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There are various methods for reconstructing the anterior cruciate ligament (ACL) from other muscles or tendons. Initial tension of the reconstructed ACL is one of the key elements affecting postoperative outcomes. However, tension cannot be measured after graft fixation. The only intraoperative assessment is pull probing, which is performed by pulling joint soft tissues with the arthroscopic probe and can be measured quantitatively. Therefore, its value might be used as an alternative value for the mechanical property of the ACL. Using a probing device one author developed to measure the resistance force of soft tissues quantitatively while probing, we measured the resistance force of dissected ACLs and used tensile testing to investigate the correlation between the resistance force and the mechanical property of the ligaments. According to the results, when a certain amount of tension (strain; 16.6%) was applied, its mechanical properties were moderately correlated (r = 0.56 [p = 0.045]) with the probing force. Therefore, the tension of the reconstructed ACL after fixation under real ACL reconstruction surgery can be derived from the value of the probing device.

Background Meniscal cysts are not uncommon in clinical practice, with reported incidence rates varying from 1 to 22%. Most meniscal cysts are parameniscal cysts, which are created by extravasation of synovial fluid through the meniscal tear into the adjacent soft tissue. In contrast, intrameniscal cysts in which the fluid collects in the meniscus are very rare. We encountered a teenager with a huge intrameniscal cyst accompanied by a small vertical meniscal tear in the red-white zone of the upper surface of the medial meniscus. A literature search revealed no information regarding the appropriate treatment methods and results for this type of lesion. Case presentation A 14-year-old boy presented to our outpatient clinic because of right knee pain that had been present for the previous 2 months. The patient participated in Hapkido, but had no specific trauma history. Magnetic resonance imaging revealed a huge intrameniscal cyst located in the central parenchyma of the posteromedial corner of the medial meniscus. In addition, one sagittal slice on MRI revealed a vertical tear in the red-white zone of the upper surface of the medial meniscus. The presence of such a tear accompanied by a huge intrameniscal cyst is very unusual. The patient was treated via arthroscopic inside-out meniscal suture repair and open cystic debridement with additional meniscocapsular suturing. During 4 years of magnetic resonance imaging follow-up, the lesion has completely disappeared and the meniscus has successfully recovered its normal form. Conclusions Our treatment method may be considered as the first choice for young patients who require surgical treatment for large intrameniscal cysts with accompanying small vertical meniscal tears.

In this study, we combined quantitative ultrashort echo time (UTE) magnetic resonance (MR) imaging and an investigation by a probing device with tri-axial force sensor to seek correlations with mechanical properties of human patellar cartilage for in situ evaluation of biomechanical properties. Cartilage blocks (15 × 20 × 5 mm3) were dissected from the patella of six donors, 5 mm square regions of interest from the cartilage blocks were imaged using UTE-MR imaging sequences (T2* and magnetization transfer ratio (MTR)), and mechanical properties were measured using a micro indentation device. Then, the vertical reaction force on the cartilage surface was measured while push-probing forward 3 mm with the probing device at a 30° tilt to the horizontal plane. The results showed a positive correlation between stiffness/elastic modulus and each predictor variable (UTE-T2* (r = 0.240 and 0.255, respectively, UTE-MTR (r = 0.378 and 0.379, respectively), and probing device force (r = 0.426 and 0.423, respectively). Furthermore, multiple linear regression analysis showed the combination of the three predictors had stronger correlation (adjusted r2 = 0.314 (stiffness), 0.323 (elastic), respectively). Our results demonstrate the potential for these non- and less- invasive methods for in situ evaluation of the mechanical properties of cartilage tissue.

