Journal of Orthopaedic Research

Osteoarthritis is a disease marked by progressive and irreversible hyaline cartilage and fibrocartilage breakdown that affects the lives of millions of patients worldwide. Female sex and menopause are both risk factors for knee osteoarthritis, indicating that estrogen could play a role in this disease. In this study, RNA sequencing was used to determine the effects of estrogen treatment on human meniscal cells. Differences in the number and type of differentially expressed genes were seen based on donor sex, estrogen dose, and dosing kinetics. Significantly more differentially expressed genes were seen from male meniscal cells in response to all dosing conditions compared to female cells. Importantly, more genes were differentially expressed in cells treated with continuous dosing of estrogen, which has been shown to stimulate genomic estrogen signaling, as compared to pulsed dosing. Additionally, functional enrichment analysis revealed that many genes of the extracellular matrix, which is important for joint health and injury repair, were differentially expressed. Overall, this initial study lays the groundwork for future avenues to pursue the effect of estrogen delivery on regenerative pathways. This critical analysis will then inform the design and implementation of estrogen replacement therapies to promote meniscal health and reduce the onset of osteoarthritis.

Osteoarthritis (OA) is a common chronic degenerative joint disease affecting articular cartilage and underlying bone. Both genetic and environmental factors appear to contribute to the development of this disease. Specifically, pathological levels of biomechanical stress on joints play a notable role in disease initiation and progression. Population-level gene expression studies of cartilage cells experiencing biomechanical stress may uncover gene-by-environment interactions relevant to OA and human joint health. To build a foundation for such studies, we applied differentiation protocols to develop an in vitro system of chondrogenic cell lines (iPSC-chondrocytes). We characterized gene regulatory responses of three human iPSC-chondrocyte lines to cyclic tensile strain treatment. We measured the contribution of biological and technical factors to gene expression variation in this system and, even in this small sample, found several genes that exhibit inter-individual expression differences in response to mechanical strain, including genes previously implicated in OA. Expanding this system to include iPSC-chondrocytes from a larger number of individuals will allow us to characterize and better understand gene-by-environment interactions related to OA and joint health.

BackgroundComputational modeling is a tool being deployed for orthopaedic solutions but its use in the hand and wrist remains limited. This work used a model to simulate a clinically relevant provocative scaphoid shift maneuver (SSM) with different levels of scapholunate interosseous ligament (SLIL) injuries to observe the effect on different metrics. MethodsA personalized model simulated the full SSM motion cycle from ulnar deviation with extension to radial deviation with flexion informed by the participants motion obtained from dynamic computed tomography. Models repeated the SSM under different levels of SLIL injury and reported changes in joint kinematics, contact mechanics, and ligament forces. ResultsThe fully injured model increased scaphoid dorsal translation, flexion, and radial deviation compared to the intact condition and caused a subluxation of the scaphoid. Radioscaphoid contact areas were approximately 200% greater in the fully injured model compared with all others and the fully injured model was the only condition where contact force decreased across the motion cycle. Ligament forces in the intact condition were on average 33.0 N and 54.2 N for the volar and dorsal SLIL, respectively. Lastly, the long radiolunate, an extrinsic stabilizer, had forces that increased following SLIL injury. ConclusionsComputational models can successfully recreate clinically observed behaviors of an SSM, including scaphoid subluxation, while providing new insights via quantification of contact mechanics and ligament forces. Contact mechanics metrics may be important for understanding the long-term progression of untreated SLIL injuries to osteoarthritis. Additionally, ligament force metrics may explain the progression of SLIL injuries from volar SLIL to dorsal SLIL and highlight the importance of repairing extrinsic stabilizers of the joint, due to increased force sharing following SLIL injury. This work provides a pathway to future studies investigating the effects of SLIL injury and repair, both acutely and chronically.

