Impact insertion of osteochondral grafts: Interference fit and central graft reduction affect biomechanics and cartilage damage

Su, Alvin W.; Chen, Yunchan; Wailes, Dustin H; Wong, Van W.; Cai, Shengqiang; Chen, Albert C.; Bugbee, William D.; Sah, Robert L.

doi:10.1002/jor.23645

Cited by 8 publications

(10 citation statements)

References 34 publications

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“…One disadvantage of the suture and press-fit technologies is the risk of adversely impacting tissue health. 17 For example, press-fitting may cause chondrocyte necrosis and cartilage matrix degradation in the interface area. 10 We also examined that the continuous force generated by suturing would induce chondrocyte apoptosis.…”

Section: Resultsmentioning

confidence: 99%

Infiltration and In-Tissue Polymerization of Photocross-Linked Hydrogel for Effective Fixation of Implants into Cartilage—An In Vitro Study

2019

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Effective and biocompatible fixation of implants into cartilage defects has yet to be successfully achieved. [Poly-d,l-lactic acid/polyethyleneglycol/poly-d,l-lactic acid] (PDLLA-PEG) is a chondrosupportive scaffold that is photocross-linked using the visible-light photoinitiator lithium phenyl-2,4,6-trimethylbenzoylphosphinate (LAP). Interestingly, LAP and its monomer DLLA-EG are able to infiltrate the cartilage and form hydrogels upon the detection of light. After the infiltration of LAP and DLLA-EG into the implant and host cartilage, an interconnected and continuous hydrogel structure is formed which fixes the implant within the host cartilage. A mechanical test shows that the infiltrated group displays a significantly higher push-out force than the group that has not been infiltrated (the traditional fibrin fixation group). Surprisingly, the in-cartilage hydrogel also reduces the release of sulfated glycosaminoglycan from cartilage explants. However, infiltration does not affect the cell viability or the expression of cartilage marker genes. This new strategy thus represents a biocompatible and efficient method to fix implants into host tissues.

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Section: Resultsmentioning

confidence: 99%

Infiltration and In-Tissue Polymerization of Photocross-Linked Hydrogel for Effective Fixation of Implants into Cartilage—An In Vitro Study

2019

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“…Besides, testing of isolated tissues, often performed in in vitro studies, does not represent the mechanical response of these tissues in situ, in that the response of articular cartilage in isolation is different 29,42,44 than when firmly attached to underlying subchondral bone. 52 Thus, "articulating joint" models better mimic live trauma or impact loading conditions. Furthermore, contrary to the few previously conducted closedjoint studies, 9,53 the current study attempted to induce and investigate osteochondral damage on microscale level instead of macroscopic damage or gross intra-articular fractures.…”

Section: Discussionmentioning

confidence: 99%

A Single Axial Impact Load Causes Articular Damage That Is Not Visible with Micro-Computed Tomography: AnEx VivoStudy on Caprine Tibiotalar Joints

et al. 2019

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Objective Excessive articular loading, for example, an ankle sprain, may result in focal osteochondral damage, initiating a vicious degenerative process resulting in posttraumatic osteoarthritis (PTOA). Better understanding of this degenerative process would allow improving posttraumatic care with the aim to prevent PTOA. The primary objective of this study was to establish a drop-weight impact testing model with controllable, reproducible and quantitative axial impact loads to induce osteochondral damage in caprine tibiotalar joints. We aimed to induce osteochondral damage on microscale level of the tibiotalar joint without gross intra-articular fractures of the tibial plafond. Design Fresh-frozen tibiotalar joints of mature goats were used as ex vivo articulating joint models. Specimens were axially impacted by a mass of 10.5 kg dropped from a height of 0.3 m, resulting in a speed of 2.4 m/s, an impact energy of 31.1 J and an impact impulse of 25.6 N·s. Potential osteochondral damage of the caprine tibiotalar joints was assessed using contrast-enhanced high-resolution micro-computed tomography (micro-CT). Subsequently, we performed quasi-static loading experiments to determine postimpact mechanical behavior of the tibiotalar joints. Results Single axial impact loads with a mass of 15.5 kg dropped from 0.3 m, resulted in intra-articular fractures of the tibial plafond, where a mass of 10.55 kg dropped from 0.3 m did not result in any macroscopic damage. In addition, contrast-enhanced high-resolution micro-CT imaging neither reveal any acute microdamage (i.e., microcracks) of the subchondral bone nor any (micro)structural changes in articular cartilage. The Hexabrix content or voxel density (i.e., proteoglycan content of the articular cartilage) on micro-CT did not show any differences between intact and impacted specimens. However, quasi-static whole-tibiotalar-joint loading showed an altered biomechanical behavior after application of a single axial impact (i.e., increased hysteresis when compared with the intact or nonimpacted specimens). Conclusions Single axial impact loads did not induce osteochondral damage visible with high-resolution contrast-enhanced micro-CT. However, despite the lack of damage on macro- and even microscale, the single axial impact loads resulted in “invisible injuries” because of the observed changes in the whole-joint biomechanics of the caprine tibiotalar joints. Future research must focus on diagnostic tools for the detection of early changes in articular cartilage after a traumatic impact (i.e., ankle sprains or ankle fractures), as it is well known that this could result in PTOA.

