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Mederake M, Trappe D, Jacob C, Hofmann UK, Schüll D, Dalheimer P, Exner L, Walter C. Influence of hyaluronic acid on intra-articular friction - a biomechanical study in whole animal joints. BMC Musculoskelet Disord 2022; 23:927. [PMID: 36266652 PMCID: PMC9585852 DOI: 10.1186/s12891-022-05867-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cartilage is a mechanically highly stressed tissue in the human body and an important part of synovial joints. The joint cartilage is lubricated by synovial fluid with hyaluronic acid (HA) as main component. However, in joints with osteoarthritis HA has a lower concentration and molecular weight compared to healthy joints. In recent years, the intra-articular injection of therapeutic HA lubricant, has become a popular therapy. The effect of HA application on the friction of a complete joint with physiological movement needs to be further determined. METHODS The aim of the present study was to evaluate the lubrication effect of the joint by three lubricants (NaCl, fetal calf serum (FCS) and HA) and their effect on the friction in nine complete ovine carpo-metacarpal joints. The joints were mounted on a material testing machine and a physiological movement with 10° rotation was simulated with ascending axial load (100 - 400 N). Specimens were tested native, with cartilage damage caused by drying out and relubricated. Dissipated energy (DE) as a measure of friction was recorded and compared. RESULTS Investigating the effect of axial load, we found significant differences in DE between all axial load steps (p < .001), however, only for the defect cartilage. Furthermore, we could document an increase in DE from native (Mean: 15.0 mJ/cycle, SD: 8.98) to cartilage damage (M: 74.4 mJ/cycle, SD: 79.02) and a decrease after relubrication to 23.6 mJ/cycle (SD: 18.47). Finally, we compared the DE values for NaCl, FCS and HA. The highest values were detected for NaCl (MNorm = 16.4 mJ/cycle, SD: 19.14). HA achieved the lowest value (MNorm = 4.3 mJ/cycle, SD: 4.31), although the gap to FCS (MNorm = 5.1 mJ/cycle, SD: 7.07) was small. CONCLUSIONS We were able to elucidate three effects in joints with cartilage damage. First, the friction in damaged joints increases significantly compared to native joints. Second, especially in damaged joints, the friction increases significantly more with increased axial load compared to native or relubricated joints. Third, lubricants can achieve an enormous decrease in friction. Comparing different lubricants, our results indicate the highest decrease in friction for HA.
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Affiliation(s)
- Moritz Mederake
- Department of Trauma and Reconstructive Surgery, BG Klinik, University of Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany.
| | - Dominik Trappe
- University Hospital Tübingen, Hoppe Seyler -Str. 3, 72076, Tübingen, Germany
| | - Christopher Jacob
- University Hospital Tübingen, Hoppe Seyler -Str. 3, 72076, Tübingen, Germany
| | - Ulf Krister Hofmann
- University Hospital Tübingen, Hoppe Seyler -Str. 3, 72076, Tübingen, Germany.,Department of Orthopedic Trauma and Reconstructive Surgery, University of Aachen Medical Center, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Daniel Schüll
- University Hospital Tübingen, Hoppe Seyler -Str. 3, 72076, Tübingen, Germany
| | - Philipp Dalheimer
- University Hospital Tübingen, Hoppe Seyler -Str. 3, 72076, Tübingen, Germany
| | - Lisanne Exner
- University Hospital Tübingen, Hoppe Seyler -Str. 3, 72076, Tübingen, Germany
| | - Christian Walter
- University Hospital Tübingen, Hoppe Seyler -Str. 3, 72076, Tübingen, Germany
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Dee DT, Hung VT, Schamblin CJ, Lupica GM, Hitchens HR, McGarry MH, Lee TQ. Radiocapitellar Contact Characteristics After Osteochondral Defect Repair Using a Novel Hybrid Reconstructive Procedure. Orthop J Sports Med 2022; 10:23259671221083582. [PMID: 35340725 PMCID: PMC8941709 DOI: 10.1177/23259671221083582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Many procedures to reconstruct osteochondral defects of the elbow
radiocapitellar (RC) joint lack versatility or durability or do
not directly address the subchondral bone structure and
function. Purpose/Hypothesis: To biomechanically characterize the RC joint contact area, force,
pressure, and peak pressure before and after reconstruction of
osteochondral defects using a novel hybrid reconstructive
procedure. It was hypothesized that the procedure would restore