BackgroundScientific research is replete with poor accessibility to data, materials, and protocol, which limits the reproducibility of a study. Transparency with regard to materials, protocols, and raw data sets enhances reproducibility by providing the critical information necessary to verify, replicate, and resynthesize research findings. The extent to which transparency and reproducibility exist in the field of orthopaedics is unclear. In our study, we aimed to evaluate transparency and reproducibility-related characteristics of randomly sampled publications in orthopaedic journals.\n\nMethodsWe used the National Library of Medicine catalog to identify English language and MEDLINE-indexed orthopaedic journals. From the 74 journals meeting our inclusion criteria, we randomly sampled 300 publications using a refined PubMed search that were published between January 1, 2014, and December 31, 2018. Two investigators were trained for data extraction and analysis. Both investigators were blinded and independently extracted data from the 300 studies.\n\nResultsOur initial search yielded 68,102 publications, from which we drew a random sample of 300 publications. Of these 300 publications, 286 were screened for empirical data and 14 were inaccessible. For analysis purposes, we excluded publications without empirical data. Of the 182 with empirical data, 13 studies (7.1%) included a data availability statement, 9 (4.9%) reported materials were available, none (0.0%) provided analysis scripts, 2 (1.1%) provided access to the protocol used, 5 (2.7%) were preregistered, and only 2 (1.1%) provided a statement about being a replicated study.\n\nConclusionsComponents necessary for reproducibility are lacking in orthopaedic surgery journals. The vast majority of publications did not provide data or material availability statements, protocols, or analysis scripts, and had no preregistration statements. Intervention is needed to improve reproducibility in the field of orthopaedics. The current state of reproducibility in orthopaedic surgery could be improved by combined efforts from funding agencies, authors, peer reviewers, and journals alike.\n\nLevel of EvidenceN/A

Anterior cruciate ligament (ACL) injuries are a major problem in the pediatric and adolescent populations. Some of these injuries extend only partially through the tissue cross-section; yet, there is limited data to inform clinical treatment of such partial tears. In particular, it is unknown how injury severity impacts long-term degenerative changes in the joint. Here, we leverage a skeletally immature preclinical porcine model to evaluate joint biomechanics and degeneration after partial (isolated anteromedial (AM) or posterolateral (PL) bundle) or complete ACL injury. Six months after injury, joint laxity increases were minimal after PL bundle injury, minor after AM bundle injury, and major after ACL injury. Joint degeneration (evaluated in the cartilage and meniscus) was minimal after PL bundle injury, moderate after AM bundle injury, and substantial after ACL injury. With subjects grouped by clinical Lachman grade (indicating the extent of joint destabilization), degeneration was associated with increasing grade, irrespective of injury type. These findings point to the importance of considering joint laxity as a factor when treating young patients, particularly those with partial ACL injuries.

ObjectivePost-traumatic osteoarthritis (PTOA) is a common long-term outcome following ACL injury. However, early changes to bone and synovial fluid after ACL injury are not sufficiently understood. The objectives of this study were to (1) evaluate whether acute bone loss one week after ACL injury is accompanied by altered subchondral bone plate modulus, (2) determine if bone changes are localized to the injured limb or extend to the contralateral-to-injured limb compared with sham-loaded controls, and (3) identify shifts in synovial fluid metabolism unique to injured limbs. DesignFemale C57Bl\6N mice (19 weeks at injury) were subjected to either a single tibial compression overload to simulate ACL injury (n=8) or a small pre-load (n=8). Mice were euthanized 7 days after injury, and synovial fluid was immediately harvested for metabolomic profiling. Bone microarchitecture, bone formation, and subchondral bone modulus at the proximal tibia were studied using microCT, histomorphometry, and nanoindentation, respectively. Osteoclast number density was assessed at the distal femur. For each bone measure a mixed model ANOVA was generated to determine the effects of injury and loaded side. ResultsEpiphyseal and subchondral bone microarchitecture decreased while subchondral bone tissue modulus was unchanged after ACL injuries. Bone resorption increased but bone formation was not changed. Loss of bone microarchitecture also occurred for the contralateral-to-injured limb, demonstrating that the early response to ACL injury extended beyond the injured joint. While the metabolomic profiles of the injured and contralateral-to-injured limbs had many similarities, there were also distinct metabolic shifts present in only the injured limbs. The most prominent of the pathways was cysteine and methionine metabolism, which is associated with osteoclast activity. ConclusionThese results add to the understanding of early bone changes following ACL injury. Confirming prior reports, we observe a decline in epiphyseal and subchondral bone microarchitecture. We add the finding that subchondral bone modulus remains unchanged at one week after ACL injury. A potential biomarker of this initial bone catabolic response may be synovial fluid cysteine and methionine metabolism, which was only dysregulated in injured knees. Our results implicate a rapidly changing biological and mechanical environment within both the injured and contralateral joints that has the potential for influencing the progression to PTOA.

