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Oláh T, Cucchiarini M, Madry H. Subchondral bone remodeling patterns in larger animal models of meniscal injuries inducing knee osteoarthritis - a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:5346-5364. [PMID: 37742232 PMCID: PMC10719152 DOI: 10.1007/s00167-023-07579-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE Elucidating subchondral bone remodeling in preclinical models of traumatic meniscus injury may address clinically relevant questions about determinants of knee osteoarthritis (OA). METHODS Studies on subchondral bone remodeling in larger animal models applying meniscal injuries as standardizing entity were systematically analyzed. Of the identified 5367 papers reporting total or partial meniscectomy, meniscal transection or destabilization, 0.4% (in guinea pigs, rabbits, dogs, minipigs, sheep) remained eligible. RESULTS Only early or mid-term time points were available. Larger joint sizes allow reporting higher topographical details. The most frequently reported parameters were BV/TV (61%), BMD (41%), osteophytes (41%) and subchondral bone plate thickness (39%). Subchondral bone plate microstructure is not comprehensively, subarticular spongiosa microstructure is well characterized. The subarticular spongiosa is altered shortly before the subchondral bone plate. These early changes involve degradation of subarticular trabecular elements, reduction of their number, loss of bone volume and reduced mineralization. Soon thereafter, the previously normal subchondral bone plate becomes thicker. Its porosity first increases, then decreases. CONCLUSION The specific human topographical pattern of a thinner subchondral bone plate in the region below both menisci is present solely in the larger species (partly in rabbits), but absent in rodents, an important fact to consider when designing animal studies examining subchondral consequences of meniscus damage. Large animal models are capable of providing high topographical detail, suggesting that they may represent suitable study systems reflecting the clinical complexities. For advanced OA, significant gaps of knowledge exist. Future investigations assessing the subchondral bone in a standardized fashion are warranted.
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Affiliation(s)
- Tamás Oláh
- Center of Experimental Orthopaedics, Saarland University, Kirrberger Straße, Building 37, 66421, Homburg/Saar, Germany
| | - Magali Cucchiarini
- Center of Experimental Orthopaedics, Saarland University, Kirrberger Straße, Building 37, 66421, Homburg/Saar, Germany
| | - Henning Madry
- Center of Experimental Orthopaedics, Saarland University, Kirrberger Straße, Building 37, 66421, Homburg/Saar, Germany.
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Zaki S, Blaker CL, Little CB. OA foundations - experimental models of osteoarthritis. Osteoarthritis Cartilage 2022; 30:357-380. [PMID: 34536528 DOI: 10.1016/j.joca.2021.03.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/01/2021] [Accepted: 03/10/2021] [Indexed: 02/02/2023]
Abstract
Osteoarthritis (OA) is increasingly recognised as a disease of diverse phenotypes with variable clinical presentation, progression, and response to therapeutic intervention. This same diversity is readily apparent in the many animal models of OA. However, model selection, study design, and interpretation of resultant findings, are not routinely done in the context of the target human (or veterinary) patient OA sub-population or phenotype. This review discusses the selection and use of animal models of OA in discovery and therapeutic-development research. Beyond evaluation of the different animal models on offer, this review suggests focussing the approach to OA-animal model selection on study objective(s), alignment of available models with OA-patient sub-types, and the resources available to achieve valid and translatable results. How this approach impacts model selection is discussed and an experimental design checklist for selecting the optimal model(s) is proposed. This approach should act as a guide to new researchers and a reminder to those already in the field, as to issues that need to be considered before embarking on in vivo pre-clinical research. The ultimate purpose of using an OA animal model is to provide the best possible evidence if, how, when and where a molecule, pathway, cell or process is important in clinical disease. By definition this requires both model and study outcomes to align with and be predictive of outcomes in patients. Keeping this at the forefront of research using pre-clinical OA models, will go a long way to improving the quality of evidence and its translational value.
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Affiliation(s)
- S Zaki
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Australia; Raymond Purves Bone and Joint Research Laboratory, Australia.
| | - C L Blaker
- Raymond Purves Bone and Joint Research Laboratory, Australia; Murray Maxwell Biomechanics Laboratory, The Kolling Institute, University of Sydney Faculty of Medicine and Health, At Royal North Shore Hospital, Australia.
| | - C B Little
- Raymond Purves Bone and Joint Research Laboratory, Australia.
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Oláh T, Cai X, Michaelis JC, Madry H. Comparative anatomy and morphology of the knee in translational models for articular cartilage disorders. Part I: Large animals. Ann Anat 2021; 235:151680. [PMID: 33548412 DOI: 10.1016/j.aanat.2021.151680] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/08/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The human knee is a complex joint, and affected by a variety of articular cartilage disorders. Large animal models are critical to model the complex disease mechanisms affecting a functional joint. Species-dependent differences highly affect the results of a pre-clinical study and need to be considered, necessitating specific knowledge not only of macroscopic and microscopic anatomical and pathological aspects, but also characteristics of their individual gait and joint movements. METHODS Literature search in Pubmed. RESULTS AND DISCUSSION This narrative review summarizes the most relevant anatomical structural and functional characteristics of the knee (stifle) joints of the major translational large animal species, comprising dogs, (mini)pigs, sheep, goats, and horses in comparison with humans. Specific characteristics of each species, including kinematical gait parameters are provided. Considering these multifactorial dimensions will allow to select the appropriate model for answering the research questions in a clinically relevant fashion.
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Affiliation(s)
- Tamás Oláh
- Center of Experimental Orthopaedics, Saarland University, Homburg, Germany
| | - Xiaoyu Cai
- Center of Experimental Orthopaedics, Saarland University, Homburg, Germany
| | | | - Henning Madry
- Center of Experimental Orthopaedics, Saarland University, Homburg, Germany; Department of Orthopaedic Surgery, Saarland University Medical Center, Homburg, Germany.
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Oláh T, Reinhard J, Gao L, Haberkamp S, Goebel LKH, Cucchiarini M, Madry H. Topographic modeling of early human osteoarthritis in sheep. Sci Transl Med 2020; 11:11/508/eaax6775. [PMID: 31484789 DOI: 10.1126/scitranslmed.aax6775] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 08/12/2019] [Indexed: 12/22/2022]
Abstract
Articular cartilage damage occurring during early osteoarthritis (OA) is a key event marking the development of the disease. Here, we modeled early human OA by gathering detailed spatiotemporal data from surgically induced knee OA development in sheep. We identified a specific topographical pattern of osteochondral changes instructed by a defined meniscal injury, showing that both cartilage and subchondral bone degeneration are initiated from the region adjacent to the damage. Alterations of the subarticular spongiosa arising locally and progressing globally disturbed the correlations of cartilage with subchondral bone seen at homeostasis and were indicative of disease progression. We validated our quantitative findings against human OA, showing a similar pattern of early OA correlating with regions of meniscal loss and an analogous late critical disturbance within the entire osteochondral unit. This translational model system can be used to elucidate mechanisms of OA development and provides a roadmap for investigating regenerative therapies.
