In vivo facet joint loading of the canine lumbar spine.

This study describes a technique to measure in vivo loads and the resultant load-contact locations in the facet joint of the canine lumbar spine. The technique is a modification of a previously described in vitro method that used calibrated surface strains of the lateral aspect of the right L3 cranial articular process. In the present study, strains were measured during various in vivo static and dynamic activities 3 days after strain gage implantation. The in vivo recording technique and its errors, which depend on the location of the applied facet loads, is described. The results of applying the technique to five dogs gave the following results. Relative resultant contact load locations on the facet tended to be in the central and caudal portion of the facet in extension activities, central and cranial in standing, and cranial and ventral in flexion or right-turning activities. Right-turning contact locations were ventral and cranial to left-turning locations. Resultant load locations at peak loading during walking were in the central region of the facet, whereas resultant load locations at minimum loading during walking were relatively craniad. This resultant load-contact location during a walk gait cycle typically migrated in an arc with a displacement of 4 mm from minimum to maximum loading. Static tests resulted in a range of facet loads of 0 N in flexion and lying to 185 N for two-legged standing erect, and stand resulted in facet loads of 26 +/- 15 N (mean +/- standard deviation [SD]). Dynamic tests resulted in peak facet loads ranging from 55 N while walking erect to 170 N for climbing up stairs. Maximum walk facet loads were 107 +/- 27 N. The technique is applicable to in vivo studies of a canine facet joint osteoarthritis model and may be useful for establishing an understanding of the biomechanics of low-back pain.     

Validity of joint space width measurements in hand osteoarthritis

Objective

To investigate the validity of joint space width (JSW) measurements in millimeters (mm) in hand osteoarthritis (OA) patients by comparison to controls, grading of joint space narrowing (JSN), and clinical features.

Methods

Hand radiographs of 235 hand OA patients (mean age 65 years, 83% women) and 471 controls were used. JSW was measured with semi-automated image analysis software in the distal, proximal interphalangeal and metacarpal joints (DIPJs, PIPJs and MCPJs). JSN (grade 0–3) was assessed using the osteoarthritis research society international (OARSI) atlas. Associations between the two methods and clinical determinants (presence of pain, nodes and/or erosions, decreased mobility) were assessed using Generalized Estimating Equations with adjustments for age, sex, body mass index (BMI) and mean width of proximal phalanx.

Results

JSW was measured in 5631 joints with a mean JSW of 0.98 mm (standard deviation (SD) 0.21), being the smallest for DIPJs (0.70 (SD 0.25)) and largest for MCPJs (1.40 (SD 0.25)). The JSN = 0 group had a mean JSW of 1.28 mm (SD 0.34), the JSN = 3 group 0.17 mm (SD 0.23). Controls had larger JSW than hand OA patients (P-value < 0.001). In hand OA, females had smaller JSW than men (β −0.08, (95% confidence interval (95% CI) −0.15 to −0.01)) and lower JSW was associated with the presence of pain, nodes, erosions and decreased mobility (adjusted β −0.21 (95% CI −0.27, −0.16), −0.37 (−0.40, −0.34), −0.61 (−0.68, −0.54) and −0.46 (−0.68, −0.24) respectively). These associations were similar for JSN in grades.

Conclusion

In hand OA the quantitative JSW measurement is a valid method to measure joint space and shows a good relation with clinical features.     

Proteoglycan alterations during developing experimental osteoarthritis in a novel hip joint model

