Acute cell viability and nitric oxide release in lateral menisci following closed-joint knee injury in a lapine model of post-traumatic osteoarthritis

BACKGROUND: Traumatic impaction is known to cause acute cell death and macroscopic damage to cartilage and menisci in vitro. The purpose of this study was to investigate cell viability and macroscopic damage of the medial and lateral menisci using an in situ model of traumatic loading. Furthermore, the release of nitric oxide from meniscus, synovium, cartilage, and subchondral bone was also documented. METHODS: The left limbs of five rabbits were subjected to tibiofemoral impaction resulting in anterior cruciate ligament (ACL) rupture and meniscal damage. Meniscal tear morphology was assessed immediately after trauma and cell viability of the lateral and medial menisci was assessed 24 hrs post-injury. Nitric oxide (NO) released from joint tissues to the media was assayed at 12 and 24 hrs post injury. RESULTS: ACL and meniscal tearing resulted from the traumatic closed joint impact. A significant decrease in cell viability was observed in the lateral menisci following traumatic impaction compared to the medial menisci and control limbs. While NO release was greater in the impacted joints, this difference was not statistically significant. CONCLUSION: This is the first study to investigate acute meniscal viability following an in situ traumatic loading event that results in rupture of the ACL. The change in cell viability of the lateral menisci may play a role in the advancement of joint degeneration following traumatic knee joint injury. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/1471-2474-15-297) contains supplementary material, which is available to authorized users

Estimation of ligament strains and joint moments in the ankle during a supination sprain injury

This study presents the ankle ligament strains and ankle joint moments during an accidental injury event diagnosed as a grade I anterior talofibular ligament (ATaFL) sprain. A male athlete accidentally sprained his ankle while performing a cutting motion in a laboratory setting. The kinematic data were input to a three-dimensional rigid-body foot model for simulation analyses. Maximum strains in 20 ligaments were evaluated in simulations that investigated various combinations of the reported ankle joint motions. Temporal strains in the ATaFL and the calcaneofibular ligament (CaFL) were then compared and the three-dimensional ankle joint moments were evaluated from the model. The ATaFL and CaFL were highly strained when the inversion motion was simulated (10% for ATaFL and 12% for CaFL). These ligament strains were increased significantly when either or both plantarflexion and internal rotation motions were added in a temporal fashion (up to 20% for ATaFL and 16% for CaFL). Interestingly, at the time strain peaked in the ATaFL, the plantarflexion angle was not large but apparently important. This computational simulation study suggested that an inversion moment of approximately 23 N m plus an internal rotation moment of approximately 11 N m and a small plantarflexion moment may have generated a strain of 15–20% in the ATaFL to produce a grade I ligament injury in the athlete's ankle. This injury simulation study exhibited the potentially important roles of plantarflexion and internal rotation, when combined with a large inversion motion, to produce a grade I ATaFL injury in the ankle of this athlete

ANKLE LIGAMENT STRAIN DURING SUPINATION SPRAIN INJURY – A COMPUTATIONAL BIOMECHANICS STUDY

This study presents ankle ligament strain data during a grade I mild anterior talofibular ligamentous sprain. Kinematics data obtained during the injury and a 3BW were imported to a validated dynamic foot model. Four simulations were done: (1) inversion, (2) inversion plus plantarflexion, (3) inversion plus internal rotation, and (4) inversion, plantarflexion and internal rotation. Results showed that in situation (1), the calcaneofibular ligament was strained the most (12%), followed by the anterior talofibular ligament (10%). In situations (2) and (3), both ligaments were strained to about 14-16%. In situation (4), the anterior talofibular ligament was strained to 20%. This study suggested that plantarflexion and internal rotation, together with inversion, may have greatly strained and torn the anterior talofibular ligament during the reported injury event

Rotational Stiffness of Football Shoes Influences Talus Motion during External Rotation of the Foot

Shoe-surface interface characteristics have been implicated in the high incidence of ankle injuries suffered by athletes. Yet, the differences in rotational stiffness among shoes may also influence injury risk. It was hypothesized that shoes with different rotational stiffness will generate different patterns of ankle ligament strain. Four football shoe designs were tested and compared in terms of rotational stiffness. Twelve (six pairs) male cadaveric lower extremity limbs were externally rotated 30 deg using two selected football shoe designs, i.e., a flexible shoe and a rigid shoe. Motion capture was performed to track the movement of the talus with a reflective marker array screwed into the bone. A computational ankle model was utilized to input talus motions for the estimation of ankle ligament strains. At 30 deg of rotation, the rigid shoe generated higher ankle joint torque at 46.2 6 9.3 Nm than the flexible shoe at 35.4 6 5.7 Nm. While talus rotation was greater in the rigid shoe (15.9 6 1.6 deg versus 12.1 6 1.0 deg), the flexible shoe generated more talus eversion (5.6 6 1.5 deg versus 1.26 0.8 deg). While these talus motions resulted in the same level of anterior deltoid ligament strain (approxiamtely 5%) between shoes, there was a significant increase of anterior tibiofibular ligament strain (4.56 0.4% versus 2.3 6 0.3%) for the flexible versus more rigid shoe design. The flexible shoe may provide less restraint to the subtalar and transverse tarsal joints, resulting in more eversion but less axial rotation of the talus during foot=shoe rotation. The increase of strain in the anterior tibiofibular ligament may have been largely due to the increased level of talus eversion documented for the flexible shoe. There may be a direct correlation of ankle joint torque with axial talus rotation, and an inverse relationship between torque and talus eversion. The study may provide some insight into relationships between shoe design and ankle ligament strain patterns. In future studies, these data may be useful in characterizing shoe design parameters and balancing potential ankle injury risks with player performance

