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Uflacker AB, Keefe N, Bruner ET, Avery A, Salzar R, Henderson K, Spratley M, Nacey N, Miller W, Grewal S, Chahin J, Safavian D, Haskal ZJ. Assessing the Effects of Geniculate Artery Embolization in a Non-Surgical Animal Model of Osteoarthritis. J Vasc Interv Radiol 2022; 33:1073-1082.e2. [PMID: 35659574 DOI: 10.1016/j.jvir.2022.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/06/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To create a non-surgical animal model of osteoarthritis (OA) to evaluate effects of embolotherapy during geniculate artery embolization. MATERIALS AND METHODS Fluoroscopy-guided injections of 700mg Sodium-Monoiodoacetate were made into the left stifle in 6 rams. Kinematic data were collected pre/post-induction. 10-weeks post-induction, subjects 1, 4-6 underwent MRI with dynamic contrast enhancement (DCE-MRI), and angiography (subjects 1, 3, 4-6) with angiographic scoring to identify regions with greatest disease severity for superselective embolization (75-250μm microspheres, subjects 1, 3, 4, and 6). Target vessel size was measured. 24-weeks after angiography, DCE-MRI, angiography, and euthanasia were performed and bilateral stifles harvested. Medial/lateral tibial and femoral condyles, patella and synovium samples were cut, preserved, decalcified, and scored with OARSI criteria. Stifle and synovium WORMS and MOST scores were obtained. Ktrans and extracellular volume fraction (ve) were calculated from DCE-MRI along lateral synovial regions of interest. RESULTS Mean gross/microscopic pathological scores were elevated at 38/61. Mean synovitis score was elevated at 9.2. Mean pre/post-embolization angiographic scores were 5/3.8, respectively. Mean Superior/Transverse/Inferior Geniculate artery diameters(mm) were 3.1±1.21, 2.0±0.50, and 1.6±0.41. Mean Pre/post-embolization cartilage/synovitis scores were elevated at 35.13/73.3 and 5.5/9.2, respectively. Subjects 4-6 Ktrans/ve values were elevated at 0.049/0.38, 0.074/0.53, and 0.065/0.51. Altered gait of the hind limb was observed in all subjects post-induction, with reduced joint mobility. No skin or osteonecrosis were observed. CONCLUSION A non-surgical ovine animal knee OA model was created which allowed the collection of angiographic, histopathological, MRI and kinematic data were obtained to study the effects of geniculate artery embolization.
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Affiliation(s)
- Andre B Uflacker
- Medical University of South Carolina, Department of Radiology, Division of Vascular and Interventional Radiology
| | - Nicole Keefe
- University of Virginia, Department of Radiology and Medical Imaging, Division of Vascular and Interventional Radiology
| | - Evelyn T Bruner
- Medical University of South Carolina, Department of Pathology & Laboratory Medicine
| | - Alexandra Avery
- Medical University of South Carolina, Department of Pathology & Laboratory Medicine
| | - Robert Salzar
- University of Virginia, Department of Engineering, Center for Applied Biomechanics
| | - Kyvory Henderson
- University of Virginia, Department of Engineering, Center for Applied Biomechanics
| | - Meade Spratley
- University of Virginia, Department of Engineering, Center for Applied Biomechanics
| | - Nicholas Nacey
- University of Virginia, Department of Radiology and Medical Imaging
| | - Wilson Miller
- University of Virginia, Department of Radiology and Medical Imaging
| | - Sukhdeep Grewal
- University of Virginia, Department of Radiology and Medical Imaging, Division of Vascular and Interventional Radiology
| | - Jonathan Chahin
- University of Virginia, Department of Radiology and Medical Imaging, Division of Vascular and Interventional Radiology
| | - Dana Safavian
- University of Virginia, Department of Radiology and Medical Imaging, Division of Vascular and Interventional Radiology
| | - Ziv J Haskal
- University of Virginia, Department of Radiology and Medical Imaging, Division of Vascular and Interventional Radiology
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Chen X, Li Z, Zhang X, Yan J, Ding L, Song Y, Huo Y, Chan MTV, Wu WKK, Lin J. A new robotically assisted system for total knee arthroplasty: A sheep model study. Int J Med Robot 2021; 17:e2264. [PMID: 33855810 DOI: 10.1002/rcs.2264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/09/2021] [Accepted: 04/09/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND We investigated the accuracy and safety of a new HURWA robotic-assisted total knee arthroplasty (TKA) system in a sheep model. METHODS Ten male small-tailed Han sheep were used in this study. Sheep were imaged by computed tomography scan before and after bone resection and the cutting errors between actual bone preparation and preoperative planning of the femur and tibia in three dimensions were measured. RESULTS The overall accuracies after surgery compared with that from preoperative surgical planning of the left and right femurs were 1.93 ± 1.02° and 1.93 ± 1.23°, respectively. Additionally, similarly high overall accuracies for the left and right tibia of 1.26 ± 1.04 and 1.68 ± 0.92°, respectively, were obtained. The gap distances of the distal cut, anterior chamfer, anterior cut, posterior chamfer and posterior cut on the medial side were 0.47 ± 0.35 mm, 0.41 ± 0.37 mm, 0.12 ± 0.26 mm, 0.41 ± 0.44 mm and 0.12 ± 0.23 mm, respectively. No intraoperative complications, such as intraoperative fracture, massive bleeding or death, occurred. CONCLUSION This new HURWA robotic-assisted TKA system is an accurate and safe tool for TKA surgery based on the sheep model.
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Affiliation(s)
- Xin Chen
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng Li
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaofeng Zhang
- BEIJING HURWA-ROBOT Medical Technology Co.Ltd, Beijing, China
| | - Jun Yan
- BEIJING HURWA-ROBOT Medical Technology Co.Ltd, Beijing, China
| | - Lele Ding
- BEIJING HURWA-ROBOT Medical Technology Co.Ltd, Beijing, China
| | - Youdong Song
- BEIJING HURWA-ROBOT Medical Technology Co.Ltd, Beijing, China
| | - Yujia Huo
- BEIJING HURWA-ROBOT Medical Technology Co.Ltd, Beijing, China
| | - Matthew T V Chan
- Department of Anaesthesia and Intensive Care and Peter Hung Pain Research Institute, The Chinese University of Hong Kong, Hong Kong, China
| | - William K K Wu
- Department of Anaesthesia and Intensive Care and Peter Hung Pain Research Institute, The Chinese University of Hong Kong, Hong Kong, China.,State Key Laboratory of Digestive Diseases, Centre for Gut Microbiota Research, Institute of Digestive Diseases and LKS Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Jin Lin
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Chakrabarti S, Ai M, Henson FM, Smith ESJ. Peripheral mechanisms of arthritic pain: A proposal to leverage large animals for in vitro studies. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2020; 8:100051. [PMID: 32817908 PMCID: PMC7426561 DOI: 10.1016/j.ynpai.2020.100051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/22/2020] [Accepted: 07/22/2020] [Indexed: 04/14/2023]
Abstract
Pain arising from musculoskeletal disorders such as arthritis is one of the leading causes of disability. Whereas the past 20-years has seen an increase in targeted therapies for rheumatoid arthritis (RA), other arthritis conditions, especially osteoarthritis, remain poorly treated. Although modulation of central pain pathways occurs in chronic arthritis, multiple lines of evidence indicate that peripherally driven pain is important in arthritic pain. To understand the peripheral mechanisms of arthritic pain, various in vitro and in vivo models have been developed, largely in rodents. Although rodent models provide numerous advantages for studying arthritis pathogenesis and treatment, the anatomy and biomechanics of rodent joints differ considerably to those of humans. By contrast, the anatomy and biomechanics of joints in larger animals, such as dogs, show greater similarity to human joints and thus studying them can provide novel insight for arthritis research. The purpose of this article is firstly to review models of arthritis and behavioral outcomes commonly used in large animals. Secondly, we review the existing in vitro models and assays used to study arthritic pain, primarily in rodents, and discuss the potential for adopting these strategies, as well as likely limitations, in large animals. We believe that exploring peripheral mechanisms of arthritic pain in vitro in large animals has the potential to reduce the veterinary burden of arthritis in commonly afflicted species like dogs, as well as to improve translatability of pain research into the clinic.