Degenerative hip joint disease was induced in dogs by extra-articular surgery that created a condition that mimics hip dysplasia. Decreased acetabular coverage of the femoral head gave altered mechanical load, with ensuing cartilage degeneration. For comparison, degenerative knee joint disease was induced in other dogs by transection of the anterior cruciate ligament of the knee. The femoral head articular cartilage showed macroscopic signs of degeneration within a month. No macroscopical changes of synovitis were present. Chemical analysis of cartilage samples showed loss of proteoglycans. Guanidine hydrochloride extracts of the cartilage contained proteoglycan fragments that could be separated by equilibrium density gradient centrifugation in cesium chloride. The data indicate that proteoglycans are fragmented by proteolytic cleavage and lost from the cartilage. The proteoglycans remaining in the tissue are smaller and have lost the ability to aggregate with hyaluronic acid. Similarly, in experimental knee joint osteoarthritis, the proteoglycan content of the cartilage decreased. The structural changes of those proteoglycans remaining were of a different nature, with no changes in proteoglycan size or aggregation properties, possibly indicating that both degradation and repair took place in the knee articular cartilage and/or that fragments were rapidly lost from the tissue. This may follow from different surgical procedures, only the one used for the hip joint being extra-articular, or from the different anatomy and physiology of the hip joint and the knee joint.     

Early osteoarthritis of the trapeziometacarpal joint is not associated with joint instability during typical isometric loading

The saddle‐shaped trapeziometacarpal (TMC) joint contributes importantly to the function of the human thumb. A balance between mobility and stability is essential in this joint, which experiences high loads and is prone to osteoarthritis (OA). Since instability is considered a risk factor for TMC OA, we assessed TMC joint instability during the execution of three isometric functional tasks (key pinch, jar grasp, and jar twist) in 76 patients with early TMC OA and 44 asymptomatic controls. Computed tomography images were acquired while subjects held their hands relaxed and while they applied 80% of their maximum effort for each task. Six degree‐of‐freedom rigid body kinematics of the metacarpal with respect to the trapezium from the unloaded to the loaded task positions were computed in terms of a TMC joint coordinate system. Joint instability was expressed as a function of the metacarpal translation and the applied force. We found that the TMC joint was more unstable during a key pinch task than during a jar grasp or a jar twist task. Sex, age, and early OA did not have an effect on TMC joint instability, suggesting that instability during these three tasks is not a predisposing factor in TMC OA. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:1639–1645, 2015.     

In vivo measurements of leakage current during transurethral resection

To estimate the magnitude of leakage current during transurethral resection 3 tape electrodes were applied to the penis and connected to earth through 50 kohm resistances (in order to minimize the current drawn from the neutral plate). A total of maximally 4 mAmp was measured through these electrodes. The measurements were independent of the concentration of hemoglobin in the irrigation fluid, the lubricant applied or whether a Teflon coated shaft was used. The maximum current of 4 mAmp has to pass an area as small as 0.1 mm2 for 0.2 sec in order to produce a second degree burn in the urethra. It is thus concluded that from an electrical point of view transurethral resection is a safe procedure not liable to give rise to any urethral burns. Using an isolated Teflon coated shaft has thus no practical value in reducing the leakage current.     

Passive hip movement measurements related to dynamic motion during gait in hip osteoarthritis

Reduced sagittal plane range of motion (ROM) has been reported in individuals with hip osteoarthritis (OA) both during walking and passive testing. The purpose of this study was to determine if a relationship exists between hip extension ROM recorded during gait and passive hip extension ROM in individuals with moderate and severe hip OA, in comparison to an asymptomatic group. Sagittal plane hip ROM was calculated using skin surface marker trajectories captured during treadmill walking at self‐selected speed. Passive hip ROM was measured using standardized position and recording procedures with a goniometer. Sagittal plane extension, flexion, and overall ROM were measured dynamically and passively. A two‐way mixed model analysis of variance determined significant differences between groups and between passive and dynamic ROM (α = 0.05). Pearson correlations determined relationships between passive and dynamic ROM. Significant group by ROM interactions were found for flexion and extension ROM (p < 0.05). For extension, the severe OA group had less dynamic and passive ROM compared to the other groups and greater passive than dynamic ROM (p < 0.05). For flexion, significant differences in passive ROM existed between all three groups (p < 0.05) whereas no differences were found for dynamic flexion (p < 0.05). Significant correlations between dynamic and passive hip extension were found in the moderate (r = 0.596) and severe OA (r = 0.586) groups, and no correlation was found in the asymptomatic group (r = 0.139). Passive ROM explains variance in dynamic ROM measurements obtained during gait in individuals with moderate and severe hip OA which have implications for the design of treatment strategies targeting walking pathomechanics. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1790–1797, 2016.     