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Affiliation(s)
- Tamás Oláh
- Center of Experimental Orthopaedics, Saarland University, 66421 Homburg, Germany
| | - Jan Reinhard
- Center of Experimental Orthopaedics, Saarland University, 66421 Homburg, Germany
| | - Liang Gao
- Center of Experimental Orthopaedics, Saarland University, 66421 Homburg, Germany
| | - Sophie Haberkamp
- Center of Experimental Orthopaedics, Saarland University, 66421 Homburg, Germany
| | - Lars K H Goebel
- Center of Experimental Orthopaedics, Saarland University, 66421 Homburg, Germany
| | - Magali Cucchiarini
- Center of Experimental Orthopaedics, Saarland University, 66421 Homburg, Germany
| | - Henning Madry
- Center of Experimental Orthopaedics, Saarland University, 66421 Homburg, Germany. .,Department of Orthopaedic Surgery, Saarland University Medical Center, 66421 Homburg, Germany
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Han Q, Ma Y, Jia P, Wang X, Wang B, Zheng Y. A Randomized Controlled Pilot Study Comparing the Efficacy of Pulsed Radiofrequency Combined With Exercise Versus Exercise Alone in Pain Relief and Functional Improvement for Chronic Knee Osteoarthritis. Pain Pract 2020; 21:160-170. [PMID: 32700432 DOI: 10.1111/papr.12942] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To compare the long-term efficacy between pulsed radiofrequency (PRF) combined with passive stretching (PRF-PS) exercise and PS exercise alone in reducing pain and improving quadriceps muscle strength and knee function. METHODS Sixty-two participants were randomly assigned with a 1:1 allocation to the PRF-PS exercise group or the PS exercise group. Level of pain, muscle strength, and knee function were assessed from baseline to the first, third, and sixth months after treatment using the VAS, peak torque (PT), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), respectively. RESULTS There were no significant differences at baseline between the 2 groups. Compared to exercise alone, participants achieved superior efficacy with PRF-PS in pain relief, improvement of muscle strength, and knee function. Moreover, the improvement of all variables was maintained for a longer period of time in the PRF-PS group. The reduction in participants' VAS pain intensity scores was superior for PRF-PS vs. PS with overall estimation (adjusted mean difference: -1.85 cm; 95% confidence interval [CI] -2.25, -1.45 cm; P = 0.000). The increase in participants' PT scores was superior for PRF-PS vs. PS with overall estimation (adjusted mean difference: 15.53 N. m; 95% CI 7.07, 23.98 N. m; P = 0.000; and 12.62 N. m; 95% CI 0.96, 24.28 N. m; P = 0.000 for PT 60 degrees/s and PT 180 degrees/s, respectively). The reduction in participants' WOMAC scores was superior for PRF-PS vs. PS with overall estimation (adjusted mean difference: -16.43; 95% CI -22.22, -10.64; P = 0.000). DISCUSSION The improvement in pain relief and knee function might be associated with restoration of muscle strength after PRF-PS exercise by overcoming muscle inhibition.
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Affiliation(s)
- Qi Han
- Department of Pain Management, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Yantao Ma
- Department of Pain Management, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Peiyu Jia
- Department of Pain Management, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Xiaolei Wang
- Department of Pain Management, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Bo Wang
- Department of Pain Management, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Yongjun Zheng
- Department of Pain Management, Huadong Hospital Affiliated to Fudan University, Shanghai, China
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Impact of a daily exercise dose on knee joint cartilage - a systematic review and meta-analysis of randomized controlled trials in healthy animals. Osteoarthritis Cartilage 2017; 25:1223-1237. [PMID: 28323138 DOI: 10.1016/j.joca.2017.03.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 03/04/2017] [Accepted: 03/09/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the impact of a daily exercise dose on cartilage composition and thickness, by conducting a systematic review of randomized controlled trials (RCTs) involving healthy animals. METHODS A narrative synthesis of the effect of a daily exercise dose on knee cartilage aggrecan, collagen and thickness was performed. A subset of studies reporting sufficient data was combined in meta-analysis using a random-effects model. Meta-regression analyses were performed to investigate the impact of covariates. RESULTS Twenty-nine RCTs, involving 64 comparisons, were included. In the low dose exercise group, 21/25 comparisons reported decreased or no effect on cartilage aggrecan, collagen and thickness. In the moderate dose exercise group, all 12 comparisons reported either no or increased effect. In the high dose exercise group, 19/27 comparisons reported decreased effect. A meta-analysis of 14 studies investigating cartilage thickness showed no effect in the low dose exercise group (SMD -0.02; 95% CI -0.42 to 0.38; I2 = 0.0%), large but non-significant cartilage thickening in the moderate dose exercise group (SMD 0.95; 95% CI -0.33 to 2.23; I2 = 72.1%) and non-significant cartilage thinning in the high dose exercise group (SMD -0.19; 95% CI -0.49 to 0.12; I2 = 0.0%). Results were independent of analyzed covariates. The overall quality of the studies was poor because of inadequate reporting of data and high risk of bias. CONCLUSIONS Our results suggest that the relationship between daily exercise dose and cartilage composition, but not necessarily cartilage thickness, may be non-linear. While we found inconclusive evidence for a low daily dose of exercise, a high daily dose of exercise may have negative effects and a moderate daily dose of exercise may have positive effects on cartilage matrix composition in healthy animals.
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The Influence of Oblique Angle Forced Exercise in Surgically Destabilized Stifle Joints Is Synergistic with Bone, but Antagonistic with Cartilage in an Ovine Model of Osteoarthritis. ARTHRITIS 2017; 2017:7481619. [PMID: 28348888 PMCID: PMC5350401 DOI: 10.1155/2017/7481619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 02/09/2017] [Indexed: 11/23/2022]
Abstract
Large animal models of osteoarthritis are a necessary testing ground for FDA approval of human medicine applications. Sheep models have advantages over other available large animals, but development and progression of osteoarthritis in sheep is exceedingly slow, which handicaps progress in development of potential treatments. We combined oblique angle forced exercise to increase stress on the stifle, with surgical destabilization to hasten the development of osteoarthritis in ewes. Methods for early detection of clinical signs included radiography, urine, and serum biomarker assays and gait analysis and ex vivo we used microcomputed tomography and macroscopic joint analysis. Our model was able to produce clinically detectable signs of osteoarthritis in a relatively short period (14 weeks). Changes in bone were highly correlated between microcomputed tomography and radiographic analysis and changes in cartilage correlated well between urinary glycosaminoglycan levels and serum aggrecanase analyses. Exercise improved the negative effects of destabilization in bone but exacerbated the negative effects of destabilization in cartilage. These observations suggest that we may need to consider treatments for bone and cartilage separately. These results represent an improved large animal model of osteoarthritis with rapid onset of disease and superior detection of bone and soft tissue changes.