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Affiliation(s)
- Sampurna Chakrabarti
- Department of Neuroscience, Max-Delbrück-Centrum für Molekulare Medizin (MDC), Berlin, Germany
- Department of Pharmacology, University of Cambridge, UK
| | - Minji Ai
- Department of Veterinary Medicine, University of Cambridge, UK
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Bei MJ, Tian FM, Xiao YP, Cao XH, Liu N, Zheng ZY, Dai MW, Wang WY, Song HP, Zhang L. Raloxifene retards cartilage degradation and improves subchondral bone micro-architecture in ovariectomized rats with patella baja-induced - patellofemoral joint osteoarthritis. Osteoarthritis Cartilage 2020; 28:344-355. [PMID: 31326553 DOI: 10.1016/j.joca.2019.06.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 06/04/2019] [Accepted: 06/10/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Abnormal remodeling of subchondral bone (SB) induced by estrogen deficiency has been shown to be involved in osteoarthritis (OA). Raloxifene (RAL) is commonly used to treat postmenopausal osteoporosis (OP). However, little is known about its effects on OA combined with estrogen deficiency. This study was performed to evaluate the efficacy of RAL on patella baja-induced patellofemoral joint OA (PFJOA) in an ovariectomized rat model. DESIGN Patellar ligament shortening (PLS) and ovariectomy (OVX) were performed simultaneously in 3-month-old female Sprague-Dawley rats, which were treated with RAL (10 mg/kg/day) or vehicle at 72 h postoperatively for 10 weeks. PFJOA was assessed by immunohistochemistry (IHC), real-time polymerase chain reaction (PCR), tartrate-resistant acid phosphatase (TRAP) staining, enzyme-linked immunosorbent assay (ELISA), micro-computed tomography (μCT), histomorphology and behavioral analyses. RESULTS X-ray examinations showed that patella baja was successfully established by PLS. Histomorphological analysis revealed that PFJOA was significantly exacerbated by OVX and markedly alleviated by RAL. Moreover, RAL improved cartilage metabolism by decreasing MMP-13, ADAMTS-4, and caspase-3 and increasing Col-II and aggrecan at both the protein and mRNA levels. Furthermore, RAL markedly improved bone mass and SB microarchitecture and reduced osteoclast numbers and the serum osteocalcin and CTX-I levels. Although RAL showed a trend toward reducing pain sensitivity based on mechanical allodynia testing, this result was not statistically significant. CONCLUSION These findings demonstrate that RAL treatment retards PFJOA progression in an ovariectomized rat model, suggesting that it may be a potential candidate for amelioration of the progression of PFJOA accompanied by postmenopausal OP.
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Affiliation(s)
- M-J Bei
- Department of Orthopedic Surgery, Hebei Medical University, Shijiazhuang, Hebei, PR China.
| | - F-M Tian
- Medical Research Center, North China University of Science and Technology, Tangshan, Hebei, PR China.
| | - Y-P Xiao
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, PR China.
| | - X-H Cao
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, PR China.
| | - N Liu
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, PR China.
| | - Z-Y Zheng
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, PR China.
| | - M-W Dai
- Department of Orthopedic Surgery, Hebei Medical University, Shijiazhuang, Hebei, PR China.
| | - W-Y Wang
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, PR China.
| | - H-P Song
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, PR China.
| | - L Zhang
- Department of Orthopedic Surgery, Hebei Medical University, Shijiazhuang, Hebei, PR China.
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Rothrauff BB, Sasaki H, Kihara S, Overholt KJ, Gottardi R, Lin H, Fu FH, Tuan RS, Alexander PG. Point-of-Care Procedure for Enhancement of Meniscal Healing in a Goat Model Utilizing Infrapatellar Fat Pad-Derived Stromal Vascular Fraction Cells Seeded in Photocrosslinkable Hydrogel. Am J Sports Med 2019; 47:3396-3405. [PMID: 31644307 DOI: 10.1177/0363546519880468] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Large radial tears of the meniscus involving the avascular region can compromise meniscal function and result in poor healing and subsequent osteochondral degeneration. Augmentation of surgical repairs with adipose-derived stromal vascular fraction (SVF), which contains mesenchymal stromal cells, may improve meniscal healing and preserve function (ie, chondroprotection). PURPOSES (1) To develop a goat model of a radial meniscal tear with resulting osteoarthritis and (2) to explore the efficacy of a 1-step procedure utilizing infrapatellar fat pad-derived SVF cells seeded in a photocrosslinkable hydrogel to enhance meniscal healing and mitigate osteochondral degeneration. STUDY DESIGN Controlled laboratory study. METHODS A full-thickness radial tear spanning 90% of the medial meniscal width was made at the junction of the anterior and middle bodies of the goat stifle joint. Tears received 1 of 3 interventions (n = 4 per group): untreated, repair, or repair augmented with photocrosslinkable methacrylated gelatin hydrogel containing 2.0 × 106 SVF cells/mL and 2.0 µg/mL of transforming growth factor β3. The contralateral (left) joint served as a healthy control. At 6 months, meniscal healing and joint health were evaluated by magnetic resonance imaging (MRI) and assessed by histological and macroscopic scoring. The Whole-Organ Magnetic Resonance Imaging Score and the presence of a residual tear, as evaluated with T2 MRI sequences, were determined by a single blinded orthopaedic surgeon. RESULTS When compared with tears left untreated or repaired with suture alone, augmented repairs demonstrated increased tissue formation in the meniscal tear site, as seen on MRI and macroscopically. Likewise, the neotissue of augmented repairs possessed a histological appearance more similar, although still inferior, to healthy meniscus. Osteochondral degeneration in the medial compartment, as evaluated by the Whole-Organ Magnetic Resonance Imaging Score and Inoue (macroscopic) scale, revealed increased degeneration in the untreated and repair groups, which was mitigated in the augmented repair group. Histological evaluation with a modified Mankin score showed a similar trend. In all measures of osteochondral degeneration, the augmented repair group did not differ significantly from the uninjured control. CONCLUSION A radial tear spanning 90% of the medial meniscal width in a goat stifle joint showed poor healing potential and resulted in osteochondral degeneration by 6 months, even if suture repair was performed. Augmentation of the repair with a photocrosslinkable hydrogel containing transforming growth factor β3 and SVF cells, isolated intraoperatively by rapid enzymatic digestion, improved meniscal healing and mitigated osteoarthritic changes. CLINICAL RELEVANCE Repair augmentation with an SVF cell-seeded hydrogel may support successful repair of meniscal tears previously considered irreparable.
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Affiliation(s)
- Benjamin B Rothrauff
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hiroshi Sasaki
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shinsuke Kihara
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kalon J Overholt
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Riccardo Gottardi
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hang Lin
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Freddie H Fu
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rocky S Tuan
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Peter G Alexander
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Hontoir F, Pirson R, Simon V, Clegg P, Nisolle JF, Kirschvink N, Vandeweerd JME. Age-related morphometric changes of the tidemark in the ovine stifle. Anat Histol Embryol 2019; 48:366-374. [PMID: 31106466 DOI: 10.1111/ahe.12449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/03/2019] [Indexed: 01/17/2023]
Abstract
Though the ovine stifle is commonly used to study osteoarthritis, there is limited information about the age-related morphometric changes of the tidemark. The objective of this study was to document the number of tidemarks in the stifle of research sheep without clinical signs of osteoarthritis and of various ages (n = 80). Articular cartilage of the medial and lateral tibial condyles and of the medial and lateral femoral condyles was assessed by histology: (a) to count the number of tidemark; and (b) to assess the OARSI (Osteoarthritis Research Society International) score for structural changes of cartilage. The number of tidemarks varied between anatomical regions, respectively, from 4.2 in the medial femoral condyle to 5.0 in the lateral tibial condyle. The axial part showed a significant higher number of tidemarks than the abaxial part, for all regions except the medial tibial condyle. Whilst the tidemark count strongly correlated with age (Spearman's correlation coefficient = 0.70; 95% confidence interval (95% CI): 0.67-0.73; p < 0.0001), the OARSI score was weakly correlated with age in our cohort of sheep (Spearman's correlation coefficient = 0.25; 95% CI: 0.19-0.30; p < 0.0001). Interestingly, no tidemark was seen in the three animals aged 6 months. Our data indicate that the number of tidemarks increases with age and vary with anatomical region. The regional variation also revealed a higher number of tidemarks in the tibia than in the femur. This could be attributed to the local variation in cartilage response to strain and to the difference in chondrocyte biology and density.
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Affiliation(s)
- Fanny Hontoir
- Department of Veterinary Medicine, Integrated Veterinary Research Unit (IVRU) -Namur Research Institute for Life Sciences (NARILIS), Faculty of Sciences, University of Namur, Namur, Belgium
| | - Romain Pirson
- Department of Veterinary Medicine, Integrated Veterinary Research Unit (IVRU) -Namur Research Institute for Life Sciences (NARILIS), Faculty of Sciences, University of Namur, Namur, Belgium
| | - Vincent Simon
- Department of Veterinary Medicine, Integrated Veterinary Research Unit (IVRU) -Namur Research Institute for Life Sciences (NARILIS), Faculty of Sciences, University of Namur, Namur, Belgium
| | - Peter Clegg
- Department of Musculoskeletal Biology, Institute of Ageing and Chronic disease, University of Liverpool, Liverpool, UK
| | - Jean-François Nisolle
- Centre Hospitalier Universitaire (CHU) UCL Namur Mont Godinne, Université Catholique de Louvain, Yvoir, Belgium
| | - Nathalie Kirschvink
- Department of Veterinary Medicine, Integrated Veterinary Research Unit (IVRU) -Namur Research Institute for Life Sciences (NARILIS), Faculty of Sciences, University of Namur, Namur, Belgium
| | - Jean-Michel E Vandeweerd
- Department of Veterinary Medicine, Integrated Veterinary Research Unit (IVRU) -Namur Research Institute for Life Sciences (NARILIS), Faculty of Sciences, University of Namur, Namur, Belgium
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Potential enhancement of articular cartilage histological grading with collagen integrity. Clin Biomech (Bristol, Avon) 2018; 56:1-10. [PMID: 29730264 DOI: 10.1016/j.clinbiomech.2018.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 02/27/2018] [Accepted: 04/25/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Histological evaluation of articular cartilage, such as using the Mankin scoring system, is the gold standard for characterization of tissue integrity. This scoring system takes into account several parameters indicative of the tissue's health; however, the collagen integrity, which is a primary indicator of cartilage health is not taken into consideration. Thus, there is need to enhance histological grading of articular cartilage by incorporating explicit scoring of collagen degeneration into the Modified Mankin grading system. This paper explores a new histological grading parameter for collagen network degradation and how this information can be used to augment a widely used grading scheme like the Modified Mankin grading system. METHODS Intact and degenerated human cartilage were examined histologically and then subjected to second harmonic generation imaging, leading to qualitative and quantitative description of collagen disruption emanating from the surface to subsurface layers of the tissue. This data was then incorporated into the Modified Mankin grading system. FINDINGS Second harmonic generation image analysis reveals a relationship between changes in collagen architecture and histologically observed tissue disruption in degenerated articular cartilage. INTERPRETATION Histological tissue disruption in degenerated human articular cartilage is directly related to the reorganization of collagen fibrils in the form of intense fibril aggregation, either as a result of degeneration or aging. This method of mapping disrupted tissue regions to quantitative collagen fibril damage can be coded into cartilage grading systems and could inform clinical practice and scientific research.