1.BackgroundPost-traumatic osteoarthritis (PTOA) is caused by knee injuries like anterior cruciate ligament (ACL) injuries. Often, ACL injuries are accompanied by damage to other tissues and structures within the knee including the meniscus. Both are known to cause PTOA but underlying cellular mechanisms driving disease remain unknown. Aside from injury, patient sex is a prevalent risk factor associated with PTOA. HypothesisMetabolic phenotypes of synovial fluid that differ by knee injury pathology and participant sex will be distinct from each other. Study DesignA cross-sectional study. MethodsSynovial fluid from n=33 knee arthroscopy patients between 18 and 70 years with no prior knee injuries was obtained pre-procedure and injury pathology assigned post-procedure. Synovial fluid was extracted and analyzed via liquid chromatography mass spectrometry metabolomic profiling to examine differences in metabolism between injury pathologies and participant sex. Additionally, samples were pooled and underwent fragmentation to identify metabolites. ResultsMetabolite profiles revealed that injury pathology phenotypes were distinct from each other where differences in endogenous repair pathways that are triggered post-injury were detected. Specifically, acute differences in metabolism mapped to amino acid metabolism, lipid-related oxidative metabolism, and inflammatory-associated pathways. Lastly, sexual dimorphic metabolic phenotypes were examined between male and female participants, and within injury pathology. Specifically, Cervonyl Carnitine and other identified metabolites differed in concentration between sexes. ConclusionsThe results of this study suggest that different injuries (e.g., ligament vs. meniscus), as well as sex are associated with distinct metabolic phenotypes. Considering these phenotypic associations, a greater understanding of metabolic mechanisms associated with specific injuries and PTOA development may yield data regarding how endogenous repair pathways differ between injury types. Furthermore, ongoing metabolomic analysis of synovial fluid in injured male and female patients can be performed to monitor PTOA development and progression. Clinical RelevanceExtension of this work may potentially lead to the identification of biomarkers as well as drug targets that slow, stop, or reverse PTOA progression based on injury type and patient sex.

BackgroundAnterior cruciate ligament rupture (ACLR) is a well-known risk factor for the development of post-traumatic osteoarthritis (PTOA). While clinical and pre-clinical studies have characterized the onset and progression of PTOA in the tibiofemoral joint compartment, very little is known about degenerative changes in the patellofemoral compartment after ACL injury. Hypothesis/PurposeTo evaluate the extent to which ACL rupture induces acute patellofemoral joint degeneration by quantifying articular cartilage morphology and remodeling of subchondral and trabecular bone microarchitecture in the patellofemoral compartment. Study DesignDescriptive laboratory study. MethodsAdult female Lewis rats were randomized to undergo either a non-surgical ACL rupture or a Sham procedure (n = 6 per group). Ex vivo contrast-enhanced micro-computed tomography ({micro}CT) and histological evaluation of the patellofemoral compartment were performed at 2-weeks post-injury, representing a timepoint of documented early PTOA in the tibiofemoral compartment in this model. ResultsACL rupture causes osteophyte formation in the patella and mild degeneration in the superficial zone of articular cartilage (AC), including surface fibrillation, fissures, increased cellularity, and abnormal chondrocyte clustering at two weeks post-injury. Contrast-enhanced {micro}CT analysis demonstrates significant increases in AC thickness of patellar and trochlear cartilage. Loss of subchondral bone thickness, bone volume fraction, and tissue mineral density, as well as changes to trabecular microarchitecture in both the patella and trochlea, were indicative of catabolic bone remodeling. ConclusionThese results demonstrate that the patellofemoral joint develops mild but evident degenerative changes in the acute time period following ACL rupture, extending the utility of this rat model to the study of degenerative patellofemoral changes following joint trauma. Clinical RelevanceACL rupture causes mild degeneration and swelling of articular cartilage, coupled with catabolic bone remodeling in the patellofemoral compartment. Characterizing the pathophysiology of patellofemoral PTOA in its early stages may provide a better understanding of disease progression and provide opportunities for preventative therapeutic intervention.

