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1. Synovial fluid lubricin increases in spontaneous canine cruciate ligament rupture

   https://doi.org/10.1038/s41598-020-73270-2  

   Wang, Yuyan ; Gludish, David W. ; Hayashi, Kei ; Todhunter, Rory J. ; Krotscheck, Ursula ; Johnson, Philippa J. ; Cummings, Bethany P. ; Su, Jin ; Reesink, Heidi L. ( October 2020 , Scientific Reports)

   Lubricin is an important boundary lubricant and chondroprotective glycoprotein in synovial fluid. Both increased and decreased synovial fluid lubricin concentrations have been reported in experimental post-traumatic osteoarthritis (PTOA) animal models and in naturally occurring joint injuries in humans and animals, with no consensus about how lubricin is altered in different species or injury types. Increased synovial fluid lubricin has been observed following intra-articular fracture in humans and horses and in human late-stage osteoarthritis; however, it is unknown how synovial lubricin is affected by knee-destabilizing injuries in large animals. Spontaneous rupture of cranial cruciate ligament (RCCL), the anterior cruciate ligament equivalent in quadrupeds, is a common injury in dogs often accompanied by OA. Here, clinical records, radiographs, and synovial fluid samples from 30 dogs that sustained RCCL and 9 clinically healthy dogs were analyzed. Synovial fluid lubricin concentrations were nearly 16-fold greater in RCCL joints as compared to control joints, while IL-2, IL-6, IL-8, and TNF-α concentrations did not differ between groups. Synovial fluid lubricin concentrations were correlated with the presence of radiographic OA and were elevated in three animals sustaining RCCL injury prior to the radiographic manifestation of OA, indicating that lubricin may be a potential biomarker for early joint injury.

    

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2. Genipin crosslinking decreases the mechanical wear and biochemical degradation of impacted cartilage in vitro

   https://doi.org/10.1002/jor.23411  

   Bonitsky, Craig M. ; McGann, Megan E. ; Selep, Michael J. ; Ovaert, Timothy C. ; Trippel, Stephen B. ; Wagner, Diane R. ( September 2016 , Journal of Orthopaedic Research)

   High energy trauma to cartilage causes surface fissures and microstructural damage, but the degree to which this damage renders the tissue more susceptible to wear and contributes to the progression of post‐traumatic osteoarthritis (PTOA) is unknown. Additionally, no treatments are currently available to strengthen cartilage after joint trauma and to protect the tissue from subsequent degradation and wear. The purposes of this study were to investigate the role of mechanical damage in the degradation and wear of cartilage, to evaluate the effects of impact and subsequent genipin crosslinking on the changes in the viscoelastic parameters of articular cartilage, and to test the hypothesis that genipin crosslinking is an effective treatment to enhance the resistance to biochemical degradation and mechanical wear. Results demonstrate that cartilage stiffness decreases after impact loading, likely due to the formation of fissures and microarchitectural damage, and is partially or fully restored by crosslinking. The wear resistance of impacted articular cartilage was diminished compared to undamaged cartilage, suggesting that mechanical damage that is directly induced by the impact may contribute to the progression of PTOA. However, the decrease in wear resistance was completely reversed by the crosslinking treatments. Additionally, the crosslinking treatments improved the resistance to collagenase digestion at the impact‐damaged articular surface. These results highlight the potential therapeutic value of collagen crosslinking via genipin in the prevention of cartilage degeneration after traumatic injury. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:558–565, 2017.

