Multipotential stromal cells in the talus and distal tibia in ankle osteoarthritis - Presence, potency and relationships to subchondral bone changes.

A large proportion of ankle osteoarthritis (OA) has an early onset and is post-traumatic. Surgical interventions have low patient satisfaction and relatively poor clinical outcome, whereas joint-preserving treatments, which rely on endogenous multipotential stromal cells (MSCs), result in suboptimal repair. This study investigates MSC presence and potency in OA-affected talocrural osteochondral tissue. Bone volume fraction (BV/TV) changes for the loading region trabecular volume and subchondral bone plate (SBP) thickness in OA compared with healthy tissue were investigated using microcomputed tomography. CD271-positive MSC topography was related to bone and cartilage damage in OA tissue, and in vitro MSC potency was compared with control healthy iliac crest (IC) MSCs. A 1.3- to 2.5-fold SBP thickening was found in both OA talus and tibia, whereas BV/TV changes were depth-dependent. MSCs were abundant in OA talus and tibia, with similar colony characteristics. Tibial and talar MSCs were tripotential, but talar MSCs had 10-fold lower adipogenesis and twofold higher chondrogenesis than IC MSCs (P = .01 for both). Cartilage damage in both OA tibia and talus correlated with SBP thickening and CD271+ MSCs was 1.4- to twofold more concentrated near the SBP. This work shows multipotential MSCs are present in OA talocrural subchondral bone, with their topography suggesting ongoing involvement in SBP thickening. Potentially, biomechanical stimulation could augment the chondrogenic differentiation of MSCs for joint-preserving treatments.

Influence of contact pressure, cross-shear and counterface material on the wear of PEEK and CFR-PEEK for orthopaedic applications.

Total joint replacement is a successful surgical intervention for the treatment of the degeneration of many joints, particularly the hip and knee. As the demand for joint replacement grows, and the life expectancy of the population increases, the performance requirements of these implants also changes. New materials, to improve longevity and enhance performance have been explored including PEEK and CFR-PEEK. This study investigated whether CFR-PEEK and PEEK were appropriate materials for total joint replacement by examining wear performance in simple configuration studies articulating against cobalt chrome under a range of cross-shear and contact pressure conditions. Simple geometry pin on plate studies were conducted for one million cycles for each test condition, with the contact pressure and cross-shear conditions representing a range in which the material may need to operate in-vivo. The wear factor for PEEK was significantly higher than CFR-PEEK and conventional polyethylene under all test conditions. Both PEEK and CFR-PEEK wear were influenced by contact pressure, with the highest wear factors for both materials measured at the highest pressure conditions. PEEK appeared to have a cross-shear dependent wear response, but this was not observed for the CFR-PEEK material. This study has further characterised the wear performance of two materials that are gaining interest for total joint replacement. The wear performance of the PEEK material showed poorer wear performance compared to polyethylene when articulating with a metal counterface, but the performance of the CFR-PEEK material suggested it may provide a suitable alternative to polyethylene in some applications. The wear performance of CFR-PEEK was poorer than polyethylene when it was used as the plate, when there was translation of the contact zone over the surface of the CFR-PEEK plate. This has implications for applications in low conforming contacts, such as lower conformity knee replacement.

The wear of fixed and mobile bearing unicompartmental knee replacements.

Unicompartmental knee replacements (UKR) are an option for surgical intervention for the treatment of single-compartment osteoarthritis. The aim of this study was to compare the wear of a low-conformity fixed-bearing UKR with a conforming mobile bearing UKR under two kinematic conditions, to investigate the effect of implant design and kinematics on wear performance in a physiological knee wear simulator. Under both sets of kinematic conditions, the relatively low-conforming fixed UKR showed lower wear, compared with the more conforming anterior-posterior sliding mobile bearing. However, it should be noted that differences in materials between the two designs also contribute to the relative wear performance of the bearings. The combined wear of the medial and lateral bearings of the fixed-bearing UKR as a 'total knee' were significantly reduced compared with a fixed-bearing total knee replacement studied under the same kinematic conditions.

Identifying athletes at risk of hamstring strains and how to protect them.

1. One common soft-tissue injury in sports involving sprinting and kicking a ball is the hamstring strain. Strain injuries often occur while the contracting muscle is lengthened, an eccentric contraction. We have proposed that the microscopic damage to muscle fibres that routinely occurs after a period of unaccustomed eccentric exercise can lead to a more severe strain injury. 2. An indicator of susceptibility for the damage from eccentric exercise is the optimum angle for torque. When this is at a short muscle length, the muscle is more prone to eccentric damage. It is known that subjects most at risk of a hamstring strain have a previous history of hamstring strains. By means of isokinetic dynamometry, we have measured the optimum angle for torque for nine athletes with a history of unilateral hamstring strains. We also measured optimum angles for 18 athletes with no previous history of strain injuries. It was found that mean optimum angle in the previously injured muscles was at a significantly shorter length than for the uninjured muscles of the other leg and for muscles of both legs in the uninjured group. This result suggests that previously injured muscles are more prone to eccentric damage and, therefore, according to our hypothesis, more prone to strain injuries than uninjured muscles. 3. After a period of unaccustomed eccentric exercise, if the exercise is repeated 1 week later, there is much less evidence of damage because the muscle has undergone an adaptation process that protects it against further damage. We propose that for athletes considered at risk of a hamstring strain, as indicated by the optimum angle for torque, a regular programme of mild eccentric exercise should be undertaken. This approach seems to work because evidence from a group of athletes who have implemented such a programme shows a significant reduction in the incidence of hamstring strains.