Unilateral hip osteoarthritis: The effect of compensation strategies and anatomic measurements on frontal plane joint loading

In order to reduce pain caused by the affected hip joint, unilateral hip osteoarthritis patients (HOAP) adopt characteristic gait patterns. However, it is unknown if the knee and hip joint loading in the non‐affected (limb_{non‐affected}) and the affected (limb_affected) limb differ from healthy controls (HC) and which gait parameters correlate with potential abnormal joint loading. Instrumented 3D‐gait analysis was performed on 18 HOAP and 18 sex, age, and height matched HC. The limb_{non‐affected} showed greater first and second peak external hip adduction moments (first HAM: +15%, p = 0.014; second HAM: +15%, p = 0.021, respectively), than seen in HC. In contrast, the second peak external knee adduction moment (KAM) in the limb_affected is reduced by about 23% and 30% compared to the limb_{non‐affected} and HC, respectively. Furthermore, our patients showed characteristic gait compensation strategies including reduced peak vertical forces (pvF), a greater foot progression angle (FPA), and reduced knee range of motion (ROM) in the limb_affected. The limb_affected was 5.6 ± 3.8 mm shorter than the limb_{non‐affected}. Results of stepwise regression analyses showed that increased first pvF explain 16% of first HAM alterations, whereas knee ROM and FPA explain 39% of second KAM alterations. We therefore expect an increased rate of progression of OA in the hip joint of the limb_{non‐affected} and suggest that the shift in the medial‐to‐lateral knee joint load distribution may impact the rate of progression of OA in the limb_affected. The level of evidence is III. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1764–1773, 2017.

     

The canine bilateral groove model of osteoarthritis

In studies aimed at local treatment of experimental osteoarthritis (OA) it is optimal to have an internal (untreated) OA control. Such an approach excludes interanimal variation, and allows paired statistical evaluation of treatment efficacy. For this purpose, we developed and characterized a bilateral version of the canine Groove model. We hypothesized that the bilateral version of the canine Groove model would show consistent and clear development of features of OA similar to those found in the unilateral version. In six Beagle dogs, grooves were surgically made in the articular cartilage of the femoral condyles of both knee joints. Six additional dogs underwent bilateral sham surgery. The degree of OA was quantified 20 weeks after surgery and was compared in retrospect to 23 animals that undergone the same procedure in a single knee joint with the contralateral knee serving as a non‐OA control. Bilateral groove surgery resulted in OA. This was based on the observed ineffective repair response in which an increase in proteoglycan synthesis, a diminished retention of these newly formed proteoglycans, and an enhanced loss of resident proteoglycans resulted in a decreased cartilage proteoglycan content. These biochemical effects were corroborated by clear histological features of OA. All these effects were found in femor as well as in the (surgically untouched) tibia. Interestingly, features of OA were slightly more severe in the bilateral model than in the unilateral variant. The bilateral canine Groove model showed consistent and clear development of features of OA, comparable to the unilateral model. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:1471–1477, 2008     

Cervical ligamentous instability in a canine in vivo model

A canine in vivo model of midcervical ligamentous instability was developed by dividing the anterior longitudinal ligament, anulus fibrosus, and all posterior ligamentous structures including the ligamentum flavum. The natural history of healing in the model, the effect on its healing by an adjacent one-level arthrodesis, and the effect of a one-level arthrodesis on normal adjacent ligamentous structures were studied radiographically, mechanically, and histologically. The authors determined that healing takes place primarily by anterior scar formation in their instability model but not to a degree sufficient to recreate normal mechanical stability. After three months, healing in the model was not affected by an adjacent arthrodesis; however, acutely, instability apparently was increased as three animals became quadriplegic between the second and fourth postoperative days. Arthrodesis did not affect adjacent normal ligamentous structures, during this period. Incomplete healing in the authors' model supports those who advocate arthrodesis as the treatment of choice for destabilizing cervical ligamentous injury. The authors previously reported the case of a patient who sustained bilateral facet dislocations adjacent to an arthrodesed segment and questioned whether this resulted from a stress-concentrating effect. This study indicates that this could well have been the case acutely. Thus, inadvertent exclusion of an unstable segment from an arthrodesis has potentially catastrophic results. Finally, the authors also have previously questioned whether arthrodesis of a midcervical segment could lead to instability of adjacent normal segments. This project does not support such a concern, at least for the three postoperative months of study.     