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Nickien M, Heuijerjans A, Ito K, van Donkelaar CC. Comparison between in vitro and in vivo cartilage overloading studies based on a systematic literature review. J Orthop Res 2018; 36:2076-2086. [PMID: 29644716 PMCID: PMC6120482 DOI: 10.1002/jor.23910] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 03/27/2018] [Indexed: 02/04/2023]
Abstract
Methodological differences between in vitro and in vivo studies on cartilage overloading complicate the comparison of outcomes. The rationale of the current review was to (i) identify consistencies and inconsistencies between in vitro and in vivo studies on mechanically-induced structural damage in articular cartilage, such that variables worth interesting to further explore using either one of these approaches can be identified; and (ii) suggest how the methodologies of both approaches may be adjusted to facilitate easier comparison and therewith stimulate translation of results between in vivo and in vitro studies. This study is anticipated to enhance our understanding of the development of osteoarthritis, and to reduce the number of in vivo studies. Generally, results of in vitro and in vivo studies are not contradicting. Both show subchondral bone damage and intact cartilage above a threshold value of impact energy. At lower loading rates, excessive loads may cause cartilage fissuring, decreased cell viability, collagen network de-structuring, decreased GAG content, an overall damage increase over time, and low ability to recover. This encourages further improvement of in vitro systems, to replace, reduce, and/or refine in vivo studies. However, differences in experimental set up and analyses complicate comparison of results. Ways to bridge the gap include (i) bringing in vitro set-ups closer to in vivo, for example, by aligning loading protocols and overlapping experimental timeframes; (ii) synchronizing analytical methods; and (iii) using computational models to translate conclusions from in vitro results to the in vivo environment and vice versa. © 2018 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. J Orthop Res 9999:1-11, 2018.
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Affiliation(s)
- Mieke Nickien
- Department of Biomedical Engineering, Orthopaedic BiomechanicsEindhoven University of TechnologyP.O. Box 513, 5600MBEindhovenThe Netherlands
| | - Ashley Heuijerjans
- Department of Biomedical Engineering, Orthopaedic BiomechanicsEindhoven University of TechnologyP.O. Box 513, 5600MBEindhovenThe Netherlands
| | - Keita Ito
- Department of Biomedical Engineering, Orthopaedic BiomechanicsEindhoven University of TechnologyP.O. Box 513, 5600MBEindhovenThe Netherlands
| | - Corrinus C. van Donkelaar
- Department of Biomedical Engineering, Orthopaedic BiomechanicsEindhoven University of TechnologyP.O. Box 513, 5600MBEindhovenThe Netherlands
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Chan DD, Cai L, Butz KD, Nauman EA, Dickerson DA, Jonkers I, Neu CP. Functional MRI can detect changes in intratissue strains in a full thickness and critical sized ovine cartilage defect model. J Biomech 2018; 66:18-25. [PMID: 29169631 PMCID: PMC5767131 DOI: 10.1016/j.jbiomech.2017.10.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/02/2017] [Accepted: 10/27/2017] [Indexed: 02/07/2023]
Abstract
Functional imaging of tissue biomechanics can reveal subtle changes in local softening and stiffening associated with disease or repair, but noninvasive and nondestructive methods to acquire intratissue measures in well-defined animal models are largely lacking. We utilized displacement encoded MRI to measure changes in cartilage deformation following creation of a critical-sized defect in the medial femoral condyle of ovine (sheep) knees, a common in situ and large animal model of tissue damage and repair. We prioritized visualization of local, site-specific variation and changes in displacements and strains following defect placement by measuring spatial maps of intratissue deformation. Custom data smoothing algorithms were developed to minimize propagation of noise in the acquired MRI phase data toward calculated displacement or strain, and to improve strain measures in high aspect ratio tissue regions. Strain magnitudes in the femoral, but not tibial, cartilage dramatically increased in load-bearing and contact regions especially near the defect locations, with an average 6.7% ± 6.3%, 13.4% ± 10.0%, and 10.0% ± 4.9% increase in first and second principal strains, and shear strain, respectively. Strain heterogeneity reflected the complexity of the in situ mechanical environment within the joint, with multiple tissue contacts defining the deformation behavior. This study demonstrates the utility of displacement encoded MRI to detect increased deformation patterns and strain following disruption to the cartilage structure in a clinically-relevant, large animal defect model. It also defines imaging biomarkers based on biomechanical measures, in particular shear strain, that are potentially most sensitive to evaluate damage and repair, and that may additionally translate to humans in future studies.
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Affiliation(s)
- Deva D Chan
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, United States; Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180, United States
| | - Luyao Cai
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, United States
| | - Kent D Butz
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, United States
| | - Eric A Nauman
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, United States; School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, United States; BioRegeneration Technologies, Inc., West Lafayette, IN 47907, United States
| | - Darryl A Dickerson
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, United States; BioRegeneration Technologies, Inc., West Lafayette, IN 47907, United States
| | - Ilse Jonkers
- Kinesiology Department, KU Leuven, Leuven, Belgium
| | - Corey P Neu
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, United States; Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO 80309, United States.
