A Morphological Study of the Meniscus, Cartilage and Subchondral Bone Following Closed-Joint Traumatic Impact to the Knee.

Post-traumatic osteoarthritis (PTOA) is a debilitating disease that is a result of a breakdown of knee joint tissues following traumatic impact. The interplay of how these tissues influence each other has received little attention because of complex interactions. This study was designed to correlate the degeneration of the menisci, cartilage and subchondral bone following an acute traumatic event that resulted in anterior cruciate ligament (ACL) and medial meniscus tears. We used a well-defined impact injury animal model that ruptures the ACL and tears the menisci. Subsequently, the knee joints underwent ACL reconstruction and morphological analyses were performed on the menisci, cartilage and subchondral bone at 1-, 3- and 6-months following injury. The results showed that the morphological scores of the medial and lateral menisci worsened with time, as did the tibial plateau and femoral condyle articular cartilage scores. The medial meniscus was significantly correlated to the medial tibial subchondral bone at 1 month (p = 0.01), and to the medial tibial cartilage at 3 months (p = 0.04). There was only one significant correlation in the lateral hemijoint, i.e., the lateral tibial cartilage to the lateral tibial subchondral bone at 6 months (p = 0.05). These data may suggest that, following trauma, the observed medial meniscal damage should be treated acutely by means other than a full or partial meniscectomy, since that procedure may have been the primary cause of degenerative changes in the underlying cartilage and subchondral bone. In addition to potentially treating meniscal damage differently, improvements could be made in optimizing treatment of acute knee trauma.

Influence of age and housing systems on properties of tibia and humerus of Lohmann White hens1: Bone properties of laying hens in commercial housing systems.

This study was aimed at analyzing bone properties of Lohmann White hens in different commercial housing systems at various points throughout production. Pullets reared in conventional cages (CC) were either continued in CC or moved to enriched colony cages (EN) at 19 weeks. Pullets reared in cage-free aviaries (AV) were moved to AV hen houses. Bone samples were collected from 60 hens at each of 18 and 72 wk and 30 hens at 26 and 56 wk from each housing system. Left tibiae and humeri were broken under uniform bending to analyze mechanical properties. Cortical geometry was analyzed using digital calipers at the fracture site. Contralateral tibiae and humeri were used for measurement of ash percentage. AV pullets' humeri had 41% greater cortical areas, and tibiae had 19% greater cortical areas than the CC pullets (P < 0.05). Average humeri diameter was greater in AV pullets than in CC pullets (P < 0.05), whereas the tibiae outer dimensions were similar. Aviary pullet bones had greater stiffness (31 and 7% greater for tibiae and humeri, respectively) and second moment of inertia (43 and 13% greater for tibiae and humeri, respectively) than CC pullets (P < 0.05). The differences between bones of AV and CC hens persisted throughout the laying cycle. Moving CC pullets to EN resulted in decreased endosteal resorption in humeri, evident by a 7.5% greater cortical area in the EN hens (P < 0.05). Whole-bone breaking strength did not change with age. Stiffness increased with age, while energy to failure decreased in both the tibiae and humeri. These results indicated that tibiae and humeri of laying hens become stiffer but lose toughness and become brittle with age. Furthermore, AV and EN systems can bring positive changes in mechanical and structural properties that are more pronounced in the humerus than the tibia.

A study of acute and chronic tissue changes in surgical and traumatically-induced experimental models of knee joint injury using magnetic resonance imaging and micro-computed tomography.

OBJECTIVE: The objective of this study was to monitor the progression of joint damage in two animal models of knee joint trauma using two non-invasive, clinically available imaging modalities. METHODS: A 3-T clinical magnet and micro-computed tomography (µCT) was used to document changes immediately following injury (acute) and post-injury (chronic) at time points of 4, 8, or 12 weeks. Joint damage was recorded at dissection and compared to the chronic magnetic resonance imaging (MRI) record. Fifteen Flemish Giant rabbits were subjected to a single tibiofemoral compressive impact (ACLF), and 18 underwent a combination of anterior cruciate ligament (ACL) and meniscal transection (mACLT). RESULTS: All ACLF animals experienced ACL rupture, and 13 also experienced acute meniscal damage. All ACLF and mACLT animals showed meniscal and articular cartilage damages at dissection. Meniscal damage was documented as early as 4 weeks and worsened in 87% of the ACLF animals and 71% of the mACLT animals. Acute cartilage damage also developed further and increased in occurrence with time in both models. A progressive decrease in bone quantity and quality was documented in both models. The MRI data closely aligned with dissection notes suggesting this clinical tool may be a non-invasive method for documenting joint damage in lapine models of knee joint trauma. CONCLUSIONS: The study investigates the acute to chronic progression of meniscal and cartilage damage at various time points, and chronic changes to the underlying bone in two models of posttraumatic osteoarthritis (PTOA), and highlights the dependency of the model on the location, type, and progression of damage over time.