Joint injuries, such as rupture of the anterior cruciate ligament (ACL), is associated with the development of post-traumatic osteoarthritis (PTOA). It is known that ACL rupture can lead to disruption of metabolic pathways, including the conversion of the essential amino acid tryptophan to kynurenine, which is associated with a sustained inflammatory response. An in vivo study was undertaken to determine the acute effects of intra-articular administration of liposomes loaded with the tryptophan-catabolizing enzyme indoleamine 2,3-dioxygenase-1 (IDO-1) following ACL rupture. Using an established rat model of non-surgical ACL injury, male and female Lewis rats underwent a single intra-articular injection of empty liposomes, or liposomes loaded with IDO-1 and were subsequently randomized to 1- or 2-week endpoints. IDO-1 treatment after ACL injury was associated with a significant reduction in synovial fluid concentration of tryptophan at both 1-and 2-week endpoints. In addition to a reduction in tryptophan, IDO-1 treatment led to significantly lower synovial fluid concentrations of IL-1b and TNF-a. Intra-articular administration of IDO-1-loaded liposomes also increased the ratio of regulatory T lymphocytes (Tregs) to IL-17-secreting helper T lymphocytes (Th17 cells). Similarly, IDO-1 treatment increased the number of CTLA4+ cells relative to IL-17A+ cells that infiltrated joint tissues at a 2-week endpoint. Contrast-enhanced micro-computed tomography (CE-uCT) was used to quantify treatment-based effects on articular cartilage thickness and surface roughness at at 2-week endpoint. In addition to sex-based differences, IDO-1-loaded liposome treatment was associated with increased cartilage thickness, with no significant effects on surface roughness. Histologic characterization is needed to determine whether this increased cartilage thickness represents a chondroprotective effect, or a degenerative effect of IDO-1-treatment.

BackgroundLigaments work to stabilize the human knee joint and prevent excessive movement. Whilst ligaments are known to decline in structure and function with aging, there has been no systematic effort to study changes in gross mechanical properties in the four major human knee ligaments due to osteoarthritis (OA). This study aims to collate material properties for the anterior (ACL) and posterior (PCL) cruciate ligaments, medial (MCL) and lateral (LCL) collateral ligaments. Our cadaveric samples come from a diverse demographic from which the effects of aging and OA on bone and cartilage material properties have already been quantified. Therefore, by combining our previous bone and cartilage data with the new ligament data from this study we are facilitating subject-specific whole-joint modelling studies. MethodsThe demographics of the collected cadaveric knee joints were diverse with age range between 31 to 88 years old, and OA International Cartilage Repair Society grade 0 to 4. Twelve cadaveric human knee joints were dissected, and bone-ligament-bone specimens were extracted for mechanical loading to failure. Ligament material properties were determined from the load-extension curves, namely: linear and ultimate (failure) stress and strain, secant modulus, tangent modulus, and stiffness. ResultsThere were significant negative correlations between age and ACL linear force (p=0.01), stress (p=0.03) and extension (p=0.05), ACL failure force (p=0.02), stress (p=0.02) and extension (p=0.02), PCL secant (p=0.02) and tangent (p=0.02) modulus, and LCL stiffness (p=0.05). Significant negative correlations were also found between OA grades and ACL linear force (p=0.05), stress (p=0.02), extension (p=0.01) and strain (p=0.03), and LCL failure stress (p=0.05). However, changes in age or OA grade did not show a statistically significant correlation with the MCL tensile parameters. Trends showed that almost all the tensile parameters of the ACL and PCLs decreased with increasing age and progression of OA. Due to small sample size, the combined effect of age and presence of OA could not be statistically derived. ConclusionsThis research is the first to correlate changes in tensile properties of the four major human knee ligaments to aging and OA. The current ligament study when combined with our previous findings on bone and cartilage for the same twelve knee cadavers, supports conceptualization of OA as a whole-joint disease that impairs the integrity of many peri-articular tissues within the knee. The subject-specific data pool consisting of the material properties of the four major knee ligaments, subchondral and trabecular bones and articular cartilage will aid reconstruction and graft replacements and advance knee joint finite element models, whilst knowledge of aged or diseased mechanics may direct future therapeutic interventions.