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Russo F, Hartman RA, Bell KM, Vo N, Sowa GA, Kang JD, Vadalà G, Denaro V. Biomechanical Evaluation of Transpedicular Nucleotomy With Intact Annulus Fibrosus. Spine (Phila Pa 1976) 2017; 42:E193-E201. [PMID: 28207656 DOI: 10.1097/brs.0000000000001762] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Biomechanical testing of partially nucleotomized ovine cadaveric spines. OBJECTIVE To explore how the nucleus pulposus (NP) affects the biomechanical behavior of the intervertebral disc (IVD) by performing a partial nucleotomy via the transpedicular approach. SUMMARY OF BACKGROUND DATA Mechanical loading represents a crucial part of IVD homeostasis. However, traditional regenerative strategies require violation of the annulus fibrosus (AF) resulting in significant alteration of joint mechanics. The transpedicular nucleotomy represents a suitable method to create a cavity into the NP, as a model to study IVD regeneration with intact AF. METHODS A total of 30 ovine-lumbar- functional spinal units (FSUs) (L1-L6) randomly assigned to 5 groups: control; transpedicular tunnel (TT); TT + polymethylmethacrylate (PMMA) to repair the bone tunnel; nucleotomy; nucleotomy + PMMA. Flexion/extension, lateral-bending, and axial-rotation were evaluated under adaptive displacement control. Axial compression was applied for 15 cycles of preconditioning followed by 1 hour of constant compression. Viscoelastic behavior was modeled and parameterized. RESULTS TT has minimal effects on rotational biomechanics. The nucleotomy increases ROM and neutral zone (NZ) displacement width whereas decreasing NZ stiffness. TT + PMMA has small effects in terms of ROM. Nucleotomy + PMMA brings ROM back to the control, increases NZ stiffness, and decreases NZ displacement width. The nucleotomy tends to increase the rate of early creep. TT reduces early and late damping. The use of PMMA increased late elastic stiffness (S2) and reduced viscous damping (η2) culminating in faster resolution of creep. CONCLUSION Biomechanical properties of NP are crucial for IVD repair. This study demonstrated that TT does not affect rotational stability whereas partial nucleotomy with intact AF induce rotational instability, highlighting the central role of NP in early stages of IDD. Therefore, this model represents a successful platform to validate and optimize disc regeneration strategies. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Fabrizio Russo
- Department of Orthopedic and Traumatology, University Campus BioMedico of Rome, Rome, Italy
| | - Robert A Hartman
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, USA
| | - Kevin M Bell
- Ferguson Laboratory for Orthopedic and Spine Research, University of Pittsburgh, Pittsburgh, PA
| | - Nam Vo
- Ferguson Laboratory for Orthopedic and Spine Research, University of Pittsburgh, Pittsburgh, PA
| | - Gwendolyn A Sowa
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, USA
| | - James D Kang
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Gianluca Vadalà
- Department of Orthopedic and Traumatology, University Campus BioMedico of Rome, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopedic and Traumatology, University Campus BioMedico of Rome, Rome, Italy
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Subchondral screw abutment: does it harm the joint cartilage? An in vivo study on sheep tibiae. INTERNATIONAL ORTHOPAEDICS 2017; 41:1607-1615. [DOI: 10.1007/s00264-017-3404-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 01/09/2017] [Indexed: 11/26/2022]
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12
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Takroni T, Laouar L, Adesida A, Elliott JAW, Jomha NM. Anatomical study: comparing the human, sheep and pig knee meniscus. J Exp Orthop 2016; 3:35. [PMID: 27928740 PMCID: PMC5143332 DOI: 10.1186/s40634-016-0071-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 11/30/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Animal models are commonly used in investigating new treatment options for knee joint injuries including injuries to the meniscus. The reliability and applicability of these models to replicate findings in humans depends on determining the most suitable animal proxy. Therefore, this study was designed to compare the wet weight, volume and dimensions of the human meniscus with two commonly used animal models: sheep and pig. METHODS Human menisci (n = 6 pairs) were obtained from the knee joints of cadaveric male donors. Sheep menisci (n = 6 pairs) and pig menisci (n = 22 pairs) were obtained from the stifle joints of adult sheep and pigs. Meniscal wet weight, volume and dimensions of the body were measured and compared among the species. Anatomical dimensions included circumference, width, peripheral height, articular height and superior articular length. RESULTS The circumference of human menisci (lateral: 84.0 mm, medial: 88.7 mm) was significantly longer than that of sheep (lateral: 50.0 mm, medial: 55.5 mm) and pig (lateral: 66.8 mm, medial: 64.9 mm). The majority of the remaining dimensions of the medial and all of the remaining dimensions of the lateral menisci in sheep showed no statistical difference in comparison to the human menisci. The meniscal weight in pig was significantly larger (lateral: 6.4 g, medial: 5.0 g) than the human (lateral: 4.9 g, medial: 4.4 g) and sheep (lateral: 2.5 g, medial: 2.2 g). Porcine meniscal volume (lateral: 6.5 ml, medial: 5.1 ml) was also larger than the human (lateral: 5.0 ml, medial: 4.5 ml) and sheep (lateral: 2.3 ml, medial: 2.2 ml) menisci. The dimensions measured in the pig meniscus were generally larger than human menisci with statistically significant differences in most categories. CONCLUSION Sheep meniscal dimensions more closely matched human meniscal dimensions than the pig meniscal dimensions. This information may help guide the choice of an animal proxy in meniscal research.
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Affiliation(s)
- Talal Takroni
- Department of Surgery, Laboratory of Orthopaedic Research, University of Alberta, Edmonton, Canada.
- Rabigh Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Leila Laouar
- Department of Surgery, Laboratory of Orthopaedic Research, University of Alberta, Edmonton, Canada
| | - Adetola Adesida
- Department of Surgery, Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, University of Alberta, Edmonton, Canada
| | - Janet A W Elliott
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - Nadr M Jomha
- Department of Surgery, Laboratory of Orthopaedic Research, University of Alberta, Edmonton, Canada
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Kuyinu EL, Narayanan G, Nair LS, Laurencin CT. Animal models of osteoarthritis: classification, update, and measurement of outcomes. J Orthop Surg Res 2016; 11:19. [PMID: 26837951 PMCID: PMC4738796 DOI: 10.1186/s13018-016-0346-5] [Citation(s) in RCA: 328] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 01/11/2016] [Indexed: 12/13/2022] Open
Abstract
Osteoarthritis (OA) is one of the most commonly occurring forms of arthritis in the world today. It is a debilitating chronic illness causing pain and immense discomfort to the affected individual. Significant research is currently ongoing to understand its pathophysiology and develop successful treatment regimens based on this knowledge. Animal models have played a key role in achieving this goal. Animal models currently used to study osteoarthritis can be classified based on the etiology under investigation, primary osteoarthritis, and post-traumatic osteoarthritis, to better clarify the relationship between these models and the pathogenesis of the disease. Non-invasive animal models have shown significant promise in understanding early osteoarthritic changes. Imaging modalities play a pivotal role in understanding the pathogenesis of OA and the correlation with pain. These imaging studies would also allow in vivo surveillance of the disease as a function of time in the animal model. This review summarizes the current understanding of the disease pathogenesis, invasive and non-invasive animal models, imaging modalities, and pain assessment techniques in the animals.
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Affiliation(s)
- Emmanuel L Kuyinu
- Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA. .,Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health, Farmington, CT, USA. .,Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, CT, USA.
| | - Ganesh Narayanan
- Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA. .,Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health, Farmington, CT, USA. .,Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, CT, USA.
| | - Lakshmi S Nair
- Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA. .,Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health, Farmington, CT, USA. .,Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, CT, USA. .,Department of Biomedical Engineering, University of Connecticut, Storrs, CT, USA. .,Department of Materials Science and Engineering, University of Connecticut, Storrs, CT, USA. .,Institute of Materials Science, University of Connecticut, Storrs, CT, USA.
| | - Cato T Laurencin
- Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA. .,Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health, Farmington, CT, USA. .,Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, CT, USA. .,Department of Biomedical Engineering, University of Connecticut, Storrs, CT, USA. .,Department of Materials Science and Engineering, University of Connecticut, Storrs, CT, USA. .,Institute of Materials Science, University of Connecticut, Storrs, CT, USA. .,Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut Health, Farmington, CT, USA. .,Department of Chemical and Biomolecular Engineering, University of Connecticut, Storrs, CT, USA.
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14
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Gruchenberg K, Ignatius A, Friemert B, von Lübken F, Skaer N, Gellynck K, Kessler O, Dürselen L. In vivo performance of a novel silk fibroin scaffold for partial meniscal replacement in a sheep model. Knee Surg Sports Traumatol Arthrosc 2015; 23:2218-2229. [PMID: 24770350 PMCID: PMC4661201 DOI: 10.1007/s00167-014-3009-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 04/09/2014] [Indexed: 01/12/2023]
Abstract
PURPOSE Due to the negative effects of meniscectomy, there is a need for an adequate material to replace damaged meniscal tissue. To date, no material tested has been able to replace the meniscus sufficiently. Therefore, a new silk fibroin scaffold was investigated in an in vivo sheep model. METHODS Partial meniscectomy was carried out to the medial meniscus of 28 sheep, and a scaffold was implanted in 19 menisci (3-month scaffold group, n = 9; 6-month scaffold group, n = 10). In 9 sheep, the defect remained empty (partial meniscectomy group). Sham operation was performed in 9 animals. RESULTS The silk scaffold was able to withstand the loads experienced during the implantation period. It caused no inflammatory reaction in the joint 6 months postoperatively, and there were no significant differences in cartilage degeneration between the scaffold and sham groups. The compressive properties of the scaffold approached those of meniscal tissue. However, the scaffolds were not always stably fixed in the defect, leading to gapping between implant and host tissue or to total loss of the implant in 3 of 9 cases in each scaffold group. Hence, the fixation technique needs to be improved to achieve a better integration into the host tissue, and the long-term performance of the scaffolds should be further investigated. CONCLUSION These first in vivo results on a new silk fibroin scaffold provide the basis for further meniscal implant development. Whilst more data are required, there is preliminary evidence of chondroprotective properties, and the compressive properties and biocompatibility are promising.
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Affiliation(s)
- Katharina Gruchenberg
- Institute of Orthopaedic Research and Biomechanics, Centre of Musculoskeletal Research, University of Ulm, Helmholtzstraße 14, 89081, Ulm, Germany
| | - Anita Ignatius
- Institute of Orthopaedic Research and Biomechanics, Centre of Musculoskeletal Research, University of Ulm, Helmholtzstraße 14, 89081, Ulm, Germany
| | - Benedikt Friemert
- Department of Trauma and Orthopaedic Surgery, Centre of Musculoskeletal Research, Hospital of the Federal Armed Forces Ulm, 89081, Ulm, Germany
| | - Falk von Lübken
- Department of Trauma and Orthopaedic Surgery, Centre of Musculoskeletal Research, Hospital of the Federal Armed Forces Ulm, 89081, Ulm, Germany
| | | | - Kris Gellynck
- Division of Biomaterials and Tissue Engineering, Eastman Dental Institute, University College London, London, WC1X 8LD, UK
| | - Oliver Kessler
- Centre for Orthopaedic and Sports Medicine, 8047, Zurich, Switzerland
| | - Lutz Dürselen
- Institute of Orthopaedic Research and Biomechanics, Centre of Musculoskeletal Research, University of Ulm, Helmholtzstraße 14, 89081, Ulm, Germany.