Housing conditions alter properties of the tibia and humerus during the laying phase in Lohmann white Leghorn hens.

Osteoporosis in caged hens is one driving factor for the United States egg industry to explore options regarding alternative housing systems for laying hens. The aim of our research was to study the influence of housing systems on tibiae and humeri of 77-week-old Lohmann White hens. Pullets raised in an aviary system were either continued in aviary hen systems (AV) or conventional cages (AC) whereas pullets reared in conventional cages continued in conventional hen cages (CC) or enriched colony cages (EN) at 19 weeks. From each group, 120 hens were randomly euthanized and right and left tibae and humeri were excised for structural and mechanical analysis. Volumetric density of the cortical bone was measured using quantitative computed tomography (QCT). Aviary (AV) hens had greater cortical thickness and density but similar outer dimensions to AC hens (P < 0.05). Hens in EN system had humeri with similar cortical thickness and density but wider outer dimensions than the humeri of CC hens (P < 0.05). Cortical geometry of the tibiae was the same for the EN and CC hens, whereas EN hens had denser tibial cortex than CC hens (P < 0.05). Geometrical changes in the humeri suggest that hens in the AV system were better able to protect their structure from endosteal resorption during the laying phase. Humeri of AV and EN hens had increased second moment of area compared to the AC and CC hens; however, the changes were not observed in tibiae. Mechanical property differences were observed, with bones of AV hens having greater failure moment and stiffness than AC hens and the same difference was observed between the EN and CC hens, (P < 0.05). These findings indicate that movement limitation causes loss of bone mass and density whereas provision of moderate movement increases certain bone quality parameters during adulthood in laying hens.

Effect of bending direction on the mechanical behaviour of 3.5 mm String-of-Pearls and Limited Contact Dynamic Compression Plate constructs.

OBJECTIVE: To compare the bending properties of String-of-Pearls® (SOP) and Limited Contact Dynamic Compression Plate® (LC-DCP) constructs in orthogonal bending directions. METHODS: 3.5 mm SOP and LC-DCP plates were fixed to a bone model simulating a comminuted tibial fracture. Specimens were non-destructively tested in both mediolateral and craniocaudal bending for 10 cycles. Bending stiffness and total angular deformation were compared using parametric analyses (p <0.05). RESULTS: For both constructs, stiffness was significantly less when bending moments were applied against the thickness of the plates (mediolateral bending) than against the width (craniocaudal bending). When compared to the mediolateral plane, bending constructs in the craniocaudal plane resulted in a 49% (SOP group) and 370% (LC-DCP group) increase in stiffness (p <0.001). Mediolateral bending stiffness was significantly greater in the SOP than the LC-DCP constructs. Conversely, in craniocaudal bending, SOP constructs stiffness was significantly less than that of the LC-DCP constructs. The differences between the two constructs in total angular deformation had an identical pattern of significance. CLINICAL SIGNIFICANCE: This study found that SOP showed less variability between the orthogonal bending directions than LC-DCP in a comminuted fracture model, and also described the bi-planar bending behaviour of both constructs. Although not exhibiting identical bending properties in both planes, SOP constructs had a more homogenous bending behaviour in orthogonal loading directions. The difference between the SOP with a circular cross sectional shape compared to the rectangular shape of standard plates is probably responsible for this difference.

Effect of rearing environment on bone growth of pullets.

