Health Care System, Palo Alto,
CA, USA
| | - T.P. Andriacchi
- Department of Orthopedic Surgery, Stanford University,
Stanford, CA, USA,Mechanical Engineering, Stanford University, Stanford, CA,
USA,Veterans Affairs Palo Alto Health Care System, Palo Alto,
CA, USA
| | - C.R. Chu
- Department of Orthopedic Surgery, Stanford University,
Stanford, CA, USA,Veterans Affairs Palo Alto Health Care System, Palo Alto,
CA, USA,Address correspondence and reprint requests to: C.R.
Chu, Stanford University Medical Center, Department of Orthopaedic Surgery, 450
Broadway Street, MC 6342, Redwood City, CA 94063, USA. Fax: 1-650-721-3470.
(C.R. Chu)
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Britzman D, Igah I, Eftaxiopoulou T, Macdonald W, Bull AMJ. Tibial Osteotomy as a Mechanical Model of Primary Osteoarthritis in Rats. Sci Rep 2018; 8:5132. [PMID: 29572481 PMCID: PMC5865111 DOI: 10.1038/s41598-018-23405-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 02/26/2018] [Indexed: 12/21/2022] Open
Abstract
This study has presented the first purely biomechanical surgical model of osteoarthritis (OA) in rats, which could be more representative of the human primary disease than intra-articular techniques published previously. A surgical tibial osteotomy (TO) was used to induce degenerative cartilage changes in the medial knee of Sprague-Dawley rats. The presence of osteoarthritic changes in the medial knee compartment of the operated animals was evaluated histologically and through analysis of serum carboxy-terminal telepeptides of type II collagen (CTX-II). In-vivo biomechanical analyses were carried out using a musculoskeletal model of the rat hindlimb to evaluate the loading conditions in the knee pre and post-surgically. Qualitative and quantitative medial cartilage degeneration consistent with OA was found in the knees of the operated animals alongside elevated CTX-II levels and increased tibial compressive loading. The potential avoidance of joint inflammation post-surgically, the maintenance of internal joint biomechanics and the ability to quantify the alterations in joint loading should make this model of OA a better candidate for modeling primary forms of the disease in humans.
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Affiliation(s)
- David Britzman
- Department of Bioengineering, Imperial College London, South Kensington, SW7 2AZ, UK.
| | - Ibidumo Igah
- Department of Bioengineering, Imperial College London, South Kensington, SW7 2AZ, UK
| | | | - Warren Macdonald
- Department of Bioengineering, Imperial College London, South Kensington, SW7 2AZ, UK
| | - Anthony M J Bull
- Department of Bioengineering, Imperial College London, South Kensington, SW7 2AZ, UK
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43
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Chu CR, Sheth S, Erhart-Hledik JC, Do B, Titchenal MR, Andriacchi TP. Mechanically stimulated biomarkers signal cartilage changes over 5 years consistent with disease progression in medial knee osteoarthritis patients. J Orthop Res 2018; 36:891-897. [PMID: 28862360 PMCID: PMC6548432 DOI: 10.1002/jor.23720] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 08/29/2017] [Indexed: 02/04/2023]
Abstract
Using serum biomarkers to assess osteoarthritis (OA) disease state and risks of progression remain challenging. This study tested the hypothesis that changes to serum biomarkers in response to a mechanical stimulus in patients with medial knee OA signal cartilage thickness changes 5 years later. Specifically, serum concentrations of a collagen degradation marker (C1,2C) and a chondroitin sulfate synthesis marker (CS846) were measured 0.5 and 5.5 hours after a 30-min walk in 16 patients. Regional cartilage thickness changes measured from magnetic resonance images obtained at study entry and at 5-year follow-up were tested for correlations with baseline biomarker changes after mechanical stimulus, and for differences between groups stratified based on whether biomarker levels increased or decreased. Results showed that an increase in the degradation biomarker C1,2C correlated with cartilage thinning of the lateral tibia (R = -0.63, p = 0.009), whereas an increase in the synthesis marker CS846 correlated with cartilage thickening of the lateral femur (R = 0.76, p = 0.001). Changes in C1,2C and CS846 were correlated (R2 = 0.28, p = 0.037). Subjects with increased C1,2C had greater (p = 0.05) medial tibial cartilage thinning than those with decreased C1,2C. In conclusion, the mechanical stimulus appeared to metabolically link the biomarker responses where biomarker increases signaled more active OA disease states. The findings of medial cartilage thinning for patients with increases in the degradation marker and correlation of cartilage thickening in the less involved lateral femur with increases in the synthetic marker were consistent with progression of medial compartment OA. Thus, the mechanical stimulus facilitated assessing OA disease states using serum biomarkers. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:891-897, 2018.
