The Relationship Between the Tensile and the Torsional Properties of the Native Scapholunate Ligament and Carpal Kinematics

PURPOSE

The purpose of this exploratory study was to examine the relationship between the tensile and the torsional properties of the native scapholunate interosseous ligament (SLIL) and kinematics of the scaphoid and lunate of an intact wrist during passive radioulnar deviation.

METHODS

Eight fresh-frozen cadaveric specimens were transected at the elbow joint and loaded into a custom jig. Kinematic data of the scaphoid and lunate were acquired in a simulated resting condition for 3 wrist positions-neutral, 10° radial deviation, and 30° ulnar deviation-using infrared-emitting rigid body trackers. The SLIL bone-ligament-bone complex was then resected and loaded on a materials testing machine. Specimens underwent cyclic torsional and tensile testing and SLIL tensile and torsional laxity were evaluated. Correlations between scaphoid and lunate rotations and SLIL tensile and torsional properties were determined using Pearson correlation coefficients.

RESULTS

Ulnar deviation of both the scaphoid and the lunate were found to decrease as the laxity of SLIL in torsion increased. In addition, the ratio of lunate flexion-extension to radial-ulnar deviation was found to increase with increased SLIL torsional rotation.

CONCLUSIONS

Our findings support the theory that there is a relationship between scapholunate kinematics and laxity at the level of the interosseous ligaments.

CLINICAL RELEVANCE

Laxity and, specifically, the tensile and torsional properties of an individual's native SLIL should guide reconstruction using a graft material that more closely replicates the individual's native SLIL properties.

Tensile and Torsional Structural Properties of the Native Scapholunate Ligament

PURPOSE

The ideal material for reconstruction of the scapholunate interosseous ligament (SLIL) should replicate the mechanical properties of the native SLIL to recreate normal kinematics and prevent posttraumatic arthritis. The purpose of our study was to evaluate the cyclic torsional and tensile properties of the native SLIL and load to failure tensile properties of the dorsal SLIL.

METHODS

The SLIL bone complex was resected from 10 fresh-frozen cadavers. The scaphoid and lunate were secured in polymethylmethacrylate and mounted on a test machine that incorporated an x-y stage and universal joint, which permitted translations perpendicular to the rotation/pull axis as well as nonaxial angulations. After a 1 N preload, specimens underwent cyclic torsional testing (±0.45 N m flexion/extension at 0.5 Hz) and tensile testing (1-50 N at 1 Hz) for 500 cycles. Lastly, the dorsal 10 mm of the SLIL was isolated and displaced at 10 mm/min until failure.

RESULTS

During intact SLIL cyclic torsional testing, the neutral zone was 29.7° ± 6.6° and the range of rotation 46.6° ± 7.1°. Stiffness in flexion and extension were 0.11 ± 0.02 and 0.12 ± 0.02 N m/deg, respectively. During cyclic tensile testing, the engagement length was 0.2 ± 0.1 mm, the mean stiffness was 276 ± 67 N/mm, and the range of displacement was 0.4 ± 0.1 mm. The dorsal SLIL displayed a 0.3 ± 0.2 mm engagement length, 240 ± 65 N/mm stiffness, peak load of 270 ± 91 N, and displacement at peak load of 1.8 ± 0.3 mm.

CONCLUSIONS

We report the torsional properties of the SLIL. Our novel test setup allows for free rotation and translation, which reduces out-of-plane force application. This may explain our observation of greater dorsal SLIL load to failure than previous reports.

CLINICAL RELEVANCE

By matching the natural ligament with respect to its tensile and torsional properties, we believe that reconstructions will better restore the natural kinematics of the wrist and lead to improved outcomes. Future clinical studies should aim to investigate this further.

A Biomechanical Comparison of Shape Design and Positioning of Transforaminal Lumbar Interbody Fusion Cages

STUDY DESIGN

Cadaveric biomechanical analysis.

OBJECTIVE

The aim of this study was to compare three interbody cage shapes and their position within the interbody space with regards to construct stability for transforaminal lumbar interbody fusion.

METHODS

Twenty L2-L3 and L4-L5 lumbar motion segments from fresh cadavers were potted in polymethyl methacrylate and subjected to testing with a materials testing machine before and after unilateral facetectomy, diskectomy, and interbody cage insertion. The three cage types were kidney-shaped, articulated, and straight bullet-shaped. Each cage type was placed in a common anatomic area within the interbody space before testing: kidney, center; kidney, anterior; articulated, center; articulated, anterior; bullet, center; bullet, lateral. Load-deformation curves were generated for axial compression, flexion, extension, right bending, left bending, right torsion, and left torsion. Finally, load to failure was tested.