Background Periprosthetic tibial fracture after unicompartmental knee replacement is a challenging post-operative complication. Patients have an increased risk of mortality after fracture, the majority undergo further surgery, and the revision operations are less successful. Inappropriate surgical technique increases the risk of fracture, but it is unclear which technical aspects of the surgery are most problematic and no research has been performed on how surgical factors interact. Methods Firstly, this study quantified the typical variance in surgical cuts made during unicompartmental knee replacement (determined from bones prepared by surgeons during an instructional course). Secondly, these measured distributions were used to create a probabilistic finite element model of the tibia after replacement. A thousand finite element models were created using the Monte Carlo method, representing 1000 virtual operations, and the risk of tibial fracture was assessed. Findings Multivariate linear regression of the results showed that excessive resection depth and making the vertical cut too deep posteriorly increased the risk of fracture. These two parameters also had high variability in the prepared synthetic bones. The regression equation calculated the risk of fracture from three cut parameters (resection depth, vertical and horizonal posterior cuts) and fit the model results with 90% correlation. Interpretation This study introduces for the first time the application of a probabilistic approach to predict the aetiology of fracture after unicompartmental knee replacement, providing unique insight into the relative importance of surgical saw cut variations. Targeted changes to operative technique can now be considered to seek to reduce the risk of periprosthetic fracture.

Cortical bone shows as a signal void when using conventional clinical magnetic resonance imaging (MRI). Ultrashort echo time MRI (UTE-MRI) can acquire high signal from cortical bone, thus enabling quantitative assessments. Magnetization transfer (MT) imaging combined with UTE-MRI can indirectly assess protons in the organic matrix of bone. This study aimed to examine UTE-MT MRI techniques to estimate the mechanical properties of cortical bone. A total of 156 rectangular human cortical bone strips were harvested from the tibial and femoral midshafts of 43 donors (62 ± 22 years old, 62 specimens from females, 94 specimens from males). Bone specimens were scanned using UTE-MT sequences on a clinical 3 T MRI scanner and on a micro-computed tomography (μCT) scanner. A series of MT pulse saturation powers (400°, 600°, 800°) and frequency offsets (2, 5, 10, 20, 50 kHz) was used to measure the macromolecular fraction (MMF) utilizing a two-pool MT model. Failure mechanical properties of the bone specimens were measured using 4-point bending tests. MMF from MRI results showed significant strong correlations with cortical bone porosity (R = -0.72, P, Highlights • Correlations between two-pool UTE-MT MRI modeling and cortical bone mechanical properties was investigated. • UTE-MT MRI modeling showed significant moderate correlations with mechanical properties. • UTE-MT MRI also showed strong correlations with μCT-based bone porosity and BMD.

Objective Mesenchymal stem cells (MSCs) are a promising cell-based therapy treatment option for several orthopedic indications. Because culture expansion of MSC is time and cost intensive, a bedside concentration of bone marrow (BM) aspirate is used as an alternative. Many commercial systems are available but the available literature and knowledge regarding these systems is limited. We compared different point-of-care devices that concentrate BM (BMC) by focusing on technical features and quality parameters to help surgeons make informed decisions while selecting the appropriate device. Methods We compared published data on the BMC devices of Arteriocyte, Arthrex, Celling Biosciences, EmCyte, Exactech, ISTO Tech, Harvest Tech/Terumo BCT, and Zimmer/BIOMET regarding technical features (centrifugation speed/time, input/output volume, kit components, type of aspiration syringes, filter usage) and quality parameters of their final BMC product (hematocrit, concentration of platelets and total nucleated cells, concentration of MSC and connective tissue progenitor cells). Results The systems differ significantly in their technical features and centrifugation parameters. Only the fully automated systems use universal kits, which allow processing different volumes of BM. Only the Arthrex system allows selection of final hematocrit. There was no standardized reporting method to describe biologic potency. Conclusions Based on the data obtained in this review, recommending a single device is not possible because the reported data could not be compared between devices. A standardized reporting method is needed for valid comparisons. Furthermore, clinical outcomes are required to establish the true efficacy of these systems. We are conducting additional studies for more careful comparison among the devices.

