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Credille KT, Wang ZRC, Horner NS, Regan DP, Gadomski BC, Easley JT, Garrigues GE, Yanke AB. Biphasic Interpositional Allograft for Rotator Cuff Repair Augmentation Is Safe in an Ovine Model. Arthroscopy 2023; 39:1983-1997. [PMID: 37001743 DOI: 10.1016/j.arthro.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 03/04/2023] [Accepted: 03/09/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE To perform a preclinical histologic assessment of a biphasic acellular interpositional cancellous allograft in an ovine model of rotator cuff repair (RCR) designed to better understand its safety profile and effects on tendon healing after RCR. METHODS Thirty skeletally mature sheep with clinically normal shoulders with an artificially created degenerative infraspinatus tendon tear were randomized to control and treatment groups. Animals were euthanized at 3 weeks, 6 weeks, and 12 weeks. After gross dissection, rotator cuff specimens were fixed with formalin and polymerized for sectioning and staining. Blinded histologic scores evaluated inflammatory cell infiltrates, signs of degradation, particulate debris, collagen arrangement, neovascularization, and enthesis qualitative measures. RESULTS There were no treatment specimens that exhibited histologic signs of a significant infection, inflammatory infiltrate, or foreign body reaction such as granuloma or fibrous capsule formation. Histologic scores in all categories were not significantly different at all time points, including the primary end point mean cumulative inflammatory score (control: 3.66 ± 1.21 vs treated: 4.33 ± 1.51, P = .42), when comparing the treatment and control RCR groups. In general, the degree of tendon healing and host tissue response was essentially equivalent between the 2 groups with observation of low overall levels of inflammation and progressive improvements in collagen organization, reduced tenocyte activity, and fibrocartilaginous enthesis reformation. CONCLUSIONS This histologic study demonstrated the use of a biphasic interpositional allograft for RCR augmentation in an ovine model does not generate an inflammatory response or foreign body reaction. Use of the biphasic interpositional allograft resulted in a histological profile that was essentially equivalent to that of a standard RCR at 3-, 6-, and 12-week postoperative timepoints. These findings suggest that a biphasic interpositional allograft is safe for further clinical investigation in humans before broader clinical application. CLINICAL RELEVANCE Patch augmentation of RCR is a popular technique that has shown clinical success in improving the likelihood of a successful repair in patients at elevated risk for retear. Newer augmentation technologies are being developed to address the biology at the interface between the bone and soft tissue where failure typically occurs.
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Affiliation(s)
- Kevin T Credille
- Midwest Orthopedics at Rush University Medical Center, Chicago, Illinois
| | - Zachary R C Wang
- Midwest Orthopedics at Rush University Medical Center, Chicago, Illinois
| | - Nolan S Horner
- Midwest Orthopedics at Rush University Medical Center, Chicago, Illinois
| | - Daniel P Regan
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, U.S.A
| | - Benjamin C Gadomski
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, Colorado, U.S.A
| | - Jeremiah T Easley
- Preclinical Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, U.S.A
| | - Grant E Garrigues
- Midwest Orthopedics at Rush University Medical Center, Chicago, Illinois
| | - Adam B Yanke
- Midwest Orthopedics at Rush University Medical Center, Chicago, Illinois.
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Lin S, Maekawa H, Moeinzadeh S, Lui E, Alizadeh HV, Li J, Kim S, Poland M, Gadomski BC, Easley JT, Young J, Gardner M, Mohler D, Maloney WJ, Yang YP. An osteoinductive and biodegradable intramedullary implant accelerates bone healing and mitigates complications of bone transport in male rats. Nat Commun 2023; 14:4455. [PMID: 37488113 PMCID: PMC10366099 DOI: 10.1038/s41467-023-40149-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 07/12/2023] [Indexed: 07/26/2023] Open
Abstract
Bone transport is a surgery-driven procedure for the treatment of large bone defects. However, challenging complications include prolonged consolidation, docking site nonunion and pin tract infection. Here, we develop an osteoinductive and biodegradable intramedullary implant by a hybrid tissue engineering construct technique to enable sustained delivery of bone morphogenetic protein-2 as an adjunctive therapy. In a male rat bone transport model, the eluting bone morphogenetic protein-2 from the implants accelerates bone formation and remodeling, leading to early bony fusion as shown by imaging, mechanical testing, histological analysis, and microarray assays. Moreover, no pin tract infection but tight osseointegration are observed. In contrast, conventional treatments show higher proportion of docking site nonunion and pin tract infection. The findings of this study demonstrate that the novel intramedullary implant holds great promise for advancing bone transport techniques by promoting bone regeneration and reducing complications in the treatment of bone defects.
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Affiliation(s)
- Sien Lin
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Hirotsugu Maekawa
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Seyedsina Moeinzadeh
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Elaine Lui
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
- Department of Mechanical Engineering, School of Engineering, Stanford University, Stanford, CA, 94305, USA
| | - Hossein Vahid Alizadeh
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Jiannan Li
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Sungwoo Kim
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Michael Poland
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, 80523, USA
| | - Benjamin C Gadomski
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, 80523, USA
| | - Jeremiah T Easley
- Preclinical Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, Fort Collins, CO, 80523, USA
| | - Jeffrey Young
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Michael Gardner
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - David Mohler
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - William J Maloney
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Yunzhi Peter Yang
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA.
- Department of Materials Science and Engineering, School of Engineering, Stanford University, Stanford, CA, 94305, USA.
- Department of Bioengineering, School of Medicine, Stanford University, Stanford, CA, 94305, USA.
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Shum JM, Gadomski BC, Tredinnick SJ, Fok W, Fernandez J, Nelson B, Palmer RH, McGilvray KC, Hooper GJ, Puttlitz C, Easley J, Woodfield TBF. Enhanced bone formation in locally-optimised, low-stiffness additive manufactured titanium implants: An in silico and in vivo tibial advancement study. Acta Biomater 2023; 156:202-213. [PMID: 35413478 DOI: 10.1016/j.actbio.2022.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 01/18/2023]
Abstract
A tibial tuberosity advancement (TTA), used to treat lameness in the canine stifle, provides a framework to investigate implant performance within an uneven loading environment due to the dominating patellar tendon. The purpose of this study was to reassess how we design orthopaedic implants in a load-bearing model to investigate potential for improved osseointegration capacity of fully-scaffolded mechanically-matched additive manufactured (AM) implants. While the mechanobiological nature of bone is well known, we have identified a lower limit in the literature where investigation into exceedingly soft scaffolds relative to trabecular bone ceases due to the trade-off in mechanical strength. We developed a finite element model of the sheep stifle to assess the stresses and strains of homogeneous and locally-optimised TTA implant designs. Using additive manufacturing, we printed three different low-stiffness Ti-6Al-4 V TTA implants: 0.8 GPa (Ti1), 0.6 GPa (Ti2) and an optimised design with a 0.3 GPa cortex and 0.1 GPa centre (Ti3), for implantation in a 12-week in vivo ovine pilot study. Static histomorphometry demonstrated uniform bone ingrowth in optimised low-modulus Ti3 samples compared to homogeneous designs (Ti1 and Ti2), and greater bone-implant contact. Mineralising surfaces were apparent in all implants, though mineral apposition rate was only consistent throughout Ti3. The greatest bone formation scores were seen in Ti3, followed by Ti2 and Ti1. Results from our study suggest lower stiffnesses and higher strain ranges improve early bone formation, and that by accounting for loading environments through rational design, implants can be optimised to improve uniform osseointegration. STATEMENT OF SIGNIFICANCE: The effect of different strain ranges on bone healing has been traditionally investigated and characterised through computational models, with much of the literature suggesting higher strain ranges being favourable. However, little has been done to incorporate strain-optimisation into porous orthopaedic implants due to the trade-off in mechanical strength required to induce these microenvironments. In this study, we used finite element analysis to optimise the design of additive manufactured (AM) titanium orthopaedic implants for different strain ranges, using a clinically-relevant surgical model. Our research suggests that there is potential for locally-optimised AM scaffolds in the use of orthopaedic devices to induce higher strains, which in turn encourages de novo bone formation and uniform osseointegration.