The role of the length-tension curve in the control of movement.

The length-tension curve of muscle is one of the important descriptors of mechanical performance, and also a direct reflection of the underlying structure, particularly the number of sarcomeres connected in series in muscle fibres. This number is one of the most plastic properties of muscle, changing within days after changes in activity patterns. We propose that this adaptation is to prevent eccentric contractions from occurring beyond the optimum length for tension generation, since this is the region of sarcomere instability and muscle damage. Evidence for this is presented for muscles from rats trained on a treadmill, and from motor units of the gastrocnemius muscle of the cat.

Damage to different motor units from active lengthening of the medial gastrocnemius muscle of the cat.

Slow-twitch motor units in the medial gastrocnemius muscle of the anesthetized cat were found to have an average optimum length for active tension that was 0.8 +/- 0.5 (SE) mm longer than the whole muscle optimum. For fast-twitch units (time to peak < 50 ms), the average optimum was 1.3 +/- 0.3 mm shorter than the whole muscle optimum. After the muscle had been subjected to 10 stretches while maximally activated, beginning at the whole muscle optimum length, the optimum lengths of the 27 fast-twitch motor units shifted significantly further in the direction of longer muscle lengths (mean 4.3 +/- 0.3 mm) than for the eight slow-twitch units (2.1 +/- 0.4 mm). A shift in the muscle's length-tension relation was interpreted as being due to sarcomere disruption. Statistical analysis showed that a motor unit's optimum length for a contraction, relative to the whole muscle optimum, was a better indicator of the unit's susceptibility to damage from active lengthenings than was motor unit type.

Effect of eccentric muscle contractions on Golgi tendon organ responses to passive and active tension in the cat.

To investigate the possibility of a peripheral contribution to the perturbations of force sensation reported to occur after eccentric exercise, responses to passive and active tension were recorded from Golgi tendon organs in the medial gastrocnemius muscle of the anaesthetised cat, before and after a series of eccentric contractions. After the eccentric contractions, nearly all tendon organs commenced firing at a shorter muscle length during slow passive stretch than before, probably because of a rise in whole muscle passive tension. There was a small drop in the sensitivity to incremental tension, but no mean change in tension threshold. Following the eccentric contractions, there was a small, but not significant, increase in tendon organ sensitivity to active tension, which was graded using a method of optimised, distributed stimulation of divided ventral roots. Sensitivity was estimated as the mean response over a range of tensions and as the change in discharge rate in response to incremental tension. The experiments provided the opportunity of comparing tendon organ sensitivities to graded passive and active whole muscle tension. In agreement with previous work in which whole muscle nerve stimulation was employed, little difference was found. It was concluded that the peripheral contribution to perturbations of force perception after eccentric exercise is likely to be small and that the centrally derived sense of effort plays the dominant role. Tendon organs appear to be remarkably reliable in signalling whole muscle tension, whether passive or active, and even after the muscle's force production has been disturbed by fatigue or eccentric exercise.

Human hamstring muscles adapt to eccentric exercise by changing optimum length.

PURPOSE: It is now established that unaccustomed eccentric exercise leads to muscle fiber damage and to delayed-onset muscle soreness (DOMS) in the days after exercise. However, a second bout of eccentric exercise, a week after the first, produces much less damage and soreness. The purpose of this study was to provide evidence from muscle mechanical properties of a proposed mechanism for this training effect in human hamstring muscles. METHODS: The eccentric exercise involved 12 sets of 6 repetition "hamstring lowers," performed on specially designed equipment. Hamstring angle-torque curves were constructed for each of 10 subjects (8 male and 2 female) while they performed maximum voluntary knee extension and flexion movements on an isokinetic dynamometer. Testing sessions were performed over the week before eccentric exercise, immediately post exercise, and daily, up to 8 d post exercise. Subject soreness ratings and leg girth measurements were also made post exercise. Six subjects performed a second bout of eccentric exercise, 8 d after the first, and measurements were continued up to 10 d beyond that. RESULTS: There was a significant shift in the optimum angle for torque generation (Lo), to longer muscle lengths immediately post exercise (7.7 degrees +/- 2.1 degrees, P < 0.01), indicating an increase in series compliance within some muscle fibers. Subsequent measurements showed increases in leg girth and some muscle soreness, suggesting muscle damage. The shift in Lo persisted, even after other injury parameters had returned to normal, consistent with a training effect. Subjects also showed fewer signs of muscle damage after the second exercise bout. CONCLUSION: This is the first study to show a sustained shift in optimum angle of human muscle as a protective strategy against injury from eccentric exercise. Implications of this work for athletes, particularly those prone to hamstring strains are discussed.