The self-healing capacity of an injured meniscus is limited to the vascularized regions and is especially challenging in the inner avascular regions. As such, we investigated the use of human meniscus cell-seeded electrospun (ES) collagen type I scaffolds to produce meniscal tissue and explored whether these cell-seeded scaffolds can be implanted to repair defects created in meniscal avascular tissue explants. Human meniscal cells (derived from vascular and avascular meniscal tissue) were seeded on ES scaffolds and cultured. Constructs were evaluated for cell viability, gene expression, and mechanical properties. To determine potential for repair of meniscal defects, human meniscus avascular cells were seeded and cultured on aligned ES collagen scaffolds for 4 weeks before implantation. Surgical defects resembling "longitudinal tears" were created in the avascular zone of bovine meniscus and implanted with cell-seeded collagen scaffolds and cultured for 3 weeks. Tissue regeneration and integration were evaluated by histology, immunohistochemistry, mechanical testing, and magentic resonance imaging. Ex vivo implantation with cell-seeded collagen scaffolds resulted in neotissue that was significantly better integrated with the native tissue than acellular collagen scaffolds or untreated defects. Human meniscal cell-seeded ES collagen scaffolds may therefore be useful in facilitating meniscal repair of avascular meniscus tears.

Objective Mouse models are commonly used in research applications due to the relatively low cost, highly characterized strains, as well as the availability of many genetically modified phenotypes. In this study, we characterized an ex vivo murine osteochondral repair model using human infrapatellar fat pad (IPFP) progenitor cells. Design Femurs from euthanized mice were removed and clamped in a custom multidirectional vise to create cylindrical osteochondral defects 0.5 mm in diameter and 0.5 mm deep in both condyles. The IPFP contains progenitors that are a promising cell source for the repair of osteochondral defects. For proof of concept, human IPFP-derived progenitor cells, from osteoarthritic (OA) patients, cultured as pellets, were implanted into the defects and cultured in serum-free medium with TGFβ3 for 3 weeks and then processed for histology and immunostaining. Results The custom multidirectional vise enabled reproducible creation of osteochondral defects in murine femoral condyles. Implantation of IPFP-derived progenitor cells led to development of cartilaginous tissue with Safranin O staining and deposition of collagen type II in the extracellular matrix. Conclusions We showed feasibility in creating ex vivo osteochondral defects and demonstrated the regenerative potential of OA human IPFP-derived progenitors in mouse femurs. The murine model can be used to study the effects of aging and OA on tissue regeneration and to explore molecular mechanisms of cartilage repair using genetically modified mice.

Advances in imaging technology and computer-assisted design (CAD) have recently enabled the introduction of patient-specific knee implant designs that hold the potential to improve functional performance on the basis of patient-specific geometries, namely a patient-specific sagittal and coronal curvature, as well as enhanced bone preservation. The objective of this study was to investigate the use of a novel implant design utilizing a patient specific sagittal J-curve on the femoral component combined with a novel constant, patient-derived femoral coronal curvature and to assess tibio-femoral contact area and contact stress on a femur matched curved tibial polyethylene insert. Mean contact area and standard deviations were 81±5, 96±5 and 74±4 mm2 for the heel strike, toe off and mid-stance positions, respectively. Mean contact stress and standard deviations were 23.83±1.39, 23.27±1.14 and 20.78±0.54 MPa for the heel strike, toe off and mid-stance positions, respectively. Standard deviations of the measurements were small, not exceeding 6-7% confirming the consistency of loading conditions across different flexion angles. The results were comparable to those reported for standard, off-the-shelf fixed-bearing implants with paired femoral and tibial geometries. These data show that a constant coronal curvature can be applied to a patient-specific implant by measuring coronal curvatures across the femoral condyle in each patient and by deriving an average curvature. This novel approach combines unique benefits of patient-specific geometry with proven design concepts for minimizing polyethylene wear.

