Demineralized bone matrix and platelet-rich plasma do not improve healing of osteochondral defects of the talus: an experimental goat study.

OBJECTIVE: The purpose of this study was to evaluate the effectiveness of demineralized bone matrix (DBM) with and without platelet-rich plasma (PRP) in the treatment of osteochondral defects (OCDs) of the talus. We hypothesized that treatment with DBM would result in more bone formation than no treatment in control OCDs, and that PRP would further enhance the regenerative capacity of DBM. METHOD: A standardized 6-mm OCD was created in each talus of 16 adult goats. According to a randomization scheme, one OCD of each goat was treated with allogeneic DBM hydrated with normal saline (n = 8) or hydrated with autologous PRP (n = 8). The contralateral OCD (n = 16) served as control. After 24 weeks, the animals were euthanized and the tali excised. Various outcome parameters were analyzed with use of macroscopic evaluation, micro-computed tomography (µCT), histology, histomorphometry, and fluorescence microscopy. RESULTS: None of the analyses revealed statistically significant differences between the groups for any of the parameters analyzed in any volume of interest. For example, the mean bone volume fraction (BV/TV) of the defect, as measured by µCT, was 0.56 (95% confidence interval [CI], 0.44-0.68) for DBM hydrated with normal saline and 0.52 (95% CI, 0.40-0.65) for DBM hydrated with PRP, compared to 0.53 (95% CI, 0.45-0.61) and 0.54 (95% CI, 0.44-0.64) for the internal controls, respectively (P > 0.05). CONCLUSION: In contrast to our hypotheses, no beneficial treatment effect of DBM with or without PRP was found for OCDs of the caprine talus.

Low-intensity pulsed ultrasound affects human articular chondrocytes in vitro.

We investigated whether low-intensity pulsed ultrasound (LIPUS) stimulates chondrocyte proliferation and matrix production in explants of human articular cartilage obtained from donors suffering from unicompartimental osteoarthritis of the knee, as well as in isolated human chondrocytes in vitro. Chondrocytes and explants were exposed to LIPUS (30 mW/cm(2); 20 min/day, 6 days). Stimulation of [35S]-sulphate incorporation into proteoglycans by LIPUS was 1.3-fold higher in degenerative than in collateral monolayers as assessed biochemically and 1.9-fold higher in explants as assessed by autoradiography. LIPUS decreased the number of cell nests containing 1-3 chondrocytes by 1.5 fold in collateral and by 1.6 fold in degenerative explants. LIPUS increased the number of nests containing 4-6 chondrocytes by 4.8 fold in collateral and by 3.9 fold in degenerative explants. This suggests that LIPUS stimulates chondrocyte proliferation and matrix production in chondrocytes of human articular cartilage in vitro. LIPUS might provide a feasible tool for cartilage tissue repair in osteoarthritic patients, since it stimulates chondrocyte proliferation and matrix production.

Stimulation of bone cell differentiation by low-intensity ultrasound--a histomorphometric in vitro study.

Several investigations have established a stimulatory effect of low-intensity ultrasound treatment on osteogenesis and fracture healing. The objective of this study was to examine whether the stimulatory effect of low-intensity ultrasound results in increased bone cell activity and/or proliferation. Twenty-four paired triplets of metatarsal bone rudiments of twelve 17-days-old fetal mice were dissected and divided into two groups. One group of bone rudiments was treated with pulsating low-intensity ultrasound (30 mW/cm(2); 1.5 MHz) for 20 min/day for a period of 3 or 6 days. The other group served as controls. After culture, the metatarsal bone rudiments were prepared for computer aided light microscopy. The following histomorphometric parameters were determined: length, width and volume of the calcified cartilage and of the bone collar, and cell number. GLM analysis demonstrated that bone collar volume and calcified cartilage percentage were significantly higher in the ultrasound-stimulated rudiments compared to untreated controls. Further, the calcified cartilage volume bordering the hypertrophic zone was significantly higher than in the center of the bone rudiment. Ultrasound treatment did not change the number of the cells. These results suggest that the stimulatory effect of low-intensity ultrasound on endochondral ossification is likely due to stimulation of bone cell differentiation and calcified matrix production, but not to changed cell proliferation.