Female athletes are significantly more likely to tear their anterior cruciate ligament (ACL) compared to their male counterparts. While there are several potential reasons for this, previous data from our lab demonstrated that female ACL explants have an impaired remodeling response to loading, which may prevent the repair of fatigue damage and lead to increased ACL rupture. The objective of this study was to identify the mechanisms driving the impaired remodeling of female ACLs to cyclic loading, including the role of estrogen. ACLs were harvested from male and female New Zealand white rabbits and cyclically loaded in a tensile bioreactor followed by bulk RNA-sequencing. Additional ACL explants treated with or without estradiol were analyzed using RT-qPCR to determine the regulatory effect of estrogen on markers for tissue remodeling and inflammatory cytokines with cyclic loading. We found that female ACLs exhibited significantly fewer differentially expressed genes (DEGs) in response to loading compared to male ACLs. Additionally, multiple mechanotransduction pathways were enriched with loading only in the male ACLs. While a few estrogen-related pathways were enriched in both male and female ACLs with loading, the expression of tissue remodeling markers was not different between estrogen treatment and vehicle control. Together, our findings highlight specific mechanotransduction pathways that may be responsible for the muted biological response of female ACLs to load, which provides a potential explanation for the increased rate of ACL tears in women.

ObjectiveMeniscal calcifications are associated with meniscal degeneration and osteoarthritis (OA). We investigated micro-computed tomography ({micro}CT) imaging for identification of calcification patterns caused by basic calcium phosphate (BCP) and calcium pyrophosphate (CPP). DesignPosterior horns of human medial and lateral menisci from 19 individuals with medial compartment knee OA and 21 deceased donors were imaged with high-resolution {micro}CT. Raman spectroscopy characterized the calcification types from histological sections, adjacent to {micro}CT piece. Qualitative and quantitative analysis, visualization, and grading were performed using 3D {micro}CT images of meniscal calcifications. ResultsDifferent calcification patterns were observed with BCP and CPP. BCP was found at the borders of meniscal tissue and inside complex tears or fibrillation. In contrast, CPP accumulated as circumferential rod-like structures between collagen bundles, mainly inside the meniscal tissue, and lacked the porous 3D structure observed in BCP calcifications. Quantitatively, CPP samples had a higher calcification volume compared to BCP with a geometric mean ratio of 14 (95%CI; 3,73), and larger particle sizes with a ratio of 7 (95%CI; 2,8). Additionally, BCP calcifications had an organized porous structure with a closed porosity range of 6-19, while a similar structure was not seen in CPPs (range 1-3.5). ConclusionsWe qualitatively and quantitatively identified volumetric and morphological differences in the calcification deposition patterns between BCP and CPP calcifications in human meniscus. The calculated differences may help distinguish the calcification types with in vivo imaging modalities in the future, as well as provide a better understanding of their role in OA.

