Cartilage Abrasion Research Articles

The effects of amphiregulin induced MMP-13 production in human osteoarthritis synovial fibroblast.

Osteoarthritis (OA) belongs to a group of degenerative diseases. Synovial inflammation, cartilage abrasion, and subchondral sclerosis are characteristics of OA. Researchers do not fully understand the exact etiology of OA. However, matrix metalloproteinases (MMPs), which are responsible for cartilage matrix degradation, play a pivotal role in the progression of OA. Amphiregulin (AREG) binds to the EGF receptor (EGFR) and activates downstream proteins. AREG is involved in a variety of pathological processes, such as the development of tumors, inflammatory diseases, and rheumatoid arthritis. However, the relationship between AREG and MMP-13 in OA synovial fibroblasts (SFs) remains unclear. We investigated the signaling pathway involved in AREG-induced MMP-13 production in SFs. AREG caused MMP-13 production in a concentration- and time-dependent manner. The results of using pharmacological inhibitors and EGFR siRNA to block EGFR revealed that the EGFR receptor was involved in the AREG-mediated upregulation of MMP-13. AREG-mediated MMP-13 production was attenuated by PI3K and Akt inhibitors. The stimulation of cells by using AREG activated p65 phosphorylation and p65 translocation from the cytosol to the nucleus. Our results provide evidence that AREG acts through the EGFR and activates PI3K, Akt, and finally NF-kappaB on the MMP-13 promoter, thus contributing to cartilage destruction during osteoarthritis.

Assessment of the effect of glucosamine sulfate and exercise on knee cartilage using magnetic resonance imaging in patients with knee osteoarthritis: A randomized controlled clinical trial

Osteoarthritis (OA) is a chronic disease characterized by the focal deterioration and abrasion of articular cartilage. The goals of therapy are preserving normal joint function, relieving pain and improving quality of life (QOL). This study is performed to investigate whether glocosamine sulfate and exercise could both delay joint structure degradation evaluated with magnetic resonance imaging (MRI) and improve symptoms in a short time period. Thirty-nine women with the diagnosis of knee OA were enrolled in the study. Patients were randomized into two groups. Group I (n=20) received an exercise program, while group II (n=19) received glucosamin sulphate (1500 mg/day) in addition to the exercise therapy. Both groups were treated for 12 weeks. The patients were evaluated before and after the treatment regarding pain, disability, functional performance, muscle strength, QOL, depression and MRI findings (cartilage volume, medial and lateral cartilage thickness). Both groups showed significant improvements in pain, disability, functional performance, QOL and depression with no statistically significant difference between the groups after the therapy. While there were significant improvements for all MRI parameters expect right knee cartilage volume and lateral cartilage thickness in two groups, statistically significant differences could not be demonstrated between the groups after the therapy. We found no additional effect of glucosamine in delaying the radiological progression and relieving the symptoms of OA. We also demonstrated that exercise alone was adequate to prevent structural changes and cartilage loss of the knee joint as assessed by MRI.

Effects of glucosamine sulfate and exercise therapy on serum leptin levels in patients with knee osteoarthritis: preliminary results of randomized controlled clinical trial

Osteoarthritis (OA) is a slow, chronic disease characterized by the focal deterioration and abrasion of articular cartilage. Leptin may play an important role in the pathophysiology of OA. Exercise and glucosamine sulfate therapy is one of the most commonly used in patients with knee OA. The goals of the present study are performed to investigate whether 12-week strength training program and glucosamine sulfate have an effect on serum leptin levels in knee OA and the relationship between leptin, clinical parameters, and radiographic severity of knee OA. Thirty-seven women with the diagnosis of knee OA were enrolled in the study. Patients were randomized into two groups. Group I (n = 19) received an exercise program, while group II (n = 18) received glucosamine sulfate (1,500 mg/day) in addition to the exercise therapy. Both groups were treated for 12 weeks. Leptin level was assessed at baseline and after 12 weeks. The concentration of leptin was measured by ELISA. The patients were evaluated regarding pain, disability, functional performance, and muscle strength. Both groups showed significant improvements in leptin levels, pain, disability, muscle strength, and functional performance with no statistically significant difference between the groups after the therapy. At basal time, plasma leptin levels were significantly correlated with body mass index and duration of disease, but no significant correlation was found with patient age, pain, disability, functional performance, muscle strength, and radiographic severity of knee OA. The results of this preliminary study revealed that exercise alone was adequate to prevent structural changes relieving the symptoms of OA. We also found that exercise alone could affect serum plasma levels of the leptin, important mediators of cartilage metabolism. Decreases in serum leptin may be one mechanism by which cartilage metabolism affects physical function and symptoms in OA patients.

