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Smith AF, Lendhey M, Winfield J, Mahoney JM, Bucklen BS, Carlson JB. A feasibility cadaver study for placing screws in various pelvic osseous fracture pathways using a robotic arm. Eur J Orthop Surg Traumatol 2024; 34:1457-1463. [PMID: 38240824 DOI: 10.1007/s00590-023-03821-6] [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] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/20/2023] [Indexed: 04/02/2024]
Abstract
INTRODUCTION The use of a robotic system for the placement of pedicle screws in spine surgeries is well documented in the literature. However, there is only a single report in the United States describing the use of a robotic system to place two screws in osseous fixation pathways (OFPs) commonly used in the treatment of pelvic and acetabular fractures in a simulated bone model. The purpose of this study was to demonstrate the use of a robotic system to place screws in multiple, clinically relevant OFPs in a cadaveric model and to quantitatively measure accuracy of screw placement relative to the preoperative plan. METHODS A single cadaveric specimen was obtained for the purpose of this study. All surrounding soft tissues were left intact. Screws were placed in OFPs, namely iliosacral (IS), trans-sacral (TS), Lateral Compression-II (LC-II), antegrade anterior column (AC) and antegrade posterior column (PC) of the right hemipelvis using standard, fluoroscopically assisted percutaneous or mini-open technique. Following the placement of screws into the right hemipelvis using standard techniques, screws were planned and placed in the same OFPs of the contralateral hemipelvis using the commercially available ExcelsiusGPS® robotic system (Globus Medical Inc., Audubon, PA). After robotic-assisted screw placement, a post-procedure CT scan was obtained to evaluate actual screw placement against the pre-procedure plan. A custom-made image analysis program was devised to measure screw tip/tail offset and angular offset on axial and sagittal planes. RESULTS For different OFPs, the mean tip offset, tail offset and angular offsets were 1.6 ± 0.9 mm (Range 0.0-3.6 mm), 1.4 ± 0.4 mm (Range 0.3-2.5 mm) and 1.1 ± 0.4° (Range 0.5-2.1), respectively. CONCLUSION In this feasibility study, surgeons were able to place screws into the clinically relevant fracture pathways of the pelvis using ExcelsiusGPS® for robotic-assisted surgery. The measured accuracy was encouraging; however, further investigation is needed to demonstrate that robotic-assisted surgery can be used to successfully place the screws in the bony corridors of the pelvis to treat traumatic pelvic injuries.
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Affiliation(s)
- Austin F Smith
- Department of Orthopaedic Surgery, University of Louisville, Louisville, KY, USA
| | - Matin Lendhey
- Musculoskeletal Education and Research Center, A Division of Globus Medical Inc., Audubon, PA, USA
| | - Jalen Winfield
- School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Jonathan M Mahoney
- Musculoskeletal Education and Research Center, A Division of Globus Medical Inc., Audubon, PA, USA.
- Biomechanics Research, Globus Medical, Inc., 2560 General Armistead Ave, Audubon, PA, 19403, USA.
| | - Brandon S Bucklen
- Musculoskeletal Education and Research Center, A Division of Globus Medical Inc., Audubon, PA, USA
| | - Jon B Carlson
- Department of Orthopaedic Surgery, University of Louisville, Louisville, KY, USA
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Kurland DB, Lendhey M, Delavari N, Winfield J, Mahoney JM, Becske T, Shapiro M, Raz E, Pacione D, Bucklen BS, Frempong-Boadu AK. Percutaneous Juxtapedicular Cement Salvage of Failed Spinal Instrumentation? Institutional Experience and Cadaveric Biomechanical Study. Oper Neurosurg (Hagerstown) 2024; 26:38-45. [PMID: 37747337 DOI: 10.1227/ons.0000000000000924] [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] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/22/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Instrumented spinal fusion constructs sometimes fail because of fatigue loading, frequently necessitating open revision surgery. Favorable outcomes after percutaneous juxtapedicular cement salvage (perc-cement salvage) of failing instrumentation have been described; however, this approach is not widely known among spine surgeons , and its biomechanical properties have not been evaluated. We report our institutional experience with perc-cement salvage and investigate the relative biomechanical strength of this technique as compared with 3 other common open revision techniques. METHODS A retrospective chart review of patients who underwent perc-cement salvage was conducted. Biomechanical characterization of revision techniques was performed in a cadaveric model of critical pedicle screw failure. Three revision cohorts involved removal and replacement of hardware: (1) screw upsizing, (2) vertebroplasty, and (3) fenestrated screw with cement augmentation. These were compared with a cohort with perc-cement salvage performed using a juxtapedicular trajectory with the failed primary screw remaining engaged in the vertebral body. RESULTS Ten patients underwent perc-cement salvage from 2018 to 2022 to address screw haloing and/or endplate fracture threatening construct integrity. Pain palliation was reported by 8/10 patients. Open revision surgery was required in 4/10 patients, an average of 8.9 months after the salvage procedure (range 6.2-14.7 months). Only one revision was due to progressive hardware dislodgement. The remainder avoided open revision surgery through an average of 1.9 years of follow-up. In the cadaveric study, there were no significant differences in pedicle screw pullout strength among any of the revision cohorts. CONCLUSION Perc-cement salvage of failing instrumentation is reasonably efficacious. The technique is biomechanically noninferior to other revision strategies that require open surgery for removal and replacement of hardware. Open revision surgery may be avoided by perc-cement salvage in select cases.