BackgroundCurrent management options for partial tendon tears may not offer future potential to heal tissue and improve clinical results. This study tested the hypothesis that treatment of a partial rabbit common calcaneus tendon (CCT) defect with uncultured, autologous, adipose derived regenerative cells (UA-ADRCs) enables regenerative healing without scar formation, as recently observed in a biopsy of a human supraspinatus tendon. MethodsA full-thickness hole (diameter, 3 mm) was punched into the midsubstance of the right gastrocnemius tendon (GT; which is a part of the CCT) of adult, female New Zealand white rabbits. Immediately thereafter the rabbits were treated by application of an averaged 28.3x106 UA-ADRCs in 0.5 ml lactated Ringers solution (RLS) into the GT defect and surrounding tendon tissue, or underwent sham treatment. Rabbits were sacrificed either four weeks (W4) or twelve weeks (W12) post-treatment, and the CCTs were investigated using histology, immunohistochemistry and non-destructive biomechanical testing. ResultsNewly formed connective tissue was consistent with the formation of new tendon tissue after treatment with UA-ADRCs, and with the formation of scar tissue after sham treatment, at both W4 and W12 post-treatment. Biomechanical testing demonstrated a significantly higher mean percent relaxation after treatment with UA-ADRCs than after sham treatment (p < 0.05), and significant, negative correlations between the peak stress as well as the equilibrium stress and the cross-sectional area of the CCT (p < 0.05) after treatment with UA-ADRCs but not after sham treatment. ConclusionsManagement of partial tendon tears with UA-ADRCs has the potential to be truly "structure-modifying".

Rotator cuff injuries result in over 500,000 surgeries performed annually, an alarmingly high number of which fail. These procedures typically involve repair of the injured tendon and removal of the subacromial bursa. However, recent identification of a resident population of mesenchymal stem cells and inflammatory responsiveness of the bursa to tendinopathy indicate an unexplored biological role of the bursa in the context of rotator cuff disease. Therefore, we aimed to understand the clinical relevance of bursa-tendon crosstalk, characterize the biologic role of the bursa within the shoulder, and test the therapeutic potential for targeting the bursa. Proteomic profiling of patient bursa and tendon samples demonstrated that the bursa is activated by tendon injury. Using a rat to model rotator cuff injury and repair, tenotomy-activated bursa protected the intact tendon adjacent to the injured tendon and maintained the morphology of the underlying bone. The bursa also promoted an early inflammatory response in the injured tendon, initiating key players in wound healing. In vivo results were supported by targeted organ culture studies of the bursa. To examine the potential to therapeutically target the bursa, dexamethasone was delivered to the bursa, prompting a shift in cellular signaling towards resolution of inflammation in the healing tendon. In conclusion, contrary to current clinical practice, the bursa should be retained to the greatest extent possible and provides a new therapeutically target for improving tendon healing outcomes. One Sentence SummaryThe subacromial bursa is activated by rotator cuff injury and regulates the paracrine environment of the shoulder to maintain the properties of the underlying tendon and bone.

Clinical and animal studies have reported the influence of sex on the incidence and progression of tendinopathy, which results in disparate structural and biomechanical outcomes. However, there remains a paucity in our understanding of the sex-specific biological mechanisms underlying effective tendon healing. To overcome this hurdle, our group has investigated the impact of sex on tendon regeneration using the super-healer Murphy Roths Large (MRL/MpJ) mouse strain. Despite a shared scarless healing capacity, we have shown that MRL/MpJ patellar tendons exhibit sexually dimorphic regulation of gene expression for pathways involved in fibrosis, cell migration, and extracellular matrix (ECM) remodeling following an acute midsubstance injury. Moreover, we previously found decreased matrix metalloproteinase-2 (MMP-2) activity in female MRL/MpJ tendons after injury. Thus, we hypothesized that MRL/MpJ scarless tendon healing is mediated by sex-specific and temporally distinct orchestration of cell-ECM interactions. Accordingly, the present study comparatively evaluated MRL/MpJ tendon cells under two-dimensional (glass) and three-dimensional (nanofiber scaffolds) culture platforms to examine cell behavior under biochemical and biophysical cues associated with tendon homeostasis and healing. Female MRL/MpJ cells showed reduced 2D migration and spreading area accompanied with enhanced mechanosensing, 2D ECM alignment, and fibronectin-dependent cell proliferation. Interestingly, female MRL/MpJ cells cultured on 3D isotropic scaffolds showed diminished ECM deposition and alignment. Regardless of culture condition and sex, MRL/MpJ cells outperformed B6 cells and elicited a universal regenerative cellular phenotype. These results illustrate the utility of these in vitro systems for elucidating regenerative tendon cell biology, which will facilitate the long-term development of more equitable therapeutics.