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15
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Caminal M, Fonseca C, Peris D, Moll X, Rabanal RM, Barrachina J, Codina D, García F, Cairó JJ, Gòdia F, Pla A, Vives J. Use of a chronic model of articular cartilage and meniscal injury for the assessment of long-term effects after autologous mesenchymal stromal cell treatment in sheep. N Biotechnol 2014; 31:492-8. [PMID: 25063342 DOI: 10.1016/j.nbt.2014.07.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 06/28/2014] [Accepted: 07/02/2014] [Indexed: 10/25/2022]
Abstract
Regenerative therapies using adult stem cells have attracted great interest in the recent years and offer a promising alternative to current surgical practices. In this report, we evaluated the safety and efficacy of an autologous cell-based treatment of osteoarthritis using mesenchymal stromal cells expanded from bone marrow aspirates that were administered intra-articularly. Ten 2-year old ewes were divided in two groups (for analysis at 6 and 12 months, respectively). Full thickness articular cartilage defects of approximately 60mm(2) were created arthroscopically in the medial femorotibial condyles and a meniscal tear in the anterior horn of the medial meniscus in the 20 hind legs. Intra-articular injection of 4 mL of either treatment (a suspension of cells) or control (same as treatment, without cells) were applied one month after generating a chronic condition similar to human pathology. Animals were monitored radiographically, by MRI and ultrasound scanning; and macroscopic and histological analyses were conducted at 6 and 12 months. Furthermore a full necropsy was performed at 12 months post-treatment. The intra-articular injection of autologous MSC was safe, as judged by the lack of local or systemic adverse effects during the clinical follow-up and by a full necropsy performed at 12 months post-treatment. Evidence of regeneration of articular cartilage and meniscus was case-dependent but statistically significant improvement was found in specific macroscopic and histological parameters. Such parameters included colour, rigidity, cell distribution and hyaline quality of the refill tissue as well as the structure of subchondral bone.
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Affiliation(s)
- Marta Caminal
- Divisió de Teràpies Avançades/XCELIA, Banc de Sang i Teixits, Edifici Dr. Frederic Duran i Jordà, Passeig Taulat, 116, Barcelona 08005, Spain
| | - Carla Fonseca
- Departament de Medicina i Cirurgia Animals, Àrea de Medicina i Cirurgia Animal, Facultat de Veterinària, Universitat Autònoma de Barcelona, Edifici V, Campus de la UAB, 08193 Bellaterra, Cerdanyola del Vallès, Spain
| | - David Peris
- Grup d'Enginyeria Cel·lular i Tissular, Departament d'Enginyeria Química, Escola d'Enginyers, Universitat Autònoma de Barcelona, Edifici Q, Campus de la UAB, 08193 Bellaterra, Cerdanyola del Vallès, Spain
| | - Xavier Moll
- Departament de Medicina i Cirurgia Animals, Àrea de Medicina i Cirurgia Animal, Facultat de Veterinària, Universitat Autònoma de Barcelona, Edifici V, Campus de la UAB, 08193 Bellaterra, Cerdanyola del Vallès, Spain
| | - Rosa M Rabanal
- Departament de Medicina i Cirurgia Animals, Àrea de Medicina i Cirurgia Animal, Facultat de Veterinària, Universitat Autònoma de Barcelona, Edifici V, Campus de la UAB, 08193 Bellaterra, Cerdanyola del Vallès, Spain
| | - Josep Barrachina
- Hospital ASEPEYO, Avinguda Alcalde Barnils, 54-60, Sant Cugat del Vallès, Barcelona 08174, Spain
| | - David Codina
- Hospital ASEPEYO, Avinguda Alcalde Barnils, 54-60, Sant Cugat del Vallès, Barcelona 08174, Spain
| | - Félix García
- Departament de Medicina i Cirurgia Animals, Àrea de Medicina i Cirurgia Animal, Facultat de Veterinària, Universitat Autònoma de Barcelona, Edifici V, Campus de la UAB, 08193 Bellaterra, Cerdanyola del Vallès, Spain
| | - Jordi J Cairó
- Grup d'Enginyeria Cel·lular i Tissular, Departament d'Enginyeria Química, Escola d'Enginyers, Universitat Autònoma de Barcelona, Edifici Q, Campus de la UAB, 08193 Bellaterra, Cerdanyola del Vallès, Spain
| | - Francesc Gòdia
- Grup d'Enginyeria Cel·lular i Tissular, Departament d'Enginyeria Química, Escola d'Enginyers, Universitat Autònoma de Barcelona, Edifici Q, Campus de la UAB, 08193 Bellaterra, Cerdanyola del Vallès, Spain
| | - Arnau Pla
- Divisió de Teràpies Avançades/XCELIA, Banc de Sang i Teixits, Edifici Dr. Frederic Duran i Jordà, Passeig Taulat, 116, Barcelona 08005, Spain
| | - Joaquim Vives
- Divisió de Teràpies Avançades/XCELIA, Banc de Sang i Teixits, Edifici Dr. Frederic Duran i Jordà, Passeig Taulat, 116, Barcelona 08005, Spain.
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16
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Solbak N, Achari Y, Chung M, Shrive NG, Hart DA, Frank CB. Normal sheep synovium has similar appearances and constitutive expression of inflammatory cytokines within and between knee joints: a baseline histological and molecular analysis. Connect Tissue Res 2014; 55:156-63. [PMID: 24409814 DOI: 10.3109/03008207.2014.880427] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Abstract Clinical evidence suggests that synovium can add to adjacent articular cartilage damage, potentially contributing to the development of osteoarthritis (OA). Inflammation of the synovium (synovitis) is dependent on the type of injury sustained, the time after injury and concomitant changes in other joint tissues. To define the role of synovitis in OA development, there is a need for baseline measures that can reliably distinguish synovial inflammation from normal synovium both within and between joints. This study tested the hypothesis that normal synovium from distinct anatomical locations in young and adult sheep is homogeneous with respect to consistently low molecular expression of the inflammatory mediators - tumour necrosis factor alpha (TNF-α) and interleukins (IL) such as IL-1β, IL-1Ra, IL-6 and IL-8. Additionally, maturation will not influence the expression of these select inflammatory biomarkers. Samples of synovium from four anatomic locations (medial and lateral margins, suprapatellar pouch (patella region), posterior to the posterior cruciate ligament, from each joint of 5 adult and 4 immature animals were graded histologically or analyzed for mRNA expression of inflammatory cytokines. Histologically, no evidence of synovitis was noted although some variance in sub-intimal fibrosis was observed between sample locations in mature sheep. Molecular expression of all inflammatory mediators was low and homogeneously expressed at constitutive levels in all sample locations. These findings confirm the hypothesis that the normal sheep synovium is a homogeneous tissue throughout the joint and establishes the baseline expression levels for several pro-inflammatory mediators in both immature and mature sheep.
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17
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Garnov N, Gründer W, Thörmer G, Trampel R, Turner R, Kahn T, Busse H. In vivo MRI analysis of depth-dependent ultrastructure in human knee cartilage at 7 T. NMR IN BIOMEDICINE 2013; 26:1412-1419. [PMID: 23801556 DOI: 10.1002/nbm.2968] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 02/26/2013] [Accepted: 04/01/2013] [Indexed: 06/02/2023]
Abstract
Signal intensities of T2-weighted magnetic resonance images depend on the local fiber arrangement in hyaline cartilage. The aims of this study were to determine whether angle-sensitive MRI at 7 T can be used to quantify the cartilage ultrastructure of the knee in vivo and to assess potential differences with age. Ten younger (21-30) and ten older (55-76 years old) healthy volunteers were imaged with a T2-weighted spin-echo sequence in a 7 T whole-body MRI. A "fascicle" model was assumed to describe the depth-dependent fiber arrangement of cartilage. The R/T boundary positions between radial and transitional zones were assessed from intensity profiles in small regions of interest in the femur and tibia, and normalized to cartilage thickness using logistic curve fits. The quality of our highly resolved (0.3 × 0.3 × 1.0 mm(3)) MR cartilage images were high enough for quantitative analysis (goodness of fit R(2) = 0.91 ± 0.09). Between younger and older subjects, normalized positions of the R/T boundary, with value 0 at the bone-cartilage interface and 1 at the cartilage surface, were significantly (p < 0.05) different in femoral (0.51 ± 0.12 versus 0.41 ± 0.10), but not in tibial cartilage (0.65 ± 0.11 versus 0.57 ± 0.09, p = 0.119). Within both age groups, differences between femoral and tibial R/T boundaries were significant. Using a fascicle model and angle-sensitive MRI, the depth-dependent anisotropic fiber arrangement of knee cartilage could be assessed in vivo from a single 7 T MR image. The derived quantitative parameter, thickness of the radial zone, may serve as an indicator of the structural integrity of cartilage. This method may potentially be suitable to detect and monitor early osteoarthritis because the progressive disintegration of the anisotropic network is also indicative of arthritic changes in cartilage.