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Affiliation(s)
- Constance R. Chu
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California,Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Shikha Sheth
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California,Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Jennifer C. Erhart-Hledik
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California,Veterans Affairs Palo Alto Health Care System, Palo Alto, California,Department of Mechanical Engineering, Stanford University, Building 520, Stanford 94305-4040, California
| | - Bao Do
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California,Veterans Affairs Palo Alto Health Care System, Palo Alto, California,Department of Radiology, Stanford University Medical Center, Stanford, California
| | - Matthew R. Titchenal
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California,Veterans Affairs Palo Alto Health Care System, Palo Alto, California,Department of Mechanical Engineering, Stanford University, Building 520, Stanford 94305-4040, California
| | - Thomas P. Andriacchi
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California,Veterans Affairs Palo Alto Health Care System, Palo Alto, California,Department of Mechanical Engineering, Stanford University, Building 520, Stanford 94305-4040, California
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44
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pregizer SK, Kiapour AM, Young M, Chen H, Schoor M, Liu Z, Cao J, Rosen V, Capellini TD. Impact of broad regulatory regions on Gdf5 expression and function in knee development and susceptibility to osteoarthritis. Ann Rheum Dis 2018; 77:450. [PMID: 29311146 PMCID: PMC6338229 DOI: 10.1136/annrheumdis-2017-212475] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/11/2017] [Accepted: 12/23/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Given the role of growth and differentiation factor 5 (GDF5) in knee development and osteoarthritis risk, we sought to characterise knee defects resulting from Gdf5 loss of function and how its regulatory regions control knee formation and morphology. METHODS The brachypodism (bp) mouse line, which harbours an inactivating mutation in Gdf5, was used to survey how Gdf5 loss of function impacts knee morphology, while two transgenic Gdf5 reporter bacterial artificial chromosome mouse lines were used to assess the spatiotemporal activity and function of Gdf5 regulatory sequences in the context of clinically relevant knee anatomical features. RESULTS Knees from homozygous bp mice (bp/bp) exhibit underdeveloped femoral condyles and tibial plateaus, no cruciate ligaments, and poorly developed menisci. Secondary ossification is also delayed in the distal femur and proximal tibia. bp/bp mice have significantly narrower femoral condyles, femoral notches and tibial plateaus, and curvier medial femoral condyles, shallower trochlea, steeper lateral tibial slopes and smaller tibial spines. Regulatory sequences upstream from Gdf5 were weakly active in the prenatal knee, while downstream regulatory sequences were active throughout life. Importantly, downstream but not upstream Gdf5 regulatory sequences fully restored all the key morphological features disrupted in the bp/bp mice. CONCLUSIONS Knee morphology is profoundly affected by Gdf5 absence, and downstream regulatory sequences mediate its effects by controlling Gdf5 expression in knee tissues. This downstream region contains numerous enhancers harbouring human variants that span the osteoarthritis association interval. We posit that subtle alterations to morphology driven by changes in downstream regulatory sequence underlie this locus' role in osteoarthritis risk.
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Affiliation(s)
- Steven K pregizer
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Ata M Kiapour
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, Massachusetts, USA
| | - Mariel Young
- Department of Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA
| | - Hao Chen
- Genentech, South San Francisco, California, USA
| | | | - Zun Liu
- Department of Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA
| | - Jiaxue Cao
- Department of Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA
- Sichuan Agricultural University, Chengdu, China
| | - Vicki Rosen
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Terence D Capellini
- Department of Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
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45
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Ladd AL. The Teleology of the Thumb: On Purpose and Design. J Hand Surg Am 2018; 43:248-259. [PMID: 29502577 PMCID: PMC5841599 DOI: 10.1016/j.jhsa.2018.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 01/03/2018] [Accepted: 01/03/2018] [Indexed: 02/02/2023]
Abstract
The Andrew J. Weiland Medal is presented by the American Society for Surgery of the Hand to a midcareer researcher dedicated to advancing patient care in the field of hand surgery. The Weiland Medal for 2017 was presented to the author at the annual meeting of the American Society for Surgery of the Hand. The purpose of this article is to present current evidence on how biomechanics and morphology influence the pathophysiology of thumb carpometacarpal joint osteoarthritis.