Osteoarthritis (OA) is the most common joint disease globally. In OA, articular cartilage degradation is often accompanied with sclerosis of the subchondral bone. However, the association between OA and tissue mineralization at the nanostructural level is currently not understood. Especially, it is technically challenging to identify calcified cartilage, where relevant but poorly understood pathological processes like tidemark multiplication and advancement occur. Here, we used state-of-the-art micro-focus small-angle X-ray scattering with high 5{micro}m spatial resolution to determine mineral crystal thickness in human subchondral bone and calcified cartilage. Specimens with a wide spectrum of OA severities were acquired from the medial and lateral compartments of medial compartment knee OA patients (n=15) and cadaver knees (n=10). For the first time, we identified a well-defined layer of calcified cartilage associated with pathological tidemark multiplication, containing 0.32nm thicker crystals compared to the rest of calcified cartilage. In addition, we found 0.2nm thicker mineral crystals in both tissues of the lateral compartment in OA compared with healthy knees, indicating a loading-related disease process since the lateral compartment is typically less loaded in medial compartment knee OA. Furthermore, the crystal thickness of the subchondral bone was lower with increasing histopathological OA severity. In summary, we report novel changes in mineral crystal thickness during OA. Our data suggest that unloading in the knee is associated with the growth of mineral crystals, which is especially evident in the calcified cartilage. In the subchondral bone, mineral crystals become thinner with increasing OA severity, which indicates new bone formation with sclerosis. One Sentence SummaryMineral crystal thickness increases with osteoarthritis in the lateral condyle that is typically unloaded.

The objective of this study was to determine compressive loads that could be generated using a tibial plateau leveling osteotomy (TPLO) jig with a tensioned strand of 18-gauge stainless steel orthopedic wire in a simulated transverse fracture model. The wire was sequentially tensioned using heavy needle holders or an AO wire tightener. Recorded loads were subsequently compared to loads generated by applying a 3.5 mm limited contact-dynamic compression plate (LC-DCP) as a compression plate. Two segments of 2 cm diameter Delrin rod were placed in a testing apparatus and used to simulate a transverse fracture. A load cell was interposed between the two segments to measure the compressive loads generated during the application of the TPLO jig or the LC-DCP. Compression was generated by sequential tensioning a strand of 18-gauge wire secured through the base of the arms of the TPLO jig or by placing one or two load screws in the LC-DCP. Wires were tensioned using heavy needle holders or an AO wire tightener. Eight replicates of each construct were tested. Recorded loads were compared using a one-way repeated measures ANOVA and Tukey Honestly Significant Difference test. The wire being tensioned broke while attempting a second quarter rotation of the needle holders and when the crank handle of the AO wire tightener was advanced beyond two rotations. The mean + SD peak compressive loads recorded when tensioning the wire using the heavy needle holders and AO wire tightener was 148 {+/-} 7 N and 217 {+/-} 16 N, respectfully. The mean {+/-} SD load recorded after placement of the first and second load screw in the LC-DCP was 131 {+/-} 39 N and 296 {+/-} 49 N, respectively. The compression generated by placing two load screws in the LC-DCP was superior to the compression generated using the jig. The maximum load recorded by tensioning the wire secured through the TPLO jig using the AO wire tightener was superior to the compression generated by placing a single load screw and tensioning the wire using needle holders. Our results demonstrate that the TPLO jig allows surgeons to compress transverse fractures or osteotomies effectively. Tensioning the AO wire tightener allows for sequential tensioning and generates superior compressive loads than tensioning wires with heavy needle holders.