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Affiliation(s)
- Josephine M Shum
- Christchurch Regenerative Medicine and Tissue Engineering (CReaTE) Group, Department of Orthopaedic Surgery & Musculoskeletal Medicine, Centre for Bioengineering & Nanomedicine, University of Otago, Christchurch, New Zealand
| | - Benjamin C Gadomski
- Orthopaedic Bioengineering Research Laboratory, Colorado State University, Fort Collins, CO, United States
| | - Seamus J Tredinnick
- Christchurch Regenerative Medicine and Tissue Engineering (CReaTE) Group, Department of Orthopaedic Surgery & Musculoskeletal Medicine, Centre for Bioengineering & Nanomedicine, University of Otago, Christchurch, New Zealand
| | - Wilson Fok
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Justin Fernandez
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Bradley Nelson
- Orthopaedic Bioengineering Research Laboratory, Colorado State University, Fort Collins, CO, United States
| | - Ross H Palmer
- Orthopaedic Bioengineering Research Laboratory, Colorado State University, Fort Collins, CO, United States
| | - Kirk C McGilvray
- Orthopaedic Bioengineering Research Laboratory, Colorado State University, Fort Collins, CO, United States
| | - Gary J Hooper
- Christchurch Regenerative Medicine and Tissue Engineering (CReaTE) Group, Department of Orthopaedic Surgery & Musculoskeletal Medicine, Centre for Bioengineering & Nanomedicine, University of Otago, Christchurch, New Zealand
| | - Christian Puttlitz
- Orthopaedic Bioengineering Research Laboratory, Colorado State University, Fort Collins, CO, United States
| | - Jeremiah Easley
- Orthopaedic Bioengineering Research Laboratory, Colorado State University, Fort Collins, CO, United States
| | - Tim B F Woodfield
- Christchurch Regenerative Medicine and Tissue Engineering (CReaTE) Group, Department of Orthopaedic Surgery & Musculoskeletal Medicine, Centre for Bioengineering & Nanomedicine, University of Otago, Christchurch, New Zealand.
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Koch DW, Johnson JW, Smith QE, Brekhus C, Gadomski BC, Palmer RH, Easley JT, Nelson BB. Biomechanical evaluation of interlocking nail and locking compression plating for stabilization of ovine critical-sized segmental tibia defects. Ann Transl Med 2023; 11:258. [PMID: 37082686 PMCID: PMC10113068 DOI: 10.21037/atm-22-4886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/08/2023] [Indexed: 03/17/2023]
Abstract
Background Segmental large volume bone loss resulting from fracture or osseous neoplasia is a major challenge to orthopedic surgeons and there is an ongoing quest to identify treatments that optimize healing. To advance treatment, large animal translational models-such as the ovine critical-sized tibia defect model-are instrumental for testing of novel scaffolds for bone regeneration. However, little standardization in the implants utilized for defect stabilization has been determined and current commercially available implants may be inadequate to replicate the strength of the native tibia. We hypothesize that a 10-mm interlocking nail (ILN) would be stiffer in axial, bending, and torsional loading than its 8-mm counterpart and would be stiffer in axial and torsional loading compared to a 4.5-mm broad locking compression plate (LCP). Methods Tibias were harvested from 24 ovine hind limbs from skeletally mature ewes euthanized for reasons unrelated to this study and were randomized to treatment group. An ex vivo comparison of a novel 10-mm angle-stable non-tapered ILN was compared to a commercially available 8-mm angle-stable tapered ILN and a broad LCP in an ovine critical-sized (5-cm) tibia defect model. Axial stiffness, torsional stiffness, and bending stiffness were determined in control intact tibia and tibial constructs in the three treatment groups. Following implantation, radiography was performed in all limbs and tibia length and cortical and medullary cavity diameter were measured. Comparisons between groups were assessed with a one-way analysis of variance. Significance was set at P<0.05. Results The 10-mm ILN in tibia containing a 5-cm ostectomy gap most closely replicated the structural properties of intact tibia compared with other constructs. The 10-mm ILN had significantly stronger torsional (P<0.001) and bending (P=0.002) stiffness than the 8-mm ILN, and was significantly stronger than the LCP in axial (P=0.04) and torsional (P=0.01) stiffness. Conclusions A 10-mm ILN used to stabilize an ovine critically-sized tibia defect most closely mimicked the structural properties of the intact tibia when compared to a 8-mm ILN or broad LCP. Further in vivo testing will aid in determining which stabilization method is best suited for testing of novel tissue engineering and bone healing studies.
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Affiliation(s)
- Drew W. Koch
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - James W. Johnson
- Orthopaedic Bioengineering Research Laboratory, C. Wayne McIlwraith Translational Medicine Institute, Colorado State University, Fort Collins, CO, USA
| | - Quinn E. Smith
- Orthopaedic Bioengineering Research Laboratory, C. Wayne McIlwraith Translational Medicine Institute, Colorado State University, Fort Collins, CO, USA
| | - Chloe Brekhus
- Orthopaedic Bioengineering Research Laboratory, C. Wayne McIlwraith Translational Medicine Institute, Colorado State University, Fort Collins, CO, USA
| | - Benjamin C. Gadomski
- Orthopaedic Bioengineering Research Laboratory, C. Wayne McIlwraith Translational Medicine Institute, Colorado State University, Fort Collins, CO, USA
| | - Ross H. Palmer
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
- Preclinical Surgical Research Laboratory, C. Wayne McIlwraith Translational Medicine Institute, Colorado State University, Fort Collins, CO, USA
| | - Jeremiah T. Easley
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
- Preclinical Surgical Research Laboratory, C. Wayne McIlwraith Translational Medicine Institute, Colorado State University, Fort Collins, CO, USA
| | - Brad B. Nelson
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
- Preclinical Surgical Research Laboratory, C. Wayne McIlwraith Translational Medicine Institute, Colorado State University, Fort Collins, CO, USA
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Hindman BJ, Dexter F, Gadomski BC, Puttlitz CM. Relationship Between Glottic View and Intubation Force During Macintosh and Airtraq Laryngoscopy and Intubation. Anesth Analg 2022; 135:815-819. [PMID: 35551148 PMCID: PMC9481653 DOI: 10.1213/ane.0000000000006082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Because intubation-mediated cervical spine and spinal cord injury are likely determined by intubation force magnitude, understanding the determinants of intubation force magnitude is clinically relevant. With direct (Macintosh) laryngoscopy, when glottic view is less favorable, anesthesiologists apply greater force. We hypothesized that, when compared with direct (Macintosh) laryngoscopy, intubation force with an optical indirect laryngoscope (Airtraq) would be less dependent on glottic visualization. METHODS Using data obtained in a prior clinical study, we tested whether the slope of the intubation force versus glottic view relationship differed between intubations performed in 14 patients who were intubated twice, once with a Macintosh and once with an Airtraq videolaryngoscope. Slopes were compared using least-squares linear regression and robust regression. RESULTS The slope of the intubation force (N) versus glottic view (%) relationship with the Macintosh (-0.679 [standard error {SE}, 0.147]) was significantly more negative than that of the Airtraq (-0.076 [SE, 0.246]). The least-squares regression difference in slopes was -0.603 (SE, 0.287); P = .046. The robust regression difference in slopes was -0.747 (SE, 0.187); P = .0005. Thus, when compared with the Macintosh, intubation force magnitude with Airtraq laryngoscopy was less dependent on glottic visualization. CONCLUSIONS Previously, we reported that intubation force with the Airtraq was less in magnitude compared with the Macintosh. Our current study adds that intubation force also is less dependent on glottic view with Airtraq compared with the Macintosh.