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Affiliation(s)
- Nikita Garnov
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstrasse 20, Leipzig, Germany
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Sayre EC, Singer J, Thorne A, Wong H, Kopec JA, Esdaile JM, Guermazi A, Nicolaou S, Cibere J. Does moderate or severe nonspecific knee injury affect radiographic osteoarthritis incidence and progression? BMC Musculoskelet Disord 2013; 14:309. [PMID: 24164716 PMCID: PMC4231427 DOI: 10.1186/1471-2474-14-309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 10/22/2013] [Indexed: 11/16/2022] Open
Abstract
Background Knee injuries can lead to radiographic osteoarthritis (ROA). Injuries may be “specific” (SI) including ligament or meniscal tears or patellar trauma, or “nonspecific” (NSI). Our objective is to understand the effect of knee NSI on ROA incidence and progression. Methods 163 people (sample-weighted for population representativeness) aged 40+ with history of knee pain had radiographs assessed on Kellgren Lawrence (KL) grade (0/1 collapsed) at baseline and follow-up (median 3.2 years apart). Progression was an increase in KL score. SIs and NSIs were labeled “severe” (walking aid for ≥1 week) or “moderate”. One model treated SI and NSI as dichotomous (yes/no), and another as trichotomous (none/moderate/severe). Models were adjusted for age, sex, BMI, KL grade and follow-up time. Results SI/NSI history was none, moderate (7.8/24.4%) or severe (11.0/10.8%). Duration at baseline since SI/NSI ranged from <1 year to several decades (SI/NSI mean 4.6/6.5 years). SI was significantly associated with ROA incidence and progression (odds ratio (OR) = 2.90; 95% CI = 1.04, 8.09), but NSI showed no significant effect (OR = 1.36; 95% CI = 0.61, 3.02). In the trichotomous model, severe SI was significant (OR = 4.35, 95% CI = 1.26, 15.02), while moderate SI was not (OR = 1.51, 95% CI = 0.33, 6.84). NSI showed no effect: moderate OR = 1.51, 95% CI = 0.61, 3.74; severe OR = 0.90, 95% CI = 0.24, 3.40. This study had 80% power to detect an NSI OR of 2.9. Conclusion We find no evidence that history of NSI affects knee ROA incidence and progression in a population with knee pain, adjusting for SI, age, sex, BMI, KL grade and follow-up time.
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Affiliation(s)
- Eric C Sayre
- Arthritis Research Centre of Canada, 5591 No, 3 Rd, Richmond, BC, V6X 2C7, Canada.
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Garnov N, Busse H, Gründer W. Angle-sensitive MRI for quantitative analysis of fiber-network deformations in compressed cartilage. Magn Reson Med 2013; 70:225-31. [PMID: 23716388 DOI: 10.1002/mrm.24795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 04/11/2013] [Accepted: 04/14/2013] [Indexed: 11/10/2022]
Abstract
PURPOSE To demonstrate the feasibility of a novel experimental method to quantitatively analyze fiber-network deformation in compressed cartilage by angle-sensitive magnetic resonance imaging (MRI) of cartilage. METHODS Three knee cartilage samples of an adult sheep were imaged in a high-resolution MRI scanner at 7 T. Main fiber orientation and its "offset" from the direction perpendicular to the bone-cartilage boundary were derived from MR images taken at different orientations with respect to B0. Bending of the collagen fibers was determined from weight-bearing MRI with the load (up to 1.0 MPa) applied over the whole sample surface. A "fascicle" model of the cartilage ultrastructure was assumed to analyze characteristic intensity variations in T2-weighted images under load. RESULTS T2-weighted MR images showed a strong variation of the signal intensities with sample orientation. In the T2-weighted weight-bearing series, regions of high signal intensity underwent shifts from the lateral to the central parts in all three cartilage samples. The bending of the collagen fibers was determined to be 27.2°, 35.4°, and 40.0° per MPa, respectively. CONCLUSION Assuming a "fascicle" model, the presented MRI method provides quantitative measures of structural adjustments in compressed cartilage. Our preliminary analysis suggests that cartilage fiber deformation includes both bending and crimping.
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Affiliation(s)
- Nikita Garnov
- Department of Diagnostic and Interventional Radiology Leipzig University Hospital Liebigstrasse 20 Leipzig Germany.
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20
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Zilkens C, Miese FR, Crumbiegel C, Kim YJ, Herten M, Antoch G, Krauspe R, Bittersohl B. Magnetic resonance imaging and histology of ovine hip joint cartilage in two age populations: a sheep model with assumed healthy cartilage. Skeletal Radiol 2013; 42:699-705. [PMID: 23275026 DOI: 10.1007/s00256-012-1554-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 10/08/2012] [Accepted: 11/18/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare morphologically normal appearing cartilage in two age groups with delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) and correlate magnetic resonance imaging (MRI) findings with histology. MATERIALS AND METHODS Twenty femoral head specimens collected from ten lambs (group I) and ten young adult sheep (group II) underwent dGEMRIC and histological assessment. A region of 2 cm(2) with morphologically normal-appearing cartilage was marked with a surgical suture for subsequent matching of MRI and histological sections. The MRI protocol included a three-dimensional (3D) double-echo steady-state sequence for morphological cartilage assessment, a B1 pre-scan with various flip angles for B1 field heterogeneity correction, and 3D volumetric interpolated breathhold examination for T1(Gd) mapping (dGEMRIC). Histological analysis was performed according to the Mankin scoring system. RESULTS A total of 303 regions of interest (ROI; 101 MRI reformats matching 101 histological sections) was assessed. Twenty-six ROIs were excluded owing to morphologically apparent cartilage damage or insufficient MR image quality. Therefore, 277 ROIs were analyzed. Histological analyses revealed distinct degenerative changes in various cartilage samples of group II (young adult sheep). Corresponding T1(Gd) values were significantly lower in the group of sheep (mean T1(Gd) = 540.4 ms) compared with the group of lambs (mean T1(Gd) = 623.6 ms; p < 0.001). CONCLUSIONS Although morphologically normal, distinct cartilage degeneration may be present in young adult sheep cartilage. dGEMRIC can reveal these changes and may be a tool for the assessment of early cartilage degeneration.
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Affiliation(s)
- Christoph Zilkens
- Department of Orthopedic Surgery, Medical Faculty, University of Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany.
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Trabecular bone structure and spatial differences in articular cartilage MR relaxation times in individuals with posterior horn medial meniscal tears. Osteoarthritis Cartilage 2013; 21:86-93. [PMID: 23047010 PMCID: PMC3538917 DOI: 10.1016/j.joca.2012.09.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 09/16/2012] [Accepted: 09/22/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To analyze knee trabecular bone structure and spatial cartilage T(1ρ) and T(2) relaxation times using 3-T magnetic resonance imaging (MRI) in subjects with and without tears of posterior horn of the medial meniscus (PHMM). DESIGN 3-T MRI from 59 subjects (>18 years), were used to evaluate PHMM tears based on modified Whole-Organ Magnetic Resonance Imaging Score (WORMS) scoring; and to calculate apparent trabecular bone-volume over total bone volume fraction (app. BV/TV), apparent trabecular number (app. Tb.N), apparent trabecular separation (app. Tb.Sp) and apparent trabecular thickness (app. Tb.Th) for overall femur/tibia and medial/lateral femur/tibia; and relaxation times for deep and superficial layers of articular cartilage. A repeated measures analysis using Generalized Estimating Equation (GEE) was performed to compare trabecular bone and cartilage relaxation time parameters between people with (n = 35) and without (n = 24) PHMM tears, while adjusting for age and knee OA presence. RESULTS Subjects with PHMM tears had lower app. BV/TV and app. Tb.N, and greater app. Tb.Th, and app. Tb.Sp. They also had higher T(1ρ) times in the deep cartilage layer for lateral tibia and medial femur and higher T(2) relaxation times for the deep cartilage layer across all compartments. CONCLUSIONS PHMM tears are associated with differences in underlying trabecular bone and deep layer of cartilage. Over-load of subchondral bone can lead to its sclerosis and stress shielding of trabecular bone leading to the resorptive changes observed in this study. The results underline the importance of interactions of trabecular bone and cartilage in the pathogenesis of knee OA in people with PHMM tears.
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Henry S, Mascarenhas R, Kowalchuk D, Forsythe B, Irrgang JJ, Harner CD. Medial meniscus tear morphology and chondral degeneration of the knee: is there a relationship? Arthroscopy 2012; 28:1124-1134.e2. [PMID: 22440795 DOI: 10.1016/j.arthro.2011.12.020] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 12/23/2011] [Accepted: 12/28/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to examine the association of medial meniscus tear morphology with the pathogenesis of articular cartilage degeneration. METHODS From May 2006 to December 2007, we prospectively evaluated 103 patients diagnosed with an isolated medial meniscus tear. Meniscus tear morphology and location, cartilage degeneration according to the Noyes score, and covariates including age, body mass index, gender, and injury date were documented. The relationship between severity of articular cartilage degeneration and meniscus tear morphology was analyzed by analysis of variance. Regression analysis was used to analyze predictors of severity of cartilage lesions. RESULTS Analysis of variance showed significant differences in the severity of articular cartilage lesions based on medial meniscus tear morphology (P < .05). Compared with bucket-handle/vertical tears, root and radial/flap tears were associated with significantly greater degeneration on the medial femoral condyle; root and complex tears were associated with significantly greater degeneration on the medial tibial plateau; and radial/flap tears were associated with significantly greater degeneration on the lateral tibial plateau. Age and gender were significant predictors of the Noyes medial-compartment score, and age, body mass index, and meniscus tear morphology were significant predictors of the Noyes lateral-compartment score. CONCLUSIONS Meniscus tears with increasing disruption of the circumferential meniscal fibers were significantly associated with cartilage lesions of increasing severity in both the medial and lateral compartments of the knee. LEVEL OF EVIDENCE Level IV, prognostic case series.