In situ force distribution in the glenohumeral joint capsule during anterior-posterior loading.

Our objective was to examine the function of the glenohumeral capsule and ligaments during application of an anterior-posterior load by directly measuring the in situ force distribution in these structures as well as the compliance of the joint. We hypothesized that interaction between different regions of the capsule due to its continuous nature results in a complex force distribution throughout the glenohumeral joint capsule. A robotic/universal force-moment sensor testing system was utilized to determine the force distribution in the glenohumeral capsule and ligaments of intact shoulder specimens and the joint kinematics resulting from the application of external loads at four abduction angles. Our results suggest that the glenohumeral capsule carries no force when the humeral head is centered in the glenoid with the humerus in anatomic rotation. However, once an anterior-posterior load is applied to the joint, the glenohumeral ligaments carry force (during anterior loading, the superior glenohumeral-coracohumeral ligaments carried 26+/-16 N at 0 degrees and the anterior band of the inferior glenohumeral ligament carried 30+/-21 N at 90 degrees). Therefore, the patient's ability to use the arm with the humerus in anatomic rotation should not be limited following repair procedures for shoulder instability because the repaired capsuloligamentous structures should not carry force during this motion. Separation of the capsule into its components revealed that forces are being transmitted between each region and that the glenohumeral ligaments do not act as traditional ligaments that carry a pure tensile force along their length. The interrelationship of the glenohumeral ligaments forms the biomechanical basis for the capsular shift procedure. The compliance of the joint under our loading conditions indicates that the passive properties of the capsule provide little resistance to motion of the humerus during 10 mm of anterior or posterior translation with anatomic humeral rotation. Finally, this knowledge also enhances the understanding of arm positioning relative to the portion of the glenohumeral capsule that limits translation during examination under anesthesia.     

In vivo dynamic loading reduces bone growth without histomorphometric changes of the growth plate

This in vivo study aimed at investigating the effects of dynamic compression on the growth plate. Rats (28 days old) were divided into three dynamically loaded groups, compared with two groups (control, sham). A device was implanted on the 6th and 8th caudal vertebrae for 15 days. Controls (n = 4) did not undergo surgery. Shams (n = 4) were operated but not loaded. Dynamic groups had sinusoidal compression with a mean value of 0.2 MPa: 1.0 Hz and ±0.06 MPa (group a, n = 4); 0.1 Hz and ±0.2 MPa (group b, n = 4); 1.0 Hz and ±0.14 MPa (group c, n = 3). Growth rates (µm/day) of dynamic groups (a) and (b) were lower than shams (p < 0.01). Growth plate heights, hypertrophic cell heights and proliferative cell counts per column did not change in dynamic (a) and (b) groups compared with shams (p > 0.01). Rats from dynamic group (c) had repeated inflammations damaging tissues; consequently, their analysis was unachievable. Increasing magnitude or frequency leads to growth reduction without histomorphometric changes. However, the combined augmentation of magnitude and frequency alter drastically growth plate integrity. Appropriate loading parameters could be leveraged for developing novel growth modulation implants to treat skeletal deformities. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:1129–1136, 2014.     