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Ko JY, Lee J, Lee J, Im GI. Intra-articular Xenotransplantation of Adipose-Derived Stromal Cells to Treat Osteoarthritis in a Goat Model. Tissue Eng Regen Med 2017; 14:65-71. [PMID: 30603463 PMCID: PMC6171577 DOI: 10.1007/s13770-016-0010-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 03/21/2016] [Accepted: 03/22/2016] [Indexed: 01/14/2023] Open
Abstract
Adipose-derived stromal cells (ASCs) have been investigated as a cell source for tissue regeneration. The purpose of this study was first to confirm if medial meniscectomy induces osteoarthritis (OA) in goats within a relative short period of time, and more importantly, to investigate if systemic treatment with immunosuppressive drugs is necessary in intra-articular ASC xenotransplantation for successful regeneration of articular cartilage and prevention of joint inflammation. Eight Korean native black goats 1-2 years of age underwent medial meniscectomy. To evaluate the gross and histological appearance of articular cartilage, knee joints were re-exposed by a medial parapatellar incision at 8 weeks. After macroscopic scoring of gross appearance, cartilage biopsy specimens 6 mm in diameter were obtained from the femoral condyle in four goats. The goats were injected with single intra-articular dose of 7×106 human ASCs (hASCs) 7 days after the second arthrotomy. Four animals were treated with daily injections of cyclosporin A 10 mg/kg for 7 days, followed by a reduced dose of 5 mg/kg for another 7 days, while other 4 animals did not receive immunosuppressive therapy. All animals were sacrificed for analysis 8 weeks after injection of hASCs. OA was successfully induced 8 weeks after medial meniscectomy. Eight weeks after injection of hASCs, various signs of articular cartilage regeneration were observed. There were no significant macroscopic and histological differences between goats treated with cyclosporine and untreated goats. Interleukin-1ß and tumor necrosis factor-α level from synovial fluid did not differ between cyclosporine-treated and untreated goats. The results indicate that immunosuppressive therapy did not influence the result of ASC xenotransplantation to treat OA.
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Affiliation(s)
- Ji-Yun Ko
- Department of Orthopedics, Dongguk University Ilsan Hospital, 814 Siksa-Dong, Goyang, 410-773 Republic of Korea
| | - Jungsun Lee
- Research and Development Institute, MCTT Inc., Seoul, Republic of Korea
| | - Jimin Lee
- Department of Orthopedics, Dongguk University Ilsan Hospital, 814 Siksa-Dong, Goyang, 410-773 Republic of Korea
| | - Gun-Il Im
- Department of Orthopedics, Dongguk University Ilsan Hospital, 814 Siksa-Dong, Goyang, 410-773 Republic of Korea
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Delling U, Brehm W, Ludewig E, Winter K, Jülke H. Longitudinal Evaluation of Effects of Intra-Articular Mesenchymal Stromal Cell Administration for the Treatment of Osteoarthritis in an Ovine Model. Cell Transplant 2015; 24:2391-407. [DOI: 10.3727/096368915x686193] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In this study, the therapeutic effect of intra-articularly injected autologous mesenchymal stromal cells (MSCs) was evaluated in an ovine osteoarthritis (OA) model using consecutive magnetic resonance imaging (MRI), radiography, and macroscopic and histologic postmortem examination. In 12 sheep, OA was induced by bilateral, lateral meniscectomy. After 6 weeks, 20 × 106 bone marrow-derived MSCs (50% MSCs were superparamagnetic iron oxide particle labeled) were injected intra-articularly into one knee joint. The contralateral knee served as negative control. MR images were acquired before OA induction, immediately before and after MSC injection, and 1, 4, 8, and 12 weeks thereafter using a 0.5T unit and a T2* gradient echo sequence. Radiographs were obtained before OA induction, at MSC injection, and 12 weeks thereafter. The MRI scoring system included articular cartilage, bone, joint capsule, and synovial fluid evaluation. The radiographic scoring system included the joint space and bone. Postmortem evaluation entailed macroscopic and histologic assessment. Longitudinal MRI revealed a significant deceleration of OA progression in MSC-treated joints. However, at the conclusion of the study, there was no significant difference in the degree of OA detected by MRI, radiography, and postmortem evaluation between the treatment and control group. The degree of OA on MRI varied among the 12 animals at the time of injection, but there was no difference between the left and right limb. In conclusion, intra-articular MSCs decreased OA progression. However, no significant treatment effects were seen at the conclusion of the study at 12 weeks. This somewhat contradicts previously published results. Nevertheless, the choice of OA model, outcome measures, or lack of additional medication might explain the differences. Our results indicate that OA might benefit from intra-articular MSC injection, but further studies are needed to refine patient selection and injection parameters for a more substantially improved outcome.
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Affiliation(s)
- Uta Delling
- University of Leipzig, Faculty of Veterinary Medicine, Large Animal Clinic for Surgery, Leipzig, Germany
| | - Walter Brehm
- University of Leipzig, Faculty of Veterinary Medicine, Large Animal Clinic for Surgery, Leipzig, Germany
| | - Eberhard Ludewig
- University of Leipzig, Faculty of Veterinary Medicine, Department of Small Animal Medicine, Leipzig, Germany
| | - Karsten Winter
- University of Leipzig, Translational Centre for Regenerative Medicine (TRM), Leipzig, Germany
| | - Henriette Jülke
- University of Leipzig, Translational Centre for Regenerative Medicine (TRM), Leipzig, Germany
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Non-invasive mouse models of post-traumatic osteoarthritis. Osteoarthritis Cartilage 2015; 23:1627-38. [PMID: 26003950 PMCID: PMC4577460 DOI: 10.1016/j.joca.2015.05.009] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 04/20/2015] [Accepted: 05/10/2015] [Indexed: 02/02/2023]
Abstract
Animal models of osteoarthritis (OA) are essential tools for investigating the development of the disease on a more rapid timeline than human OA. Mice are particularly useful due to the plethora of genetically modified or inbred mouse strains available. The majority of available mouse models of OA use a joint injury or other acute insult to initiate joint degeneration, representing post-traumatic osteoarthritis (PTOA). However, no consensus exists on which injury methods are most translatable to human OA. Currently, surgical injury methods are most commonly used for studies of OA in mice; however, these methods may have confounding effects due to the surgical/invasive injury procedure itself, rather than the targeted joint injury. Non-invasive injury methods avoid this complication by mechanically inducing a joint injury externally, without breaking the skin or disrupting the joint. In this regard, non-invasive injury models may be crucial for investigating early adaptive processes initiated at the time of injury, and may be more representative of human OA in which injury is induced mechanically. A small number of non-invasive mouse models of PTOA have been described within the last few years, including intra-articular fracture of tibial subchondral bone, cyclic tibial compression loading of articular cartilage, and anterior cruciate ligament (ACL) rupture via tibial compression overload. This review describes the methods used to induce joint injury in each of these non-invasive models, and presents the findings of studies utilizing these models. Altogether, these non-invasive mouse models represent a unique and important spectrum of animal models for studying different aspects of PTOA.
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Abstract
Osteoarthritis (OA) is unquestionably one of the most important chronic health issues in humans, affecting millions of individuals and costing billions of dollars annually. Despite widespread awareness of this disease and its devastating impact, the pathogenesis of early OA is not completely understood, hampering the development of effective tools for early diagnosis and disease-modifying therapeutics. Most human tissue available for study is obtained at the time of joint replacement, when OA lesions are end stage and little can be concluded about the factors that played a role in disease development. To overcome this limitation, over the past 50 years, numerous induced and spontaneous animal models have been utilized to study disease onset and progression, as well as to test novel therapeutic interventions. Reflecting the heterogeneity of OA itself, no single "gold standard" animal model for OA exists; thus, a challenge for researchers lies in selecting the most appropriate model to answer a particular scientific question of interest. This review provides general considerations for model selection, as well as important features of species such as mouse, rat, guinea pig, sheep, goat, and horse, which researchers should be mindful of when choosing the "best" animal model for their intended purpose. Special consideration is given to key variations in pathology among species as well as recommended guidelines for reporting the histologic features of each model.