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Affiliation(s)
- Amy L Ladd
- The Robert A. Chase Hand Center, Stanford, CA.
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46
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Titchenal MR, Williams AA, Chehab EF, Asay JL, Dragoo JL, Gold GE, McAdams TR, Andriacchi TP, Chu CR. Cartilage Subsurface Changes to Magnetic Resonance Imaging UTE-T2* 2 Years After Anterior Cruciate Ligament Reconstruction Correlate With Walking Mechanics Associated With Knee Osteoarthritis. Am J Sports Med 2018; 46:565-572. [PMID: 29293364 PMCID: PMC6548433 DOI: 10.1177/0363546517743969] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury increases risk for posttraumatic knee osteoarthritis (OA). Quantitative ultrashort echo time enhanced T2* (UTE-T2*) mapping shows promise for early detection of potentially reversible subsurface cartilage abnormalities after ACL reconstruction (ACLR) but needs further validation against established clinical metrics of OA risk such as knee adduction moment (KAM) and mechanical alignment. HYPOTHESIS Elevated UTE-T2* values in medial knee cartilage 2 years after ACLR correlate with varus alignment and higher KAM during walking. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS Twenty patients (mean age, 33.1 ± 10.5 years; 11 female) 2 years after ACLR underwent 3.0-T knee magnetic resonance imaging (MRI), radiography, and gait analysis, after which mechanical alignment was measured, KAM during walking was calculated, and UTE-T2* maps were generated. The mechanical axis and the first and second peaks of KAM (KAM1 and KAM2, respectively) were tested using linear regressions for correlations with deep UTE-T2* values in the central and posterior medial femoral condyle (cMFC and pMFC, respectively) and central medial tibial plateau (cMTP). UTE-T2* values from ACL-reconstructed patients were additionally compared with those of 14 uninjured participants (mean age, 30.9 ± 8.9 years; 6 female) using Mann-Whitney U and standard t tests. RESULTS Central weightbearing medial compartment cartilage of ACL-reconstructed knees was intact on morphological MRI. Mean UTE-T2* values were elevated in both the cMFC and pMFC of ACL-reconstructed knees compared with those of uninjured knees ( P = .003 and P = .012, respectively). In ACL-reconstructed knees, UTE-T2* values of cMFC cartilage positively correlated with increasing varus alignment ( R = 0.568). Higher UTE-T2* values in cMFC and cMTP cartilage of ACL-reconstructed knees also correlated with greater KAM1 ( R = 0.452 and R = 0.463, respectively) and KAM2 ( R = 0.465 and R = 0.764, respectively) and with KAM2 in pMFC cartilage ( R = 0.602). CONCLUSION Elevated deep UTE-T2* values of medial knee cartilage 2 years after ACLR correlate with 2 clinical markers of increased risk of medial knee OA. These results support the clinical utility of MRI UTE-T2* for early diagnosis of subsurface cartilage abnormalities. Longitudinal follow-up of larger cohorts is needed to determine the predictive and staging potential of UTE-T2* for posttraumatic OA.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Constance R. Chu
- Address correspondence to Constance R. Chu, MD, Stanford University, 450 Broadway Street, MC 6342, Redwood City, CA 94061, USA ()
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47
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Lynall RC, Pietrosimone B, Kerr ZY, Mauntel TC, Mihalik JP, Guskiewicz KM. Osteoarthritis Prevalence in Retired National Football League Players With a History of Concussion and Lower Extremity Injury. J Athl Train 2018; 52:518-525. [PMID: 28653870 DOI: 10.4085/1062-6050-52.2.03] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
CONTEXT Dynamic balance deficits have been described postconcussion, even after athletes return to play. Lower extremity (LE) musculoskeletal injury rates increase for up to 1 year after concussion, but the long-term musculoskeletal implications of concussion are unclear. OBJECTIVE To (1) examine the association of concussion and LE injury histories with osteoarthritis (OA) prevalence in retired National Football League players and (2) examine the association of concussion and LE injury histories with OA prevalence in those ≤55 years of age. DESIGN Case-control study. SETTING Survey. PATIENTS OR OTHER PARTICIPANTS We administered the Health Survey of Retired National Football League Players, which collects information about demographics, OA, LE injury, and concussion history. MAIN OUTCOME MEASURE(S) Twelve discrete categories were created based on concussion and LE injury history, ranging from 0 concussions and 0 LE injuries (referent group) to 3+ concussions and 2+ LE injuries. Binomial regression analysis modeled lifetime OA prevalence. Covariates were body mass index, age at the time of the survey, and total years playing professional football. RESULTS Complete data were available for 2696 participants. Lifetime OA prevalence was smallest in the referent group (21.1%) and largest in the 3+ concussion and 2+ LE group (50.6%; 2.5 times the referent; 95% confidence interval [CI] = 2.1, 3.1). Participants in all concussion groups (1, 2, 3+) who reported a history of 0 LE injuries had a greater OA prevalence than the referent group. When participants were stratified by age, the ≤55 years of age, 3+ concussions, and 2+ LE injuries group prevalence ratio (3.6; 95% CI = 2.7, 5.2) was larger than that of the >55 years of age, 3+ concussions, and 2+ LE injuries group (1.8; 95% CI = 1.3, 2.4) compared with the respective referent groups. CONCLUSIONS Concussion with or without a history of LE injury may be an important moderator of OA. Future researchers should seek to better understand the mechanisms that influence the association among concussion, LE injury, and OA.