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Affiliation(s)
- David B Kurland
- Department of Neurosurgery, New York University Langone Medical Center, New York , New York , USA
| | - Matin Lendhey
- Musculoskeletal Education and Research Center, Globus Medical Inc., Audubon , Pennsylvania , USA
| | - Nader Delavari
- Department of Neurosurgery, New York University Langone Medical Center, New York , New York , USA
| | - Jalen Winfield
- School of Biomedical Engineering, Drexel University, Philadelphia , Pennsylvania , USA
| | - Jonathan M Mahoney
- Musculoskeletal Education and Research Center, Globus Medical Inc., Audubon , Pennsylvania , USA
| | - Tibor Becske
- Departments of Neurology, University of North Carolina, Chapel Hill , North Carolina , USA
| | - Maksim Shapiro
- Department of Radiology, New York University Langone Medical Center, New York , New York , USA
| | - Eytan Raz
- Department of Radiology, New York University Langone Medical Center, New York , New York , USA
| | - Donato Pacione
- Department of Neurosurgery, New York University Langone Medical Center, New York , New York , USA
| | - Brandon S Bucklen
- Musculoskeletal Education and Research Center, Globus Medical Inc., Audubon , Pennsylvania , USA
| | - Anthony K Frempong-Boadu
- Department of Neurosurgery, New York University Langone Medical Center, New York , New York , USA
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Kurland DB, Lendhey M, Delavari N, Winfield J, Mahoney J, Bucklen B, Frempong-Boadu A. 437 Percutaneous Juxtapedicular Cement Salvage of Failed Pedicle Screws: A Cadaveric Biomechanical Study. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
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Werner BC, Griffin JW, Thompson T, Lendhey M, Higgins LD, Denard PJ. Biomechanical evaluation of 2 techniques of repair after subscapularis peel for stemless shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:2240-2246. [PMID: 33675968 DOI: 10.1016/j.jse.2021.01.037] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/19/2021] [Accepted: 01/31/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Stemless anatomic total shoulder arthroplasty (TSA) has been gaining significant popularity but poses unique challenges for subscapularis repair. Tenotomy with side-to-side repair has been the most frequently reported technique for subscapularis repair with stemless TSA but has the poorest biomechanical properties, and clinical failures have been reported. There is limited biomechanical evidence evaluating other subscapularis repair techniques for stemless TSA. Therefore, the goal of this study was to investigate 2 additional techniques using a subscapularis peel for subscapularis repair with a stemless TSA. METHODS We used 18 male cadaveric specimens to investigate the native subscapularis (n = 6) and 2 subscapularis repair techniques (n = 12) after stemless anatomic TSA (Eclipse). A subscapularis peel with double-row, knotless anchor-based repair (n = 6) was compared with a subscapularis peel with a "backpack" repair (n = 6). The specimens then underwent biomechanical testing, including cyclic displacement and load-to-failure testing. The mode of failure was also recorded. RESULTS The native tendon had the highest ultimate load to failure (mean, 1017.1 N). Load to failure was similar between the 2 study groups: 397.9 N for the peel and backpack repair and 593.7 N for the knotless anchor-based repair (P > .05 for all comparisons). Moreover, no significant differences in cyclic displacement or construct stiffness were found between the groups (P > .05 for all comparisons). CONCLUSIONS A double-row, knotless anchor-based repair of a subscapularis peel for stemless anatomic shoulder arthroplasty has similar biomechanical properties to a backpack repair technique; however, both techniques fail to reproduce the native biomechanical properties at time zero.