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Affiliation(s)
- A M McCoy
- Department of Veterinary Clinical Medicine, University of Illinois, Urbana, IL, USA
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Deponti D, Di Giancamillo A, Scotti C, Peretti GM, Martin I. Animal models for meniscus repair and regeneration. J Tissue Eng Regen Med 2013; 9:512-27. [PMID: 23712959 DOI: 10.1002/term.1760] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 02/24/2013] [Accepted: 04/02/2013] [Indexed: 12/21/2022]
Abstract
The meniscus plays an important role in knee function and mechanics. Meniscal lesions, however, are common phenomena and this tissue is not able to achieve spontaneous successful repair, particularly in the inner avascular zone. Several animal models have been studied and proposed for testing different reparative approaches, as well as for studying regenerative methods aiming to restore the original shape and function of this structure. This review summarizes the gross anatomy, function, ultrastructure and biochemical composition of the knee meniscus in several animal models in comparison with the human meniscus. The relevance of the models is discussed from the point of view of basic research as well as of clinical translation for meniscal repair, substitution and regeneration. Finally, the advantages and disadvantages of each model for various research directions are critically discussed.
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A review of translational animal models for knee osteoarthritis. ARTHRITIS 2012; 2012:764621. [PMID: 23326663 PMCID: PMC3541554 DOI: 10.1155/2012/764621] [Citation(s) in RCA: 138] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 11/08/2012] [Accepted: 11/26/2012] [Indexed: 11/18/2022]
Abstract
Knee osteoarthritis remains a tremendous public health concern, both in terms of health-related quality of life and financial burden of disease. Translational research is a critical step towards understanding and mitigating the long-term effects of this disease process. Animal models provide practical and clinically relevant ways to study both the natural history and response to treatment of knee osteoarthritis. Many factors including size, cost, and method of inducing osteoarthritis are important considerations for choosing an appropriate animal model. Smaller animals are useful because of their ease of use and cost, while larger animals are advantageous because of their anatomical similarity to humans. This evidence-based review will compare and contrast several different animal models for knee osteoarthritis. Our goal is to inform the clinician about current research models, in order to facilitate the transfer of knowledge from the "bench" to the "bedside."
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Allen MJ, Townsend KL, Bauer TW, Gabriel SM, O'Connell M, Clifford A. Evaluation of the safety of a novel knee load-bypassing device in a sheep model. J Bone Joint Surg Am 2012; 94:77-84. [PMID: 22218385 DOI: 10.2106/jbjs.j.00918] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Unloading treatments for osteoarthritis of the knee, such as valgus braces, have been shown to reduce medial joint-loading and pain. The purpose of this preclinical study was to investigate the tissue response to an extracapsular implantable device (KineSpring System; Moximed, Hayward, California) that is designed to reduce loading across the medial compartment of the knee. METHODS Eleven sheep were implanted with the KineSpring System, consisting of bases secured to the medial femoral and tibial cortices with bone screws and also consisting of a joint-spanning load-absorber composed of a piston and spring assembly inside a polymeric sheath. In nine sheep, titanium alloy washers with either an uncoated or a plasma-sprayed titanium-hydroxyapatite (TPS-HA) coated undersurface were fixed with screws to the contralateral femur and tibia to investigate the effects of surface treatment on extracortical bone apposition. The functionality of the KineSpring System was assessed by fluoroscopy, tissue response was determined by gross and microscopic histology, and implant fixation was determined by radiography, microradiography, and histomorphometry at four, twelve, twenty-six, and fifty-two weeks. RESULTS The function of the KineSpring System was confirmed in all sheep. Seventeen of eighteen TPS-HA coated bases and thirty-six of thirty-six washers had stable bone fixation; one coated base was loose with evidence of infection. At four weeks, there was an early, expected inflammatory response, but this response resolved by twelve weeks and a pseudosynovial membrane formed around the sheath. Bone apposition increased over time for the TPS-HA coated bases and for uncoated washers (p < 0.05). There was good apposition of the TPS-HA coated washers even at early time points, with no subsequent increase in apposition over time. CONCLUSIONS The KineSpring System demonstrated safety in a simulated use model for periods of up to fifty-two weeks. Screws result in stable implant fixation and TPS-HA coating allows for early and long-lasting cortical bone apposition and integration. CLINICAL RELEVANCE This implant warrants further investigation as a means of reducing medial compartment loading and pain in patients with osteoarthritis of the knee.
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Affiliation(s)
- Matthew J Allen
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, 601 Vernon L. Tharp Street, Columbus, OH 43210, USA.
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Affiliation(s)
- Hyun Ah Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Eun Jeong Cheon
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
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Animal models of osteoarthritis. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00172-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] Open
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Little CB, Smith MM, Cake MA, Read RA, Murphy MJ, Barry FP. The OARSI histopathology initiative - recommendations for histological assessments of osteoarthritis in sheep and goats. Osteoarthritis Cartilage 2010; 18 Suppl 3:S80-92. [PMID: 20864026 DOI: 10.1016/j.joca.2010.04.016] [Citation(s) in RCA: 148] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 04/19/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Sheep and goats are commonly used large animal species for studying pathogenesis and treatment of osteoarthritis (OA). This review focuses on the macroscopic and microscopic criteria for assessing OA in sheep and goats and recommends particular assessment criteria to assist standardization in the conduct and reporting of preclinical trials of OA. METHODS A review was conducted of all published OA studies using sheep and goats and the most common macroscopic, microscopic, or ultrastructural scoring systems were summarised. General recommendations regarding methods of OA assessment in the sheep and goat have been made and a preliminary study of their reliability and utility was undertaken. RESULTS The modified Mankin scoring system is recommended for semiquantitative histological assessment of OA due to its already widespread adoption, ease of use, similarity to scoring systems used for OA in humans, and its achievable inter-rater reliability. Specific recommendations are also provided for histological scoring of synovitis and scoring of macroscopic lesions of OA. CONCLUSIONS The proposed system for assessment of sheep and goat articular tissues appears to provide a useful versatile method to quantify OA change. It is hoped that by adopting more standardised quantitative outcome measures, better comparison between different studies and arthritis models will be possible. The suggested scoring systems can be modified in the future as our knowledge of disease pathophysiology advances.
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Affiliation(s)
- C B Little
- Raymond Purves Bone and Joint Research Laboratories, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney at Royal North Shore Hospital, St Leonards, NSW 2065, Australia.