RESULTS

For all applied loads, there was a statistically significant decrease in the slope of the load-displacement curves for instrumented specimens compared with the intact state (p < 0.05) with the exception of right axial torsion (p = 0.062). Among all instrumented groups, there was no statistically significant difference in stiffness for any of the loading conditions or load to failure.

CONCLUSIONS

Our results failed to show a clearly superior cage shape design or location within the interbody space for use in transforaminal lumbar interbody fusion.

Buttress Plating versus Anterior-to-Posterior Lag Screws for Fixation of the Posterior Malleolus

Category:

Trauma

Introduction/Purpose:

The preferred method of fixation for posterior malleolus fractures remains controversial, and practices vary widely among surgeons. The purpose of this study was to compare anterior-to-posterior lag screws to posterior buttress plating for fixation of posterior malleolus fractures in a cadaveric model.

Methods:

Posterior malleolus fractures were created in seven pairs of fresh frozen cadaveric ankles. One specimen in each pair was randomly assigned to fixation with either two anterior-to-posterior lag screws or a one-third tubular buttress plate without supplemental lag screws. Each specimen was then subjected to cyclic loading from 0% to 50% of body weight for 5,000 cycles followed by loading to failure. Failure was defined as 1 mm of axial displacement.

Results:

The buttress plate group showed significantly less peak axial displacement at all time points during cyclic loading. Permanent axial displacement was significantly less in the buttress plate group beginning at cycle 200 (figure). There were no significant differences between the two groups during load to failure testing.

Conclusion:

Posterior malleolus fractures treated with posterior buttress plating showed significantly less displacement during cyclical loading compared to fractures fixed with anterior-to-posterior lag screws. Surgeons should consider these findings when selecting a fixation strategy for these common fractures. these biomechanical findings. Further research is warranted to investigate the clinical implications of

The effect of local IL-4 delivery or CCL2 blockade on implant fixation and bone structural properties in a mouse model of wear particle induced osteolysis

Modulation of macrophage polarization and prevention of CCL2-induced macrophage chemotaxis are emerging strategies to reduce wear particle induced osteolysis and aseptic total joint replacement loosening. In this study, the effect of continuous IL-4 delivery or bioactive implant coating that constitutively releases a protein inhibitor of CCL2 signaling (7ND) on particle induced osteolysis were studied in the murine continuous femoral intramedullary particle infusion model. Polyethylene particles with or without IL-4 were infused into mouse distal femurs implanted with hollow titanium rods using subcutaneous infusion pumps. In another experimental group, particles were infused into the femur through a 7ND coated rod. After 4 weeks, fixation of the implant was assessed using a pullout test. The volume of trabecular bone and the geometry of the local cortical bone were assessed by µCT and the corresponding structural properties of the cortical bone determined by torsional testing. Continuous IL-4 delivery led to increased trabecular bone volume as well as enhanced local bone geometry and structural properties, while 7ND implant coating did not have effect on these parameters. The results suggest that local IL-4 treatment is a promising strategy to mitigate wear particle induced osteolysis. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 2255-2262, 2016.

Winner of the Young Investigator Award of the Society for Biomaterials (USA) for 2016, 10th World Biomaterials Congress, May 17-22, 2016, Montreal QC, Canada: Aligned microribbon-like hydrogels for guiding three-dimensional smooth muscle tissue regeneration

Smooth muscle tissue is characterized by aligned structures, which is critical for its contractile functions. Smooth muscle injury is common and can be caused by various diseases and degenerative processes, and there remains a strong need to develop effective therapies for smooth muscle tissue regeneration with restored structures. To guide cell alignment, previously cells were cultured on 2D nano/microgrooved substrates, but such method is limited to fabricating 2D aligned cell sheets only. Alternatively, aligned electrospun nanofiber has been employed as 3D scaffold for cell alignment, but cells can only be seeded post fabrication, and nanoporosity of electrospun fiber meshes often leads to poor cell distribution. To overcome these limitations, we report aligned gelatin-based microribbons (µRBs) as macroporous hydrogels for guiding smooth muscle alignment in 3D. We developed aligned µRB-like hydrogels using wet spinning, which allows easy fabrication of tissue-scale (cm) macroporous matrices with alignment cues and supports direct cell encapsulation. The macroporosity within µRB-based hydrogels facilitated cell proliferation, new matrix deposition, and nutrient diffusion. In aligned µRB scaffold, smooth muscle cells showed high viability, rapid adhesion, and alignment following µRB direction. Aligned µRB scaffolds supported retention of smooth muscle contractile phenotype, and accelerated uniaxial deposition of new matrix (collagen I/IV) along the µRB. In contrast, cells encapsulated in conventional gelatin hydrogels remained round with matrix deposition limited to pericellular regions only. We envision such aligned µRB scaffold can be broadly applicable in growing other anisotropic tissues including tendon, nerves and blood vessel.