Second Look Arthroscopic Findings after Tibial Plateau Leveling Osteotomy

To describe the long-term (range, 2-69 months) arthroscopic appearance of intraarticular structures of the stifle after tibial plateau leveling osteotomy (TPLO). Case series. Dogs (n=63) that had repeat arthroscopic examination of the stifle after TPLO for treatment of a cranial cruciate ligament (CCL) deficient stifle. Medical records (2002-2008) of dogs that had repeat arthroscopic examination to evaluate intraarticular structures after previous TPLO for treatment of CCL injury. Regions of interest were the CCL, caudal cruciate ligament, articular cartilage, and menisci. Signalment, weight, and time to 2nd look arthroscopy were recorded. Radiographs were reviewed to measure pre- and postoperative tibial plateau angle, and craniocaudal limb alignment. There were 17 partial CCL tears with early fiber tearing and 46 stifles with a complete CCL tear or incompetent partial CCL tear. Stifles with an early partial tear had normal to near normal appearance of intraarticular structures. Most dogs with a complete or incompetent partial CCL tear had axial or abaxial grades 3 or 4 articular cartilage abrasion of the medial or lateral femoral condyle. Intraarticular structures appeared normal or near normal in dogs with early fiber tearing (caudolateral or craniomedial fibers). Most dogs that had a partial tear with an incompetent remaining CCL or a completely ruptured CCL had grades 3 or 4 articular cartilage abrasion. Early diagnosis of a CCL injury and treatment by TPLO may be protective against further CCL disruption lending stability to the joint and decreasing the incidence of meniscal injury and articular cartilage damage.

Safety and efficacy of talonavicular arthroscopy in arthroscopic triple arthrodesis. A cadaveric study

This is a cadaveric study on the safety and efficacy of talonavicular arthroscopy in arthroscopic triple arthrodesis. Talonavicular arthroscopy was performed in 18 feet of 9 fresh frozen cadavers. The specimens were divided into 3 groups (6 feet in each group). The articular cartilage of the talar and navicular facet was abraded with a hemostat through the dorsolateral portal in group 1 specimens. The cartilage was abraded through the dorsomedial portal in group 2 specimens and through the medial portal in group 3 specimens. The area of cartilage abrasion represented the working area of the corresponding portal. The working area of individual portal and the relationship of individual portal to the adjacent neurovascular structure were studied. The medial portal averaged 12 mm medial to the long saphenous vein and saphenous nerve. The dorsomedial portal was 1 mm lateral to the intermediate cutaneous branch of superficial peroneal nerve and 5 mm lateral to the extensor hallucis longus tendon. It was 4 mm lateral to the deep peroneal nerve. The dorsolateral portal was 4 mm medial to the lateral branch of superficial peroneal nerve. In group 1, the working area of the dorsolateral portal averaged 60 +/- 4% for the talar facet and 66 +/- 12% for the navicular facet. In group 2, the working area of the dorsomedial portal averaged 56 +/- 3% for the talar facet and 64 +/- 8% for the navicular facet. In group 3, the working area of the medial portal averaged 40 +/- 4% for the talar facet and 55 +/- 11% for the navicular facet. Most of the talar and navicular surfaces can be prepared for fusion without the need of excessive bone removal during arthroscopic triple arthrodesis. This study confirmed the efficacy of the arthroscopic triple arthrodesis and arouses the surgeon about the risk of neural damage especially at the dorsomedial portal.