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Laurent D, O'Byrne E, Wasvary J, Pellas TC. In vivo MRI of cartilage pathogenesis in surgical models of osteoarthritis. Skeletal Radiol 2006; 35:555-64. [PMID: 16639625 DOI: 10.1007/s00256-006-0133-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Revised: 03/30/2006] [Accepted: 03/31/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine in vivo time-course changes in macromolecular composition of articular cartilage in two surgical models of osteoarthritis (goat: meniscal transection and cartilage incision; rabbit: medial meniscectomy). DESIGN Collagen integrity and proteoglycan (PG) content were evaluated in both models by magnetization transfer (MT) and contrast-enhanced MRI, respectively. The MT rate k(m) for the exchange process between the bulk water and water bound to collagen was determined as a marker of the collagen network. Local changes in cartilage fixed charge density, i.e., where PGs are depleted, were derived from T(1) relaxation maps as obtained after an infusion of Gd(DTPA)(2-), a paramagnetic agent. RESULTS In the goat model, the MT rate constant k(m) was significantly higher at 2 weeks post surgery, a possible sign of cartilage swelling, then decreased below baseline values, most likely indicative of disruption in the collagen framework. Meanwhile, post-Gd(DTPA)(2-) MRI acquisition indicated a significant and sustained loss of PGs. The rabbit model produced milder lesions. Although the difference was non-significant, k(m) steadily decreased in response to the surgical insult while kinetics of Gd(DTPA)(2-) uptake, after reaching a peak level at 6 weeks, were back to normal values after 12 weeks. CONCLUSION In the goat model, joint instability and cartilage damage was a permanent trigger for cartilage degeneration producing MRI changes. However, biomechanical stress due to partial medial meniscectomy in knees of mature rabbits produced only mild, focal lesions and PG depletion that was partially reversible. This proof-of-concept study identified MT and T(1) parameters as useful surrogate markers in animal models of osteoarthritis.
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Affiliation(s)
- Didier Laurent
- Novartis Institutes for Biomedical Research, Inc., 250 Massachusetts Avenue, Cambridge, MA 02139, USA.
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Oakley SP, Portek I, Szomor Z, Appleyard RC, Ghosh P, Kirkham BW, Murrell GAC, Lassere MN. Arthroscopy -- a potential "gold standard" for the diagnosis of the chondropathy of early osteoarthritis. Osteoarthritis Cartilage 2005; 13:368-78. [PMID: 15882560 DOI: 10.1016/j.joca.2004.12.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2004] [Accepted: 12/24/2004] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The aims of this study were to: 1. Evaluate the performance of arthroscopy for the diagnosis of chondropathy and to compare it to that of direct non-arthroscopic assessments; 2. Determine intra-observer reliability of arthroscopic assessments; 3. Evaluate the effects of the arthroscopic video quality and probing upon diagnostic performance. DESIGN The ovine medial meniscectomy (MMx) model of early osteoarthritis (OA) was used assuming that pre-MMx articular cartilage (AC) was "normal" and post-MMx AC "chondropathic". Video recordings of arthroscopic assessments of each stifle compartment were evaluated. Scores were given for the quality of the video and the amount of probing. The diagnostic performances of dynamic shear modulus (G), light microscopic assessment and superficial zone collagen birefringence assessments were evaluated and compared to that of arthroscopy. Intra-observer reliability of arthroscopic assessments was also evaluated. RESULTS Arthroscopic assessments had high sensitivity (91-100%), specificity (62-88%) and accuracy (75-93%) for the diagnosis of chondropathy 16 weeks after MMx. Arthroscopy compared favourably with the direct non-arthroscopic assessments in the lateral compartment and was found to have extremely high intra-observer reliability (kappa 0.78-1.00). The quality of arthroscopic video recordings and the amount of probing did not significantly influence accuracy or reliability. CONCLUSIONS Arthroscopy performs as well as direct non-arthroscopic assessments of AC for diagnosis of early OA. These results suggest that arthroscopy can be used as a "gold standard" for the validation of non-invasive assessments like magnetic resonance imaging and that arthroscopic diagnosis can be based on small amounts of video footage without AC probing.
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Affiliation(s)
- S P Oakley
- Department of Rheumatology, St. George Hospital (University of New South Wales), Gray St. Kogarah, NSW 2217, Australia.
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20
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Shrier I. Muscle dysfunction versus wear and tear as a cause of exercise related osteoarthritis: an epidemiological update. Br J Sports Med 2005; 38:526-35. [PMID: 15388532 PMCID: PMC1724947 DOI: 10.1136/bjsm.2003.011262] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
There are two main hypotheses for the cause of exercise related osteoarthritis: wear and tear of the articular cartilage and muscle dysfunction. This is a review of the clinical literature to see which hypothesis has the greatest support. Clinical studies support the muscle dysfunction hypothesis over the wear and tear hypothesis.
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Affiliation(s)
- Ian Shrier
- Lady David Institute for Medical Research, Centre for Clinical Epidemiology and Community Studies, SMBD-Jewish General Hospital, 3755 Cote Sainte-Catherine Road, Montreal H3T 1E2, Canada.
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21
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Oakley SP, Lassere MN, Portek I, Szomor Z, Ghosh P, Kirkham BW, Murrell GAC, Wulf S, Appleyard RC. Biomechanical, histologic and macroscopic assessment of articular cartilage in a sheep model of osteoarthritis. Osteoarthritis Cartilage 2004; 12:667-79. [PMID: 15262247 DOI: 10.1016/j.joca.2004.05.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2003] [Accepted: 05/08/2004] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Our primary objective was to explore the full potential of the ovine medial meniscectomy (MMx) model of early osteoarthritis (OA) for studies to validate non-destructive articular cartilage (AC) assessments and therapeutic interventions. Our secondary objective was to re-evaluate the relationships between the different types of AC assessment after MMx in sheep. METHODS Macroscopic assessments, dynamic shear modulus (G*), phase lag and AC thickness measurements were performed at a total of 5437 reference points on all six articular surfaces in four normal joints and 16 MMx ovine stifle (knee) joints. Comparisons with histologic assessments of gross structural damage, collagen organisation (birefringence) and proteoglycan content were possible at 702 of these points. RESULTS Histologic gross structural damage and proteoglycan loss were seen throughout the joint with greatest severity (fibrillation) in closest proximity to the MMx site. Increases in AC (30-50%) thickness, reductions in G* (30-40%) and collagen birefringence intensity (15-30%) occurred more evenly throughout the joint. Macroscopic softening was evident only when G* declined by 80%. G* correlated with AC thickness (rho=-0.47), collagen organisation rho=0.44), gross structural damage (rho=-0.44) and proteoglycan content (rho=0.42). Multivariate analysis showed that collagen organisation contributed twice as much to dynamic shear modulus (t=6.66 as proteoglycan content (t=3.21). Collagen organisation (rho=0.11) and proteoglycan content (rho=0.09) correlated only weakly to phase lag. CONCLUSIONS Macroscopic assessments were insensitive to AC softening suggesting that arthroscopic assessments of AC status might also perform poorly. Collagen integrity was more important for the maintenance of AC stiffness (G*) than proteoglycan content. The development of major AC softening and thickening throughout the joint following MMx suggested involvement of non-mechanical (e.g., protein and biochemical) chemical and cytokine mediated processes in addition to the disturbance in biomechanical loading. The ovine MMx model provides a setting in which the spectrum of AC changes associated with the initiation and progression of OA may be evaluated.
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Affiliation(s)
- S P Oakley
- Department of Rheumatology, St. George Hospital, University of New South Wales, Gray St., Kogarah, NSW 2217, Australia.