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Affiliation(s)
- Sarah Henry
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Ave, Pittsburgh, PA 15213, U.S.A.
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23
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Moody HR, Heard BJ, Frank CB, Shrive NG, Oloyede AO. Investigating the potential value of individual parameters of histological grading systems in a sheep model of cartilage damage: the Modified Mankin method. J Anat 2012; 221:47-54. [PMID: 22591160 DOI: 10.1111/j.1469-7580.2012.01513.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A total histological grade does not necessarily distinguish between different manifestations of cartilage damage or degeneration. An accurate and reliable histological assessment method is required to separate normal and pathological tissue within a joint during treatment of degenerative joint conditions and to sub-classify the latter in meaningful ways. The Modified Mankin method may be adaptable for this purpose. We investigated how much detail may be lost by assigning one composite score/grade to represent different degenerative components of the osteoarthritic condition. We used four ovine injury models (sham surgery, anterior cruciate ligament/medial collateral ligament instability, simulated anatomic anterior cruciate ligament reconstruction and meniscal removal) to induce different degrees and potentially 'types' (mechanisms) of osteoarthritis. Articular cartilage was systematically harvested, prepared for histological examination and graded in a blinded fashion using a Modified Mankin grading method. Results showed that the possible permutations of cartilage damage were significant and far more varied than the current intended use that histological grading systems allow. Of 1352 cartilage specimens graded, 234 different manifestations of potential histological damage were observed across 23 potential individual grades of the Modified Mankin grading method. The results presented here show that current composite histological grading may contain additional information that could potentially discern different stages or mechanisms of cartilage damage and degeneration in a sheep model. This approach may be applicable to other grading systems.
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Affiliation(s)
- Hayley R Moody
- Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia
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24
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A study of the anatomy and injection techniques of the ovine stifle by positive contrast arthrography, computed tomography arthrography and gross anatomical dissection. Vet J 2012; 193:426-32. [PMID: 22264645 DOI: 10.1016/j.tvjl.2011.12.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Revised: 12/09/2011] [Accepted: 12/15/2011] [Indexed: 11/22/2022]
Abstract
Although ovine stifle models are commonly used to study osteoarthritis, meniscal pathology and cruciate ligament injuries and repair, there is little information about the anatomy of the joint or techniques for synovial injections. The objectives of this study were to improve anatomical knowledge of the synovial cavities of the ovine knee and to compare intra-articular injection techniques. Synovial cavities of 24 cadaver hind limbs from 12 adult sheep were investigated by intra-articular resin, positive-contrast arthrography, computed tomography (CT) arthrography and gross anatomical dissection. Communication between femoro-patellar, medial femoro-tibial and lateral femoro-tibial compartments occurred in all cases. The knee joint should be considered as one synovial structure with three communicating compartments. Several unreported features were observed, including a communication between the medial femoro-tibial and lateral femoro-tibial compartments and a latero-caudal recess of the lateral femoro-tibial compartment. No intermeniscal ligament was identified. CT was able to define many anatomical features of the stifle, including the anatomy of the tendinous synovial recess on the lateral aspect of the proximal tibia under the combined tendon of the peroneus tertius, extensor longus digitorum and extensor digiti III proprius. An approach for intra-articular injection into this recess (the subtendinous technique) was assessed and compared with the retropatellar and paraligamentous techniques. All three injection procedures were equally successful, but the subtendinous technique appeared to be most appropriate for synoviocentesis and for injections in therapeutic research protocols with less risk of damaging the articular cartilage.
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Fisseler-Eckhoff A, Müller KM. [Histopathological evaluation of the meniscus]. DER PATHOLOGE 2011; 32:220-7. [PMID: 21505874 DOI: 10.1007/s00292-011-1420-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Menisci fulfill many functions within the complex biomechanics of the knee joint. In the case of meniscus lesions, sparing arthroscopic resection and surgical refixation are the treatments of choice. In terms of diagnosis, this means in general that histopathologic diagnostics are carried out on detached meniscus fragments of between 5 mm and 2 cm in size. A good knowledge of physiologically possible cellular and fibrous histological meniscus damage, as opposed to nonphysiological change regarded as normal with respect to age, is essential for diagnostic meniscus evaluation. The clinician expects clear statements from the pathologist regarding the severity of previous or secondary degenerative meniscus damage, the age and type of traumatic tears, and an appraisal of the relationship between trauma and meniscus damage from an insurance point of view. Close cooperation between the clinician and the pathologist allows for a fast and unambiguous correlation of anamnesis, the clinical picture, and morphological reporting such that problematic insurance cases can be clarified quickly.
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Affiliation(s)
- A Fisseler-Eckhoff
- Institut für Pathologie und Zytologie, Dr. Horst Schmidt Kliniken GmbH Wiesbaden, Ludwig-Erhard-Str. 100, 65199, Wiesbaden.
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26
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Heard BJ, Achari Y, Chung M, Shrive NG, Frank CB. Early joint tissue changes are highly correlated with a set of inflammatory and degradative synovial biomarkers after ACL autograft and its sham surgery in an ovine model. J Orthop Res 2011; 29:1185-92. [PMID: 21387397 DOI: 10.1002/jor.21404] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 02/10/2011] [Indexed: 02/04/2023]
Abstract
While impossible in humans, the mechanisms of early cartilage, bone and meniscal damage can be quantified after anterior cruciate ligament (ACL) injury in animal models. We utilized an ovine model to determine if the mRNA expression of inflammatory and degradative molecules (IL-1β, IL-6, MMP-1, 2, 3, and 13) in the synovium correlated to changes in joint tissues 2 weeks post-ACL surgery, to test the hypothesis that synovial inflammation is a marker of these changes and possibly their originator. Nine "idealized" ACL autografts were performed and compared with three sham and six normal animals. Using validated protocols, early osteophyte formation, articular cartilage, and meniscal damage were quantified. Synovium was harvested and mRNA expression quantified using qPCR. Multiple linear regression analysis (MLRA) was utilized to correlate synovial mRNA expression in treated and contra-lateral limbs, from all treatment groups with corresponding joint scores. Synovial mRNA expression was significantly elevated in all experimental and sham joints. The MLRA model was a significant predictive tool (p = 0.001, R(2) = 0.70) of gross tissue scores with significant contributions from IL-1β, IL-6, and MMP-3. Findings suggest that this set of synovial biomarkers is predictive (p < 0.009) of early gross changes of joint tissues after arthrotomy and likely directly involved in the relevant mechanisms, particularly early osteophyte formation, in vivo.
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Affiliation(s)
- Bryan J Heard
- McCaig Institute for Bone and Joint Health, Faculty of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1
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Maher SA, Rodeo SA, Potter HG, Bonassar LJ, Wright TM, Warren RF. A pre-clinical test platform for the functional evaluation of scaffolds for musculoskeletal defects: the meniscus. HSS J 2011; 7:157-63. [PMID: 22754417 PMCID: PMC3145852 DOI: 10.1007/s11420-010-9188-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Accepted: 10/05/2010] [Indexed: 02/07/2023]
Abstract
In an attempt to delay the progression of osteoarthritis from an index injury, early intervention via repair of injured musculoskeletal soft tissue has been advocated. Despite the development of a number of scaffolds intended to treat soft tissue defects, information about their functional performance is lacking. The goal of this study was to consolidate a suite of in vitro and in vivo models into a pre-clinical test platform to assess the functional performance of meniscal repair scaffolds. Our objective was to assess the ability of a scaffold (Actifit™; Orteq, UK) to carry load without detrimentally abrading against articular cartilage. Three test modules were used to assess the functional performance of meniscal repair scaffolds. The first module tested the ability of the scaffold to carry load in an in vitro model designed to measure the change in normal contact stress magnitude on the tibial plateau of cadaveric knees after scaffold implantation. The second module assessed the in vitro frictional coefficient of the scaffold against cartilage to assess the likelihood that the scaffold would destructively abrade against articular cartilage in vivo. The third module consisted of an assessment of functional performance in vivo by measuring the structure and composition of articular cartilage across the tibial plateau 12 months after scaffold implantation in an ovine model. In vitro, the scaffold improved contact mechanics relative to a partly meniscectomized knee suggesting that, in vivo, less damage would be seen in the scaffold implanted knees vs. partly meniscectomized knees. However, there was no significant difference in the condition of articular cartilage between the two groups. Moreover, in spite of the high coefficient of friction between the scaffold and articular cartilage, there was no significant damage in the articular cartilage underneath the scaffold. The discrepancy between the in vitro and in vivo models was likely influenced by the abundant tissue generated within the scaffold and the unexpected tissue that regenerated within the site of the partial meniscectomy. We are currently augmenting our suite of tests so that we can pre-clinically evaluate the functional performance at time zero and as a function of time after implantation.