Viscoelastic properties of common suture material used for rotator cuff repair and arthroscopic procedures

PURPOSE

The purpose of this study was to evaluate the viscoelastic properties of 5 suture materials, commonly used in arthroscopic rotator cuff repairs, when subjected to physiological loads.

METHODS

We evaluated 5 commercially available No. 2 sutures undergoing both creep and cyclic testing in both dry air and phosphate-buffered saline solution (PBS) maintained at 37°C. The selected sutures were MagnumWire (ArthroCare, Austin, TX), Ethibond (Ethicon, Somerville, NJ), FiberWire (Arthrex, Naples, FL), Orthocord (DePuy, Warsaw, IN), and Force Fiber (Tornier, Bloomington, MN).

RESULTS

Regarding creep testing, in the PBS test environment, FiberWire showed the greatest stiffness (71.1 ± 2.1 N/mm), the smallest initial extension at the 60-N load (1.10 ± 0.04 mm), and the smallest amount of creep (0.57 ± 0.01 mm). Orthocord showed the smallest amount of relaxed elongation in PBS (0.73 ± 0.11 mm). Regarding cyclic testing, in the PBS testing environment, Ethibond exhibited the smallest dynamic creep (0.28 ± 0.02 mm), FiberWire displayed the smallest peak-to-peak displacement (0.17 ± 0.00 mm), and Orthocord showed the smallest amount of relaxed elongation after cyclic loading (0.63 ± 0.11 mm).

CONCLUSIONS

FiberWire consistently displayed more extreme viscoelastic properties--greater stiffness and less extensibility--than the other suture types studied. Orthocord showed the smallest amount of relaxed elongation in both testing environments. Differences in testing environment affect the behavior of each suture type. Testing in physiologically approximating conditions such as PBS maintained at 37°C is warranted.

CLINICAL RELEVANCE

Although many other factors affect the success of rotator cuff repairs, the viscoelastic properties of sutures may be a useful predictor of suture performance.

Biomechanical comparison of an all-soft suture anchor with a modified Broström-Gould suture repair for lateral ligament reconstruction

BACKGROUND

Anatomic repair is indicated for patients who have recurrent lateral ankle instability despite nonoperative measures.

HYPOTHESIS

There is no difference in repair stiffness, failure torque, or failure angle between specimens repaired with all-soft suture anchors versus the modified Broström-Gould technique with sutures only.

STUDY DESIGN

Controlled laboratory study.

METHODS

In 10 matched pairs of human cadaveric ankles, the anterior talofibular ligament (ATFL) was incised from its origin on the fibula. After randomization, 1 ankle was repaired to its anatomic insertion using two 1.4-mm JuggerKnot all-soft suture anchors; the other ankle was repaired with a modified Broström-Gould technique using 2-0 FiberWire. All were augmented using the inferior extensor retinaculum. All ankles were mounted to the testing machine in 20° of plantar flexion and 15° of internal rotation and loaded to failure after the repair. Stiffness, failure torque, and failure angle were recorded and compared using a paired Student t test with a significance level set at P < .05.

RESULTS

There was no significant difference in failure torque, failure angle, or stiffness. No anchors pulled out of bone. The primary mode of failure was pulling through the ATFL tissue.

CONCLUSION

There was no statistical difference in strength or stiffness between a 1.4-mm all-soft suture anchor and a modified Broström-Gould repair with 2-0 FiberWire. The primary mode of failure was at the tissue level rather than knot failure or anchor pullout.

CLINICAL RELEVANCE

The particular implant choice (suture only, tunnel, anchor) in repairing the lateral ligament complex may not be as important as the time to biological healing. The suture-only construct as described in the Broström-Gould repair was as strong as all-soft suture anchors, and the majority of the ankles failed at the tissue level. For those surgeons whose preference is to use anchor repair, this novel all-soft suture anchor may be an alternative to other larger anchors, as none failed by pullout.