the contact characteristics to the intact condition. Study Design: Controlled laboratory study. Methods: A total of 10 cadaveric elbows (mean age 67 ± 2.7 years) were
dissected to isolate the humerus and radial head. RC contact
area, contact force, mean contact pressure, and peak contact
pressure were measured with the elbow at 45° of flexion and
neutral forearm rotation at compressive loads of 25, 50, and 75
N. Osteochondral defects 8 and 11 mm in diameter were created at
the center of the capitellum; the defects were then
reconstructed with a titanium fenestrated threaded implant,
countersunk in the subchondral bone, with an acellular dermal
matrix allograft sutured in place on top of the implant. Five
conditions (intact, 8-mm defect, 8-mm repair, 11-mm defect, and
11-mm repair) were tested and results were compared using
repeated-measures analysis of variance. Results: Both 8- and 11-mm defects significantly increased RC mean contact
pressure at all compressive loads (P ≤ .008)
and significantly increased peak contact pressure at compressive
loads of 50 and 75 N (P < .002) compared
with the intact condition. Repair of the 8-mm defect
significantly decreased RC mean contact pressure at 25- and 50-N
loads (P ≤ .009) and significantly decreased
peak contact pressure at 50- and 75-N loads (P
≤ .035) compared with the defect condition. Repair of the 11-mm
defect decreased mean contact pressure significantly at all
compressive loads (P ≤ .001) and peak contact
pressure at 50- and 75-N loads (P < .044)
compared with the defect condition. Conclusion: RC joint contact pressure was restored to intact conditions while
avoiding increased peak contact pressure or edge loading after
repairing osteochondral defects related to osteochondrosis with
a novel hybrid reconstruction technique. Clinical Relevance: This hybrid procedure that addresses the entire osteochondral unit
may provide a new treatment option for osteochondral
defects.
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Affiliation(s)
- Derek T Dee
- Dee Sports Orthopedics, Huntington Beach, California, USA
| | - Victor T Hung
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, USA
| | - Connor J Schamblin
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, USA
| | - Gregory M Lupica
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, USA
| | - Hunter R Hitchens
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, USA
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, USA
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, USA
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Davis S, Roldo M, Blunn G, Tozzi G, Roncada T. Influence of the Mechanical Environment on the Regeneration of Osteochondral Defects. Front Bioeng Biotechnol 2021; 9:603408. [PMID: 33585430 PMCID: PMC7873466 DOI: 10.3389/fbioe.2021.603408] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 01/04/2021] [Indexed: 12/20/2022] Open
Abstract
Articular cartilage is a highly specialised connective tissue of diarthrodial joints which provides a smooth, lubricated surface for joint articulation and plays a crucial role in the transmission of loads. In vivo cartilage is subjected to mechanical stimuli that are essential for cartilage development and the maintenance of a chondrocytic phenotype. Cartilage damage caused by traumatic injuries, ageing, or degradative diseases leads to impaired loading resistance and progressive degeneration of both the articular cartilage and the underlying subchondral bone. Since the tissue has limited self-repairing capacity due its avascular nature, restoration of its mechanical properties is still a major challenge. Tissue engineering techniques have the potential to heal osteochondral defects using a combination of stem cells, growth factors, and biomaterials that could produce a biomechanically functional tissue, representative of native hyaline cartilage. However, current clinical approaches fail to repair full-thickness defects that include the underlying subchondral bone. Moreover, when tested in vivo, current tissue-engineered grafts show limited capacity to regenerate the damaged tissue due to poor integration with host cartilage and the failure to retain structural integrity after insertion, resulting in reduced mechanical function. The aim of this review is to examine the optimal characteristics of osteochondral scaffolds. Additionally, an overview on the latest biomaterials potentially able to replicate the natural mechanical environment of articular cartilage and their role in maintaining mechanical cues to drive chondrogenesis will be detailed, as well as the overall mechanical performance of grafts engineered using different technologies.