Osteochondral grafting for cartilage lesions is an attractive surgical procedure; however, the clinical results have not always been successful. Surgical recommendations differ with respect to donor site and graft placement technique. No clear biomechanical analysis of these surgical options has been reported. We hypothesized that differences in graft placement, graft biomechanical properties, and graft topography affect cartilage stresses and strains. A finite element model of articular cartilage and meniscus in a normal knee was constructed. The model was used to analyze the magnitude and the distribution of contact stresses, von Mises stresses, and compressive strains in the intact knee, after creation of an 8-mm diameter osteochondral defect, and after osteochondral grafting of the defect. The effects of graft placement, articular surface topography, and biomechanical properties were evaluated. The osteochondral defect generated minimal changes in peak contact stress (3.6 MPa) relative to the intact condition (3.4 MPa) but significantly increased peak von Mises stress (by 110%) and peak compressive strain (by 63%). A perfectly matched graft restored stresses and strains to near intact conditions. Leaving the graft proud by 0.5 mm generated the greatest increase in local stresses (peak contact stresses = 6.7 MPa). Reducing graft stiffness and curvature of articular surface had lesser effects on local stresses. Graft alignment, graft biomechanical properties, and graft topography all affected cartilage stresses and strains. Contact stresses, von Mises stresses, and compressive strains are biomechanical markers for potential tissue damage and cell death. Leaving the graft proud tends to jeopardize the graft by increasing the stresses and strains on the graft. From a biomechanical perspective, the ideal surgical procedure is a perfectly aligned graft with reasonably matched articular cartilage surface from a lower load-bearing region of the knee.

Wear-related complications remain a major issue after unicompartmental arthroplasty. We used a computational model to predict knee wear generated in vitro under diverse conditions. Inverse finite element analysis of 2 different total knee arthroplasty designs was used to determine wear factors of standard and highly crosslinked polyethylene by matching predicted wear rates to measured wear rates. The computed wear factor was used to predict wear in unicompartmental components. The articular surface design and kinematic conditions of the unicompartmental and tricompartmental designs were different. Predicted wear rate (1.77 mg/million cycles) was very close to experimental wear rate (1.84 mg/million cycles) after testing in an AMTI knee wear simulator. Finite element analysis can predict experimental wear and may reduce the cost and time of preclinical testing.

Cortical bone is typically regarded as “MR invisible” with conventional clinical magnetic resonance imaging (MRI) pulse sequences. However, recent studies have demonstrated that free water in the microscopic pores of cortical bone has a short T2* but a relatively long T2, and may be detectable with conventional clinical spin echo (SE) or fast spin echo (FSE) sequences. In this study we describe the use of a conventional two-dimensional (2D) FSE sequence to assess cortical bone microstructure and measure cortical porosity using a clinical 3T scanner. Twelve cadaveric human cortical bone samples were studied with MRI and micro computed tomography (μCT) (downsampled to the same spatial resolution). Preliminary results show that FSE-determined porosity is highly correlated (R2 = 0.83; P < 0.0001) with μCT porosity. Bland Altman analysis suggested a good agreement between FSE and μCT with tight limit of agreement at around 3%. There is also a small bias of -2% for the FSE data, which suggested that the FSE approach slightly underestimated μCT porosity. The results demonstrate that cortical porosity can be directly assessed using conventional clinical FSE sequences. The clinical feasibility of this approach was also demonstrated on six healthy volunteers using 2D FSE sequences as well as 2D ultrashort echo time (UTE) sequences with a minimal echo time (TE) of 8 μs, which provide high contrast imaging of cortical bone in vivo.