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Affiliation(s)
- Robert C Lynall
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center.,Curriculum in Human Movement Science, Department of Allied Health Sciences, University of North Carolina at Chapel Hill. Dr Lynall is now at the Concussion Research Laboratory, Department of Kinesiology, The University of Georgia, Athens. Dr Mauntel is now at Walter Reed National Military Medical Center, Department of Orthopaedics, Bethesda, MD
| | - Brian Pietrosimone
- Neuromuscular Research Laboratory.,Sports Medicine Research Laboratory.,Curriculum in Human Movement Science, Department of Allied Health Sciences, University of North Carolina at Chapel Hill. Dr Lynall is now at the Concussion Research Laboratory, Department of Kinesiology, The University of Georgia, Athens. Dr Mauntel is now at Walter Reed National Military Medical Center, Department of Orthopaedics, Bethesda, MD
| | | | - Timothy C Mauntel
- Sports Medicine Research Laboratory.,Curriculum in Human Movement Science, Department of Allied Health Sciences, University of North Carolina at Chapel Hill. Dr Lynall is now at the Concussion Research Laboratory, Department of Kinesiology, The University of Georgia, Athens. Dr Mauntel is now at Walter Reed National Military Medical Center, Department of Orthopaedics, Bethesda, MD
| | - Jason P Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center.,Curriculum in Human Movement Science, Department of Allied Health Sciences, University of North Carolina at Chapel Hill. Dr Lynall is now at the Concussion Research Laboratory, Department of Kinesiology, The University of Georgia, Athens. Dr Mauntel is now at Walter Reed National Military Medical Center, Department of Orthopaedics, Bethesda, MD
| | - Kevin M Guskiewicz
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center.,Curriculum in Human Movement Science, Department of Allied Health Sciences, University of North Carolina at Chapel Hill. Dr Lynall is now at the Concussion Research Laboratory, Department of Kinesiology, The University of Georgia, Athens. Dr Mauntel is now at Walter Reed National Military Medical Center, Department of Orthopaedics, Bethesda, MD
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48
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Desando G, Bartolotti I, Cavallo C, Schiavinato A, Secchieri C, Kon E, Filardo G, Paro M, Grigolo B. Short-Term Homing of Hyaluronan-Primed Cells: Therapeutic Implications for Osteoarthritis Treatment. Tissue Eng Part C Methods 2017; 24:121-133. [PMID: 29108480 DOI: 10.1089/ten.tec.2017.0336] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The evaluation of key factors modulating cell homing following injection can provide new insights in the comprehension of unsolved biological questions about the use of cell therapies for osteoarthritis (OA). The main purpose of this in vivo study was to investigate the biodistribution of an intra-articular injection of mesenchymal stromal cells (MSCs) and bone marrow concentrate (BMC) in a rabbit OA model and whether the additional use of sodium hyaluronate (HA) could modulate their migration and delay joint degeneration. OA was surgically induced in adult male New Zealand rabbits. A group of animals was used to test the biodistribution of labeled cells alone or with HA at 7 and 14 days to investigate cell migration. The efficacy of treatments was evaluated in other experimental groups at 2 months. Histology and immunohistochemistry for markers identifying anabolic and catabolic processes in the cartilage and meniscus, or macrophage subset population in the synovial membrane, were performed. Kruskal-Wallis test, followed by post hoc Dunn's test, and Spearman's rank-order correlation method were used. MSCs and BMC preferentially migrate toward tissue areas showing OA features in the meniscus and cartilage and in detail near inflammatory zones in the synovial membrane. The combination with HA contributed to boost cell migration toward articular cartilage. In general, both labeled cells combined with HA were found near cell cluster and fissures in the cartilage and meniscus, respectively, and close to areas of synovial membrane showing mainly anti-inflammatory macrophages. A promotion of joint repair was observed at different levels for all treatments, although BMC-HA treatment resulted as the best strategy to support joint repair. This last, displayed a good protein expression of type II collagen in the cartilage, as well as the presence of anti-inflammatory macrophages in the synovial membrane at 2 months from the treatment. Studies tracking cell biodistribution indicate that priming progenitor cells with HA modulated cell homing favoring not only attachment but also their integration within articular cartilage.