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Affiliation(s)
- Bradley J. Hindman
- Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, U.S.A
| | - Franklin Dexter
- Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, U.S.A
| | - Benjamin C. Gadomski
- Department of Mechanical Engineering, School of Biomedical Engineering, Orthopaedic Bioengineering Research Laboratory, Colorado State University, Fort Collins, CO, U.S.A
| | - Christian M. Puttlitz
- Department of Mechanical Engineering, School of Biomedical Engineering, Orthopaedic Bioengineering Research Laboratory, Colorado State University, Fort Collins, CO, U.S.A
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Gadomski BC, Hindman BJ, Poland MJ, Page MI, Dexter F, Puttlitz CM. Intubation biomechanics: Computational modeling to identify methods to minimize cervical spine motion and spinal cord strain during laryngoscopy and tracheal intubation in an intact cervical spine. J Clin Anesth 2022; 81:110909. [PMID: 35738028 DOI: 10.1016/j.jclinane.2022.110909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/08/2022] [Accepted: 06/13/2022] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE To minimize the risk of cervical spinal cord injury in patients who have cervical spine pathology, minimizing cervical spine motion during laryngoscopy and tracheal intubation is commonly recommended. However, clinicians may better aim to reduce cervical spinal cord strain during airway management of their patients. The aim of this study was to predict laryngoscope force characteristics (location, magnitude, and direction) that would minimize cervical spine motions and cord strains. DESIGN We utilized a computational model of the adult human cervical spine and spinal cord to predict intervertebral motions (rotation [flexion/extension] and translation [subluxation]) and cord strains (stretch and compression) during laryngoscopy. INTERVENTIONS Routine direct (Macintosh) laryngoscopy conditions were defined by a specific force application location (mid-C3 vertebral body), magnitude (48.8 N), and direction (70 degrees). Sixty laryngoscope force conditions were simulated using 4 force locations (cephalad and caudad of routine), 5 magnitudes (25-200% of routine), and 3 directions (50, 70, 90 degrees). MAIN RESULTS Under all conditions, extension at Oc-C1 and C1-C2 were greater than in all other cervical segments. Decreasing force magnitude to values reported for indirect laryngoscopes (8-17 N) decreased cervical extension to ~50% of routine values. The cervical cord was most likely to experience potentially injurious compressive strain at C3, but force magnitudes ≤50% of routine (≤24.4 N) decreased strain in C3 and all other cord regions to non-injurious values. Changing laryngoscope force locations and directions had minor effects on motion and strain. CONCLUSIONS The model predicts clinicians can most effectively minimize cervical spine motion and cord strain during laryngoscopy by decreasing laryngoscope force magnitude. Very low force magnitudes (<5 N, ~10% of routine) are necessary to decrease overall cervical extension to <50% of routine values. Force magnitudes ≤24.4 N (≤50% of routine) are predicted to help prevent potentially injurious compressive cord strain.
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Affiliation(s)
- Benjamin C Gadomski
- Department of Mechanical Engineering, School of Biomedical Engineering, Orthopaedic Bioengineering Research Laboratory, 300 West Drake Street, Colorado State University, Fort Collins, CO 80523, United States.
| | - Bradley J Hindman
- Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 451 Newton Road, 200 Medicine Administration Building, Iowa City, IA 52242, United States.
| | - Michael J Poland
- Department of Mechanical Engineering, School of Biomedical Engineering, Orthopaedic Bioengineering Research Laboratory, 300 West Drake Street, Colorado State University, Fort Collins, CO 80523, United States.
| | - Mitchell I Page
- Department of Mechanical Engineering, School of Biomedical Engineering, Orthopaedic Bioengineering Research Laboratory, 300 West Drake Street, Colorado State University, Fort Collins, CO 80523, United States.
| | - Franklin Dexter
- Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 451 Newton Road, 200 Medicine Administration Building, Iowa City, IA 52242, United States.
| | - Christian M Puttlitz
- Department of Mechanical Engineering, School of Biomedical Engineering, Orthopaedic Bioengineering Research Laboratory, 300 West Drake Street, Colorado State University, Fort Collins, CO 80523, United States.
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Gadomski BC, Labus KM, Stewart HL, Bisazza KT, Nelson BB, Puttlitz CM, McGilvray KC, Regan DP, Easley JT. A Large Animal Model for Orthopedic Foot and Ankle Research. Front Vet Sci 2022; 9:816529. [PMID: 35187145 PMCID: PMC8850350 DOI: 10.3389/fvets.2022.816529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/04/2022] [Indexed: 11/13/2022] Open
Abstract
Trauma to the soft tissues of the ankle joint distal syndesmosis often leads to syndesmotic instability, resulting in undesired movement of the talus, abnormal pressure distributions, and ultimately arthritis if deterioration progresses without treatment. Historically, syndesmotic injuries have been repaired by placing a screw across the distal syndesmosis to provide rigid fixation to facilitate ligament repair. While rigid syndesmotic screw fixation immobilizes the ligamentous injury between the tibia and fibula to promote healing, the same screws inhibit normal physiologic movement and dorsiflexion. It has been shown that intact screw removal can be beneficial for long-term patient success; however, the exact timing remains an unanswered question that necessitates further investigation, perhaps using animal models. Because of the sparsity of relevant preclinical models, the purpose of this study was to develop a new, more translatable, large animal model that can be used for the investigation of clinical foot and ankle implants. Eight (8) skeletally mature sheep underwent stabilization of the left and right distal carpal bones following transection of the dorsal and interosseous ligaments while the remaining two animals served as un-instrumented controls. Four of the surgically stabilized animals were sacrificed 6 weeks after surgery while the remaining four animals were sacrificed 10 weeks after surgery. Ligamentous healing was evaluated using radiography, histology, histomorphometry, and histopathology. Overall, animals demonstrated a high tolerance to the surgical procedure with minimal complications. Animals sacrificed at 10 weeks post-surgery had a slight trend toward mildly decreased inflammation, decreased necrotic debris, and a slight increase in the healing of the transected ligaments. The overall degree of soft tissue fibrosis/fibrous expansion, including along the dorsal periosteal surfaces/joint capsule of the carpal bones was very similar between both timepoints and often exhibited signs of healing. The findings of this study indicate that the carpometacarpal joint may serve as a viable location for the investigation of human foot and ankle orthopedic devices. Future work may include the investigation of orthopedic foot and ankle medical devices, biologic treatments, and repair techniques in a large animal model capable of providing translational results for human treatment.
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Affiliation(s)
- Benjamin C. Gadomski
- Orthopedic Bioengineering Research Laboratory, Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, CO, United States
- *Correspondence: Benjamin C. Gadomski
| | - Kevin M. Labus
- Orthopedic Bioengineering Research Laboratory, Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, CO, United States
| | - Holly L. Stewart
- Preclinical Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Katie T. Bisazza
- Preclinical Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Brad B. Nelson
- Preclinical Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Christian M. Puttlitz
- Orthopedic Bioengineering Research Laboratory, Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, CO, United States
| | - Kirk C. McGilvray
- Orthopedic Bioengineering Research Laboratory, Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, CO, United States
| | - Daniel P. Regan
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO, United States
| | - Jeremiah T. Easley
- Preclinical Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States
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McCready E, Easley JT, Risch M, Troyer KL, Johnson JW, Gadomski BC, McGilvray KC, Kisiday JD, Nelson BB. Biomechanical, Morphological, and Biochemical Characteristics of Articular Cartilage of the Ovine Humeral Head. Cartilage 2022; 13:19476035221081465. [PMID: 35225009 PMCID: PMC9137309 DOI: 10.1177/19476035221081465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/10/2022] [Accepted: 01/23/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Shoulder pain is commonly attributed to rotator cuff injury or osteoarthritis. Ovine translational models are used to investigate novel treatments aimed at remedying these conditions to prevent articular cartilage degeneration and subsequent joint degradation. However, topographical properties of articular cartilage in the ovine shoulder are undefined. This study investigates the biomechanical, morphological, and biochemical attributes of healthy ovine humeral head articular cartilage and characterizes topographical variations between surface locations. DESIGN Ten humeral heads were collected from healthy skeletally mature sheep and each was segregated into 4 quadrants using 16 regions of interest (ROIs) across the articular surface. Articular cartilage of each ROI was analyzed for creep indentation, thickness, and sulfated glycosaminoglycan (sGAG) and collagen quantity. Comparisons of each variable were made between quadrants and between ROIs within each quadrant. RESULTS Percent creep, thickness, and sGAG content, but not collagen content, were significantly different between humeral head quadrants. Subregion analysis of the ROIs within each surface quadrant revealed differences in all measured variables within at least one quadrant. Percent creep was correlated with sGAG (r = -0.32, P = 0.0001). Collagen content was correlated with percent creep (r = 0.32, P = 0.0009), sGAG (r = -0.19, P = 0.049), and thickness (r = -0.19, P = 0.04). CONCLUSIONS Topographical variations exist in mechanical, morphologic, and biochemical properties across the articular surface of the ovine humeral head. Recognizing this variability in ovine humeral head cartilage will provide researchers and clinicians with accurate information that could impact study outcomes.