Degenerative Disorders of the Temporomandibular Joint: Etiology, Diagnosis, and Treatment

Temporomandibular joint (TMJ) disorders have complex and sometimes controversial etiologies. Also, under similar circumstances, one person's TMJ may appear to deteriorate, while another's does not. However, once degenerative changes start in the TMJ, this pathology can be crippling, leading to a variety of morphological and functional deformities. Primarily, TMJ disorders have a non-inflammatory origin. The pathological process is characterized by deterioration and abrasion of articular cartilage and local thickening. These changes are accompanied by the superimposition of secondary inflammatory changes. Therefore, appreciating the pathophysiology of the TMJ degenerative disorders is important to an understanding of the etiology, diagnosis, and treatment of internal derangement and osteoarthrosis of the TMJ. The degenerative changes in the TMJ are believed to result from dysfunctional remodeling, due to a decreased host-adaptive capacity of the articulating surfaces and/or functional overloading of the joint that exceeds the normal adaptive capacity. This paper reviews etiologies that involve biomechanical and biochemical factors associated with functional overloading of the joint and the clinical, radiographic, and biochemical findings important in the diagnosis of TMJ-osteoarthrosis. In addition, non-invasive and invasive modalities utilized in TMJ-osteoarthrosis management, and the possibility of tissue engineering, are discussed.

Management of Prominent Ears: Personal Approach

Various methods for correcting prominent ears have been reported. Although anterior cartilage antihelix abrasion combined with posterior retention sutures is a conventional procedure, it does not include anterior conchal cartilage abrasion and thus allows easier reduction of the condromastoid angle. A simple and effective technique is described that involves using a rasp to score the whole anterior surface of the auricular cartilage, including the concha, in combination with Mustarde-type conchal-antihelical and conchal-mastoid retention sutures. This method was applied to 342 patients (675 ears) over 23 years, who were followed up for periods varying from 18 to 24 months. Good results were obtained for all patients with minimal complications.

Distribution of lactate dehydrogenase in healthy and degenerative canine stifle joint cartilage

In dogs, degenerative joint diseases (DJD) have been shown to be associated with increased lactate dehydrogenase (LDH) activity in the synovial fluid. The goal of this study was to examine healthy and degenerative stifle joints in order to clarify the origin of LDH in synovial fluid. In order to assess the distribution of LDH, cartilage samples from healthy and degenerative knee joints were investigated by means of light and transmission electron microscopy in conjunction with immunolabeling and enzyme cytochemistry. Morphological analysis confirmed DJD. All techniques used corroborated the presence of LDH in chondrocytes and in the interterritorial matrix of healthy and degenerative stifle joints. Although enzymatic activity of LDH was clearly demonstrated in the territorial matrix by means of the tetrazolium-formazan reaction, immunolabeling for LDH was missing in this region. With respect to the distribution of LDH in the interterritorial matrix, a striking decrease from superficial to deeper layers was present in healthy dogs but was missing in affected joints. These results support the contention that LDH in synovial fluid of degenerative joints originates from cartilage. Therefore, we suggest that (1) LDH is transferred from chondrocytes to ECM in both healthy dogs and dogs with degenerative joint disease and that (2) in degenerative joints, LDH is released from chondrocytes and the ECM into synovial fluid through abrasion of cartilage as well as through enhanced diffusion as a result of increased water content and degradation of collagen.

Mechanical and Handling Properties of Braided Polyblend Polyethylene Sutures in Comparison to Braided Polyester and Monofilament Polydioxanone Sutures

This study was designed to comprehensively compare the mechanical properties of 4 types of braided polyblend sutures with widely used braided polyester and monofilament polydioxanone sutures. Polyblend polyethylene sutures (FiberWire [Arthrex, Naples, FL], Herculine [Linvatec, Largo, FL], Orthocord [DePuy Mitek, Raynham, MA], and Ultrabraid [Smith & Nephew Endoscopy, Andover, MA]), a braided polyester suture (Ethibond; Ethicon, Somerville, NJ), and an absorbable monofilament polydioxanone suture (PDS II; Ethicon), all USP No. 2, were mechanically tested. Fraying resistance was tested on eyelets of metallic and absorbable suture anchors. Cartilage abrasion caused by an intra-articularly placed suture knot was simulated by fraying on distal porcine femora. All polyblend sutures were stronger than Ethibond or PDS II sutures by at least a factor of 2, with or without a knot. When knotted, Herculine (261 +/- 44 N) was strongest, followed by Ultrabraid (244 +/- 3 N). FiberWire was most resistant against fraying on metallic anchors. Orthocord was by far least abrasive with absorbable anchors. Resistance to fraying was 100- to 500-fold (absorbable anchors) and 6- to 30-fold (metallic anchor) better for all polyblend sutures than for Ethibond. All braided sutures caused a similar amount of abrasion of joint cartilage, but they caused significantly more abrasion (>20-fold) than the monofilament degradable suture. The ultimate strength of polyblend suture material was 2- to 2.5-fold greater than that of polyester or polydioxanone sutures, but the resistance to fraying was up to 500-fold greater than that of polyester or polydioxanone sutures. With regard to strength, this makes polyblend sutures particularly advantageous for use with metallic edges of anchors or prostheses or with absorbable anchor eyelets. With a high resistance to fraying against metallic edges or a decrease in cutting of absorbable suture eyelets being up to 500-fold greater than with polyester or polydioxanone sutures, the new polyblend sutures appear to fill a void in the armamentarium of the surgeon, provided that at least 2 throws more than with conventional sutures are used for knot tying.

