What's New in Orthopaedic Research

A pilot study to assess the healing of meniscal tears in young adult goats

Meniscal tears are a common orthopedic injury, yet their healing is difficult to assess post-operatively. This impedes clinical decisions as the healing status of the meniscus cannot be accurately determined non-invasively. Thus, the objectives of this study were to explore the utility of a goat model and to use quantitative magnetic resonance imaging (MRI) techniques, histology, and biomechanical testing to assess the healing status of surgically induced meniscal tears. Adiabatic T1ρ, T2, and T2* relaxation times were quantified for both operated and control menisci ex vivo. Histology was used to assign healing status, assess compositional elements, and associate healing status with compositional elements. Biomechanical testing determined the failure load of healing lesions. Adiabatic T1ρ, T2, and T2* were able to quantitatively identify different healing states. Histology showed evidence of diminished proteoglycans and increased vascularity in both healed and non-healed menisci with surgically induced tears. Biomechanical results revealed that increased healing (as assessed histologically and on MRI) was associated with greater failure load. Our findings indicate increased healing is associated with greater meniscal strength and decreased signal differences (relative to contralateral controls) on MRI. This indicates that quantitative MRI may be a viable method to assess meniscal tears post-operatively.

The increased oxygen content in tantalum leads to decreased bioactivity and osteogenic ability of tantalum implants

Tantalum (Ta) implants fabricated by current processing techniques inevitably contain more or less oxygen impurities due to the extremely high melting point and high affinity of oxygen for Ta. Therefore, in this study we investigated whether oxygen impurities cause any effects on the bioactivity of Ta. EDS analysis demonstrated the surface oxygen content difference among different fabricated Ta samples, and the surface water contact angle (WCA) of Ta with high oxygen content (HO-Ta) was significantly higher than that of Ta with medium (MO-Ta) and low (LO-Ta) oxygen content. The in vitro cellular experiments showed that MC3T3-E1 cells on Ta with lower oxygen content exhibited better adhesion, growth, morphological development and in vitro osteogenic ability. Similarly, the in vivo animal experiments indicated the better bone regeneration and ingrowth performances of Ta with lower oxygen content. In addition, the highest ROS production was detected in the HO-Ta group, while the lowest in the LO-Ta group. This study suggests that the oxygen content within Ta, which occurs unavoidably due to technical limitations, negatively affects the bioactivity of Ta in a dose-dependent manner, indicating the need to develop techniques to produce orthopedic all-Ta implants.

Basic Science Research Trends in Orthopedic Surgery: An Analysis of the Top 100 Cited Articles

BACKGROUND

Much of current clinical orthopedics traces its origin to basic science investigation of cellular and biochemical pathways, tissue engineering, and biomechanics of bone and joint physiology in animal and cadaveric models.

QUESTIONS/PURPOSES

We sought to describe research trends in highly cited basic science studies in orthopedics.

METHODS

By searching Web of Science, we identified the 100 most cited basic science orthopedics articles and focused on author position and degree (PhD, MD, or MD/PhD), topic, type of study, country, institution, and citation trends.

RESULTS

These articles were published from 1970 to 2008 (citation range, 330 to 2111), with the majority from the USA (78). While there was no correlation between years since publication and total citations, more recent articles had higher citation rates. There were 38 unique first authors represented, with Caplan, Harris, Mankin, Noyes, and Warren as primary authors or co-authors of four articles each. Twelve journals published these 100 articles, with the majority in Journal of Bone and Joint Surgery (46) and Clinical Orthopaedics and Related Research (18). Frequent topics included biomechanics (31), healing/regeneration (21), and cellular/molecular biology (13). The Hospital for Special Surgery/Cornell University (10) published the most, followed by the Hospital for Joint Diseases/New York University (6), and University of Pittsburgh (6). No difference was observed in total citations and average citation rate by author degree. Eight articles were contributed from privately owned institutions or industry, with the rest from academic hospitals.

CONCLUSION

This review may aid those seeking insight into landmark studies and future direction of basic science research in orthopedics.

The Holy Grail of Orthopedic Surgery: Mesenchymal Stem Cells-Their Current Uses and Potential Applications

Only select tissues and organs are able to spontaneously regenerate after disease or trauma, and this regenerative capacity diminishes over time. Human stem cell research explores therapeutic regenerative approaches to treat various conditions. Mesenchymal stem cells (MSCs) are derived from adult stem cells; they are multipotent and exert anti-inflammatory and immunomodulatory effects. They can differentiate into multiple cell types of the mesenchyme, for example, endothelial cells, osteoblasts, chondrocytes, fibroblasts, tenocytes, vascular smooth muscle cells, and sarcomere muscular cells. MSCs are easily obtained and can be cultivated and expanded in vitro; thus, they represent a promising and encouraging treatment approach in orthopedic surgery. Here, we review the application of MSCs to various orthopedic conditions, namely, orthopedic trauma; muscle injury; articular cartilage defects and osteoarthritis; meniscal injuries; bone disease; nerve, tendon, and ligament injuries; spinal cord injuries; intervertebral disc problems; pediatrics; and rotator cuff repair. The use of MSCs in orthopedics may transition the practice in the field from predominately surgical replacement and reconstruction to bioregeneration and prevention. However, additional research is necessary to explore the safety and effectiveness of MSC treatment in orthopedics, as well as applications in other medical specialties.