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Affiliation(s)
- Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA.
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Roca RY, Peura A, Kowaleski MP, Watson MT, Lendhey M, Rocheleau PJ, Hulse DA. Ex vivo mechanical properties of a 2.5-mm bone anchor for treatment of cranial cruciate ligament rupture in toy breed dogs. Vet Surg 2020; 49:736-740. [PMID: 32073178 DOI: 10.1111/vsu.13399] [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] [Received: 01/28/2019] [Revised: 12/05/2019] [Accepted: 01/18/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the mechanical pull-out properties of a 2.5-mm bone anchor implanted in ex vivo femurs of toy breed dogs and to determine whether there is a difference between knotted and knotless configurations. STUDY DESIGN Experimental study. SAMPLE POPULATION Eight paired harvested femurs. METHODS Femurs were assigned to knotted or knotless configuration. Equal numbers of right and left femurs were tested. The caudolateral femoral condyle at the distal pole of the lateral fabella (F2 site) was drilled. The assigned configuration with braided suture combined with the bone anchor was implanted into the F2 site. Each configuration was positioned into a mechanical testing machine to measure yield load, load at 3-mm displacement, ultimate load, stiffness, and mode of failure at the beginning of the canine standing phase angle (150°). RESULTS Mean ultimate load was 100.14 and 88.69 N (P = .798), mean yield load was 59.72 and 55.85 N (P = .708), load at 3-mm displacement was 46.72 and 43.33 N (P = .656), and stiffness was calculated to be 43.06 and 47.09 N/mm (P = .548) for knotted and knotless configurations, respectively. Mode of failure occurred primarily by anchor pull-out. CONCLUSION The bone anchor withstood deformation at the estimated forces applied on the native cranial cruciate ligament (CCL) of toy breed dogs in both configurations. CLINICAL SIGNIFICANCE This bone anchor may constitute a useful alternative for stabilization of the CCL deficient stifle in toy breed dogs. However, before it can be recommended for widespread use in dogs, closely monitored clinical trials must be conducted to assess outcome and complications associated with this implant.
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Affiliation(s)
- Rodrigo Y Roca
- Boren Veterinary Teaching Hospital, Oklahoma State University, Stillwater, Oklahoma
| | - Aliisa Peura
- Espanola Animal Hospital, Espanola, Ontario, Canada
| | | | | | | | | | - Donald A Hulse
- Austin Veterinary Emergency and Specialty, Austin, Texas
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Peura A, Rocca R, Rocheleau P, Hulse D, Lendhey M, Gawaldo T. Ex vivo Mechanical Properties of the 2.5-mm MiniPushLock. Vet Comp Orthop Traumatol 2019. [DOI: 10.1055/s-0039-1692231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- A.H. Peura
- Espanola Animal Hospital, Espanola, Ontario, Canada,
| | - R. Rocca
- Austin Veterinary Emergency and Specialty Center, Austin, Texas, United States
| | - P. Rocheleau
- Espanola Animal Hospital, Espanola, Ontario, Canada,
- Arthrex, Naples, Florida, United States
| | - D.A. Hulse
- Austin Veterinary Emergency and Specialty Center, Austin, Texas, United States
- Arthrex, Naples, Florida, United States
- Texas A&M University, College Station, Texas, United States
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Beutel BG, Ayalon O, Kennedy OD, Lendhey M, Capo JT, Melamed E. Crossed K-Wires Versus Intramedullary Headless Screw Fixation of Unstable Metacarpal Neck Fractures: A Biomechanical Study. Iowa Orthop J 2018; 38:153-157. [PMID: 30104939 PMCID: PMC6047383] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Intramedullary headless screw (IMHS) has shown promise as an alternative to other fixation devices for metacarpal neck fractures. The purpose of this study was to assess the biomechanical performance of IMHS versus the commonly-used crossed K-wire technique. We hypothesized that IMHS fixation provides superior stability to K-wires. METHODS A metacarpal neck fracture model in 23 human cadaveric metacarpals was created. The specimens were divided into two groups based upon fixation method: Group 1, 3 mm intramedullary headless screw; and Group 2, 0.045 inch crossed K-wires. A cantilever bending model was used to assess load-to-failure (LTF), maximum displacement, energy absorption, and stiffness. RESULTS The mean LTF was 70.6 ± 30.1 N for IMHS and 97.5 ± 34.7 N for crossed K-wires. Mean stiffness was 11.3 ± 3.4 N/mm and 17.7 ± 7.8 N/mm for IMHS and crossed K-wires, respectively. The mean maximum displacement was 20.2 ± 4.6 mm for IMHS and 24.1 ± 3.7 mm for crossed K-wires. Moreover, mean energy absorption was 778.3 ± 528.9 Nmm and 1095.9 ± 454.4 Nmm, respectively, for IMHS and crossed K-wires. Crossed K-wires demonstrated significantly higher stiffness and maximum displacement than IMHS (p < 0.05). CONCLUSIONS IMHS fixation of unstable metacarpal neck fractures offers less stability compared to crossed K-wires when loaded in bending. CLINICAL RELEVANCE Crossed K-wires offer superior stability for the treatment of metacarpal neck fractures. These results reveal that IMHS fixation is less favorable biomechanically and should be cautiously selected with regards to fracture stability.