ObjectiveTo identify robustly differentially expressed long non-coding RNAs (lncRNAs) with osteoarthritis (OA) pathophysiology in cartilage. Moreover to explore potential target mRNAs by establishing co-expression networks, followed by functional validation. MethodsRNA sequencing was performed on macroscopically lesioned and preserved OA cartilage of patients who underwent a joint replacement surgery due to OA (N=98). Differential expression (DE) analysis was performed on lncRNAs that were annotated in GENCODE and Ensembl. To identify potential interactions, correlations were calculated between the identified DE lncRNAs and previously reported DE protein-coding genes in the same samples. Modulation of chondrocyte lncRNA expression was achieved using LNA GapmeRs. ResultsBy applying our in-house pipeline we identified 5,053 lncRNAs to be robustly expressed, of which 191 were FDR significant differentially expressed between lesioned and preserved OA cartilage. Upon integrating mRNA sequencing data, we showed that intergenic and antisense DE lncRNAs show high, positive correlations with their flanking, respectively, sense genes. To functionally validate this observation we selected P3H2-AS1, which was downregulated in primary chondrocytes, resulting in downregulation of P3H2 gene expression levels. As such, we can confirm that P3H2-AS1 regulates its sense gene P3H2. ConclusionBy applying an improved detection strategy, robustly differentially expressed lncRNAs in OA cartilage were detected. Integration of these lncRNAs with differential mRNA expression levels in the same samples showed insight into their regulatory networks. Our data signifies that intergenic, as well as antisense lncRNAs play an important role in regulating the pathophysiology of OA.

There are situations where block grafts have to be milled to convert them into particulate grafts of definite sizes. The objectives of this study were to evaluate the quality of graft particles generated in two sizes from a custom-built automated milling system (AMS) and their biocompatibility in an animal model. A Monetite block was milled in an AMS to generate small (SS group; 0.5-0.8 mm) and medium size (MS group; 1.0-1.2 mm) particles. Measures of particle count, Ferets diameter (dF), particle distribution and size were recorded. Biocompatibility of particles was tested in a rabbit tibial defect model. The average particle size was significantly smaller in the SS group than the MS group (0.68{+/-}0.39 vs 1.10{+/-}0. 79 mm; p[&le;]0.001). There were significant to highly significant differences between SS and MS groups in measures of particle count (p[&le;]0.001), dF (p=0.02) and size (p[&le;]0.001). SS and MS groups had maximum percentage of particles in the 0.6-1mm (71%) and >1mm (70%) ranges respectively. The mineralized tissue volumes across SS, MS when compared to an autogenous block were 68.92{+/-}35.66%, 66.29{+/-}29.21% and 89.83{+/-}19.91% (p=0.003) respectively. The device was able to generate small and medium-size graft particles which were distinct from each other.

Anterior cruciate ligament (ACL) injuries disproportionately affect female adolescent athletes, with hormonal influences implicated in this sex disparity. However, the relationship between pubertal hormonal changes and ACL gene and protein expression remains poorly understood. This study characterized hormone receptor expression and transcriptional profiles in the anteromedial (AM) and posterolateral (PL) bundles of female porcine ACLs before and after puberty. ACL bundles were collected from pre-pubescent (8 weeks) and post-pubescent (>8 months) female Yorkshire cross-breed pigs (n=6/group) and analyzed using gene expression profiling, western blotting, and immunofluorescence. Pre-pubescent ACLs exhibited greater expression of primary matrix genes (COL1A1, COL1A2, ELN, TNMD), suggesting active matrix synthesis, while post-pubescent ACLs showed elevated secondary matrix genes (COL3A1, LUM, COMP), indicating a homeostatic state. Notably, estrogen receptor alpha (ER) gene and protein expression were significantly greater in post-pubescent ACLs, particularly in AM bundles, whereas G-protein coupled estrogen receptor (GPR30) expression was elevated pre-puberty. Both receptors were distributed homogeneously throughout the tissue. Progesterone receptor protein expression was not detected in any samples. Histologically, post-pubescent ACLs demonstrated decreased cellularity and thicker fascicles compared to pre-pubescent tissues. These findings indicate that ACL sensitivity to estrogen varies across development, with increased ER expression post-puberty potentially rendering the ligament more responsive to circulating estrogen. This work provides foundational evidence for age-dependent hormonal responsiveness in the ACL and motivates further investigation into how sex hormones influence ACL injury risk in adolescent females.