    

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3. Using an Arthrometer to Quantify Ankle Laxity: An Infographic Summary

   https://doi.org/10.1177/19417381221147511  

   Gulick, Dawn T. ( January 2023 , Sports Health: A Multidisciplinary Approach)

   Lateral ankle sprains are a common musculoskeletal injury. The anterior talofibular ligament (ATFL) is the primary ligament involved and is assessed via an anterior drawer test. Clinically assessing joint laxity has been a subjective task. Evaluating both magnitude of translation and quality of the endfeel has presented challenges. Until recently, a reliable and valid arthrometer to test joints other than the knee has not been available. The Mobil-Aider arthrometer has undergone bench testing for validity, reliability testing in healthy persons, and most recently the testing of participants for pathology. A summary of these studies is available in the Online Supplement . The goal of this study was to determine the ability of the arthrometer to objectively identify the anterior translation of the ankle and the relationship to the clinical diagnosis. The participant was evaluated by a physician and magnitude of ankle sprain was determined. An arthrometer was used to perform an anterior drawer test (uninjured before injured, 3 measures each) in the prone position. Both clinicians were blinded to the data of the other. There were 30 participants, 10 per group (uninjured, 1° sprain, 2° sprain). Mann-Whitney U testing found significant differences between the control and grade 1 ankle sprain groups ( P < .001), the control and grade 2 ankle sprain groups ( P < .001), and the grade 1 and grade 2 ankle sprain groups ( P = .004). There was ± 0.31 mm difference in anterior translation between healthy ankles, whereas there was 1.11 mm and 2.16 mm difference between ankles in grade 1 and grade 2 sprains, respectively. The anterior drawer test is the gold standard for clinical ATFL testing, but the subjective nature of this test poses challenges. Technology is available to assess ankle joint laxity and enhance the objectivity of patient assessment and throughout the recovery process. An arthrometer is a valuable tool in quantifying orthopaedic examination.

    

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4. Osmotic Swelling Responses Are Conserved Across Cartilaginous Tissues With Varied Sulfated‐Glycosaminoglycan Contents

   https://doi.org/10.1002/jor.24521  

   Baylon, Eva G. ; Levenston, Marc E. ( November 2019 , Journal of Orthopaedic Research)

   Determining the influence of tissue composition on the osmotic swelling stress of articular cartilage and meniscus fibrocartilage is important to enhance our understanding of physiology and disease. This osmotic swelling stress is critical for the load‐bearing capability of both tissues and results in part due to the interactions between the negatively charged sulfated glycosaminoglycan (sGAG) chains and the ionic interstitial fluid. Changes in sGAG content, as those occurring during the progression of degenerative joint disease, alter such interactions. Here, we compare the time‐varying effects of altered osmotic environments on the confined compression swelling behavior of bovine tissues spanning a range of sGAG concentrations: juvenile articular cartilage, juvenile and adult meniscus, and juvenile cartilage enzymatically degraded to reduce its sGAG content. The transient response to changes in bath conditions was evaluated for explants assigned to one of three compressive offsets (5%, 10%, or 15% strain) and one of three bath conditions (0.1X, 1X, or 10X phosphate‐buffered saline). Our results show that relative responses to alterations to the osmotic environment are consistent across native tissues but differ for degraded juvenile cartilage, demonstrating that changes in sGAG do not completely recapitulate the native swelling behaviors. Further, we found a strong correlation between aggregate modulus and sGAG/collagen, as well as between sGAG and collagen contents across native tissue types, suggesting some conservation of composition–function relationships across a range of tissue types with varying sGAG concentrations. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:785‐792, 2020

    

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5. Usability and Performance Evaluation of a Novel Surgical Suture Needle in a Cadaveric Tendon Model

   Diaz, Miguel A. ; Branch, Eric A. ; Dunn, Jake ; Brothers, Anthony ; Jordan, Steve ( February 2023 , Transactions of the annual meeting of the Orthopaedic Research Society)