In vivo contrast-enhanced micro MR-imaging of experimental osteoarthritis in the rabbit knee joint at 7.1T1

OBJECTIVE: In this longitudinal MR study the early stages of joint pathology in two surgically-induced rabbit models of osteoarthritis (OA) were monitored by in vivo contrast-enhanced MRI at 7.1T. Qualitative and quantitative MR data were compared with macroscopic and microscopic findings. METHOD: Scanning of mature, male New Zealand White rabbits (N=12) was performed before surgery, and at 2, 4, and 8 weeks after unilateral transection of the anterior cruciate ligament (ACLT), medial meniscectomy (ME), or sham operation. MR-images were simultaneously obtained of both knee joints after intravenous injection of Magnevist. We implemented a 2D T1-weighted (T1w) coronal, fat-saturated gradientecho protocol (68 x 138 microm2, slice thickness 1 mm). Additionally, consecutive 3D gradientecho images were obtained from two sham-operated and two rabbits of the ME group (234 x 273 x 234 microm(3)). ACLT animals were sacrificed at 2 weeks (N=1), and 8 weeks (N=3), ME animals were sacrificed at 4 weeks (N=2), and 8 weeks (N=4), and sham-operated animals were sacrificed at 2 weeks (N=1) and 8 weeks (N=1), respectively. RESULTS: Both OA models reflected important characteristics of the clinical picture of OA. With MR we were able to monitor time dependently the decline of synovial effusion and the formation of osteophytes. Morphologic MR examination showed a moderate to high accuracy for detecting synovial effusion (75%), meniscus (86%) and cruciate ligament (91%) lesions, and osteophytes (88%) as assessed by macroscopic examination. False-negative MR findings for gross macroscopic changes were due to the relative high slice thickness in 2D scans and the fact that the slices only covered the main weightbearing area of the femorotibial joint. Contour abnormalities of articular cartilage were not reliably detected. Quantitative analysis revealed a statistically significant increase of cartilage signal intensity in medial tibial cartilage (48+/-9% ACLT, and 29+/-9% ME in 2D datasets) as compared to contralateral control knees in two-week scans. Signal enhancement persisted or increased at later dates. CONCLUSION: With high-resolution contrast-enhanced MRI at 7.1T the time course of gross pathologic changes in rabbit knees with surgically induced OA can be monitored. Still insufficient spatial resolution and image contrast of the applied 2D protocols limit the sensitivity and prohibit detection of articular cartilage contour abnormalities. However, signal alterations in the cartilage layer indicate alterations of tissue composition at a very early stage of OA development. When used with 3D protocols, contrast-enhanced MRI offers a promising tool for qualitative and quantitative in vivo monitoring of OA in rabbit models.     

Online oxygen measurements in ex vivo perfused muscle tissue in a porcine model using dynamic quenching methods

Introduction  

Transplantation of autologous free tissue flaps is the best applicable technique for treating large and complex tissue defects and still has one major failure criterion. Tissue—and in particular muscle tissue—is strongly sensitive to ischemia, thus after a critical period of oxygen depletion the risk of a partial or total flap loss is high.     

Total coronary blood flow measurements and myocardial metabolism during cardiopulmonary bypass in a canine model.

Myocardial respiratory function and total coronary blood flow were evaluated during cardiopulmonary bypass in 18 dogs. The fibrillating heart was found to be associated with an increase in myocardial oxygen utilization and metabolic rate which was compensated for by a corresponding increase in total coronary blood flow. Following anoxic arrest of the heart, there appears to be an initial impairment to oxygen utilization. Oxygen consumption does not return to normal after 15 minutes of restoring coronary blood flow. The stability of the experimental model as outlined in this study is thought to be related to the use of autologous blood in priming the extracorporeal circuit.     