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Affiliation(s)
- Erin McCready
- Preclinical Surgical Research Laboratory, C. Wayne McIlwraith Translational Medicine Institute, Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Jeremiah T. Easley
- Preclinical Surgical Research Laboratory, C. Wayne McIlwraith Translational Medicine Institute, Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Makayla Risch
- Preclinical Surgical Research Laboratory, C. Wayne McIlwraith Translational Medicine Institute, Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Kevin L. Troyer
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - James W. Johnson
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Benjamin C. Gadomski
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Kirk C. McGilvray
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - John D. Kisiday
- Orthopaedic Research Center, C. Wayne McIlwraith Translational Medicine Institute, Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Brad B. Nelson
- Preclinical Surgical Research Laboratory, C. Wayne McIlwraith Translational Medicine Institute, Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
- Orthopaedic Research Center, C. Wayne McIlwraith Translational Medicine Institute, Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
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Gadomski BC, Labus KM, Puttlitz CM, McGilvray KC, Regan DP, Nelson B, Seim HB, Easley JT. Evaluation of lumbar spinal fusion utilizing recombinant human platelet derived growth factor-B chain homodimer (rhPDGF-BB) combined with a bovine collagen/β-tricalcium phosphate (β-TCP) matrix in an ovine model. JOR Spine 2021; 4:e1166. [PMID: 34611589 PMCID: PMC8479519 DOI: 10.1002/jsp2.1166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/16/2021] [Accepted: 06/20/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND CONTEXT While the clinical effectiveness of recombinant human Platelet Derived Growth Factor-B chain homodimer combined with collagen and β-tricalcium phosphate (rhPDGF-BB + collagen/β-TCP) treatment for indications involving hindfoot and ankle is well-established, it is not approved for use in spinal interbody fusion, and the use of autograft remains the gold standard. PURPOSE The purpose of this study was to compare the effects of rhPDGF-BB + collagen/β-TCP treatment on lumbar spine interbody fusion in an ovine model to those of autograft bone and collagen/β-TCP treatments using biomechanical, radiographic, and histological assessment techniques. STUDY DESIGN Thirty-two skeletally mature Columbian Rambouillet sheep were used to evaluate the safety and effectiveness of rhPDGF-BB + collagen/β-TCP matrix in a lumbar spinal fusion model. Interbody polyetheretherketone (PEEK) cages contained either autograft, rhPDGF-BB + collagen/β-TCP, collagen/β-TCP matrix, or left empty. METHODS Animals were sacrificed 8- or 16-weeks post-surgery. Spinal fusion was evaluated via post-sacrifice biomechanical, micro-computed tomography (μCT), and histological analysis. Outcomes were statistically compared using a two-way analysis of variance (ANOVA) with an alpha value of 0.05 and a Tukey post-hoc test. RESULTS There were no statistically significant differences between groups within treatment timepoints for flexion-extension, lateral bending, or axial rotation range of motion, neutral zone, neutral zone stiffness, or elastic zone stiffness. μCT bone volume fraction was significantly greater between treatment groups independent of timepoint where Autograft and rhPDGF-BB + collagen/β-TCP treatments demonstrated significantly greater bone volume fraction as compared to collagen/β-TCP (P = .026 and P = .038, respectively) and Empty cage treatments (P = .002 and P = .003, respectively). μCT mean bone density fraction was most improved in rhPDGF-BB + collagen/β-TCP specimens at the 8 week and 16-week timepoints as compared to all other treatment groups. There were no statistically significant differences in histomorphometric measurements of bone, soft tissue, or empty space between rhPDGF-BB + collagen/β-TCP and autograft treatments. CONCLUSIONS The results of this study indicate that the use of rhPDGF-BB combined with collagen/β-TCP promotes spinal fusion comparable to that of autograft bone. CLINICAL SIGNIFICANCE The data indicate that rhPDGF-BB combined with collagen/β-TCP promotes spinal fusion comparably to autograft bone treatment and may offer a viable alternative in large animal spinal fusion. Future prospective clinical studies are necessary to fully understand the role of rhPDGF-BB combined with collagen/β-TCP in human spinal fusion healing.
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Affiliation(s)
- Benjamin C. Gadomski
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering and School of Biomedical EngineeringColorado State UniversityFort CollinsColoradoUSA
| | - Kevin M. Labus
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering and School of Biomedical EngineeringColorado State UniversityFort CollinsColoradoUSA
| | - Christian M. Puttlitz
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering and School of Biomedical EngineeringColorado State UniversityFort CollinsColoradoUSA
| | - Kirk C. McGilvray
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering and School of Biomedical EngineeringColorado State UniversityFort CollinsColoradoUSA
| | - Daniel P. Regan
- Department of Microbiology, Immunology, and PathologyColorado State UniversityFort CollinsColoradoUSA
| | - Brad Nelson
- Preclinical Surgical Research Laboratory, Department of Clinical SciencesColorado State UniversityFort CollinsColoradoUSA
| | - Howard B. Seim
- Preclinical Surgical Research Laboratory, Department of Clinical SciencesColorado State UniversityFort CollinsColoradoUSA
| | - Jeremiah T. Easley
- Preclinical Surgical Research Laboratory, Department of Clinical SciencesColorado State UniversityFort CollinsColoradoUSA
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10
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Yang YP, Gadomski BC, Bruyas A, Easley J, Labus KM, Nelson B, Palmer RH, Stewart H, McGilvray K, Puttlitz CM, Regan D, Stahl A, Lui E, Li J, Moeinzadeh S, Kim S, Maloney W, Gardner MJ. Investigation of a Prevascularized Bone Graft for Large Defects in the Ovine Tibia. Tissue Eng Part A 2021; 27:1458-1469. [PMID: 33858216 DOI: 10.1089/ten.tea.2020.0347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
In vivo bioreactors are a promising approach for engineering vascularized autologous bone grafts to repair large bone defects. In this pilot parametric study, we first developed a three-dimensional (3D) printed scaffold uniquely designed to accommodate inclusion of a vascular bundle and facilitate growth factor delivery for accelerated vascular invasion and ectopic bone formation. Second, we established a new sheep deep circumflex iliac artery (DCIA) model as an in vivo bioreactor for engineering a vascularized bone graft and evaluated the effect of implantation duration on ectopic bone formation. Third, after 8 weeks of implantation around the DCIA, we transplanted the prevascularized bone graft to a 5 cm segmental bone defect in the sheep tibia, using the custom 3D printed bone morphogenic protein 2 (BMP-2) loaded scaffold without prior in vivo bioreactor maturation as a control. Analysis by micro-computed tomography and histomorphometry found ectopic bone formation in BMP-2 loaded scaffolds implanted for 8 and 12 weeks in the iliac pouch, with greater bone formation occurring after 12 weeks. Grafts transplanted to the tibial defect supported bone growth, mainly on the periphery of the graft, but greater bone growth and less soft tissue invasion was observed in the avascular BMP-2 loaded scaffold implanted directly into the tibia without prior in vivo maturation. Histopathological evaluation noted considerably greater vascularity in the bone grafts that underwent in vivo maturation with an inserted vascular bundle compared with the avascular BMP-2 loaded graft. Our findings indicate that the use of an initial DCIA in vivo bioreactor maturation step is a promising approach to developing vascularized autologous bone grafts, although scaffolds with greater osteoinductivity should be further studied. Impact statement This translational pilot study aims at combining a tissue engineering scaffold strategy, in vivo prevascularization, and a modified transplantation technique to accelerate large segmental bone defect repair. First, we three-dimensional (3D) printed a 5 cm scaffold with a unique design to facilitate vascular bundle inclusion and osteoinductive growth factor delivery. Second, we established a new sheep deep circumflex iliac artery model as an in vivo bioreactor for prevascularizing the novel 3D printed osteoinductive scaffold. Subsequently, we transplanted the prevascularized bone graft to a clinically relevant 5 cm segmental bone defect in the sheep tibia for bone regeneration.