   INTRODUCTION: In practice, the use of a whip stitch versus a locking stitch in anterior cruciate ligament (ACL) graft preparation is based on surgeon preference. Those who prefer efficiency and shorter stitch time typically choose a whip stitch, while those who require improved biomechanical properties select a locking stitch, the gold standard of which is the Krackow method. The purpose of this study was to evaluate a novel suture needle design that can be used to perform two commonly used stitch methods, a whip stitch, and a locking stitch, by comparing the speed of graft preparation and biomechanical properties. It was hypothesized that adding a locking mechanism to the whip stitch would improve biomechanical performance but would also require more time to complete due to additional steps required for the locking technique. METHODS: Graft preparation was performed by four orthopaedic surgeons of different training levels where User 1 and User 2 were both attendings and User’s 3 and 4 were both fellows. A total of 24 matched pair cadaveric knees were dissected and a total of 48 semitendinosus tendons were harvested. All grafts were standardized to the same size. Tendons were randomly divided into 4 groups (12 tendons per group) such that each User performed analogous stitch on matched pair: Group 1, User 1 and User 3 performed whip stitches; Group 2, User 1 and User 3 performed locking stitches; Group 3, User 2 and User 4 performed whip stitches; Group 4, User 2 and User 4 performed locking stitches. For instrumentation, the two ends of tendon grafts were clamped to a preparation stand. A skin marker was used to mark five evenly spaced points, 0.5 cm apart, as a guide to create a 5-stitch series. The stitches were performed with EasyWhip, a novel two-part suture needle which allows one to do both a traditional whip stitch and a locking whip stitch, referred to as WhipLock (Figure 1). The speed for graft preparation was timed for each User. Biomechanical testing was performed using a servohydraulic testing machine (MTS Bionix) equipped with a 5kN load cell (Figure 2). A standardized length of tendon, 10 cm, was coupled to the MTS actuator by passing it through a cryoclamp cooled by dry ice to a temperature of -5°C. All testing samples were pre-conditioned to normalize viscoelastic effects and testing variability through application of cyclical loading to 25-100 N for three cycles. The samples were then held at 89 N for 15 minutes. Thereafter, the samples were loaded to 50-200 N for 500 cycles at 1 Hz. If samples survived, they were ramped to failure at 20 mm/min. Displacement and force data was collected throughout testing. Metrics of interest were peak-to-peak displacement (mm), stiffness (N/mm), ultimate failure load (N) and failure mode. Data are presented as averages and standard deviations. A Wilcoxon signed-rank test was used to evaluate the groups for time to complete stitch and biomechanical performance. Statistical significance was set at P = .05. RESULTS SECTION: In Group 1, the time to complete the whip stitch was not significantly different between User 1 and User 3, where the average completion time was 1 min 13 sec. Similarly, there were no differences between Users when performing the WhipLock (Group 2) with an average time of 1 min 49 sec. In Group 3 (whip stitch), User 2 took 1 min 48 sec to complete the whip stitch, whereas User 4 took 1 min 25 sec (p=.033). The time to complete the WhipLock stitch (Group 4) was significantly different, where User 2 took 3 min and 44 sec, while User 4 only took 2 min 3 sec (p=.002). Overall, the whip stitch took on average 1 min 25 sec whereas the WhipLock took 2 min 20 sec (p=.001). For whip stitch constructs, no differences were found between Users and all stitches were biomechanically equivalent. Correspondingly, for WhipLock stitches, no differences were found between Users and all suture constructs were likewise biomechanically equivalent. Averages for peak-to-peak displacement (mm), stiffness (N/mm), and ultimate failure load (N) are presented in Table 1. Moreover, when the two stitch methods were compared, the WhipLock constructs significantly increased stiffness by 25% (p <.001), increased ultimate failure load by 35% (p<.001) and reduced peak-to-peak displacement by 55% (p=.001). The common mode of failure for grafts with whip stitch failed by suture pullout from tendon (18/24), where a few instances occurred by suture breakage (6/24). Tendon grafts with WhipLock stitch commonly failed by suture breakage (22/24), where two instances of combined tendon tear and suture breakage were noted. DISCUSSION: The WhipLock stitch significantly increased average construct stiffness and ultimate failure load, while significantly reducing the peak-to- peak displacement compared to the whip stitch. These added strength benefits of the WhipLock stitch took 55 seconds more to complete than the whip stitch. No statistically significant difference in biomechanical performance was found between the Users. Data suggests equivalent stitch performance regardless of the time to complete stitch and surgeon training level. SIGNIFICANCE/CLINICAL RELEVANCE: Clinically, having a suture needle device available which can be used to easily perform different constructs including one with significant strength advantages regardless of level of experience is of benefit. 

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