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Adeeb SM, Sayed Ahmed EY, Matyas J, Hart DA, Frank CB, Shrive NG. Congruency Effects on Load Bearing in Diarthrodial Joints. Comput Methods Biomech Biomed Engin 2004; 7:147-57. [PMID: 15512758 DOI: 10.1080/10255840410001710885] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Modelling load bearing in diarthrodial joints is challenging, due to the complexity of the materials, the boundary and interface conditions and the geometry. The articulating surfaces are covered with cartilage layers that are filled with a fluid that plays a major role in load bearing [Mow, V.C., Holmes, M.H., Lai, W.M. (1984) "Survey article: fluid transport and mechanical properties of articular cartilage: a review", Journal of Biomechanics 17(5), 377-394]. Researchers have tended to approximate joint geometry using axisymmetry [Donzelli, P.S., Spilker, R.L., Ateshian, G.A., Mow, V.C. (1999) "Contact analysis of biphasic transversely isotropic cartilage layers and correlations with tissue failure", Journal of Biomechanics 32, 1037-1047], often with a rounded upper articulating surface, creating a form of Hertz problem [Donzelli, P.S., Spilker, R.L., Ateshian, G.A., Mow, V.C. (1999) "Contact analysis of biphasic transversely isotropic cartilage layers and correlations with tissue failure", Journal of Biomechanics 32, 1037-1047]. However, diarthrodial joints (shoulder, hip and knee) are equipped with peripheral structures (glenoid labrum, acetabular labrum and meniscus, respectively) that tend to deepen the joint contact and thus cause initial contact to be established at the periphery of the joint rather than "centrally". The surface geometries are purposefully incongruent, and the incongruency has a significant effect on the stresses, pressures and pressure gradients inside the tissue. The models show the importance of the peripheral structures and the incongruency from a load-bearing perspective. Joint shapes must provide a compromise between demands for load-bearing, lubrication and the supply of nutrients to the chondrocytes of the cartilage and cells of the peripheral structures. Retention and repair of the functionality of these peripheral structures should be a prime consideration in any surgical treatment of an injured joint.
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Affiliation(s)
- Samer M Adeeb
- McCaig Centre for Joint Injury and Arthritis Research, University of Calgary, Alberta, T2N 1N4 Calgary, Canada
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Parker D, Hwa SY, Sambrook P, Ghosh P. Estrogen replacement therapy mitigates the loss of joint cartilage proteoglycans and bone mineral density induced by ovariectomy and osteoarthritis. ACTA ACUST UNITED AC 2003. [DOI: 10.1046/j.0219-0494.2003.00035.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Oakley SP, Lassere MN. A critical appraisal of quantitative arthroscopy as an outcome measure in osteoarthritis of the knee. Semin Arthritis Rheum 2003; 33:83-105. [PMID: 14625817 DOI: 10.1016/s0049-0172(03)00082-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES To review the performance of arthroscopic assessment of articular cartilage damage in osteoarthritis. METHODS The literature was reviewed for publications containing data regarding validity and reliability of arthroscopic systems of cartilage evaluation in knee osteoarthritis. RESULTS Fifty-two distinct measurement systems were identified in 60 publications. There were 30 simple severity-scoring systems, 3 global visual analogue scale systems, and 19 composite systems. No systems consisted solely of measurements of lesion size or site, although 13 systems used either or both of these for the calculation of composite scores. Only 6 publications (10%) undertook any reliability evaluation and these generally used inappropriate methods of statistical analysis. Thirty-five publications (58%) evaluated validity. Construct validity was tested using several constructs (clinical in 2, magnetic resonance imaging in 10, radiographs in 10, or other arthroscopic assessments in 5 publications). Criterion validity was ascertained by using several methods including cartilage histology, histochemistry, or biomechanics in 10 publications. Responsiveness was determined in 1 publication. DISCUSSION Many publications evaluated composite systems but only a few evaluated fundamental aspects of arthroscopic measurement. Conceptually, composite scoring systems have the best validity; however, at present, there is only enough evidence to support the use of simple chondropathy severity scores and there are little data on the responsiveness of these methods. A proposed program for comprehensive evaluation and development of valid and responsive arthroscopic assessments of articular cartilage is outlined.
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Affiliation(s)
- Stephen Philip Oakley
- Department of Rheumatology, The St. George Hospital Campus, University of New South Wales, Kogarah, Australia.
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25
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Abstract
Few medical professionals would dispute the obvious health benefits afforded by regular exercise if pursued judiciously and in moderation. Cardiovascular disease, hypertension, osteoporosis, diabetes, depression, and fibromyalgia are a few of the many disorders in which exercise plays a key role in management. Less well-appreciated until recently is the beneficial effect exercise may have in the treatment of osteoarthritis (OA). Previously, rest and inactivity seemed to be the prevailing treatment strategy until it was recognized that this approach was ineffective and contributed further to the patient's disability and loss of function. New trial data support the value of physical exercise whether it involves aerobic or resistance-type training. The studies are not without statistical and methodologic imperfections. Still, the evidence favoring an exercise intervention as part of the OA treatment plan is impressive. It remains for the clinician to select an appropriate exercise routine that meets the strength, balance, flexibility, and aerobic needs of the patient. The clinician then monitors and evaluates the patient's response to this activity with the same exactness used in following pharmacologic therapy.
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Affiliation(s)
- B Clyman
- VA Greater Los Angeles Health Care System, 534 Hillgreen Drive, Beverly Hills, CA 90212, USA.
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Burkhardt D, Hwa SY, Ghosh P. A novel microassay for the quantitation of the sulfated glycosaminoglycan content of histological sections: its application to determine the effects of Diacerhein on cartilage in an ovine model of osteoarthritis. Osteoarthritis Cartilage 2001; 9:238-47. [PMID: 11300747 DOI: 10.1053/joca.2000.0381] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE A new micro-histological method of assessing the sulfated glycosaminoglycan (S-GAG) content in unstained histological sections of articular cartilage was developed and used to study the effects of orally administered Diacerhein (DIA) on joint cartilage in an ovine model of osteoarthritis (OA). METHODS Twenty adult, age-matched Merino wethers were subjected to bilateral lateral meniscectomy, while 10 served as non-operated controls (NOC groups). Half of the operated sheep (N=10) remained untreated (MEN groups), while the other 10 animals were given DIA (25 mg/kg orally) daily for 3 months, then 50 mg/kg daily for a further 6 months (DIA groups). Five animals each of the DIA, MEN and NOC groups, respectively, were sacrificed at 3 months post-operatively, and the remainder 6 months later. For the present study only one knee joint of each animal was used for histological processing. The tissues studied were from the lateral femoral condyles (LFC) and lateral tibial plateaux (LTP). Each of these joint regions was further subdivided into inner (I), middle (M), and outer (O) zones. Unstained histological sections from these AC regions and zones were then analysed for S-GAG content using the following procedure. Images of each section of 6 microm thickness were acquired using a flatbed scanner and the area determined with an image analysis software program. The sections were then transferred to wells of a microtiter plate, digested with papain and the S-GAG content quantitated using a modification of the 1,9-dimethylmethylene blue dye binding assay. The data was represented as microg S-GAG/mm(3)of each tissue section. These data were also compared with toluidine blue stained sections from the same paraffin blocks. RESULTS The results obtained showed that the area of histological sections could be very accurately determined by computer assisted image analysis using a 10 mmx10 mm calibration grid. Cartilage sections of areas ranging from 1 mm(2)up to 25 mm(2)were analysed for S-GAG content with this simple technique. There was a linear relationship between section thickness (2-10 microm) and S-GAG content per unit area (R(2)=0.993). Sections of 6 microm thickness were found to be optimal. S-GAG analyses of serial sections from tibial and femoral articular cartilage (I, M and O zones) revealed an average coefficient of variation of 7.0+/-2.3% (range 4.9-10.2%) confirming the accuracy and reproducibility of this assay method. A separate experiment showed that no significant losses of S-GAG occurred during the histological sample processing. The different regions and zones of the knee joint AC in the six experimental groups revealed variable levels of S-GAG which did not necessarily correlate with the histochemical distribution of toluidine blue staining. The major S-GAG changes occurred in the middle (lesion zone) and outer zones (hypertrophic zone) of both the LFC and LTP of the MEN groups. In the lesion (M) zone the S-GAG content was reduced while in the O zone levels were increased at both 3 and 6 months post-surgery. In animals receiving Diacerhein S-GAG levels in the M zone were lower than or equivalent to those of non-drug treated OA or non-operated controls for both joint regions at 3 and 6 months. While the hypertrophic response in the outer zone of the LFC, as assessed by S-GAG content, was enhanced by drug treatment, the cartilage of the outer zones of the LTP was not affected by drug treatment. CONCLUSION The results of this study have demonstrated that the S-GAG (and therefore proteoglycan [PG]) content in different cartilage zones of OA joints can be readily quantitated by direct biochemical analysis of unstained histological sections. By this means subtle changes in PG distribution in different cartilage zones, which were not evident using traditional histochemical staining methods, could be readily detected.