The ability to predict patient-specific joint contact and muscle forces accurately could improve the treatment of walking-related disorders. Muscle synergy analysis, which decomposes a large number of muscle electromyographic (EMG) signals into a small number of synergy control signals, could reduce the dimensionality and thus redundancy of the muscle and contact force prediction process. This study investigated whether use of subject-specific synergy controls can improve optimization prediction of knee contact forces during walking. To generate the predictions, we performed mixed dynamic muscle force optimizations (i.e., inverse skeletal dynamics with forward muscle activation and contraction dynamics) using data collected from a subject implanted with a force-measuring knee replacement. Twelve optimization problems (three cases with four subcases each) that minimized the sum of squares of muscle excitations were formulated to investigate how synergy controls affect knee contact force predictions. The three cases were: (1) Calibrate+Match where muscle model parameter values were calibrated and experimental knee contact forces were simultaneously matched, (2) Precalibrate+Predict where experimental knee contact forces were predicted using precalibrated muscle model parameters values from the first case, and (3) Calibrate+Predict where muscle model parameter values were calibrated and experimental knee contact forces were simultaneously predicted, all while matching inverse dynamic loads at the hip, knee, and ankle. The four subcases used either 44 independent controls or five synergy controls with and without EMG shape tracking. For the Calibrate+Match case, all four subcases closely reproduced the measured medial and lateral knee contact forces (R2 ≥ 0.94, root-mean-square (RMS) error < 66 N), indicating sufficient model fidelity for contact force prediction. For the Precalibrate+Predict and Calibrate+Predict cases, synergy controls yielded better contact force predictions (0.61 < R2 < 0.90, 83 N < RMS error < 161 N) than did independent controls (-0.15 < R2 < 0.79, 124 N < RMS error < 343 N) for corresponding subcases. For independent controls, contact force predictions improved when precalibrated model parameter values or EMG shape tracking was used. For synergy controls, contact force predictions were relatively insensitive to how model parameter values were calibrated, while EMG shape tracking made lateral (but not medial) contact force predictions worse. For the subject and optimization cost function analyzed in this study, use of subject-specific synergy controls improved the accuracy of knee contact force predictions, especially for lateral contact force when EMG shape tracking was omitted, and reduced prediction sensitivity to uncertainties in muscle model parameter values.

© 2014. The purpose of this study was to evaluate a magnetic resonance imaging (MRI) technique for quantifying the proton density water fraction (PDWF) as a biomarker of bone marrow cellularity. Thirty-six human bone marrow specimens from 18 donors were excised and subjected to different measurements of tissue composition: PDWF quantification using a multiple gradient echo MRI technique, three biochemical assays (triglyceride, total lipid and water content) and a histological assessment of cellularity. Results showed a strong correlation between PDWF and bone marrow cellularity from histology (. r=. 0.72). A strong correlation was also found between PDWF and the biochemical assay of water content (. r=. 0.76). These results suggest the PDWF is a predictor of bone marrow cellularity in tissues and can provide a non-invasive assessment of bone marrow changes in clinical patients undergoing radiotherapy.

Interaction between chondrocytes and the cartilage extracellular matrix (ECM) is essential for maintaining the cartilage's role as a low-friction and load-bearing tissue. In this study, we examined the influence of cartilage zone-specific ECM on human articular chondrocytes (HAC) in two-dimensional and three-dimensional (3D) environments. Two culture systems were used. SYSTEM 1: HAC were cultured on cell-culture plates that had been precoated with the following ECM molecules for 7 days: decorin, biglycan, tenascin C (superficial zone), collagen type II, hyaluronan (HA) (middle and deep zones), and osteopontin (deep zone). Uncoated standard culture plates were used as controls. Expanded cells were examined for phenotypic changes using real-time polymerase chain reaction. In addition, expanded cells were placed into high-density pellet cultures for 14 days. Neocartilage formation was assessed via gene expression and histology evaluations. SYSTEM 2: HAC that were cultured on untreated plates and encapsulated in a 3D alginate scaffold were mixed with one of the zone-specific ECM molecules. Cell viability, gene expression, and histology assessments were conducted on 14-day-old tissues. In HAC monolayer culture, exposure to decorin, HA, and osteopontin increased COL2A1 and aggrecan messenger RNA (mRNA) levels compared with controls. Biglycan up-regulated aggrecan without a significant impact on COL2A1 expression; Tenascin C reduced COL2A1 expression. Neocartilage formed after preculture on tenascin C and collagen type II expressed higher COL2A1 mRNA compared with control pellets. Preculture of HAC on HA decreased both COL2A1 and aggrecan expression levels compared with controls, which was consistent with histology. Reduced proteoglycan 4 (PRG4) mRNA levels were observed in HAC pellets that had been precultured with biglycan and collagen type II. Exposing HAC to HA directly in 3D-alginate culture most effectively induced neocartilage formation, showing increased COL2A1 and aggrecan, and reduced COL1A1 compared with controls. Decorin treatments increased HAC COL2A1 mRNA levels. These data indicate that an appropriate exposure to cartilage-specific ECM proteins could be used to enhance cartilage formation and to even induce the formation of zone-specific phenotypes to improve cartilage regeneration.