The effects of interactive mechanical and biochemical niche signaling on osteogenic differentiation of adipose-derived stem cells using combinatorial hydrogels

Stem cells reside in a multi-factorial environment containing biochemical and mechanical signals. Changing biochemical signals in most scaffolds often leads to simultaneous changes in mechanical properties, which makes it difficult to elucidate the complex interplay between niche cues. Combinatorial studies on cell-material interactions have emerged as a tool to facilitate analyses of stem cell responses to various niche cues, but most studies to date have been performed on two-dimensional environments. Here we developed three-dimensional combinatorial hydrogels with independent control of biochemical and mechanical properties to facilitate analysis of interactive biochemical and mechanical signaling on adipose-derived stem cell osteogenesis in three dimensions. Our results suggest that scaffold biochemical and mechanical signals synergize only at specific combinations to promote bone differentiation. Leading compositions were identified to have intermediate stiffness (∼55kPa) and low concentration of fibronectin (10μg ml(-1)), which led to an increase in osteocalcin gene expression of over 130-fold. Our results suggest that scaffolds with independently tunable niche cues could provide a powerful tool for conducting mechanistic studies to decipher how complex niche cues regulate stem cell fate in three dimensions, and facilitate rapid identification of optimal niche cues that promote desirable cellular processes or tissue regeneration.

The effect of suture coated with mesenchymal stem cells and bioactive substrate on tendon repair strength in a rat model

PURPOSE

Exogenously administered mesenchymal stem cells and bioactive molecules are known to enhance tendon healing. Biomolecules have been successfully delivered using sutures that elute growth factors over time. We sought to evaluate the histologic and biomechanical effect of delivering both cells and bioactive substrates on a suture delivery vehicle in comparison with sutures coated with bioactive substrates alone.

METHODS

Bone marrow-derived stem cells were harvested from Sprague-Dawley rat femurs. Experimental cell and substrate-coated, coated suture (CS) group sutures were precoated with intercellular cell adhesion molecule 1 and poly-L-lysine and seeded with labeled bone marrow-derived stem cells. Control (substrate-only [SO] coated) group sutures were coated with intercellular cell adhesion molecule 1 and poly-L-lysine only. Using a matched-paired design, bilateral Sprague-Dawley rat Achilles tendons (n = 105 rats) were transected and randomized to CS or SO repairs. Tendons were harvested at 4, 7, 10, 14, and 28 days and subjected to histologic and mechanical assessment.

RESULTS

Labeled cells were present at repair sites at all time points. The CS suture repairs displayed statistically greater strength compared to SO repairs at 7 days (12.6 ± 5.0 N vs 8.6 ± 3.7 N, respectively) and 10 days (21.2 ± 4.9 N vs 16.4 ± 4.8 N, respectively). There was no significant difference between the strength of CS suture repairs compared with SO repairs at 4 days (8.1 ± 5.1 N vs 6.6 ± 2.3 N, respectively), 14 days (22.8 ± 7.3 N vs 25.1 ± 9.7 N, respectively), and 28 days (40.9 ± 12.4 N vs 34.6 ± 15.0 N, respectively).

CONCLUSIONS

Bioactive CS sutures enhanced repair strength at 7 to 10 days. There was no significant effect at later stages.

CLINICAL RELEVANCE

The strength nadir of a tendon repair occurs in the first 2 weeks after surgery. Bioactive suture repair might provide a clinical advantage by jump-starting the repair process during this strength nadir. Improved early strength might, in turn allow earlier unprotected mobilization.

QTL mapping for resistance against non-parasitic leaf spots in a spring barley doubled haploid population

Phenotypic variability for resistance against non-parasitic leaf spots (NPLS) has been observed between varieties. For the genetic characterization of NPLS resistance, a population with 430 doubled haploid (DH) lines was developed from the cross between the NPLS-resistant Hordeum vulgare breeding line IPZ24727 and the NPLS-sensitive barley cultivar Barke. A molecular map was constructed based on 164 AFLPs, 30 SSRs and one STS marker derived from the mlo gene. Field trials were performed over four environments in which NPLS and other agronomic traits were assessed. Estimates of genotypic variance were highly significant for NPLS. Moreover, no transgression was found for the trait. Quantitative trait loci (QTLs) for NPLS resistance were mapped in the DH population on chromosomes 1H, 4H, and 7H, with the most important effect on chromosome 4H. The QTLs for NPLS explained together 39% of the phenotypic and 49% of the genotypic variance, thereby showing additive gene action. Consequently, marker-assisted selection for improving NPLS resistance is possible.

Histocompatibility antigens in polymyalgia rheumatica and giant cell arteritis

Fifty-five Caucasoid patients with polymyalgia rheumatica or giant cell arteritis were typed for HLA, A, B, C and DR locus antigens. In the total patient group, DR4 had a significantly increased frequency. The prevalence of CW3 and CW6 was also significantly increased, the rise of CW3 possibly being attributable to its well-documented linkage disequilibrium with DR4. The rise in CW6 cannot be attributed to its known linkage disequilibrium with DR7.