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“…L crack was determined as half of the total length of all crack edges visible at the articular surface. Samples were stained with India Ink (Chang et al, 1997), imaged en face by reflected light microscopy, and analyzed with NIH ImageJ software for total length of all crack edges (Su et al, 2017). L crack was taken as the average from three independent observers (intra-class correlation coefficient of 0.98).…”

Section: Methodsmentioning

confidence: 99%

“…V AC , was determined as (live cells)/(live cells+dead cells) in the central areas of the articular cartilage surface. Cartilage was isolated from bone, incubated for 24 hr in tissue culture medium including 10% FBS, stained with LIVE/DEAD® dye, imaged en face in the central 3.75×0.75 mm 2 area using fluorescence microscopy, and analyzed for live and dead cells by image processing (Borazjani et al, 2006; Pallante et al, 2009; Su et al, 2017).…”

Section: Methodsmentioning

confidence: 99%

Biomechanics of osteochondral impact with cushioning and graft Insertion: Cartilage damage is correlated with delivered energy

Chen

Yang

et al. 2018

Journal of Biomechanics

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Articular cartilage is susceptible to impact injury. Impact may occur during events ranging from trauma to surgical insertion of an OsteoChondral Graft (OCG) into an OsteoChondral Recipient site (OCR). To evaluate energy density as a mediator of cartilage damage, a specialized drop tower apparatus was used to impact adult bovine samples while measuring contact force, cartilage surface displacement, and OCG advancement. When a single impact was applied to an isolated (non-inserted) OCG, force and surface displacement each rose monotonically and then declined. In each of five sequential impacts of increasing magnitude, applied to insert an OCG into an OCR, force rose rapidly to an initial peak, with minimal OCG advancement, and then to a second prolonged peak, with distinctive oscillations. Energy delivered to cartilage was confirmed to be higher with larger drop height and mass, and found to be lower with an interposed cushion or OCG insertion into an OCR. For both single and multiple impacts, the total energy density delivered to the articular cartilage correlated to damage, quantified as total crack length. The corresponding fracture toughness of the articular cartilage was 12.0 mJ/mm. Thus, the biomechanics of OCG insertion exhibits distinctive features compared to OCG impact without insertion, with energy delivery to the articular cartilage being a factor highly correlated with damage.

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Impact insertion of osteochondral grafts: Interference fit and central graft reduction affect biomechanics and cartilage damage

Cited by 8 publications

References 34 publications

Infiltration and In-Tissue Polymerization of Photocross-Linked Hydrogel for Effective Fixation of Implants into Cartilage—An In Vitro Study

Infiltration and In-Tissue Polymerization of Photocross-Linked Hydrogel for Effective Fixation of Implants into Cartilage—An In Vitro Study

A Single Axial Impact Load Causes Articular Damage That Is Not Visible with Micro-Computed Tomography: AnEx VivoStudy on Caprine Tibiotalar Joints

Biomechanics of osteochondral impact with cushioning and graft Insertion: Cartilage damage is correlated with delivered energy

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