Persistent pain is an important cause of patient dissatisfaction after unicompartmental knee replacement (UKR) and has been correlated with localized tibial strain. However, the factors that influence these strains are not well understood. To address this issue, we created finite element models to examine the effect on tibial strain of: (1) muscle forces (estimated using instrumented knee data) acting on attachment sites on the proximal tibia, (2) UKR implantation, (3) loading position, and (4) changes in gait pattern. Muscle forces acting on the tibia had no significant influence on strains within the periprosthetic region, but UKR implantation increased strain by 20%. Strain also significantly increased if the region of load application was moved >3 mm medially. The strain within the periprosthetic region was found to be dependent on gait pattern and was influenced by both medial and lateral loads, with the medial load having a greater effect (regression coefficients: medial = 0.74, lateral = 0.30). These findings suggest that tibial strain is increased after UKR and may be a cause of pain. It may be possible to reduce pain through modification of surgical factors or through altered gait patterns.

Knee osteoarthritis (OA) commonly occurs in the medial compartment of the knee and has been linked to overloading of the medial articular cartilage. Gait modification represents a non-invasive treatment strategy for reducing medial compartment knee force. The purpose of this study was to evaluate the effectiveness of a variety of gait modifications that were expected to alter medial contact force. A single subject implanted with a force-measuring knee replacement walked using nine modified gait patterns, four of which involved different hiking pole configurations. Medial and lateral contact force at 25, 50, and 75% of stance phase, and the average value over all of stance phase (0-100%), were determined for each gait pattern. Changes in medial and lateral contact force values relative to the subject's normal gait pattern were determined by a Kruskal-Wallis test. Apart from early stance (25% of stance), medial contact force was most effectively reduced by walking with long hiking poles and wide pole placement, which significantly reduced medial and lateral contact force during stance phase by up to 34% (at 75% of stance) and 26% (at 50% of stance), respectively. Although this study is based on data from a single subject, the results provide important insight into changes in medial and lateral contact forces through gait modification. The results of this study suggest that an optimal configuration of bilateral hiking poles may significantly reduce both medial and lateral compartment knee forces in individuals with medial knee osteoarthritis.

In this study we describe the use of ultrashort echo time (UTE) magnetic resonance imaging (MRI) to evaluate short and long T2* components as well as the water content of cortical bone. Fourteen human cadaveric distal femur and proximal tibia were sectioned to produce 44 rectangular slabs of cortical bone for quantitative UTE MR imaging, microcomputed tomography (µCT), and biomechanical testing. A two-dimensional (2D) UTE pulse sequence with a minimal nominal TE of 8 µseconds was used together with bicomponent analysis to quantify the bound and free water in cortical bone using a clinical 3T scanner. Total water concentration was measured using a 3D UTE sequence together with a reference water phantom. UTE MR measures of water content (total, free, and bound), T2* (short and long), and short and long T2* fractions were compared with porosity assessed with µCT, as well as elastic (modulus, yield stress, and strain) and failure (ultimate stress, failure strain, and energy) properties, using Pearson correlation. Porosity significantly correlated positively with total (R2 = 0.23; p