Alternative housing systems for laying hens provide mechanical loading and help reduce bone loss. Moreover, achieving greater peak bone mass during pullet phase can be crucial to prevent fractures in the production period. The aim of this study was to determine the housing system effects on bone quality of pullets. Tibiae and humeri of White Leghorn pullets reared in conventional cages (CCs) and a cage-free aviary (AV) system were studied. At 16 wk, 120 birds at random from each housing system were euthanized. Right and left tibiae and humeri were collected and further analyzed. Cortical bone density and thickness were measured using computed tomography. Periosteal and endosteal dimensions were measured at the fracture site during mechanical testing. At 4, 8, 12, and 16 wk, serum concentrations of osteocalcin and hydroxylysyl pyridinoline were analyzed as markers of bone formation and resorption. Cortical bone density was higher (P<0.05) in humeri of AV pullets, and tibiae were denser (P<0.05) for AV pullets in the distal section of the bone compared to CC pullets. Ash content was higher (P<0.05) in AV humeri with no difference in tibiae ash content. Tibiae and humeri of AV pullets had a thicker cortex than the CC pullets (P<0.05). Additionally, the tibiae and humeri of AV pullets had greater (P<0.05) second moment of areas than the CC pullets. While some bone material properties between groups were different (P<0.05), the differences were so small (<7%) that they likely have no clinical significance. Serum osteocalcin concentrations were not different between the treatments, but hydroxylsyl pyridinoline concentrations were higher in CC pullets at 12 wk compared to the AV pullets and the effect reversed at 16 wk (P<0.05). These findings indicate that tibiae and humeri respond differently to load bearing activities during growth. The improved load bearing capability and stiffness in bones of AV pullets were related to increased cross-sectional geometry.

Bone characteristics and femoral strength in commercial toms: the effect of protein and energy restriction.

Selection for rapid growth in turkeys has resulted in skeletal problems such as femoral fractures. Slowing growth rate has improved bone structure, but the effect on mechanical properties of the bone is unclear. The current study's hypothesis was that slowing the growth of turkeys by reducing energy and CP in the diet would result in increased femur integrity. Commercial turkeys were fed 1 of 3 diets: control with 100% of NRC energy and CP levels, as well as a diet feeding 80 or 60% of NRC energy and CP levels. All other nutrients met or exceeded NRC requirements. Control birds were grown to 20 wk of age, whereas the 80 and 60% NRC birds were sampled when BW matched that of control birds at wk 4, 8, 12, 16, and 20. Both femurs were extracted, with one being measured and ashed and the other twisted to failure to evaluate mechanical properties. Total bone length, diameter, cortical thickness, and cortical density were measured. The total femur length was longer in the 60% NRC birds at 5 and 10 kg of BW compared with control (P < 0.05); this significance was lost by the time birds reached 16 kg of BW. At 5 and 10 kg of BW, ash content was higher in the control birds than in the 60% NRC birds (P < 0.05). At 16 kg of BW, the 60% NRC birds had the highest femur ash (P < 0.05). The mechanical testing parameters were failure torque, shear strength, and shear modulus of the bones. The 60% diet produced the highest failure torque (P < 0.05), at 16 kg of BW and onward. The shear strength was greater (P = 0.01) once the birds reached 5 kg of BW for the 60% diet than other diets. In conclusion, reducing the energy and protein in the diet to 60% of NRC recommendations, thus slowing growth, improved bone strength, as measured by failure torque, and bone quality, as measured by shear strength, without altering bone length or ash content by the time birds reached market weight.

In vitro mechanical evaluation of a limited contact dynamic compression plate and hybrid carpal arthrodesis plate for canine pancarpal arthrodesis.