In vivo matrix microdamage in a naturally occurring canine fatigue fracture

Greyhound central tarsal bone (CTB) from animals with (n = 11) and without CTB fatigue fracture (n = 15) was examined histologically for the presence, numerical density, and morphology of in vivo microdamage. Complete fracture of the right CTB is a common occurrence during dog racing, because this is the outside limb when running counterclockwise on a circular or oval track. The CTB consisted of both remodeled cortical bone and inner trabecular bone. Thickening and coalescence of trabeculae were observed, particularly dorsally and medially, causing reduction or elimination of the marrow void spaces. A band of tightly packed transverse osteons was also observed adjacent to the concave proximal joint surface. Typical linear microcracks were most often seen in remodeled cortical and trabecular bone and were often observed adjacent to vascular channels. In contrast, ultra-microcracking, represented by diffuse staining with basic fuchsin, was consistently observed in the plantar process around the attachment site for the plantar ligament complex. Dog status (fractured or intact) and side (left or right) both had a significant effect on microcrack density and microcrack surface density (p < 0.05). Microcrack density and microcrack surface density were increased in the right (fractured) CTB from greyhounds with CTB fracture. There was also a trend for side to have a significant effect on microcrack length, with microcrack lengths being higher in the right CTB of both intact and fractured dogs. These data support the general hypothesis that fatigue fracture occurs because of ongoing cyclic stresses after induction of reparative remodeling. Development of methods for biomechanical testing of small cuboidal bones should allow investigation of relationships between accumulation of loading cycles and bone weakening because of microdamage.     

In vivo loading model to examine bone adaptation in humans: A pilot study

Bone is typically well suited for its habitual loading environment because of its ability to adapt. Although characteristics of the mechanical loading environment predict the bone adaptive response in animals, this has not been prospectively validated in humans. Here, we describe an in vivo loading model in which women apply forces to the radius by leaning onto their hand. We characterized the strain environment imposed on the radius using cadaveric experimentation and conducted a prospective study in which 19 adult women loaded their distal radii 50 cycles/day, 3 days/week, for 28 weeks and seven additional adult women served as controls. In four cadaveric specimens, loading caused compressive principal strains of ?1,695 ± 396 μ? with radial bending dorsally and towards the ulna. Prospective in vivo loading produced measurable improvements to bone and appeared to protect against bone loss associated with seasonal fluctuations in physical activity and sun exposure. Experimental subjects had significant gains to bone volume (BV) and moments of inertia, while, control subjects had significant losses in BMC and moments of inertia. The loading model is thus suitable as a model system for exploring bone adaptation in humans, and may eventually be clinically useful for strengthening the radius of women. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31:1406–1413, 2013.

     

Knee pain and joint loading in subjects with osteoarthritis of the knee.

Although treatments for osteoarthritis of the knee are often directed at relieving pain, pain may cause patients to alter how they perform activities to decrease the loads on the joints. The knee-adduction moment is a major determinant of the load distribution between the medial and lateral plateaus. Therefore, the interrelationship between pain and the external knee-adduction moment during walking may be especially important for understanding mechanical factors related to the progression of medial tibiofemoral osteoarthritis. Fifty-three subjects with symptomatic radiographic evidence of osteoarthritis of the knee were studied. These subjects were a subset of those enrolled in a double-blind study in which gait analysis and radiographic and clinical evaluations were performed after a 2-week washout of anti-inflammatory and analgesic treatment. The subjects then took a nonsteroidal anti-inflammatory drug, acetaminophen, or placebo for 2 weeks, and the gait and clinical evaluations were repeated. The change in the peak external adduction moment between the two evaluations was inversely correlated with the change in pain (R = 0.48, p < 0.001) and was significantly different between those whose pain increased (n = 7), decreased (n = 18), or remained unchanged (n = 28) (p = 0.009). Those with increased pain had a significant decrease in the peak external adduction (p = 0.005) and flexion moments (p = 0.023). In contrast, the subjects with decreased pain tended to have an increase in the peak external adduction moment (p = 0.095) and had a significant increase in the peak external extension moment (p = 0.017). The subjects whose pain was unchanged had no significant change in the peak external adduction (p = 0.757), flexion (p = 0.234), or extension (p = 0.465) moments. Thus, decreases in pain among patients with medial tibiofemoral osteoarthritis were related to increased loading of the degenerative portion of the joints. Additional long-term prospective studies are needed to determine whether increased loading during walking actually results in accelerated progression of the disease.