Menisci play a crucial role in weight distribution, load bearing, shock absorption, lubrication, and nutrition of articular cartilage within the knee joint. Damage to the meniscus typically does not heal spontaneously due to its partial avascular nature. Partial or complete meniscectomy is a common clinical treatment of the defective meniscus. However, this procedure ultimately leads to osteoarthritis due to increased mechanical stress to the articular cartilage. Meniscus tissue engineering offers a promising solution for partial or complete meniscus deficiency. Mesenchymal stem cells (MSC) have the potential to differentiate into meniscal fibrochondrocyte as well as deliver trophic effects to the differentiated cells. This study tested the feasibility of using MSC co-cultured with mature meniscal cells (MC) for meniscus tissue engineering. Structured cell pellets were created using MC and MSC at varying ratios (100:0, 75:25, 50:50, 25:75, and 0:100) and cultured with or without transforming growth factor-beta 3 supplemented chondrogenic media for 21 days. The meniscal and hypertrophic gene expression, gross appearance and structure of the pellets, meniscus extracellular matrix (ECM), histology and immunohistochemistry of proteoglycan and collagen were evaluated. Co-culture of MC with MSC at 75:25 demonstrated highest levels of collagen type I and glycosaminoglycans (GAG) production, as well as the lowest levels of hypertrophic genes, such as COL10A1 and MMP13. All co-culture conditions showed better meniscus ECM production and hypertrophic inhibition as compared to MSC culture alone. The collagen fiber bundles observed in the co-cultures are important to produce heterogenic ECM structure of meniscus. In conclusion, co-culturing MC and MSC is a feasible and efficient approach to engineer meniscus tissue with enhanced ECM production without hypertrophy.

ObjectiveTo compare the MANKIN and OARSI cartilage histopathology assessment systems using human articular cartilage from a large number of donors across the adult age spectrum representing all levels of cartilage degradation.DesignHuman knees (n=125 from 65 donors; age range 23–92) were obtained from tissue banks. All cartilage surfaces were macroscopically graded. Osteochondral slabs representing the entire central regions of both femoral condyles, tibial plateaus, and the patella were processed for histology and Safranin O – Fast Green staining. Slides representing normal, aged, and osteoarthritis (OA) tissue were scanned and electronic images were scored online by five observers. Statistical analysis was performed for inter- and intra-observer variability, reproducibility and reliability.ResultsThe inter-observer variability among five observers for the MANKIN system showed a similar good Intra-class correlation coefficient (ICC>0.81) as for the OARSI system (ICC>0.78). Repeat scoring by three of the five readers showed very good agreement (ICC>0.94). Both systems showed a high reproducibility among four of the five readers as indicated by the Spearman’s rho value. For the MANKIN system, the surface represented by lesion depth was the parameter where all readers showed an excellent agreement. Other parameters such as cellularity, Safranin O staining intensity and tidemark had greater inter-reader disagreement.ConclusionBoth scoring systems were reliable but appeared too complex and time consuming for assessment of lesion severity, the major parameter determined in standardized scoring systems. To rapidly and reproducibly assess severity of cartilage degradation, we propose to develop a simplified system for lesion volume.