Endoscopic otoplasty in the rabbit model: effect of mechanical abrasion on ear cartilage deformation.

The purpose of this study was (1) to introduce an endoscopic technique for performing otoplasty; (2) to compare the durability of folding with scoring, sutures, or abrasion; and (3) to study the histologic changes associated with three techniques. Thirteen adult New Zealand White rabbits (26 ears) were divided into three otoplasty groups: bent cartilage (nine ears), cut cartilage (nine ears), or endoscopic abrasion of cartilage (eight ears). In all three groups, the ears were folded using external mattress sutures, with a transverse 180-degree fold. Sutures were removed at 1 to 6 weeks, and the ears followed for 4 weeks postoperatively. Ear-folding angles were followed weekly from suture removal to 4 weeks postoperatively. After sacrifice, the ear cartilage was harvested for histologic analysis. The ears were maintained in a 180-degree ventral fold by splinting sutures, which were removed at various times. Four weeks after suture removal, the mean ear angles were 13 degrees in the bent (control) group, 84 degrees in the cut group, and 132 degrees in the abraded group. The differences between the abraded and cut versus bent groups were significant (p = 0.0001 and 0.0073, respectively). There was no significant difference between the abraded versus cut groups. Histologic analysis showed perichondrial thickening on the convex surface in all of the groups. Fibrocartilage was produced in the cut and abraded groups. Based on histologic observation, the repair cartilage in the cut group was more fibrous, whereas that in the endoscopic group was more abundant with marked degenerative changes in the central zone. A new method of percutaneous endoscopic otoplasty in the rabbit model is described. This study showed that endoscopic otoplasty produced folding that was well maintained during the study period.

Correction of the prominent ear with cartilage abrasion and concha-mastoid sutures

Robert M. Oneal, MD, Ann Arbor, MI, is a board-certified plastic surgeon and an ASAPS member. The pathologic genesis of the protruding ear is a combination of the antihelix's failure to fold and some form of conchal protrusion, in which either the whole ear is tilted laterally or conchal hypertrophy exists. The corrective procedure should address both of these factors. I use a combination of techniques, including lateral cartilage surface abrasion, as originally described by Sten Stenstrom, MD, and posterior sutures, as described by John Mustarde, MD, to create the antihelix. Rather than resect the posterior conchal wall, I prefer to remove the soft tissue from the posterior area of the concha down to the mastoid fascia and then remove a …

The ultrastructure and calcification of matrix vesicles in osteoarthritic articular cartilage

Osteoarthritis progresses through the abrasion of articular cartilage and associated changes, such as those in calcification. In this study, initial cartilage calcification was examined by electron microscopy with microwave fixation to preserve the matrix vesicles. We developed a procedure for the separation of functionally active matrix vesicles from the osteoarthritic cartilage. Isolated matrix vesicles bound with unit membranes possessed osmiophilic properties and were filled with much protein content. Calcium content in matrix vesicle fractions was extremely high compared to that of phosphate content. Elution profiles of the matrix vesicles showed rich calcium content, moderate activity of alkaline phosphatase, and lactate dehydrogenase in a high molecular weight area. The matrix vesicles in osteoarthritis accumulated large amounts of calcium and moderate amounts of phosphate prior to the appearance of crystals.