OBJECTIVE: To compare the mechanical properties of pancarpal arthrodesis (PCA) constructs stabilized at 20° of extension using either a 3.5 mm limited contact dynamic compression plate (LC-DCP) or a 3.5/2.7 mm hybrid plate (HP). METHODS: Seven forelimb pairs were used from dogs of similar size. All soft tissues were removed except for supporting structures of the carpus and proximal metacarpal region. All plates were accurately bent to 20°, and then instrumented with two, 350Ω strain gauges applied at the level of the bend. Constructs were embedded in epoxy moulds then mounted onto a servo-hydraulic testing machine. Specimens were loaded for 10 cycles at 100N, 200N and 300N. Tenth cycle construct compliance (CC), maximum angular deformation (MAD), and peak plate strain (PPS) were compared using two-factor analysis of variance (ANOVA) and Student-Newman-Keuls post-hoc tests (p <0.05). RESULTS: Regardless of load, CC was 29% to 33% smaller in the HP than the LC-DCP group (p <0.03). In each group, the CC significantly increased with increasing loads (p <0.02). Mean MAD was 19% to 22% less in HP than LC-DCP constructs, with significant differences seen at 200N and 300N loads. In both groups, MAD was significantly greater with increasing loads (p <0.02). In addition, PPS was 37% to 43% smaller for HP than LC-DCP. CLINICAL SIGNIFICANCE: The mechanical advantages of the HP over the LC-DCP make it a viable alternative for PCA. Smaller CC, MAD and PSS of the HP may reduce the risk of implant failure and postoperative morbidity following PCA.

Effect of bending direction on the mechanical behaviour of interlocking nail systems.

OBJECTIVES: To compare the mechanical properties of various interlocking nail constructs in medio-lateral (ML) and cranio-caudal (CC) bending. METHODS: Synthetic bone models simulating a severely comminuted tibial fracture were treated with either screwed or bolted, 6 or 8 mm standard interlocking nails (ILN), or an angle-stable ILN (AS-ILN), after which they were then sequentially tested in ML and CC bending. Construct compliance, maximum angular deformation (MaxDef) and slack were statistically compared (p<0.05). RESULTS: The compliance of all constructs was significantly greater in CC than in ML bending. However, due to the presence of a greater slack in the ML plane, standard ILN constructs sustained significantly more deformation in that plane. Maximum deformation of the novel AS-ILN constructs was the smallest of all constructs and consistently occurred without slack regardless of bending direction. CLINICAL SIGNIFICANCE: This study suggested that standard ILN construct overall deformation and acute instability (slack) may be more critical in ML than in CC bending. Conversely, the small MaxDef and the absence of slack in both bending planes seen in novel angle-stable AS-ILN may provide optimal construct stability and in turn may be more conducive to bone healing.

Association of knee bone bruise frequency with time postinjury and type of soft tissue injury.

This study correlated the frequency of bone bruises with soft tissue injuries in the knee and examined bruise frequency as a function of time postinjury. Magnetic resonance imaging of 1546 patients revealed bone bruises in 19% of patients without an associated meniscal or ligamentous injury. For those patients presenting with at least one meniscoligamentous injury, the frequency of bruising was 60% at 0 to 4 weeks, 42% at 4 to 10 weeks, and 31% at 10 to 26 weeks postinjury. The frequency of bruising varied with the presence of concomitant injuries, with the greatest frequency of bruises (78%) observed in patients with anterior cruciate ligament injuries.

Treatment with the non-ionic surfactant poloxamer P188 reduces DNA fragmentation in cells from bovine chondral explants exposed to injurious unconfined compression.

Excessive mechanical loading to a joint has been linked with the development of post-traumatic osteoarthritis (OA). Among the suspected links between impact trauma to a joint and associated degeneration of articular cartilage is an acute reduction in chondrocyte viability. Recently, the non-ionic surfactant poloxamer 188 (P188) has been shown to reduce by approximately 50% the percentage of non-viable chondrocytes 24 h post-injury in chondral explants exposed to 25 MPa of unconfined compression. There is a question whether these acutely 'saved' chondrocytes will continue to degrade over time, as P188 is only thought to act by acute repair of damaged cell membranes. In order to investigate the degradation of traumatized chondrocytes in the longer term, the current study utilized TUNEL staining to document the percentage of cells suffering DNA fragmentation with and without an immediate 24 h period of exposure of the explants to P188 surfactant. In the current study, as in the previous study by this laboratory, chondral explants were excised from bovine metacarpophalangeal joints and subjected to 25 MPa of unconfined compression. TUNEL staining was performed at 1 h, 4 days, and 7 days post-impact. The current study found that P188 was effective in reducing the percentage of cells with DNA fragmentation in impacted explants by approximately 45% at 4 and 7 days post-impact. These data suggest that early P188 intervention was effective in preventing DNA fragmentation of injured chondrocytes. The current hypothesis is that this process was mitigated by the acute repair of damaged plasma membranes by the non-ionic surfactant P188, and that most repaired cells did not continue to degrade as measured by the fragmentation of their DNA.