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Affiliation(s)
- Yunzhi Peter Yang
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Material Science and Engineering, Stanford University, Stanford, California, USA.,Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Benjamin C Gadomski
- Department of Mechanical Engineering and School of Biomedical Engineering, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Arnaud Bruyas
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Jeremiah Easley
- Department of Clinical Sciences, and Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Kevin M Labus
- Department of Mechanical Engineering and School of Biomedical Engineering, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Brad Nelson
- Department of Clinical Sciences, and Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Ross H Palmer
- Department of Clinical Sciences, and Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Holly Stewart
- Department of Clinical Sciences, and Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Kirk McGilvray
- Department of Mechanical Engineering and School of Biomedical Engineering, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Christian M Puttlitz
- Department of Mechanical Engineering and School of Biomedical Engineering, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Dan Regan
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Alexander Stahl
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Chemistry and Stanford University, Stanford, California, USA
| | - Elaine Lui
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Mechanical Engineering, Stanford University, Stanford, California, USA
| | - Jiannan Li
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Seyedsina Moeinzadeh
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Sungwoo Kim
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - William Maloney
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Michael J Gardner
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
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11
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Risch M, Easley JT, McCready EG, Troyer KL, Johnson JW, Gadomski BC, McGilvray KC, Kisiday JD, Nelson BB. Mechanical, biochemical, and morphological topography of ovine knee cartilage. J Orthop Res 2021; 39:780-787. [PMID: 32833239 DOI: 10.1002/jor.24835] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/11/2020] [Accepted: 08/18/2020] [Indexed: 02/04/2023]
Abstract
The knee is the most common site for translational cartilage research in sheep, though topographic features of articular cartilage across surfaces are unspecified. We aimed to characterize the mechanical, morphological, and biochemical properties of articular cartilage across ovine knee surfaces and document variations between and within surface locations. Regions of interest (ROIs) were delineated across surfaces of 10 healthy ovine knees. Articular cartilage at each ROI was measured for creep indentation, thickness, and glycosaminoglycan (GAG) and collagen content. Variables were compared between surface locations (trochlea, and lateral [LFC] and medial [MFC] femoral condyles) and between ROIs within each surface location. Correlations between variables were also assessed. Articular surface location had a significant effect on creep (P < .0001), thickness (P < .0001), and collagen (P = .0007), but not GAG (P = .28). Significant differences in percent creep between ROIs were found within the LFC (P < .0001), MFC (P < .0001), and trochlea (P = .0002). Cartilage thickness was different between ROIs within the LFC, MFC, and trochlea (all P < .0001). The LFC (P = .002) and trochlea (P = .01) each had significant differences in GAG between ROIs. Collagen content between ROIs was different within the LFC (P = .0003), MFC (P = .0005), and trochlea (P < .0001). Collagen content was correlated with thickness (r = -.55), percent creep (r = .47), and GAG (r = -.21). Percent creep was correlated with thickness (r = -.64) and GAG (r = -.19). Topographic variations in mechanical, morphological, and biochemical properties exist across knee cartilage surfaces in sheep. Recognition of this variability is important to optimize study protocols and improve accuracy of results.
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Affiliation(s)
- Makayla Risch
- Preclinical Surgical Research Laboratory, C. Wayne McIlwraith Translational Medicine Institute, Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
| | - Jeremiah T Easley
- Preclinical Surgical Research Laboratory, C. Wayne McIlwraith Translational Medicine Institute, Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
| | - Erin G McCready
- Preclinical Surgical Research Laboratory, C. Wayne McIlwraith Translational Medicine Institute, Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
| | - Kevin L Troyer
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, Colorado.,Woodward, Inc., Fort Collins, Colorado
| | - James W Johnson
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, Colorado
| | - Benjamin C Gadomski
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, Colorado
| | - Kirk C McGilvray
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, Colorado
| | - John D Kisiday
- Orthopaedic Research Center, C. Wayne McIlwraith Translational Medicine Institute, Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
| | - Brad B Nelson
- Preclinical Surgical Research Laboratory, C. Wayne McIlwraith Translational Medicine Institute, Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado.,Orthopaedic Research Center, C. Wayne McIlwraith Translational Medicine Institute, Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
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12
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Yang YP, Labus KM, Gadomski BC, Bruyas A, Easley J, Nelson B, Palmer RH, McGilvray K, Regan D, Puttlitz CM, Stahl A, Lui E, Li J, Moeinzadeh S, Kim S, Maloney W, Gardner MJ. Osteoinductive 3D printed scaffold healed 5 cm segmental bone defects in the ovine metatarsus. Sci Rep 2021; 11:6704. [PMID: 33758338 PMCID: PMC7987996 DOI: 10.1038/s41598-021-86210-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/11/2021] [Indexed: 12/16/2022] Open
Abstract
Autologous bone grafts are considered the gold standard grafting material for the treatment of nonunion, but in very large bone defects, traditional autograft alone is insufficient to induce repair. Recombinant human bone morphogenetic protein 2 (rhBMP-2) can stimulate bone regeneration and enhance the healing efficacy of bone grafts. The delivery of rhBMP-2 may even enable engineered synthetic scaffolds to be used in place of autologous bone grafts for the treatment of critical size defects, eliminating risks associated with autologous tissue harvest. We here demonstrate that an osteoinductive scaffold, fabricated by combining a 3D printed rigid polymer/ceramic composite scaffold with an rhBMP-2-eluting collagen sponge can treat extremely large-scale segmental defects in a pilot feasibility study using a new sheep metatarsus fracture model stabilized with an intramedullary nail. Bone regeneration after 24 weeks was evaluated by micro-computed tomography, mechanical testing, and histological characterization. Load-bearing cortical bridging was achieved in all animals, with increased bone volume observed in sheep that received osteoinductive scaffolds compared to sheep that received an rhBMP-2-eluting collagen sponge alone.
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Affiliation(s)
- Yunzhi Peter Yang
- Department of Orthopedic Surgery, School of Medicine, Stanford University, 240 Pasteur Drive, BMI 258, Stanford, CA, 94304, USA.
- Department of Material Science and Engineering, Stanford University, Stanford, USA.