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Affiliation(s)
- Giovanna Desando
- 1 Laboratorio RAMSES, Istituto Ortopedico Rizzoli (IOR) , Bologna, Italy
| | | | - Carola Cavallo
- 1 Laboratorio RAMSES, Istituto Ortopedico Rizzoli (IOR) , Bologna, Italy
| | | | | | - Elizaveta Kon
- 3 Humanitas University Department of Biomedical Sciences , Humanitas Clinical and Research Center, Milan, Italy
| | - Giuseppe Filardo
- 4 Laboratorio di Nano-Biotecnologie, Istituto Ortopedico Rizzoli , Bologna, Italy
| | | | - Brunella Grigolo
- 6 Laboratorio RAMSES/Immunoreumatologia e Rigenerazione Tissutale, IOR , Bologna, Italy
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49
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Desando G, Giavaresi G, Cavallo C, Bartolotti I, Sartoni F, Nicoli Aldini N, Martini L, Parrilli A, Mariani E, Fini M, Grigolo B. Autologous Bone Marrow Concentrate in a Sheep Model of Osteoarthritis: New Perspectives for Cartilage and Meniscus Repair. Tissue Eng Part C Methods 2017; 22:608-19. [PMID: 27151837 DOI: 10.1089/ten.tec.2016.0033] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Cell-based therapies are becoming a valuable tool to treat osteoarthritis (OA). This study investigated and compared the regenerative potential of bone marrow concentrate (BMC) and mesenchymal stem cells (MSC), both engineered with Hyaff(®)-11 (HA) for OA treatment in a sheep model. METHODS OA was induced via unilateral medial meniscectomy. Bone marrow was aspirated from the iliac crest, followed by concentration processes or cell isolation and expansion to obtain BMC and MSC, respectively. Treatments consisted of autologous BMC and MSC seeded onto HA. The regenerative potential of bone, cartilage, menisci, and synovia was monitored using macroscopy, histology, immunohistochemistry, and micro-computed tomography at 12 weeks post-op. Data were analyzed using the general linear model with adjusted Sidak's multiple comparison and Spearman's tests. RESULTS BMC-HA treatment showed a greater repair ability in inhibiting OA progression compared to MSC-HA, leading to a reduction of inflammation in cartilage, meniscus, and synovium. Indeed, the decrease of inflammation positively contributed to counteract the progression of fibrotic and hypertrophic processes, known to be involved in tissue failure. Moreover, the treatment with BMC-HA showed the best results in allowing meniscus regeneration. Minor healing effects were noticed at bone level for both cell strategies; however, a downregulation of subchondral bone thickness (Cs.Th) was found in both cell treatments compared to the OA group in the femur. CONCLUSION The transplantation of BMC-HA provided the best effects in supporting regenerative processes in cartilage, meniscus, and synovium and at less extent in bone. On the whole, both MSC and BMC combined with HA reduced inflammation and contributed to switch off fibrotic and hypertrophic processes. The observed regenerative potential by BMC-HA on meniscus could open new perspectives, suggesting its use not only for OA care but also for the treatment of meniscal lesions, even if further analyses are necessary to confirm its healing potential at long-term follow-up.