Exposure to a standard culture medium alters the response of cartilage explants to injurious unconfined compression.

Previous studies on chondral explants have not clearly described to what extent the degree and the distribution of cell death are dependent on the amount of free swelling seen during tissue equilibration in a standard culture medium. The current study hypothesized that increased fluid content inside equilibrated chondral explants, when subjected to injurious compression, would lead to greater matrix damage during unconfined compression. Equilibrated and non-equilibrated chondral explants were loaded to 30 MPa at a fast rate of loading ( approximately 600 MPa/s). Stress-strain curves were documented for each explant. Matrix damage was assessed by the length of surface fissures. Chondrocyte viability was also measured in the various layers of the explants. The stiffness of the equilibrated specimens was less than non-equilibrated specimens, and it correlated with the amount of fluid absorbed during equilibration. More matrix damage and associated cell death in the superficial zone were documented in equilibrated than non-equilibrated explants, and these correlated positively with fluid absorbed during equilibration. This study indicated that equilibration of chondral explants in a standard culture medium alters their response to mechanical loading in terms of stiffness, matrix damage and cell viability.

Gene expression profile of mechanically impacted bovine articular cartilage explants.

Traumatic injury to a joint can initiate cartilage degradation. Blunt trauma increases matrix damage and decreases proteoglycan synthesis in in vitro models. Few studies have investigated gene expression of articular cartilage (AC) following mechanical loading. Recent advances in microarray technology allow analysis of a number of genes, and may elucidate pathways of AC degradation. In the present study, we used a bovine cDNA microarray to determine how acute trauma of cartilage explants in the absence of underlying bone alters gene expression. Results indicate that at least 19 genes were differentially expressed at 3 h after trauma. Fourteen genes were up-regulated and five genes were down-regulated relative to control explants. The up-regulated genes included cytokine and chemokine receptors, enzymes, and molecules involved in signal transduction. Genes of adhesion molecules and apoptosis were down-regulated. The results of this study highlight the potential benefits of using a bovine cDNA microarray to study cartilage metabolism.

The limitation of acute necrosis in retro-patellar cartilage after a severe blunt impact to the in vivo rabbit patello-femoral joint.

We have previously shown that surface lesions and acute necrosis of chondrocytes are produced by severe levels of blunt mechanical load, generating contact pressures greater than 25 MPa, on chondral and osteochondral explants. We have also found surface lesions and chronic degradation of retro-patellar cartilage within 3 years following a 6J impact intensity with an associated average pressure of 25 MPa in the rabbit patello-femoral joint. We now hypothesized that cellular necrosis is produced acutely in the retro-patellar cartilage in this model as a result of a 6J impact and that an early injection of the non-ionic surfactant, poloxamer 188 (P188), would significantly reduce the percentage of necrotic cells in the traumatized cartilage. Eighteen rabbits were equally divided into a 'time zero' group and two other groups carried out for 4 days. One '4 day' group was administered a 1.5 ml injection of P188 into the impacted joint immediately after trauma, while the other was injected with a placebo solution. Impact trauma produced surface lesions on retro-patellar cartilage in all groups. Approximately 15% of retro-patellar chondrocytes suffered acute necrosis in the 'time zero' and '4-day no poloxamer' groups. In contrast, significantly fewer cells (7%) suffered necrosis in the poloxamer group, most markedly in the superficial cartilage layer. The use of P188 surfactant early after severe trauma to articular cartilage may allow sufficient time for damaged cells to heal, which may in turn mitigate the potential for post-traumatic osteoarthritis. Additional studies are needed to improve the efficacy of this surfactant and to determine the long-term health of joint cartilage after P188 intervention.

The extent and distribution of cell death and matrix damage in impacted chondral explants varies with the presence of underlying bone.