Tibiofemoral forces are important in the design and clinical outcomes of TKA. We developed a tibial tray with force transducers and a telemetry system to directly measure tibiofemoral compressive forces in vivo. Knee forces and kinematics traditionally have been measured under laboratory conditions. Although this approach is useful for quantitative measurements and experimental studies, the extrapolation of results to clinical conditions may not always be valid.We therefore developed wearable monitoring equipment and computer algorithms for classifying and identifying unsupervised activities outside the laboratory.Tibial forces were measured for activities of daily living, athletic and recreational activities, and with orthotics and braces, during 4 years postoperatively. Additional measurements included video motion analysis, EMG, fluoroscopic kinematic analysis, and ground reaction force measurement. In vivo measurements were used to evaluate computer models of the knee. Finite element models were used for contact analysis and for computing knee kinematics from measured knee forces. A third-generation system was developed for continuous monitoring of knee forces and kinematics outside the laboratory using a wearable data acquisition hardware.By using measured knee forces and knee flexion angle, we were able to compute femorotibial AP translation (-12 to +4 mm), mediolateral translation (-1 to 1.5 mm), axial rotation (-3° to 12°), and adduction-abduction (-1° to +1°). The neural-network-based classification system was able to identify walking, stair-climbing, sit-to-stand, and stand-to-sit activities with 100% accuracy.Our data may be used to improve existing in vitro models and wear simulators, and enhance prosthetic designs and biomaterials.

Though changes in normal joint motions and loads (e.g., following anterior cruciate ligament injury) contribute to the development of knee osteoarthritis, the precise mechanism by which these changes induce osteoarthritis remains unknown. As a first step toward identifying this mechanism, this study evaluates computational wear simulations of a patellofemoral joint specimen wear tested on a knee simulator machine. A multi-body dynamic model of the specimen mounted in the simulator machine was constructed in commercial computer-aided engineering software. A custom elastic foundation contact model was used to calculate contact pressures and wear on the femoral and patellar articular surfaces using geometry created from laser scan and MR data. Two different wear simulation approaches were investigated – one that wore the surface geometries gradually over a sequence of 10 one-cycle dynamic simulations (termed the “progressive” approach), and one that wore the surface geometries abruptly using results from a single one-cycle dynamic simulation (termed the “non-progressive” approach). The progressive approach with laser scan geometry reproduced the experimentally measured wear depths and areas for both the femur and patella. The less costly non-progressive approach predicted deeper wear depths, especially on the patella, but had little influence on predicted wear areas. Use of MR data for creating the articular and subchondral bone geometry altered wear depth and area predictions by at most 13%. These results suggest that MR-derived geometry may be sufficient for simulating articular cartilage wear in vivo and that a progressive simulation approach may be needed for the patella and tibia since both remain in continuous contact with the femur.

External knee adduction moment can be reduced using footwear interventions, but the exact changes in in vivo medial joint loading remain unknown. An instrumented knee replacement was used to assess changes in in vivo medial joint loading in a single patient walking with a variable-stiffness intervention shoe. We hypothesized that during walking with a load modifying variable-stiffness shoe intervention: (1) the first peak knee adduction moment will be reduced compared to a subject's personal shoes; (2) the first peak in vivo medial contact force will be reduced compared to personal shoes; and (3) the reduction in knee adduction moment will be correlated with the reduction in medial contact force. The instrumentation included a motion capture system, force plate, and the instrumented knee prosthesis. The intervention shoe reduced the first peak knee adduction moment (13.3%, p = 0.011) and medial compartment joint contact force (12.3%; p = 0.008) compared to the personal shoe. The change in first peak knee adduction moment was significantly correlated with the change in first peak medial contact force (R2 = 0.67, p = 0.007). Thus, for a single subject with a total knee prosthesis the variable-stiffness shoe reduces loading on the affected compartment of the joint. The reductions in the external knee adduction moment are indicative of reductions in in vivo medial compressive force with this intervention. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:1548–1553, 2010

Stresses and strains are major factors influencing growth, remodeling and repair of musculoskeletal tissues. Therefore, knowledge of forces and deformation within bones and joints is critical to gain insight into the complex behavior of these tissues during development, aging, and response to injury and disease. Sensors have been used in vivo to measure strains in bone, intraarticular cartilage contact pressures, and forces in the spine, shoulder, hip, and knee. Implantable sensors have a high impact on several clinical applications, including fracture fixation, spine fixation, and joint arthroplasty. This review summarizes the developments in strain-measurement-based implantable sensor technology for musculoskeletal research.