[Effects of low-intensity ultrasound on bone. Perspectives for dentistry?]. / Effecten van lage-intensiteit ultrageluid op bot. Perspectieven voor de tandheelkunde?

Low-intensity ultrasound is frequently used for non-invasive diagnostic purposes. However, low intensity ultrasound can also be used as a therapeutical agent. It has been concluded from animal experiments that it significantly stimulates the growth of bone. In clinical trials an accelerated healing of fracture has been found. Future research has to define the role in dentistry and the final therapeutical value of low intensity ultrasound.

Agreement between radiographic and photographic trabecular patterns.

PURPOSE: It has been hypothesized that photographs can facilitate the interpretation of the radiographic characteristics of trabecular bone. The reliability of these photographic and radiographic approaches has been determined, as have various agreements between the two approaches and their correlations with biomechanical characteristics. MATERIAL AND METHODS: Fourteen vertebral bodies were obtained at autopsy from 6 women and 8 men aged 22-76 years. Photographs (n = 28) and radiographs (n = 28) were taken of midsagittal slices from the third lumbar vertebra. The radiographs and photographs were digitized and the geometric properties of the trabecular architecture were then determined with a digital image analysis technique. Information on the compressive strength and ash density of the vertebral body was also available. RESULTS: The geometric properties of both radiographs and photographs could be measured with a high degree of reliability (Cronbach's alpha > 0.85). Agreement between the radiographic and photographic approaches was mediocre as only the radiographic measurements showed significant correlations (p < 0.05) with the biomechanical characteristics. We suggest that optical phenomena may result in the insignificant correlations between the photographs and the biomechanical characteristics. CONCLUSION: For digital image processing, radiography offers a superior description of the architecture of trabecular bone to that offered by photography.

Reliability of an image analysis system for quantifying the radiographic trabecular pattern.

A reliability evaluation technique was used to examine the reliability of an image analysis system of the trabecular pattern and to determine the contribution of three possible sources of error variance. Two series of radiographs were taken of 14 lumbar vertebral slices (28 radiographs). Every radiograph was placed on a viewing box for digitization four times by a single operator (112 positions of radiographs) and from every position of a radiograph an area of 15 mm x 15 mm was digitized twice (224 samples for analysis). Ten geometrical characteristics of the trabecular pattern were studied and its orientation was analyzed in 12 directions. Reliability was determined by calculating Cronbach's alpha. This design enabled dividing the measurement error (1-alpha) into fractions associated with the X-ray procedure, the operator and the system. Using this reliability evaluation technique, it was found that the orientation variables are more reliable than the geometric variables. It was found that effort to increase the reliability should be directed toward improving the technical procedure of this image analysis system. Also, repeated measurements will increase the reliability. The number of repeated measurements based on a desired reliability can be calculated. This procedure of evaluation gives the opportunity to select a source of error variance which have to be reduced to increase reliability most effectively.

Relations between radiographic trabecular pattern and biomechanical characteristics of human vertebrae.

PURPOSE: Relations between the radiographic trabecular pattern and the biomechanical characteristics of bone were studied. MATERIAL AND METHODS: The material comprised L2 and L3 vertebral bodies of 14 individuals (aged 22-76 years; 6 women and 8 men). Compressive strength and ash density of the complete L2 vertebral body were determined. Of the L3 vertebral body, ash density and compressive strength in both horizontal and vertical directions were measured on cylinders of merely trabecular bone. Radiographs were taken of a midsagittal slice of L3 vertebrae. They were digitized to measure trabecular bone geometry and orientation. The procedure was repeated several times to obtain reliable measures. RESULTS: The radiographic trabecular pattern was significantly related to compressive strength, ash density and age. One of the radiographic geometric features in particular seems to offer information concerning the structural integrity of the trabecular architecture. CONCLUSION: Analysis of the radiographic trabecular pattern appears to be a promising technique for prediction of trabecular bone strength.

