Does low-intensity pulsed ultrasound stimulate maturation of tissue-engineered cartilage?

Traumatic events are a primary cause of local lesions of articular cartilage. Tissue engineered, cartilage-like structures represent an alternative to current treatment methods. The time necessary for tissue maturation and the mechanical quality of the regenerate at implantation are both critical factors for clinical success. Low-intensity pulsed ultrasound has proven to accelerate chondrogenesis in vitro. The goal of this study was to evaluate whether low-intensity pulsed ultrasound is capable of accelerating the process of cartilage maturation and increasing regenerate stability. Hyaline-like cartilage specimens were generated in vitro and subcutaneously implanted in the backs of nude mice. Twenty-eight animals received 20 min of low-intensity pulsed ultrasound treatment daily, and 28 animals received a sham treatment. Specimens were explanted after 1, 3, 6, and 12 weeks, mechanically tested with the use of an indentation test, histologically examined, and processed for RT-PCR. The Young's moduli significantly increased from 3 to 12 weeks, and at 6 weeks were comparable to those of native articular cartilage. In histological examination, specimens showed neocartilage formation. There was no significant difference between ultrasound-treated and sham-treated groups. The mechanical stability of the neocartilage specimens increased with treatment time and reached values of native cartilage after 6 weeks in vivo. Low-intensity pulsed-ultrasound stimulation showed no stimulatory effect on tissue maturation. In contrast, ultrasound-treated specimens showed a reduced Col 2 expression at 1 week and were significantly less stiff compared to native cartilage at 6 and 12 weeks. An acceleration of the maturation of tissue-engineered neocartilage in a clinical setting by means of low-intensity pulsed ultrasound therefore appears rather unrealistic.

Cartilage thickness of the trochlea of the talus, with emphasis on sites predisposed to osteochondrosis dissecans, in clinically normal juvenile and adult dogs.

OBJECTIVE: To evaluate cartilage thickness of the talus (especially at sites predisposed to osteochondrosis dissecans [OCD]) in growing and adult dogs not affected with OCD. SAMPLE: Tarsocrural joints from cadavers of 34 juvenile (approx 3 months old) and 10 adult dogs. PROCEDURES: Tarsal cartilage thickness was examined via a stereophotography microscopic system. Articular cartilage thickness was determined at 11 locations on longitudinal slices of the trochlear ridges and the sulcus between the ridges and at 2 locations in the cochlea tibiae. Cartilage thickness was measured at the proximal, proximodorsal, dorsal, and distal aspects of the trochlear ridges; proximodorsal, dorsal, and distal aspects of the trochlear sulcus; and craniolateral and caudomedial aspects of the cochlea tibiae. Differences within a joint and between sexes were evaluated. RESULTS: Mean cartilage thickness decreased from proximal to distal in juvenile (lateral trochlear ridge, 1.52 to 0.41 mm; medial trochlear ridge, 1.10 to 0.40 mm) and from proximal to dorsal in adult (lateral trochlear ridge, 0.41 to 0.34 mm; medial trochlear ridge, 0.33 to 0.23 mm) dogs. Cartilage was thickest at the proximal aspect of the lateral trochlear ridge in both groups. Differences in proximodorsal, dorsal, and distal aspects of the ridges were not evident. CONCLUSIONS AND CLINICAL RELEVANCE: Healthy tarsocrural joints did not have thicker cartilage in sites predisposed to development of OCD. Evaluation of affected tarsocrural joints is necessary to exclude influences of cartilage thickness. These data are useful as a reference for distribution of cartilage thickness of the trochlea of the talus in dogs.

Interfragmentary movements in the early phase of healing in distraction and correction osteotomies stabilized with ring fixators.

BACKGROUND: Experimental analyses have demonstrated the impact of mechanical conditions on bone healing. In critical clinical cases the mechanical conditions may be even more demanding than those in experimental studies. This study set out to examine the gap movements in distraction and correction osteotomies and to determine the suitability of initial fixation. PATIENTS AND METHODS: Interfragmentary movements, ground reaction forces, and stability (ground reaction force divided by interfragmentary movement) were measured in 18 patients with tibial osteotomies stabilized by Ilizarov hybrid constructs until either bone union or conversion to internal fixation occurred (9 distraction treatments, 9 correction osteotomies). Consolidation was determined by clinical evaluation and standard radiographic techniques. RESULTS: In both groups cocontraction led to gap movements comparable to level walking. Although the in vitro stiffness was slightly increased in the correction constructs, the interfragmentary movement in vivo was initially comparable between the groups. Patients undergoing distraction returned later to full weight bearing than patients undergoing correction treatment. In the correction group the stability increased with treatment time, while in the distraction group the stability remained relatively small. CONCLUSIONS: The in vivo mechanical conditions in challenging clinical cases appear far more demanding than those in experimental studies. In distraction, mechanical conditions at the defect appear to be more critical than during correction osteosynthesis. According to the persistence of shear motion, even after 80 days of treatment, it may from the clinical point of view be important to maintain interfragmentary compression during the whole healing process and thereby reduce shear.

Interfragmentary motion in tibial osteotomies stabilized with ring fixators.

Relative movement of bone fragments affects healing processes. In vivo data exist for patients with reduced transverse fractures only. The gap movements that occur under more complex conditions such as in tibial osteotomies, however, are unknown. The goal of this study was to determine the initial gap movements in tibial correction osteotomies, to monitor movements during the early healing period, and to determine the suitability of initial fixation stability in relation to daily activities. The interfragmentary movements were measured in six patients with correction osteotomies stabilized by Ilizarov ring fixator constructs until union or until conversion to internal fixation. Consolidation was determined by clinical evaluation and standard radiographic techniques. Co-contraction led to gap movements comparable with level walking or standing. Shear generally exceeded axial compression. Although ground reactions and fixation stiffness were comparable with those reported for reduced fractures, movement magnitudes generally were larger than 2 mm. The shear movement component reflected the nature of the mechanical conditions at the bone gap. In a direct comparison with data from animal experiments, the local mechanical environment at the bone gap seemed unstable rather than overly stable. The method introduced in this study opens the perspective of adjusting osteosynthesis stability to the specific needs of each patient.