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Affiliation(s)
- Sarah Davis
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom
| | - Marta Roldo
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom
| | - Gordon Blunn
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom
| | - Gianluca Tozzi
- Zeiss Global Centre, School of Mechanical and Design Engineering, University of Portsmouth, Portsmouth, United Kingdom
| | - Tosca Roncada
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom
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Walter C, Trappe D, Beck A, Jacob C, Hofmann UK. Effect of graft positioning on dissipated energy in knee osteochondral autologous transplantation-A biomechanical study. J Orthop Res 2020; 38:1727-1734. [PMID: 31994755 DOI: 10.1002/jor.24612] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/22/2020] [Indexed: 02/04/2023]
Abstract
Focal cartilage defects can be treated by osteochondral autologous transplantation (OAT). High congruence of the graft with the surrounding cartilage structure is essential for a good clinical outcome, but can not always be achieved. We recently established a method to measure dissipated energy (DE) as a friction parameter in knee joints. We now investigated how autograft harvesting and implant positioning affect the DE during knee motion. Six sheep knee joints were cyclically motioned under 400 N axial load. During the cyclic motion, the flexion angle and the respective torque were recorded and the DE was calculated. Several experimental conditions were tested: first, the DE was measured after approach had been performed ("native"). Subsequently, a cylinder was removed from the medial femur condyles and a donor cylinder was inserted from an unloaded site in four different transplant positions: even, 1 mm deeper, 1 mm higher, and flush without cartilage (defect). No significant changes in friction were observed between the native knee and an even or deep OAT positioning. We, however, found a small but significant increase in DE between the "native" and "1 mm high" formations (ΔDE compared with native = 14 mJ/cycle; P = .004 after data normalization) and a large increase in defect situation (ΔDE compared with native = 119 mJ/cycle; P = .001). Considering the long-term therapeutic aim that is pursued when performing OAT, elevated graft positioning should clearly be avoided. From a biomechanical point of view, donor site morbidity after cylinder harvest can be neglected.
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Affiliation(s)
- Christian Walter
- Orthopedic Department, University Hospital Tübingen, Tübingen, Germany
| | - Dominik Trappe
- Orthopedic Department, University Hospital Tübingen, Tübingen, Germany
| | - Alexander Beck
- Orthopedic Department, University Hospital Tübingen, Tübingen, Germany
| | - Christopher Jacob
- Orthopedic Department, University Hospital Tübingen, Tübingen, Germany
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Development of a preclinical natural porcine knee simulation model for the tribological assessment of osteochondral grafts in vitro. J Biomech 2018; 77:91-98. [PMID: 30049448 DOI: 10.1016/j.jbiomech.2018.06.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 04/12/2018] [Accepted: 06/19/2018] [Indexed: 11/21/2022]
Abstract
In order to pre-clinically evaluate the performance and efficacy of novel osteochondral interventions, physiological and clinically relevant whole joint simulation models, capable of reproducing the complex loading and motions experienced in the natural knee environment are required. The aim of this study was to develop a method for the assessment of tribological performance of osteochondral grafts within an in vitro whole natural joint simulation model. The study assessed the effects of osteochondral allograft implantation (existing surgical intervention for the repair of osteochondral defects) on the wear, deformation and damage of the opposing articular surfaces. Tribological performance of osteochondral grafts was compared to the natural joint (negative control), an injury model (focal cartilage defects) and stainless steel pins (positive controls). A recently developed method using an optical profiler (Alicona Infinite Focus G5, Alicona Imaging GmbH, Austria) was used to quantify and characterise the wear, deformation and damage occurring on the opposing articular surfaces. Allografts inserted flush with the cartilage surface had the lowest levels of wear, deformation and damage following the 2 h test; increased levels of wear, deformation and damage were observed when allografts and stainless steel pins were inserted proud of the articular surface. The method developed will be applied in future studies to assess the tribological performance of novel early stage osteochondral interventions prior to in vivo studies, investigate variation in surgical precision and aid in the development of stratified interventions for the patient population.