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Affiliation(s)
- D Burkhardt
- Institute of Bone and Joint Research (University of Sydney), Royal North Shore Hospital, St Leonards, New South Wales, 2065, Australia.
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Cake MA, Read RA, Guillou B, Ghosh P. Modification of articular cartilage and subchondral bone pathology in an ovine meniscectomy model of osteoarthritis by avocado and soya unsaponifiables (ASU). Osteoarthritis Cartilage 2000; 8:404-11. [PMID: 11069724 DOI: 10.1053/joca.1999.0315] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the effect of an oral preparation of avocado and soya unsaponifiables (ASU) on the development of joint pathology in an ovine model of osteoarthritis (OA), using computer-assisted histomorphometric methods. DESIGN OA was induced in ovine knee joints by bilateral lateral meniscectomy (N=32). ASU (900 mg/weekday) was given orally to half the group (MenX+ASU), the remainder receiving placebo (MenX). Sixteen animals were used as non-operated controls (NOC). At 3 and 6 months post-meniscectomy, histological sections from the medial and lateral femoral condyles (MFC, LFC), tibial plateaux (MTP, LTP) and trochlear groove (TG) were prepared from all joints. Sections were scored using traditional histopathological scales, and computerized image analysis, measuring total cartilage area, uncalcified cartilage (UCC) and subchondral bone plate (SCP) thickness, and intensity of articular cartilage toluidine blue staining (mean greyscale intensity, black=255) as an index of proteoglycan (PG) content. RESULTS Computerized image analysis showed significant histological differences not detectable by traditional scoring methods. ASU-treated animals at 6 months showed reduced loss of toluidine blue stain in the MTP (P=0.015) and LTP (P=0.001), and significantly greater staining in the TG than either placebo or NOC groups (P=0.011). UCC thickness increased after meniscectomy, but tended to be highest in ASU-treated animals, significantly so in the middle zone of the LFC (MenX+ASU: 1.03+/-0.21mm vs MenX: 0.79+/-0.14 mm, P=0.018; NOC: 0.77+/-0.17 mm). Lateral compartment SCP thickness increased post-meniscectomy but was increased significantly less in the inner zone of the LTP in ASU-treated sheep (MenX+ASU: 1.37+/-0. 23 mm vs MenX: 1.68+/-0.28 mm, P=0.033; NOC=1.22+/-0.33 mm). CONCLUSIONS In this model ASU treatment following meniscectomy appeared to confer a subtle but statistically significant protective effect on articular cartilage. Although the drug failed to prevent focal cartilage lesions, characteristic of this model, histomorphometric analysis demonstrated greater PG content and UCC thickness in adjacent joint regions of ASU-treated animals. In addition, a statistically significant reduction of subchondral bone sclerosis was noted in the LTP region of the drug-treated group. An anabolic effect on chondrocytes, resulting in the stimulation of matrix production in regions distant to the insult, was also suggested by the data. These findings support other studies which have proposed that ASU may exhibit disease-modifying anti-OA activity.
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Affiliation(s)
- M A Cake
- Division of Veterinary and Biomedical Sciences, Murdoch University, Perth, Western Australia
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Abstract
OBJECTIVE To review and determine the effectiveness of exercise treatment in osteoarthritis of the knee. METHODS A computerised literature search of Medline was carried out searching between June 1966 and January 2000. RESULTS Twenty three randomised controlled trials were identified from the literature. Only three trials were sufficiently powered. Small to moderate beneficial effects of exercise treatment were found for pain, small beneficial effects on disability outcome measures, and moderate to great beneficial effects were observed according to patient global assessment of effect. It was not possible to obtain evidence on the content of exercise interventions, as studies were hampered by lack of attention to proper concealment, reporting of adverse effects, and long term effects of exercise treatment. The lack of standard outcomes measures is also noted. CONCLUSIONS The available evidence indicates beneficial short term effects of exercise treatment in patients with osteoarthritis of the knee. However, the number of available studies is limited, and more research is needed to expand this recommendation. Specifically, additional trials should provide information on adherence, home based interventions, interaction with pharmacological treatments, functional outcomes measures relevant to exercise treatment in these patients, and long term effects. At present, doctors should recommend exercise to all patients with mild/moderate disease. Further study should be encouraged and exercise should be continued to be recommended as a mainstay of non-pharmacological treatment of osteoarthritis of the knee.
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Affiliation(s)
- R J Petrella
- Department of Family Medicine, Faculty of Medicine, School of Kinesiology, University of Western Ontario, London, Canada
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Lindhorst E, Vail TP, Guilak F, Wang H, Setton LA, Vilim V, Kraus VB. Longitudinal characterization of synovial fluid biomarkers in the canine meniscectomy model of osteoarthritis. J Orthop Res 2000; 18:269-80. [PMID: 10815829 DOI: 10.1002/jor.1100180216] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Damage to the meniscus can lead to posttraumatic osteoarthritis. Early markers of joint injury and tissue disease may be useful in developing and administering clinical treatment. We investigated the effects of total medial meniscectomy on biomarkers measured serially in synovial lavage fluid each month for 3 months. Following meniscectomy in dogs, four biomarkers were evaluated: cartilage oligomeric matrix protein, keratan sulfate epitope (5D4), the 3B3(-) neoepitope of chondroitin-6-sulfate, and the 3B3(+) chondroitinase-generated epitope of chondroitin-6-sulfate. Meniscectomy led to statistically significant elevations of all four biomarkers, with levels peaking at 4 weeks. By 12 weeks, the level of the 5D4 epitope returned to the preoperative baseline level whereas that of cartilage oligomeric matrix protein, 3B3(-), and 3B3(+) remained above the baseline. Concentrations of these biomarkers in the knees not operated on did not change significantly from the baseline. The levels of cartilage oligomeric matrix protein and 3B3(-) relative to 3B3(+) remained constant in all knees. In contrast, the level of 5D4 relative to 3B3(+) declined over time in the knee operated on but remained constant in the knee not operated on. These results demonstrate a quantitative change in the molecular components of synovial fluid after meniscectomy, as well as a qualitative change evinced by an alteration in the relative proportions of these epitopes. Extensive analyses showed a strong correlation between serum levels of 3B3(-) from the femoral and cephalic veins; however, serum 3B3(-) was not correlated with synovial fluid 3B3(-). These findings support the hypothesis that the concentrations of select cartilage biomarkers in synovial fluid are altered following meniscectomy and are promising tools for objectively monitoring the induction of osteoarthritis in this model system.