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Affiliation(s)
- Suzanne A. Maher
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Scott A. Rodeo
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Hollis G. Potter
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | | | - Timothy M. Wright
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Russell F. Warren
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Sinclair KD, Curtis BD, Koller KE, Bloebaum RD. Characterization of the Anchoring Morphology and Mineral Content of the Anterior Cruciate and Medial Collateral Ligaments of the Knee. Anat Rec (Hoboken) 2011; 294:831-8. [DOI: 10.1002/ar.21374] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 12/21/2010] [Accepted: 02/03/2011] [Indexed: 11/08/2022]
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Chondroprotective effects of a polycarbonate-urethane meniscal implant: histopathological results in a sheep model. Knee Surg Sports Traumatol Arthrosc 2011; 19:255-63. [PMID: 20635076 DOI: 10.1007/s00167-010-1210-5] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 06/23/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE injury or loss of the meniscus generally leads to degenerative osteoarthritic changes in the knee joint. However, few surgical options exist for meniscal replacement. The goal of this study was to examine the ability of a non-degradable, anatomically shaped artificial meniscal implant, composed of Kevlar-reinforced polycarbonate-urethane (PCU), to prevent progressive cartilage degeneration following complete meniscectomy. METHODS the artificial meniscus was implanted in the knees of mature female sheep following total medial meniscectomy, and the animals were killed at 3- and 6-months post-surgery. Macroscopic analysis and semi-quantitative histological analysis were performed on the cartilage of the operated knee and unoperated contralateral control joint. RESULTS the PCU implants remained well secured throughout the experimental period and showed no signs of wear or changes in structural or material properties. Histological analysis showed relatively mild cartilage degeneration that was dominated by loss of proteoglycan content and cartilage structure. However, the total osteoarthritis score did not significantly differ between the control and operated knees, and there were no differences in the severity of degenerative changes between 3 and 6 months post-surgery. CONCLUSION current findings provide preliminary evidence for the ability of an artificial PCU meniscal implant to delay or prevent osteoarthritic changes in knee joint following complete medial meniscectomy.
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Evaluation of a porous polyurethane scaffold in a partial meniscal defect ovine model. Arthroscopy 2010; 26:1510-9. [PMID: 20855181 DOI: 10.1016/j.arthro.2010.02.033] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 02/23/2010] [Accepted: 02/23/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE The objective of this study was to assess the performance of a degradable porous polyurethane scaffold in a partial meniscectomy ovine model. METHODS We subjected 42 skeletally mature ewes to unilateral partial excision of the lateral meniscus. In 19 animals the defect was left unfilled; in 23 animals a scaffold was inserted. Knees were examined by magnetic resonance imaging, gross inspection, and histologic inspection of the cartilage of the tibial plateau. RESULTS In contrast to what has been previously reported in a complete meniscal replacement model, cartilage damage did not occur under the site of scaffold implantation; this was likely influenced by the rapid infiltration of cells and the dense tissue that formed within the scaffold. Cartilage damage in both groups was located close to the midline of the joint. No significant difference in the condition of the articular cartilage of the tibial plateau was seen between groups up to 12 months postoperatively. This result was influenced by the fact that the partly meniscectomized knees also showed unexpected tissue regeneration within the defect site, which raises concern about the suitability of using a partial meniscectomy as a control in the ovine model. CONCLUSIONS Our study has shown that implantation of a polyurethane scaffold in a partial meniscectomy ovine model promotes tissue ingrowth without damaging the cartilage with which it articulates. CLINICAL RELEVANCE Meniscal deficiency is a common occurrence, the effective clinical management of which is limited by the absence of an off-the-shelf implantable construct.
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Kaplan LD, Lu Y, Snitzer J, Nemke B, Hao Z, Biro S, Albiero W, Stampfli HF, Markel M, Popkin C, Baum SZ. The effect of early hyaluronic acid delivery on the development of an acute articular cartilage lesion in a sheep model. Am J Sports Med 2009; 37:2323-7. [PMID: 19723621 DOI: 10.1177/0363546509339579] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Partial-thickness articular cartilage lesions occur with knee trauma and may progress to osteoarthritis. This study evaluates the effectiveness of hyaluronic acid on cartilage healing after acute knee injury in sheep. HYPOTHESIS Early administration of hyaluronic acid to an acute cartilage injury will prevent chondrocyte death and improve cartilage metabolism. STUDY DESIGN Controlled laboratory study. METHODS A 10 x 10 mm partial-thickness articular cartilage lesion was created on the medial condyle of 16 adult sheep stifles (hindlimbs). Eight sheep received intra-articular hyaluronic acid injections at days 0, 8, and 15, and 8 controls received saline. Contralateral stifles were nonoperated controls. All sheep were sacrificed at 12 weeks after surgery. Synovial fluid was drawn before surgery and after euthanasia for collagen II, nitric oxide, and interleukin-1 beta analysis. The medial condyle was analyzed by gross appearance, confocal laser microscopy for cell viability, histologic analysis for cartilage morphology, and dimethylmethylene blue assay for proteoglycan. RESULTS At 12 weeks, histologic analysis revealed that the hyaluronic acid group had significantly better scores than the saline group (P = .001). The hyaluronic acid group had significantly greater glycosaminoglycan content than the saline group (P = .011), and showed a trend of reduced chondrocyte death compared with the saline group (P = .07). Synovial fluid showed no significant differences between the groups in collagen II, nitric oxide, and interleukin-1 beta levels. CONCLUSION The results demonstrated that early administration of hyaluronic acid shows a significant improvement in cartilage histologic analysis and increased glycosaminoglycan content after acute traumatic cartilage injury. CLINICAL RELEVANCE Early hyaluronic acid treatment for acute partial-thickness articular cartilage lesions may decrease or delay articular degeneration.
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Affiliation(s)
- Lee D Kaplan
- Division of Sports Medicine, Department of Orthopaedics, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
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Luther JK, Cook CR, Cook JL. Meniscal release in cruciate ligament intact stifles causes lameness and medial compartment cartilage pathology in dogs 12 weeks postoperatively. Vet Surg 2009; 38:520-9. [PMID: 19538675 DOI: 10.1111/j.1532-950x.2009.00520.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To evaluate after 12 weeks the effects of caudal medial meniscal release (MR) in the cranial cruciate ligament-intact canine stifle. STUDY DESIGN Blinded, prospective in vivo study. ANIMALS Purpose-bred hound dogs (n=10). METHODS Either MR (n=5) or a sham (SH) surgery (n=5) was performed via arthroscopy. Orthopedic examination and subjective lameness evaluation were performed in each dog preoperatively and at 4, 8, and 12 weeks after surgery. Twelve weeks postoperatively, ultrasonographic, radiographic, and arthroscopic examinations were performed on the operated stifles. Gross pathology of the articular cartilage, cruciate ligaments, and menisci was assessed. India ink staining of the femoral and tibial articular surfaces was performed to determine the percent area of articular cartilage damage. RESULTS At 8 and 12 weeks after surgery, MR dogs were lamer than SH dogs. At 12 weeks, the degree of radiographic OA was significantly higher in MR stifles than in SH stifles. Gross and sonographic meniscal pathology was more severe in MR stifles compared with SH stifles. MR stifles had significantly more severe articular cartilage pathology compared with SH stifles 12 weeks after surgery; pathology was most severe in the medial compartment. CONCLUSIONS MR alone is associated with articular cartilage loss, further meniscal pathology, degenerative joint disease, and lameness. CLINICAL RELEVANCE Subsequent osteoarthritis and dysfunction of the stifle joint should be considered when making clinical decisions regarding MR in dogs.
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Affiliation(s)
- Jill K Luther
- Comparative Orthopaedic Laboratory, University of Missouri, Columbia, MO 65211, USA.
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Abstract
Menisci fulfill many functions within the complex biomechanics of the knee joint. In the case of meniscus lesions, sparing arthroscopic resections and operative refixation are the treatments of choice. With regard to diagnostics, this means that in general terms, the histopathologic diagnostics are carried out on detached meniscus fragments of between 5 mm and 2 cm in size. An experienced pathologist's knowledge of physiologically possible cellular and fibrous histological meniscus damage, as opposed to nonphysiological change regarded as normal with respect to age, is essential during a diagnostic meniscus evaluation. The clinician expects clear statements from the pathologist regarding the severity of previous or secondary degenerative meniscus damage, the age and type of traumatic tears, and appraisal of the relationship between trauma and meniscus damage from an insurance point of view. Close cooperation between the clinician and the pathologist allows for fast and unambiguous correlation of anamnesis, the clinical picture, and morphological reporting so that cases involving insurance problems - which are numerous, often long-term, and often unsatisfactory - can be clarified quickly.
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Vanderploeg EJ, Grodzinsky AJ. Can the meniscus affect the nature of a chondrocyte? Osteoarthritis Cartilage 2009; 17:969-70. [PMID: 19490964 PMCID: PMC2752629 DOI: 10.1016/j.joca.2009.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Revised: 05/08/2009] [Accepted: 05/12/2009] [Indexed: 02/02/2023]
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