- Department of Bioengineering, Stanford University, Stanford, USA.
| | - Kevin M Labus
- Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, USA
| | - Benjamin C Gadomski
- Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, USA
| | - Arnaud Bruyas
- Department of Orthopedic Surgery, School of Medicine, Stanford University, 240 Pasteur Drive, BMI 258, Stanford, CA, 94304, USA
| | - Jeremiah Easley
- Department of Clinical Sciences, Colorado State University, Fort Collins, USA
| | - Brad Nelson
- Department of Clinical Sciences, Colorado State University, Fort Collins, USA
| | - Ross H Palmer
- Department of Clinical Sciences, Colorado State University, Fort Collins, USA
| | - Kirk McGilvray
- Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, USA
| | - Daniel Regan
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, USA
| | - Christian M Puttlitz
- Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, USA
| | - Alexander Stahl
- Department of Orthopedic Surgery, School of Medicine, Stanford University, 240 Pasteur Drive, BMI 258, Stanford, CA, 94304, USA
- Department of Chemistry, Stanford University, Stanford, USA
| | - Elaine Lui
- Department of Orthopedic Surgery, School of Medicine, Stanford University, 240 Pasteur Drive, BMI 258, Stanford, CA, 94304, USA
| | - Jiannan Li
- Department of Orthopedic Surgery, School of Medicine, Stanford University, 240 Pasteur Drive, BMI 258, Stanford, CA, 94304, USA
| | - Seyedsina Moeinzadeh
- Department of Orthopedic Surgery, School of Medicine, Stanford University, 240 Pasteur Drive, BMI 258, Stanford, CA, 94304, USA
| | - Sungwoo Kim
- Department of Orthopedic Surgery, School of Medicine, Stanford University, 240 Pasteur Drive, BMI 258, Stanford, CA, 94304, USA
| | - William Maloney
- Department of Orthopedic Surgery, School of Medicine, Stanford University, 240 Pasteur Drive, BMI 258, Stanford, CA, 94304, USA
| | - Michael J Gardner
- Department of Orthopedic Surgery, School of Medicine, Stanford University, 240 Pasteur Drive, BMI 258, Stanford, CA, 94304, USA
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13
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Hindman BJ, Dexter F, Gadomski BC, Bucx MJ. Sex-Specific Intubation Biomechanics: Intubation Forces Are Greater in Male Than in Female Patients, Independent of Body Weight. Cureus 2020; 12:e8749. [PMID: 32714687 PMCID: PMC7377029 DOI: 10.7759/cureus.8749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background Studies of head, neck, and cervical spine morphology and tissue material properties indicate that cervical spine biomechanics differ between adult males and females. These differences result in sex-specific cervical spine kinematics and injury patterns in response to standardized loading conditions. Because direct laryngoscopy and endotracheal intubation require the application of a load to the cervical spine, intubation biomechanics should be sex-specific. The aim of this study was to determine if intubation forces during direct laryngoscopy differ between male and female patients and, if so, is the difference independent of body weight. Methods We pooled original data from three previously published adult clinical intubation studies that used methodologically reliable intubation force measurements (measured total laryngoscope force applied to the tongue, and force values were insensitive to or accounted for other laryngoscope blade forces). All patients had undergone direct laryngoscopy and orotracheal intubation with a Macintosh 3 blade under general anesthesia. Patient data included sex, age, height, weight, and maximum intubation force. Least squares multivariable linear regression was performed between the dependent variable (maximum intubation force) and two independent variables (patient sex and patient weight). A third term was added for the interaction between patient sex and weight. Results Among all patients (males n=42, females n=59), the median intubation force was 42.2 N (25th to 75th percentiles: 31.5 to 57.4 N). While controlling for patient body weight, intubation force differed between the sexes; P=0.011, with greater intubation force in male patients. While controlling for patient sex, there was a positive association between patient body weight and intubation force; P=0.009. In addition, there was a significant interaction between patient sex and weight; P=0.002, with intubation force in male patients having greater dependence on body weight. The difference in intubation force between male and female patients who had the same body weight exceeded 5 N when body weight exceeded 75 kg, and intubation force differences between male and female patients increased as patient body weight increased. Additional analyses using robust regression and using body mass index instead of weight provided comparable results. Conclusion In adult patients, the biomechanics of direct laryngoscopy and intubation are sex-specific. Our findings support the need to control for patient sex and weight in future clinical and laboratory studies of the human cervical spine and head and neck biomechanics.
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14
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Hindman BJ, Woodroffe RW, Zanaty M, Kawasaki H, Yamaguchi S, Puttlitz CM, Gadomski BC. C1-C2 Motion During C-MAC D-Blade Videolaryngoscopy and Endotracheal Intubation in 2 Patients With Type II Odontoid Fractures: A Case Report. A A Pract 2020; 13:121-123. [PMID: 30907749 DOI: 10.1213/xaa.0000000000001000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Laryngoscopy and endotracheal intubation in patients with unstable cervical spines may cause pathological spinal motion and resultant cord injury. Cadaver and mathematical (finite element) models of a type II odontoid fracture predict C1-C2 motions during intubation to be of low magnitude, especially with the use of a low-force videolaryngoscope. Using continuous fluoroscopy, we recorded C1-C2 motion during C-MAC D videolaryngoscopy and intubation in 2 patients with type II odontoid fractures. In these 2 patients, C1-C2 extension and change in C1-C2 canal space were comparable to motions predicted by cadaver and finite element models and did not cause neurological injury.
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Affiliation(s)
| | - Royce W Woodroffe
- Neurosurgery, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa
| | - Mario Zanaty
- Neurosurgery, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa
| | - Hiroto Kawasaki
- Neurosurgery, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa
| | - Satoshi Yamaguchi
- Neurosurgery, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa
| | - Christian M Puttlitz
- Department of Mechanical Engineering, School of Biomedical Engineering, Orthopaedic Bioengineering Research Laboratory, Colorado State University, Fort Collins, Colorado
| | - Benjamin C Gadomski
- Department of Mechanical Engineering, School of Biomedical Engineering, Orthopaedic Bioengineering Research Laboratory, Colorado State University, Fort Collins, Colorado
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15
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Sun X, Gao X, Deng Z, Zhang L, McGilvray K, Gadomski BC, Amra S, Bao G, Huard J. High bone microarchitecture, strength, and resistance to bone loss in MRL/MpJ mice correlates with activation of different signaling pathways and systemic factors. FASEB J 2019; 34:789-806. [PMID: 31914651 DOI: 10.1096/fj.201901229rr] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 10/30/2019] [Accepted: 11/02/2019] [Indexed: 12/27/2022]
Abstract
The MRL/MpJ mice have demonstrated an enhanced tissue regeneration capacity for various tissues. In the present study, we systematically characterized bone microarchitecture and found that MRL/MpJ mice exhibit higher bone microarchitecture and strength compared to both C57BL/10J and C57BL/6J WT mice at 2, 4, and 10 months of age. The higher bone mass in MRL/MpJ mice was correlated to increased osteoblasts, decreased osteoclasts, higher cell proliferation, and bone formation, and enhanced pSMAD5 signaling earlier during postnatal development (2-month old) in the spine trabecular bone, and lower bone resorption rate at later age. Furthermore, these mice exhibit accelerated fracture healing via enhanced pSMAD5, pAKT and p-P38MAPK pathways compared to control groups. Moreover, MRL/MpJ mice demonstrated resistance to ovariectomy-induced bone loss as evidenced by maintaining higher bone volume/tissue volume (BV/TV) and lower percentage of bone loss later after ovariectomy. The consistently higher serum IGF1 level and lower RANKL level in MRL/MpJ mice may contribute to the maintenance of high bone mass in uninjured and injured bone. In conclusion, our results indicate that enhanced pSMAD5, pAKT, and p-P38MAPK signaling, higher serum IGF-1, and lower RANKL level contribute to the higher bone microarchitecture and strength, accelerated healing, and resistance to osteoporosis in MRL/MpJ mice.