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Affiliation(s)
- Bryan G Beutel
- The Hand Surgery Center, Mount Sinai Beth Israel, New York, NY
| | - Omri Ayalon
- Division of Hand Surgery, NYU Langone Orthopedic Hospital, New York, NY
| | - Oran D Kennedy
- Royal College of Surgeons in Ireland, Trinity College, Dublin, Ireland
| | - Matin Lendhey
- Musculoskeletal Research Center, NYU Langone Orthopedic Hospital, New York, NY
| | - John T Capo
- Department of Orthopaedics, Jersey City Medical Center, Jersey City, NJ
| | - Eitan Melamed
- Division of Hand Surgery, NYU Langone Orthopedic Hospital, New York, NY
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Ferizi U, Rossi I, Lee Y, Lendhey M, Teplensky J, Kennedy OD, Kirsch T, Bencardino J, Raya JG. Diffusion tensor imaging of articular cartilage at 3T correlates with histology and biomechanics in a mechanical injury model. Magn Reson Med 2017; 78:69-78. [PMID: 27455389 PMCID: PMC9175493 DOI: 10.1002/mrm.26336] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 04/21/2016] [Revised: 06/01/2016] [Accepted: 06/20/2016] [Indexed: 01/23/2024]
Abstract
PURPOSE We establish a mechanical injury model for articular cartilage to assess the sensitivity of diffusion tensor imaging (DTI) in detecting cartilage damage early in time. Mechanical injury provides a more realistic model of cartilage degradation compared with commonly used enzymatic degradation. METHODS Nine cartilage-on-bone samples were obtained from patients undergoing knee replacement. The 3 Tesla DTI (0.18 × 0.18 × 1 mm3 ) was performed before, 1 week, and 2 weeks after (zero, mild, and severe) injury, with a clinical radial spin-echo DTI (RAISED) sequence used in our hospital. We performed stress-relaxation tests and used a quasilinear-viscoelastic (QLV) model to characterize cartilage mechanical properties. Serial histology sections were dyed with Safranin-O and given an OARSI grade. We then correlated the changes in DTI parameters with the changes in QLV-parameters and OARSI grades. RESULTS After severe injury the mean diffusivity increased after 1 and 2 weeks, whereas the fractional anisotropy decreased after 2 weeks (P < 0.05). The QLV-parameters and OARSI grades of the severe injury group differed from the baseline with statistical significance. The changes in mean diffusivity across all the samples correlated with the changes in the OARSI grade (r = 0.72) and QLV-parameters (r = -0.75). CONCLUSION DTI is sensitive in tracking early changes after mechanical injury, and its changes correlate with changes in biomechanics and histology. Magn Reson Med 78:69-78, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Uran Ferizi
- Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Ignacio Rossi
- Department of Radiology, New York University School of Medicine, New York, New York, USA
- Centro de Diagnostico Dr. Enrique Rossi, Buenos Aires, Argentina
| | - Youjin Lee
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York, USA
| | - Matin Lendhey
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York, USA
| | - Jason Teplensky
- Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Oran D Kennedy
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York, USA
| | - Thorsten Kirsch
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York, USA
| | - Jenny Bencardino
- Department of Radiology, New York University School of Medicine, New York, New York, USA
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York, USA
| | - José G Raya
- Department of Radiology, New York University School of Medicine, New York, New York, USA
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Corciulo C, Lendhey M, Wilder T, Schoen H, Cornelissen AS, Chang G, Kennedy OD, Cronstein BN. Endogenous adenosine maintains cartilage homeostasis and exogenous adenosine inhibits osteoarthritis progression. Nat Commun 2017; 8:15019. [PMID: 28492224 PMCID: PMC5437286 DOI: 10.1038/ncomms15019] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [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: 09/07/2016] [Accepted: 02/21/2017] [Indexed: 12/12/2022] Open
Abstract