Excessive mechanical loading can lead to matrix damage and chondrocyte death in articular cartilage. Previous studies on chondral and osteochondral explants have not clearly distinguished to what extent the degree and the distribution of cell death are dependent on the presence of an underlying layer of bone. The current study hypothesized that the presence of underlying bone would decrease the amount of matrix damage and cell death. Chondral and osteochondral explants were loaded to 30 MPa at a high rate of loading (approximately 600 MPa/s) or at a low rate of loading (30 MPa/s). After 24 hours in culture, matrix damage was assessed by the total length and average depth of surface fissures. The explants were also sectioned and stained for cell viability in the various layers of the cartilage. More matrix damage was documented in chondral than osteochondral explants for each rate of loading experiment. The total amount of cell death was also less in osteochondral explants than chondral explants. The presence of underlying bone significantly reduced the extent of cell death in all zones in low rate of loading tests. The percentage of cell death was also reduced in the intermediate zone and deep zones of the explant by the presence of the underlying bone for a high rate of loading. This study indicated that the presence of underlying bone significantly limited the degree of matrix damage and cell death, and also affected the distribution of dead cells through the explant thickness. These data may have relevance to the applicability of experimental data from chondral explants to the in situ condition.

The extent of matrix damage and chondrocyte death in mechanically traumatized articular cartilage explants depends on rate of loading.

Mechanical loads can lead to matrix damage and chondrocyte death in articular cartilage. This damage has been implicated in the pathogenesis of secondary osteoarthritis. Studies on cartilage explants with the attachment of underlying bone at high rates of loading have documented cell death adjacent to surface lesions. On the other hand, studies involving explants removed from bone at low rates of loading suggest no clear spatial association between cell death and matrix damage. The current study hypothesized that the observed differences in the distribution of cell death in these studies are attributed to the rate of loading. Ninety bovine cartilage explants were cultured for two days. Sixty explants were loaded in unconfined compression to 40 MPa in either a fast rate of loading experiment (approximately 900 MPa/s) or a low rate of loading experiment (40 MPa/s). The remaining 30 explants served as a control population. All explants were cultured for four days after loading. Matrix damage was assessed by measuring the total length and average depth of surface lesions and the release of glycosaminoglycans to the culture media. Explants were sectioned and stained with calcein and ethidium bromide homodimer to document the number of live and dead cells. Greater matrix damage was documented in explants subjected to a high rate of loading, compared to explants exposed to a low rate of loading. The high rate of loading experiments resulted in cell death adjacent to fissures, whereas more dead cells were observed in the low rate of loading experiments and a more diffuse distribution of dead cells was observed away from the fissures. In conclusion, this study indicated that the rate of loading can significantly affect the degree of matrix damage, the distribution of dead cells, and the amount of cell death in unconfined compression experiments on explants of articular cartilage.

Injuries produced by blunt trauma to the human patellofemoral joint vary with flexion angle of the knee.

Patellofemoral joint impact trauma during car accidents, sporting activities, and falls can produce acute gross fracture of bone, microfracture of bone, and soft tissue injury. Field studies of car accidents, however, show that most patellofemoral traumas are classified as 'subfracture' level injuries. While experimental studies have shown that the influence of flexion angle at impact is not well understood, flexion angle may influence injury location and severity. In the current study, 18 pairs of isolated human cadaver knees were subjected to blunt impact at flexion angles of 60 degrees, 90 degrees, or 120 degrees. One knee from each cadaver was sequentially impacted until gross fracture of bone was produced. The contralateral knee was subjected to a single, subfracture impact at 45% of the impact energy producing fracture in the first knee. The fracture experiments produced gross fracture of the patella and femoral condyles with the fracture plane positioned largely within the region of patellofemoral contact. The fracture location and character changed with flexion angle: at higher flexion angles the proximal pole of the patella and the femoral condyles were more susceptible to injury. For the 90 degrees flexion angle, the patella was fractured centrally, while at 60 degrees the distal pole fractured transversely at the insertion of the patellar tendon. In addition, the load magnitude required to produce fracture increased with flexion angle. In the 'subfracture' knees, injuries were documented for all flexion angles; occult microfractures of the subchondral and trabecular bone and fissures of the articular surface. Similar to the fracture-level experiments, the injuries coincided with the patellofemoral contact region. These data show that knee flexion angle plays an important role in impact related knee trauma. Such data may be useful in the clinical setting, as well as in the design of injury prevention strategies.