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Affiliation(s)
- E Lindhorst
- Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
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Røgind H, Bibow-Nielsen B, Jensen B, Møller HC, Frimodt-Møller H, Bliddal H. The effects of a physical training program on patients with osteoarthritis of the knees. Arch Phys Med Rehabil 1998; 79:1421-7. [PMID: 9821904 DOI: 10.1016/s0003-9993(98)90238-6] [Citation(s) in RCA: 147] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate physical function in patients with severe osteoarthritis (OA) of the knees during and after a general physical training program. DESIGN Randomized control trial, blinded observer, follow-up at 3 months and 1 year. SETTING Outpatient clinic. PATIENTS Consecutive sample of 25 patients (3 men, 22 women) with OA of the knees according to the criteria of the American College of Rheumatology (ACR). Two patients (8%) failed to complete the study. There were no withdrawals for adverse effects. INTERVENTION Twelve patients received training in groups of 6, twice a week for 3 months. Training focused on general fitness, balance, coordination, stretching, and lower extremity muscle strength, and included a daily home exercise program. MAIN OUTCOME MEASURES Muscle strength across the knee (extension and flexion), Algofunctional Index (AFI), pain (0 to 10 point scale), walking speed, clinical findings. RESULTS Patients participated in 96 of 96 assessments (100%) and in 218 of 280 training sessions (77.9%). From baseline to 3 months, isokinetic quadriceps strength (30 degrees/sec) improved 20% (confidence interval [CI] 2alpha = .05, 8% to 50%) in the least affected leg; isometric strength improved 21%. By 1 year, AFI had decreased 3.8 points (CI2alpha = .05, 1.0 to 7.0), pain had decreased 2.0 points (CI2alpha = 05, 0.0 to 4.0), and walking speed had increased 13% (CI2alpha = .05, 4% to 23%). There was an increase in the frequency of palpable joint effusions (p < .01) on the most affected side. Frequency of crepitus decreased on the least affected side (p < .01). CONCLUSIONS General physical training appears to be beneficial to patients with OA of the knee. As shown by the high compliance and low dropout frequency, such a program is feasible even in patients with severe OA of the knee.
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Affiliation(s)
- H Røgind
- Department of Rheumatology, Copenhagen Municipal Hospital, Denmark
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Little CB, Ghosh P, Bellenger CR. Topographic variation in biglycan and decorin synthesis by articular cartilage in the early stages of osteoarthritis: an experimental study in sheep. J Orthop Res 1996; 14:433-44. [PMID: 8676257 DOI: 10.1002/jor.1100140314] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Articular cartilage contains large molecular weight proteoglycans that aggregate with hyaluronic acid (aggrecan) and small species, particularly biglycan (dermatan sulphate proteoglycan-1) and decorin (dermatan sulphate proteoglycan-2), that do not. Mechanical stresses have been shown to profoundly influence the metabolism of aggrecan by articular chondrocytes; however, there are limited corresponding data on the metabolism of dermatan sulphate proteoglycans 1 and 2. The objective of this study was to examine the metabolism of aggrecan, biglycan, and decorin in articular cartilage from different weight-bearing areas of normal ovine stifle joints and in joints 6 months after menisectomy, a procedure that has been shown to induce early osteorthritic changes. [35S]proteoglycans synthesised by cartilage explants from eight different weight-bearing regions of unoperated and meniscectomised ovine stifle joints during 48 hours of culture were separated by size-exclusion chromatography, hydrophobic chromatography, and sodium dodecyl sulfate-polyacrylamide gel electrophoresis and were quantitated by phosphor-screen autoradiography. The synthesis and degradation of the proteoglycans were expressed relative to the DNA content of the explants. In control joints, the cartilage exposed to high contact stress synthesised significantly less proteoglycan overall and more decorin than joint regions bearing less stress. Explants from high stress regions also released significantly greater amounts of resident proteoglycans (dimethylmethylene blue positive) into media during culture. After lateral meniscectomy, the lateral tibial and femoral cartilages showed elevated biosynthesis of both 35S-dermatan sulphate proteoglycans 1 and 2. This chondrocyte biosynthetic response was accompanied by increased catabolism of aggrecan and the release of its degradation products into culture media. These experiments revealed, in normal joints, a topographic variation in proteoglycan synthesis by articular cartilage that was related to the mechanical stress to which the tissues were subjected in vivo. This biosynthetic pattern changed when the load distribution of the joint was altered by unilateral meniscectomy. These data suggest that an altered chondrocyte phenotypic expression of proteoglycans in response to abnormal mechanical loading is an early event in osteoarthritis.
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Affiliation(s)
- C B Little
- Raymond Purves Bone and Joint Research Laboratories, Royal North Shore Hospital, St. Leonards, New South Wales, Australia
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Armstrong SJ, Read RA, Price R. Topographical variation within the articular cartilage and subchondral bone of the normal ovine knee joint: a histological approach. Osteoarthritis Cartilage 1995; 3:25-33. [PMID: 7719953 DOI: 10.1016/s1063-4584(05)80035-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Topographical variation in the articular cartilage and subchondral bone of the normal ovine knee was examined using histological techniques. The articular cartilage was examined grossly, then histological sections were cut and the cartilage thickness and chondrocyte density were measured. Bone mineral density, thickness of the subchondral bone plate (SBP) and volume and surface histomorphometrical parameters and mineral apposition rate were calculated for the subchondral bone. It was found that the articular cartilage on the tibial plateaux was thicker, less cellular, and overlay a thicker SBP than that on the femoral condyles. Similarly, the cartilage in the medial joint compartments was thicker, less cellular and overlying a thicker less dense SBP than that in the lateral joint compartments. There was no variation in bone histomorphometric parameters or mineral apposition rate between regions. Biomechanical testing has shown that loading is not uniform throughout the normal human knee joint. The present results suggest that loading within the ovine knee is also nonuniform, with the central regions of the tibial plateaux bearing greater loads than the femoral condyles, and the medial joint compartment being loaded more than the lateral one. The articular cartilage and subchondral bone have adapted in order to best withstand these variations in loading. These histological findings, plus the topographical variations in cartilage biochemistry reported by Read et al. (Topographical variation in composition, PG-biosynthesis and swelling pressure of cartilages of loaded tibio-femoral joints (Abstract). Proceedings of the Combined Meeting of the Orthopaedic Research Societies of USA, Japan and Canada.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S J Armstrong
- School of Veterinary Studies, Murdoch University, Australia
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