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Affiliation(s)
- Xuying Sun
- Department of Orthopaedic Surgery, The Brown Foundation Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Xueqin Gao
- Department of Orthopaedic Surgery, The Brown Foundation Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas.,Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado
| | - Zhenhan Deng
- Department of Orthopaedic Surgery, The Brown Foundation Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Linlin Zhang
- Department of Biomedical Engineering, Rice University, Houston, Texas
| | - Kirk McGilvray
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado
| | - Benjamin C Gadomski
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado
| | - Sarah Amra
- Department of Orthopaedic Surgery, The Brown Foundation Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Gang Bao
- Department of Biomedical Engineering, Rice University, Houston, Texas
| | - Johnny Huard
- Department of Orthopaedic Surgery, The Brown Foundation Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas.,Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado
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16
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Gadomski BC, McGilvray KC, Easley JT, Palmer RH, Jiao J, Li X, Qin YX, Puttlitz CM. An investigation of shock wave therapy and low-intensity pulsed ultrasound on fracture healing under reduced loading conditions in an ovine model. J Orthop Res 2018; 36:921-929. [PMID: 28762588 DOI: 10.1002/jor.23666] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 07/21/2017] [Indexed: 02/04/2023]
Abstract
The use of shock wave therapy (SWT) and low-intensity pulsed ultrasound (LIPUS) as countermeasures to the inhibited fracture healing experienced during mechanical unloading was investigated by administering treatment to the fracture sites of mature, female, Rambouillet Columbian ewes exposed to partial mechanical unloading or full gravitational loading. The amount of fracture healing experienced by the treatment groups was compared to controls in which identical surgical and testing protocols were administered except for SWT or LIPUS treatment. All groups were euthanized after a 28-day healing period. In vivo mechanical measurements demonstrated no significant alteration in fixation plate strains between treatments within either partial unloading group. Similarly, DXA BMD and 4-point bending stiffness were not significantly altered following either treatment. μCT analyses demonstrated lower callus bone volume for treated animals (SWT and LIPUS, p < 0.01) in the full gravity group but not between reduced loading groups. Callus osteoblast numbers as well as mineralized surface and bone formation rate were significantly elevated to the level of the full gravity groups in the reduced loading groups following both SWT and LIPUS. Although no increase in 4-week mechanical strength was observed, it is possible that an increase in the overall rate of fracture healing (i.e., callus strength) may be experienced at longer time points under partial loading conditions given the increase in osteoblast numbers and bone formation parameters following SWT and LIPUS. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:921-929, 2018.
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Affiliation(s)
- Benjamin C Gadomski
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Ft Collins, Colorado
| | - Kirk C McGilvray
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Ft Collins, Colorado
| | - Jeremiah T Easley
- Preclinical Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, Ft Collins, Colorado
| | - Ross H Palmer
- Preclinical Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, Ft Collins, Colorado
| | - Jian Jiao
- Orthopaedic Bioengineering Research Laboratory, Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York
| | - Xiaofei Li
- Orthopaedic Bioengineering Research Laboratory, Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York
| | - Yi-Xian Qin
- Orthopaedic Bioengineering Research Laboratory, Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York
| | - Christian M Puttlitz
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Ft Collins, Colorado
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Gadomski BC, Shetye SS, Hindman BJ, Dexter F, Santoni BG, Todd MM, Traynelis VC, From RP, Fontes RB, Puttlitz CM. Intubation biomechanics: validation of a finite element model of cervical spine motion during endotracheal intubation in intact and injured conditions. J Neurosurg Spine 2018; 28:10-22. [DOI: 10.3171/2017.5.spine17189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEBecause of limitations inherent to cadaver models of endotracheal intubation, the authors’ group developed a finite element (FE) model of the human cervical spine and spinal cord. Their aims were to 1) compare FE model predictions of intervertebral motion during intubation with intervertebral motion measured in patients with intact cervical spines and in cadavers with spine injuries at C-2 and C3–4 and 2) estimate spinal cord strains during intubation under these conditions.METHODSThe FE model was designed to replicate the properties of an intact (stable) spine in patients, C-2 injury (Type II odontoid fracture), and a severe C3–4 distractive-flexion injury from prior cadaver studies. The authors recorded the laryngoscope force values from 2 different laryngoscopes (Macintosh, high intubation force; Airtraq, low intubation force) used during the patient and cadaver intubation studies. FE-modeled motion was compared with experimentally measured motion, and corresponding cord strain values were calculated.RESULTSFE model predictions of intact intervertebral motions were comparable to motions measured in patients and in cadavers at occiput–C2. In intact subaxial segments, the FE model more closely predicted patient intervertebral motions than did cadavers. With C-2 injury, FE-predicted motions did not differ from cadaver measurements. With C3–4 injury, however, the FE model predicted greater motions than were measured in cadavers. FE model cord strains during intubation were greater for the Macintosh laryngoscope than the Airtraq laryngoscope but were comparable among the 3 conditions (intact, C-2 injury, and C3–4 injury).CONCLUSIONSThe FE model is comparable to patients and cadaver models in estimating occiput–C2 motion during intubation in both intact and injured conditions. The FE model may be superior to cadavers in predicting motions of subaxial segments in intact and injured conditions.
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Affiliation(s)
- Benjamin C. Gadomski
- 1Department of Mechanical Engineering, School of Biomedical Engineering, Orthopaedic Bioengineering Research Laboratory, Colorado State University, Fort Collins, Colorado
| | - Snehal S. Shetye
- 1Department of Mechanical Engineering, School of Biomedical Engineering, Orthopaedic Bioengineering Research Laboratory, Colorado State University, Fort Collins, Colorado
| | - Bradley J. Hindman
- 2Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa
| | - Franklin Dexter
- 2Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa
| | | | - Michael M. Todd
- 4Department of Anesthesia, University of Minnesota, Minneapolis, Minnesota; and
| | | | - Robert P. From
- 2Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa
| | - Ricardo B. Fontes
- 5Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Christian M. Puttlitz
- 1Department of Mechanical Engineering, School of Biomedical Engineering, Orthopaedic Bioengineering Research Laboratory, Colorado State University, Fort Collins, Colorado
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Gadomski BC, Lerner ZF, Browning RC, Easley JT, Palmer RH, Puttlitz CM. Computational characterization of fracture healing under reduced gravity loading conditions. J Orthop Res 2016; 34:1206-15. [PMID: 26704186 DOI: 10.1002/jor.23143] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 12/21/2015] [Indexed: 02/04/2023]
Abstract
The literature is deficient with regard to how the localized mechanical environment of skeletal tissue is altered during reduced gravitational loading and how these alterations affect fracture healing. Thus, a finite element model of the ovine hindlimb was created to characterize the local mechanical environment responsible for the inhibited fracture healing observed under experimental simulated hypogravity conditions. Following convergence and verification studies, hydrostatic pressure and strain within a diaphyseal fracture of the metatarsus were evaluated for models under both 1 and 0.25 g loading environments and compared to results of a related in vivo study. Results of the study suggest that reductions in hydrostatic pressure and strain of the healing fracture for animals exposed to reduced gravitational loading conditions contributed to an inhibited healing process, with animals exposed to the simulated hypogravity environment subsequently initiating an intramembranous bone formation process rather than the typical endochondral ossification healing process experienced by animals healing in a 1 g gravitational environment. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1206-1215, 2016.