Impact responses of the flexed human knee using a deformable impact interface.

Blunt impact trauma to the patellofemoral joint during car accidents, sporting activities, and falls can produce a range of injuries to the knee joint, including gross bone fracture, soft tissue injury, and/or microinjuries to bone and soft tissue. Currently, the only well-established knee injury criterion applies to knee impacts suffered during car accidents. This criterion is based solely on the peak impact load delivered to seated cadavers having a single knee flexion angle. More recent studies, however, suggest that the injury potential, its location, and the characteristics of the damage are also a function of knee flexion angle and the stiffness of the impacting structure. For example, at low flexion angles, fractures of the distal patella are common with a rigid impact interface, while at high flexion angles splitting of the femoral condyles is more evident. Low stiffness impact surfaces have been previously shown to distribute impact loads over the anterior surface of the patella to help mitigate gross and microscopic injuries in the 90 deg flexed knee. The objective of the current study was to determine if a deformable impact interface would just as effectively mitigate gross and microscopic injuries to the knee at various flexion angles. Paired experiments were conducted on contralateral knees of 18 human cadavers at three flexion angles (60, 90, 120 deg). One knee was subjected to a fracture level impact experiment with a rigid impactor, and the opposite knee was impacted with a deformable interface (3.3 MPa crush strength honeycomb material) to the same load. This (deformable) impact interface was effective at mitigating gross bone fractures at approximately 5 kN at all flexion angles, but the frequency of split fracture of the femoral condyles may not have been significantly reduced at 120 deg flexion. On the other hand, this deformable interface was not effective in mitigating microscopic injuries observed for all knee flexion angles. These new data, in concert with the existing literature, suggest the chosen impact interface was not optimal for knee injury protection in that fracture and other minor injuries were still produced. For example, in 18 cadavers a total of 20 gross fractures and 20 subfracture injuries were produced with a rigid interface and 5 gross fractures and 21 subfracture injuries with the deformable interface selected for the current study. Additional studies will be needed to optimize the knee impact interface for protection against gross and microscopic injuries to the knee.

Blunt injuries to the patellofemoral joint resulting from transarticular loading are influenced by impactor energy and mass.

Various impact models have been used to study the injury mechanics of blunt trauma to diarthrodial joints. The current study was designed to study the relationship between impactor energy and mass on impact biomechanics and injury modalities for a specific test condition and protocol. A total of 48 isolated canine knees were impacted once with one of three free flight inertial masses (0.7, 1.5, or 4.8 kg) at one of three energy levels (2, 11, 22 J). Joint impact biomechanics (peak load, loading rate, contact area) generally increased with increasing energy. Injuries were typically more frequent and more severe with the larger mass at each energy level. Histological analyses of the patellae revealed cartilage injuries at low energy with deep injuries in underlying bone at higher energies.

Tissue-engineered rotator cuff tendon using porcine small intestine submucosa. Histologic and mechanical evaluation in dogs.

To determine its efficacy in stimulating the regeneration of a rotator cuff tendon, an implant of 10-ply porcine small intestinal submucosa was used to replace a completely resected infraspinatus tendon in 21 adult mongrel dogs. The contralateral infraspinatus tendon was elevated and then reattached to the greater tubercle with sutures to mimic conventional repair (sham operation). Mechanical evaluations were performed at 0, 3, and 6 months (five specimens at each time period). Histologic comparisons were made at 3 and 6 months (three specimens). At both times, the gross appearance, histologic continuity, and failure mode of the constructs mimicked those of sham-operated and native infraspinatus tendons, thus suggesting host tissue ingrowth and implant remodeling with solid integration of the regenerated tissue to muscular and bony interfaces. Tissue ingrowth occurred without histologic evidence of foreign body or immune-mediated reactions or adhesions to peripheral tissues. Sham operations simulated tendon mobilization and reimplantation procedures routinely performed to treat chronic rotator cuff tendon injuries. Although the ultimate strength of small intestinal submucosa-regenerated tendons was significantly less than that of native infraspinatus tendons (P < 0.001), it was similar to that of reimplanted tendons at 3 (P > 0.05) and 6 months (P > 0.05).