Osteoarthritis (OA) is characterized by cartilage destruction and chondrocytes have a central role in this process. With age and inflammation chondrocytes have reduced capacity to synthesize and maintain ATP, a molecule important for cartilage homeostasis. Here we show that concentrations of ATP and adenosine, its metabolite, fall after treatment of mouse chondrocytes and rat tibia explants with IL-1β, an inflammatory mediator thought to participate in OA pathogenesis. Mice lacking A2A adenosine receptor (A2AR) or ecto-5′nucleotidase (an enzyme that converts extracellular AMP to adenosine) develop spontaneous OA and chondrocytes lacking A2AR develop an ‘OA phenotype' with increased expression of Mmp13 and Col10a1. Adenosine replacement by intra-articular injection of liposomal suspensions containing adenosine prevents development of OA in rats. These results support the hypothesis that maintaining extracellular adenosine levels is an important homeostatic mechanism, loss of which contributes to the development of OA; targeting adenosine A2A receptors might treat or prevent OA. Osteoarthritis (OA) is a debilitating and destructive joint disease for which disease modifying drugs are not available. Here the authors show that extracellular adenosine signalling via the A2AR receptor on chondrocytes is needed to prevent OA and that liposome-bound adenosine injection can treat the pathology in rats.
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Affiliation(s)
- Carmen Corciulo
- Department of Medicine-Division of Translational Medicine-NYU School of Medicine, 550 First Avenue, New York, New York 10016, USA
| | - Matin Lendhey
- Department of Orthopedic Surgery-NYU School of Medicine, 550 First Avenue, New York, New York 10016, USA
| | - Tuere Wilder
- Department of Medicine-Division of Translational Medicine-NYU School of Medicine, 550 First Avenue, New York, New York 10016, USA
| | - Hanna Schoen
- Department of Medicine-Division of Translational Medicine-NYU School of Medicine, 550 First Avenue, New York, New York 10016, USA
| | - Alexander Samuel Cornelissen
- Department of Medicine-Division of Translational Medicine-NYU School of Medicine, 550 First Avenue, New York, New York 10016, USA
| | - Gregory Chang
- Department of Radiology-NYU School of Medicine, 550 First Avenue, New York, New York 10016, USA
| | - Oran D Kennedy
- Department of Orthopedic Surgery-NYU School of Medicine, 550 First Avenue, New York, New York 10016, USA.,Department of Anatomy, the Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland
| | - Bruce N Cronstein
- Department of Medicine-Division of Translational Medicine-NYU School of Medicine, 550 First Avenue, New York, New York 10016, USA.,Department of Medicine-Division of Rheumatology-NYU School of Medicine, 550 First Avenue, New York, New York 10016, USA
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Kennedy OD, Lendhey M, Mauer P, Philip A, Basta-Pljakic J, Schaffler MB. Microdamage induced by in vivo Reference Point Indentation in mice is repaired by osteocyte-apoptosis mediated remodeling. Bone 2017; 95:192-198. [PMID: 27919734 PMCID: PMC5776007 DOI: 10.1016/j.bone.2016.11.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/11/2016] [Accepted: 11/30/2016] [Indexed: 11/24/2022]
Abstract
Reference Point Indentation (RPI) is a technology that is designed to measure mechanical properties that relate to bone toughness, or its ability to resist crack growth, in vivo. Independent of the mechanical parameters generated by RPI, its ability to initiate and propagate microcracks in bone is itself an interesting issue. Microcracks have a crucial biological relevance in bone, are central to its ability to maintain homeostasis. In healthy tissues, a process of targeted remodeling routinely repairs microcracks in a process mediated by osteocyte apoptosis. However, in diseases such as osteoporosis this process becomes deficient and microcracks can accumulate. Small animal models such are crucial for the study of such diseases, but it is technically challenging to create microcracks in these animals without causing outright failure. Therefore we sought to use RPI as a focal microdamage placement tool, to introduce microcracks to mouse long bones and investigate whether the same pathway mediates their repair as that described in other microdamage systems. We first used SEM to confirm that microdamage is formed RPI in mouse bone. Then, since RPI is carried out transdermally, we sought to confirm that no periosteal response occurred at the indented region. We then used a pan-caspase inhibitor (QVD) to determine whether osteocyte apoptosis plays the same pivotal role in microdamage repair in this model, as has been demonstrated in others. In conclusion, we validated that the microdamage-apoptosis-remodeling pathway is maintained with this method of microdamage induction in mice. We show that RPI can be used as a reliable and reproducible microdamage placement tool in living mouse long bones without inducing a periosteal response. We also used a caspase inhibitor, to block osteocyte apoptosis and thus abrogate the remodeling response to microdamage. This demonstrates that the well described microdamage repair system, involving targeted remodeling mediated by osteocyte apoptosis, is conserved in this novel mouse model using an in vivo RPI loading system.