Longitudinal analysis of radiographic trabecular pattern by image processing.

To describe structural and textural changes in bone structure, the radiographic trabecular pattern of children, aged 4-14 years, was examined using a digital image processing system. This investigation is based on data from the Nijmegen Growth Study, a mixed-longitudinal growth study comprised of three birth cohorts, which were observed for five years. Of 3075 left hand-forearm radiographs of 426 children, a standard area of 10 x 10 mm of the radius was digitized and the trabecular pattern was described by ten image features. It is demonstrated that all image features show significant changes during the observation period (multivariate analysis of variance of p < 0.01). The age of the children correlates significantly with the image features (Spearman's Rho = 0.4; p < 0.05). Because of cohort effects, the three cohorts were studied separately. Highest correlations between age and trabecular pattern were shown in the cohort of the youngest children. The changes of the image features during the observation period seems to indicate that the fine trabecular pattern of young children changes into a coarser adult pattern. It is concluded that digital quantification of the radiographic trabecular pattern is appropriate to describe changes in trabecular bone.

An analysis of the orientation of the radiographic trabecular pattern in the distal radius of children.

A digital image processing system was used to study changes in orientation of the radiographic trabecular pattern of bone in children aged 4-14 years. The radiographs originated from a mixed-longitudinal growth study (The Nijmegen Growth Study), which comprised of three birth cohorts and which was carried out between 1971 and 1975. Of 3075 left hand-forearm radiographs of 426 children, the orientation of the trabecular pattern of the radius was analysed in twelve directions on a standard area of 10 x 10 millimetres. It was demonstrated that the trabecular pattern of the radius shows two predominant directions of orientation: along and perpendicular to the long axis of the radius. Spearman's Rank Correlations were calculated between direction of orientation and age of the children for the total population as well as for the cohorts separately, because the existence of cohorts-effects. The cohort of the youngest children showed more and higher significant correlations than the other cohorts, indicating that the trabecular pattern of young children is more subjected to changes. The results indicate that the prevalence of trabeculae orientated perpendicular to the long axis of the radius decreases. We speculate that this development reflects the effects of changes in mechanical loading in that direction during growth and development resulting in functional adaptation of the trabecular bone.

Longitudinal changes in the orientation of trabecular bone in relation to the location in the distal radius.

The aim of this study was to examine changes in orientation of trabecular bone during growth and development in relation to the location of trabeculae between the epiphysial growth plate and the marrow cavity. Five annual hand-wrist radiographs of 57 children between 4-9 years of age, originating from the Nijmegen Growth Study, were analysed by a digital image processing system. Analysis was carried out on four adjacent areas of 7 mm x 7 mm located in the distal head of the radius between the epiphyseal growthplate and the marrow cavity. The orientation of the trabecular pattern was measured in twelve directions. The orientation of trabeculae at a standardized distance from the epiphysial growth plate did not change significantly during growth and development. The orientation in directions perpendicular to the long axis of the radius was higher in newly formed trabecular bone, which is located just below the epiphysial growthplate, than in older trabecular bone at a larger distance from the epiphysial growth plate. Observation of one single area during five years of growth and development showed a comparable development.

[The stability of orthodontic treatment over the long term]. / De stabiliteit van het orthodontisch behandelings-resultaat op lange termijn.

The long term stability of orthodontic treatment was evaluated in 7 orthodontic patients who were three to 12 years out of retention. Dental relationships and irregularities in the dental arch were recorded and scored on study models taken prior to orthodontic treatment, at the end of active treatment, and at long term follow up. Lateral skull radiographs taken at the start of active treatment were also analysed. According to the (mal)occlusion observed on the post-retention study models it appeared that the sample could be subdivided into three groups. The group of patients with relatively good results after active treatment showed less relapse than the group with relatively moderate results after active treatment. The patients with relatively good treatment results were mostly treated with extractions followed by fixed appliances in both jaws. This observation indicates that treatment planning in this group generally was correct. Patients showing skeletal Class II features before orthodontic treatment showed most relapse in overjet and overbite.