Effects of excimer laser on healing of articular cartilage in rabbits

This study examined healing of 1.0 mm diameter defects in rabbit knee articular cartilage for as long as 14 weeks after creation of the defects by either laser or drilling. The purpose of the research was to determine the effects of laser debridement of cartilage on the intrinsic biomechanical properties of the repair tissue. We therefore imitated chondral shaving and subchondral abrasion of cartilage by creating partial-thickness and full-thickness cartilage defects of standardized size with both excimer laser and drilling. Light and scanning electron microscopic examinations of the repair tissue showed that healing of osteochondral defects created by laser may be delayed compared with defects created by drilling, for at least 6 weeks postoperatively. Even though there initially was a considerable delay in healing in the laser group, neither laser nor drilling had any appreciable effects on the mechanical properties of the repair tissue, as demonstrated by biomechanical testing at 14 weeks. Specifically, the repair cartilage in the defects in the laser group had the following material properties (mean +/- SD): aggregate modulus, 0.40 +/- 0.24 MPa; Poisson's ratio, 0.37 +/- 0.08; permeability, 3.72 +/- 4.28 x 10(-15) m4/N.s; and thickness, 0.20 +/- 0.06 mm. The corresponding values for the defects in the drilling group were 0.39 +/- 0.23 MPa, 0.34 +/- 0.09, 3.82 +/- 3.44 x 10(-15) m4/N.s, and 0.22 +/- 0.09 mm. The repair tissue from both types of defects was pooled, and the values were compared with those for contralateral (control) tissue.(ABSTRACT TRUNCATED AT 250 WORDS)

Calcitonin gene-related peptide, substance P and GAP-43/B-50 immunoreactivity in the normal and arthrotic knee joint of the mouse.

The aim of this study was to describe the normal distribution of calcitonin gene-related peptide (CGRP) and substance P (SP) containing fibres in the knee joint of the mouse and to obtain insight into the changes in innervation associated with degenerative processes in the joint. Arthrosis was induced by a single subpatellar intra-articular injection of bacterial collagenase. After decalcification in EDTA solutions, the CGRP and SP fibres were visualized by peroxidase-antiperoxidase pre-embedding immunocytochemistry for light microscopy. Control experiments on the mouse brain as a reference for the effect of EDTA on the immunostaining showed that the decalcification procedure with EDTA had not impaired the immunostaining. A rich innervation of thin varicose CGRP and SP immunoreactive fibres was found in most peri- and intra-articular tissue components. The periosteum, synovial tissues, the joint capsule and the intra-articular fat tissues were richly innervated. Less intense innervations were also found in the subchondral bone plates of the tibio-femoral joint and of the patella. Fibres were also found in the soft tissues between the patellar tendon and the femoral groove. No differences could be found between the location of CGRP and SP fibres with respect to the localization in the joint, but generally more CGRP fibres were found. The collagenase-induced osteoarthrosis was characterized by sclerosis of the subchondral bone, patellar dislocation, osteophyte formation, synovial proliferation and by severe cartilage abrasion, particularly on the medial side of the femoro-tibial joint. The overall distribution of CGRP and SP fibres was the same as in the control joints. However, major differences were found in all studied joints at specific locations around the cruciate ligaments, in the synovium around the patella, in the soft tissues lateral of the patella and in plica tissue between the patella and femoral groove. The CGRP and SP innervation was no longer detectable by immunolabelling with the antibodies. With a polyclonal antibody to the growth associated protein GAP-43/B-50, signs of degenerated axonal profiles were observed in these locations. At other peripheral locations, such as the muscles, the GAP-43/B-50 distribution was normal. In conclusion, the present study provides detailed information on the localization of CGRP and SP fibres, which may be involved in pain perception. Knowledge of the changes that occur during arthrosis may give more insight into the clinical symptoms.

The permanence of otoplasty in the rabbit ear: a comparison of techniques.

Otoplasty should restructure the cartilage framework of the ear with permanent results. Major techniques include the placement of permanent sutures, with or without concomitant cartilage scoring, and cartilage abrasion alone. Our study evaluates the durability of the results of each method. Fifteen New Zealand white rabbits were divided into two groups. In 10 rabbits, the posterior surface of the right ear cartilage was abraded, and the ear was folded forward and secured with nylon stitches. A similar procedure was performed on the left ear, omitting the cartilage abrasion. In 4 rabbits, both ears were abraded transversely on the posterior cartilaginous surface and no sutures were placed. In 1 rabbit only the posterior skin was undermined on both ears. For one week dressings maintained a right-angle fold at the operative site. Rabbit ears reshaped with abrasion only failed to maintain the desired conformation. Ears with suture and abrasion did not maintain the full 90-degree angle created at surgery, although they did not fully straighten. Ears reshaped with suture alone maintained a folded angle close to the original right angle. Three months after operation the sutures within the cartilage were removed to approximate the clinical situation of late suture disruption from trauma to the operated ear and the shape was assessed.