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Affiliation(s)
- Oran D Kennedy
- New York University School of Medicine NY, United States.
| | - Matin Lendhey
- New York University School of Medicine NY, United States
| | - Peter Mauer
- The City College of New York, NY; The Royal College of Surgeons in Ireland, Ireland
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Ramme AJ, Lendhey M, Raya JG, Kirsch T, Kennedy OD. A novel rat model for subchondral microdamage in acute knee injury: a potential mechanism in post-traumatic osteoarthritis. Osteoarthritis Cartilage 2016; 24:1776-1785. [PMID: 27235904 DOI: 10.1016/j.joca.2016.05.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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: 11/24/2015] [Revised: 05/16/2016] [Accepted: 05/18/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Subchondral microdamage may play an important role in post-traumatic osteoarthritis (PTOA) development following anterior cruciate ligament (ACL) rupture. It remains unknown whether this injury mechanism causes subchondral microdamage, or whether its repair occurs by targeted osteoclast-mediated remodeling. If so these events may represent a mechanism by which subchondral bone is involved in PTOA. Our objective was to test the hypothesis that subchondral microdamage occurs, and is co-localized with remodeling, in a novel rat model of ACL rupture. DESIGN We developed a novel non-invasive rat animal model for ACL rupture and subchondral microdamage generation. By inducing ACL rupture noninvasively rather than surgically, this more closely mimics the clinical injury. MicroCT, MRI and histological methods were used to measure microstructural changes, ligament damage, and cellular/matrix degeneration, respectively. RESULTS We reproducibly generated ACL rupture without damage to other soft joint tissues. Immediately after injury, increased microdamage was found in the postero-medial aspect of the tibia. Microstructural parameters showed increased resorption at 2 weeks, which returned to baseline. Dynamic histomorphometry showed increased calcein label uptake in the same region at 4 and 8 weeks. Chondrocyte death and protease activity in cartilage was also noted, however whether this was directly linked to subchondral changes is not yet known. Similarly, cartilage scoring showed degradation at 4 and 8 weeks post-injury. CONCLUSIONS This study shows that our novel model can be used to study subchondral microdamage after ACL-rupture, and its association with localized remodeling. Cartilage degeneration, on a similar time-scale to other models, is also a feature of this system.
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Affiliation(s)
- A J Ramme
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, USA.
| | - M Lendhey
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, USA.
| | - J G Raya
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA.
| | - T Kirsch
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, USA.
| | - O D Kennedy
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, USA; Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, New York, NY, USA.
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Meftah M, John M, Lendhey M, Khaimov A, Ranawat AS, Ranawat CS. Safety and efficacy of non-cemented femoral fixation in patients 75 years of age and older. J Arthroplasty 2013; 28:1378-80. [PMID: 23528549 DOI: 10.1016/j.arth.2012.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 09/06/2012] [Revised: 11/01/2012] [Accepted: 11/18/2012] [Indexed: 02/01/2023] Open
Abstract
The aim of this study was to assess peri-operative complications, safety and efficacy of non-cemented femoral fixation in total hip arthroplasty (THA) as compared to cemented femoral fixation in the elderly population. Fifty-two matched pair analysis of patients with 75 years of age and older (104 patients), who underwent primary THA from June 1997 to December 2004, was performed based on age, sex, BMI, and Charnley classification. Mean age was 81 years (75-101) and the average follow up was 3.1 ± 2.9 years (1.2-6.4). There was no difference in peri-operative cardiopulmonary complications, pulmonary failures, deep venous thrombosis, pulmonary embolus, length of stay, or discharge deposition between the two groups. Non-cemented fixation is safe and effective in patients older than 75 years of age.
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Affiliation(s)
- Morteza Meftah
- Hospital for Special Surgery, New York, New York 1002, USA
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