Pulmonary, Gonadal, and Central Nervous System Status after Bone Marrow Transplantation for Sickle Cell Disease

We conducted a prospective, multicenter investigation of human-leukocyte antigen (HLA) identical sibling bone marrow transplantation (BMT) in children with severe sickle cell disease (SCD) between 1991 and 2000. To determine if children were protected from complications of SCD after successful BMT, we extended our initial study of BMT for SCD to conduct assessments of the central nervous system (CNS) and of pulmonary function 2 or more years after transplantation. In addition, the impact on gonadal function was studied. After BMT, patients with stroke who had stable engraftment of donor cells experienced no subsequent stroke events after BMT, and brain magnetic resonance imaging (MRI) exams demonstrated stable or improved appearance. However, 2 patients with graft rejection had a second stroke after BMT. After transplantation, most patients also had unchanged or improved pulmonary function. Among the 11 patients who had restrictive lung changes at baseline, 5 were improved and 6 had persistent restrictive disease after BMT. Of the 2 patients who had obstructive changes at baseline, 1 improved and 1 had worsened obstructive disease after BMT. There was, however, significant gonadal toxicity after BMT, particularly among female recipients. In summary, individuals who had stable donor engraftment did not experience sickle-related complications after BMT, and were protected from progressive CNS and pulmonary disease

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

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°, 90°, or 120°. 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° flexion angle, the patella was fractured centrally, while at 60° 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

Insult to the human cadaver patellofemoral joint: effects of age on fracture tolerance and occult injury

Lower extremity (knee) trauma is currently based on a bone fracture criterion derived from impacts of aged specimens. Recent clinical studies, however, indicate that a chronic disease (post-traumatic osteoarthritis), may be precipitated after mechanical insult without obvious bone fracture(1). It is hypothesized this is due to microcracking of subchondral bone under cartilage. This hard tissue layer is known to change with age and pathology. Ten ‘aged’ (71 years) and ten ‘young’ (47 years) cadaver knee joints were impacted to study the influence of age and pathology on the fracture load, and incidents of occult injury. Our results indicate that fracture load, per se, was independent of specimen age. On the other hand, severely pathological specimens required significantly higher loads to fracture bone. Occult microcraking was also observed in subfracture experiments, however, fewer incidents were recorded for the ‘aged’ specimens. This type of injury has been associated with knee pain and the development of disease in the chronic setting. These data suggest that a bone fracture criterion based largely on pathological specimens would not provide a conservative measure of tolerance for the normal driving population

Brian T. Weaver A Direct Method for Mapping the Center of Pressure Measured by an Insole Pressure Sensor System to the Shoe's Local Coordinate System

A direct method to express the center of pressure (CoP) measured by an insole pressure sensor system (IPSS) into a known coordinate system measured by motion tracking equipment is presented. A custom probe was constructed with reflective markers to allow its tip to be precisely tracked with motion tracking equipment. This probe was utilized to activate individual sensors on an IPSS that was placed in a shoe fitted with reflective markers used to establish a local shoe coordinate system. When pressed onto the IPSS the location of the probe's tip was coincident with the CoP measured by the IPSS (IPSS-CoP). Two separate pushes (i.e., data points) were used to develop vectors in each respective coordinate system. Simple vector mathematics determined the rotational and translational components of the transformation matrix needed to express the IPSS-CoP into the local shoe coordinate system. Validation was performed by comparing IPSS-CoP with an embedded force plate measured CoP (FP-CoP) from data gathered during kinematic trials. Six male subjects stood on an embedded FP and performed anterior/posterior (AP) sway, internal rotation, and external rotation of the body relative to a firmly planted foot. The IPSS-CoP was highly correlated with the FP-CoP for all motions, root mean square errors (RMSRRs) were comparable to other research, and there were no statistical differences between the displacement of the IPSS-CoP and FP-CoP for both the AP and medial/lateral (ML) axes, respectively. The results demonstrated that this methodology could be utilized to determine the transformation variables need to express IPSS-CoP into a known coordinate system measured by motion tracking equipment and that these variables can be determined outside the laboratory anywhere motion tracking equipment is available

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