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Affiliation(s)
- Benjamin C Gadomski
- Department of Mechanical Engineering, School of Biomedical Engineering, Orthopaedic Research Laboratory, Colorado State University, Ft Collins, Colorado
| | - Zachary F Lerner
- Department of Health and Exercise Science, School of Biomedical Engineering, Physical Activity Laboratory, Colorado State University, Ft Collins, Colorado
| | - Raymond C Browning
- Department of Health and Exercise Science, School of Biomedical Engineering, Physical Activity Laboratory, Colorado State University, Ft Collins, Colorado
| | - Jeremiah T Easley
- Department of Clinical Sciences, Preclinical Surgical Research Laboratory, Colorado State University, Ft Collins, Colorado
| | - Ross H Palmer
- Department of Clinical Sciences, Preclinical Surgical Research Laboratory, Colorado State University, Ft Collins, Colorado
| | - Christian M Puttlitz
- Department of Mechanical Engineering, School of Biomedical Engineering, Orthopaedic Research Laboratory, Colorado State University, Ft Collins, Colorado
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Lerner ZF, Gadomski BC, Ipson AK, Haussler KK, Puttlitz CM, Browning RC. Modulating tibiofemoral contact force in the sheep hind limb via treadmill walking: Predictions from an opensim musculoskeletal model. J Orthop Res 2015; 33:1128-33. [PMID: 25721318 DOI: 10.1002/jor.22829] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 01/15/2015] [Indexed: 02/04/2023]
Abstract
Sheep are a predominant animal model used to study a variety of orthopedic conditions. Understanding and controlling the in-vivo loading environment in the sheep hind limb is often necessary for investigations relating to bone and joint mechanics. The purpose of this study was to develop a musculoskeletal model of an adult sheep hind limb and investigate the effects of treadmill walking speed on muscle and joint contact forces. We constructed the skeletal geometry of the model from computed topography images. Dual-energy x-ray absorptiometry was utilized to establish the inertial properties of each model segment. Detailed dissection and tendon excursion experiments established the requisite muscle lines of actions. We used OpenSim and experimentally-collected marker trajectories and ground reaction forces to quantify muscle and joint contact forces during treadmill walking at 0.25 m• s(-1) and 0.75 m• s(-1) . Peak compressive and anterior-posterior tibiofemoral contact forces were 20% (0.38 BW, p = 0.008) and 37% (0.17 BW, p = 0.040) larger, respectively, at the moderate gait speed relative to the slower speed. Medial-lateral tibiofemoral contact forces were not significantly different. Adjusting treadmill speed appears to be a viable method to modulate compressive and anterior-posterior tibiofemoral contact forces in the sheep hind limb. The musculoskeletal model is freely-available at www.SimTK.org.
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Affiliation(s)
- Zachary F Lerner
- School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado
| | - Benjamin C Gadomski
- School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado
| | - Allison K Ipson
- Department of Health and Exercise Science, Colorado State University, Fort Collins, Colorado
| | - Kevin K Haussler
- School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado.,College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Christian M Puttlitz
- School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado.,Department of Mechanical Engineering, Colorado State University, Fort Collins, Colorado
| | - Raymond C Browning
- School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado.,Department of Health and Exercise Science, Colorado State University, Fort Collins, Colorado
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Gadomski BC, McGilvray KC, Easley JT, Palmer RH, Santoni BG, Puttlitz CM. Partial gravity unloading inhibits bone healing responses in a large animal model. J Biomech 2014; 47:2836-42. [DOI: 10.1016/j.jbiomech.2014.07.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 07/11/2014] [Accepted: 07/31/2014] [Indexed: 12/29/2022]
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Gadomski BC, McGilvray KC, Easley JT, Palmer RH, Ehrhart EJ, Haussler KK, Browning RC, Santoni BG, Puttlitz CM. An In Vivo Ovine Model of Bone Tissue Alterations in Simulated Microgravity Conditions. J Biomech Eng 2014; 136:021020. [DOI: 10.1115/1.4025854] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 10/29/2013] [Indexed: 11/08/2022]
Abstract
Microgravity and its inherent reduction in body-weight associated mechanical loading encountered during spaceflight have been shown to produce deleterious effects on important human physiological processes. Rodent hindlimb unloading is the most widely-used ground-based microgravity model. Unfortunately, results from these studies are difficult to translate to the human condition due to major anatomic and physiologic differences between the two species such as bone microarchitecture and healing rates. The use of translatable ovine models to investigate orthopedic-related conditions has become increasingly popular due to similarities in size and skeletal architecture of the two species. Thus, a new translational model of simulated microgravity was developed using common external fixation techniques to shield the metatarsal bone of the ovine hindlimb during normal daily activity over an 8 week period. Bone mineral density, quantified via dual-energy X-ray absorptiometry, decreased 29.0% (p < 0.001) in the treated metatarsi. Post-sacrifice biomechanical evaluation revealed reduced bending modulus (–25.8%, p < 0.05) and failure load (–27.8%, p < 0.001) following the microgravity treatment. Microcomputed tomography and histology revealed reduced bone volume (–35.9%, p < 0.01), trabecular thickness (–30.9%, p < 0.01), trabecular number (–22.5%, p < 0.05), bone formation rate (–57.7%, p < 0.01), and osteoblast number (–52.5%, p < 0.001), as well as increased osteoclast number (269.1%, p < 0.001) in the treated metatarsi of the microgravity group. No significant alterations occurred for any outcome parameter in the Sham Surgery Group. These data indicate that the external fixation technique utilized in this model was able to effectively unload the metatarsus and induce significant radiographic, biomechanical, and histomorphometric alterations that are known to be induced by spaceflight. Further, these findings demonstrate that the physiologic mechanisms driving bone remodeling in sheep and humans during prolonged periods of unloading (specifically increased osteoclast activity) are more similar than previously utilized models, allowing more comprehensive investigations of microgravity-related bone remodeling as it relates to human spaceflight.
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Affiliation(s)
- Benjamin C. Gadomski
- Orthopaedic Research Center, Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, CO 80523
| | - Kirk C. McGilvray
- Orthopaedic Research Center, Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, CO 80523
| | - Jeremiah T. Easley
- Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, Fort Collins, CO 80523
| | - Ross H. Palmer
- Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, Fort Collins, CO 80523
| | - E. J. Ehrhart
- Veterinary Diagnostic Laboratory, Department of Clinical Sciences, Colorado State University, Fort Collins, CO 80523
| | - Kevin K. Haussler
- Orthopaedic Research Center, Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, CO 80523
| | - Raymond C. Browning
- Physical Activity Energetics/ Mechanics Laboratory, Department of Health and Exercise Science, Colorado State University, Fort Collins, CO 80523
| | - Brandon G. Santoni
- Phillip Speigel Orthopaedic Research Laboratory, Foundation for Orthopaedic Research and Education, Tampa, FL 33637
| | - Christian M. Puttlitz
- Associate Department Head for Graduate Studies Principal Investigator, Orthopaedic Research Center, Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, CO 80523 e-mail:
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Woldtvedt DJ, Womack W, Gadomski BC, Schuldt D, Puttlitz CM. Finite Element Lumbar Spine Facet Contact Parameter Predictions are Affected by the Cartilage Thickness Distribution and Initial Joint Gap Size. J Biomech Eng 2011; 133:061009. [DOI: 10.1115/1.4004287] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Current finite element modeling techniques utilize geometrically inaccurate cartilage distribution representations in the lumbar spine. We hypothesize that this shortcoming severely limits the predictive fidelity of these simulations. Specifically, it is unclear how these anatomically inaccurate cartilage representations alter range of motion and facet contact predictions. In the current study, cadaveric vertebrae were serially sectioned, and images were taken of each slice in order to identify the osteochondral interface and the articulating surface. A series of custom-written algorithms were utilized in order to quantify each facet joint’s three-dimensional cartilage distribution using a previously developed methodology. These vertebrae-dependent thickness cartilage distributions were implemented on an L1 through L5 lumbar spine finite element model. Moments were applied in three principal planes of motion, and range of motion and facet contact predictions from the variable thickness and constant thickness distribution models were determined. Initial facet gap thickness dimensions were also parameterized. The data indicate that the mean and maximum cartilage thickness increased inferiorly from L1 to L5, with an overall mean thickness value of 0.57 mm. Cartilage distribution and initial facet joint gap thickness had little influence on the lumbar range of motion in any direction, whereas the mean contact pressure, total contact force, and total contact area predictions were altered considerably. The data indicate that range of motion predictions alone are insufficient to establish model validation intended to predict mechanical contact parameters. These data also emphasize the need for the careful consideration of the initial facet joint gap thickness with respect to the spinal condition being studied.
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Affiliation(s)
- Daniel J. Woldtvedt
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, 1374 Campus Delivery, Fort Collins, CO 80523-1374
| | - Wesley Womack
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, 1374 Campus Delivery, Fort Collins, CO 80523-1374
| | - Benjamin C. Gadomski
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, 1374 Campus Delivery, Fort Collins, CO 80523-1374
| | - Dieter Schuldt
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, 1374 Campus Delivery, Fort Collins, CO 80523-1374
| | - Christian M. Puttlitz
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, 1374 Campus Delivery, Fort Collins, CO 80523-1374
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