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Affiliation(s)
- Giovanna Desando
- 1 Laboratory RAMSES, Rizzoli Orthopedic Institute , Bologna, Italy
| | - Gianluca Giavaresi
- 2 Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopedic Institute , Bologna, Italy .,3 Laboratory BITTA, Rizzoli Orthopedic Institute , Bologna, Italy
| | - Carola Cavallo
- 1 Laboratory RAMSES, Rizzoli Orthopedic Institute , Bologna, Italy
| | - Isabella Bartolotti
- 4 Laboratory of Immunorheumatology and Tissue Regeneration, Rizzoli Orthopedic Institute , Bologna, Italy
| | - Federica Sartoni
- 1 Laboratory RAMSES, Rizzoli Orthopedic Institute , Bologna, Italy
| | - Nicolò Nicoli Aldini
- 2 Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopedic Institute , Bologna, Italy .,3 Laboratory BITTA, Rizzoli Orthopedic Institute , Bologna, Italy
| | - Lucia Martini
- 2 Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopedic Institute , Bologna, Italy .,3 Laboratory BITTA, Rizzoli Orthopedic Institute , Bologna, Italy
| | | | - Erminia Mariani
- 4 Laboratory of Immunorheumatology and Tissue Regeneration, Rizzoli Orthopedic Institute , Bologna, Italy .,5 Department of Medical and Surgical Science, University of Bologna , Bologna, Italy
| | - Milena Fini
- 2 Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopedic Institute , Bologna, Italy .,3 Laboratory BITTA, Rizzoli Orthopedic Institute , Bologna, Italy
| | - Brunella Grigolo
- 1 Laboratory RAMSES, Rizzoli Orthopedic Institute , Bologna, Italy .,4 Laboratory of Immunorheumatology and Tissue Regeneration, Rizzoli Orthopedic Institute , Bologna, Italy
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50
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Pietrosimone B, Loeser RF, Blackburn JT, Padua DA, Harkey MS, Stanley LE, Luc-Harkey BA, Ulici V, Marshall SW, Jordan JM, Spang JT. Biochemical markers of cartilage metabolism are associated with walking biomechanics 6-months following anterior cruciate ligament reconstruction. J Orthop Res 2017; 35:2288-2297. [PMID: 28150869 PMCID: PMC5540809 DOI: 10.1002/jor.23534] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 01/23/2017] [Indexed: 02/06/2023]
Abstract
The purpose of our study was to determine the association between biomechanical outcomes of walking gait (peak vertical ground reaction force [vGRF], vGRF loading rate [vGRF-LR], and knee adduction moment [KAM]) 6 months following anterior cruciate ligament reconstruction (ACLR) and biochemical markers of serum type-II collagen turnover (collagen type-II cleavage product to collagen type-II C-propeptide [C2C:CPII]), plasma degenerative enzymes (matrix metalloproteinase-3 [MMP-3]), and a pro-inflammatory cytokine (interleukin-6 [IL-6]). Biochemical markers were evaluated within the first 2 weeks (6.5 ± 3.8 days) following ACL injury and again 6 months following ACLR in eighteen participants. All peak biomechanical outcomes were extracted from the first 50% of the stance phase of walking gait during a 6-month follow-up exam. Limb symmetry indices (LSI) were used to normalize the biomechanical outcomes in the ACLR limb to that of the contralateral limb (ACLR/contralateral). Bivariate correlations were used to assess associations between biomechanical and biochemical outcomes. Greater plasma MMP-3 concentrations after ACL injury and at the 6-month follow-up exam were associated with lesser KAM LSI. Lesser KAM was associated with greater plasma IL-6 at the 6-month follow-up exam. Similarly, lesser vGRF-LR LSI was associated with greater plasma MMP-3 concentrations at the 6-month follow-up exam. Lesser peak vGRF LSI was associated with higher C2C:CPII after ACL injury, yet this association was not significant after accounting for walking speed. Therefore, lesser biomechanical loading in the ACLR limb, compared to the contralateral limb, 6 months following ACLR may be related to deleterious joint tissue metabolism that could influence future cartilage breakdown. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2288-2297, 2017.
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Affiliation(s)
- Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States,Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Richard F. Loeser
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, United States
| | - J. Troy Blackburn
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States,Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Darin A. Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States,Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Matthew S. Harkey
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Laura E. Stanley
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Brittney A. Luc-Harkey
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Veronica Ulici
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, United States
| | - Stephen W. Marshall
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Joanne M. Jordan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, United States
| | - Jeffery T. Spang
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States
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