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Bowland P, Ingham E, Fisher J, Jennings LM. Simple geometry tribological study of osteochondral graft implantation in the knee. Proc Inst Mech Eng H 2018; 232:249-256. [PMID: 29375001 PMCID: PMC5862326 DOI: 10.1177/0954411917751560] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Robust preclinical test methods involving tribological simulations are required to investigate and understand the tribological function of osteochondral repair interventions in natural knee tissues. The aim of this study was to investigate the effects of osteochondral allograft implantation on the local tribology (friction, surface damage, wear and deformation) of the tissues in the natural knee joint using a simple geometry, reciprocating pin-on-plate friction simulator. In addition, the study aimed to assess the ability of osteochondral grafts to restore a low surface damage, deformation and wear articulation when compared to the native state. A method was developed to characterise and quantify surface damage wear and deformation of the opposing cartilage-bone pin surface using a non-contacting optical profiler (Alicona Infinite Focus). Porcine 12 mm diameter cartilage-bone pins were reciprocated against bovine cartilage-bone plates that had 6 mm diameter osteochondral allografts, cartilage defects or stainless steel pins (positive controls) inserted centrally. Increased levels of surface damage with changes in geometry were not associated with significant increases in the coefficient of dynamic friction. Significant damage to the opposing cartilage surface was observed in the positive control groups. Cartilage damage, deformation and wear (as measured by change in geometry) in the xenograft (2.4 mm3) and cartilage defect (0.99 mm3) groups were low and not significantly different (p > 0.05) compared to the negative control in either group. The study demonstrated the potential of osteochondral grafts to restore the congruent articular surface and biphasic tribology of the natural joint. An optical method has been developed to characterise cartilage wear, damage and deformation that can be applied to the tribological assessment of osteochondral grafts in a whole natural knee joint simulation model.
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Affiliation(s)
| | | | | | - Louise M Jennings
- Louise M Jennings, Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds LS2 9JT, UK.
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Bowland P, Ingham E, Jennings L, Fisher J. Review of the biomechanics and biotribology of osteochondral grafts used for surgical interventions in the knee. Proc Inst Mech Eng H 2016; 229:879-88. [PMID: 26614801 PMCID: PMC4676357 DOI: 10.1177/0954411915615470] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
A review of research undertaken to evaluate the biomechanical stability and biotribological behaviour of osteochondral grafts in the knee joint and a brief discussion of areas requiring further improvement in future studies are presented. The review takes into consideration osteochondral autografts, allografts, tissue engineered constructs and synthetic and biological scaffolds.
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Affiliation(s)
- Philippa Bowland
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - E Ingham
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Louise Jennings
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - John Fisher
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
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Bobrowitsch E, Lorenz A, Wülker N, Walter C. Simulation of in vivo dynamics during robot assisted joint movement. Biomed Eng Online 2014; 13:167. [PMID: 25516427 PMCID: PMC4279817 DOI: 10.1186/1475-925x-13-167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 12/05/2014] [Indexed: 11/27/2022] Open
Abstract
Background Robots are very useful tools in orthopedic research. They can provide force/torque controlled specimen motion with high repeatability and precision. A method to analyze dissipative energy outcome in an entire joint was developed in our group. In a previous study, a sheep knee was flexed while axial load remained constant during the measurement of dissipated energy. We intend to apply this method for the investigation of osteoarthritis. Additionally, the method should be improved by simulation of in vivo knee dynamics. Thus, a new biomechanical testing tool will be developed for analyzing in vitro joint properties after different treatments. Methods Discretization of passive knee flexion was used to construct a complex flexion movement by a robot and simulate altering axial load similar to in vivo sheep knee dynamics described in a previous experimental study. Results The robot applied an in vivo like axial force profile with high reproducibility during the corresponding knee flexion (total standard deviation of 0.025 body weight (BW)). A total residual error between the in vivo and simulated axial force was 0.16 BW. Posterior-anterior and medio-lateral forces were detected by the robot as a backlash of joint structures. Their curve forms were similar to curve forms of corresponding in vivo measured forces, but in contrast to the axial force, they showed higher total standard deviation of 0.118 and 0.203 BW and higher total residual error of 0.79 and 0.21 BW for posterior-anterior and medio-lateral forces respectively. Conclusions We developed and evaluated an algorithm for the robotic simulation of complex in vivo joint dynamics using a joint specimen. This should be a new biomechanical testing tool for analyzing joint properties after different treatments.
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Affiliation(s)
- Evgenij Bobrowitsch
- Department of Orthopaedic Surgery, Biomechanics Laboratory, University Hospital Tübingen, 72076 Tübingen, Germany.
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