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.

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.

Musculoskeletal disorders, particularly those affecting the shoulder, are a significant health concern, especially in aging populations. Nevertheless, the initiating factors of joint degeneration remain poorly understood. Research has primarily focused on age-related changes in individual musculoskeletal tissues, with limited investigation into the complex interactions between tissues. Recent studies on interorgan communication between musculoskeletal tissues and other organs have gained attention, but local interactions within the shoulder remain underexplored. This study aims to investigate age- and sex-related differences in bone-tendon-muscle (BTM) crosstalk, hypothesizing that these interactions vary by age and sex, with older and female tissues exhibiting a reduced secretory phenotype. Using novel in vitro monoculture and co- cultures of explanted whole tissues, we assessed inflammatory responses across bone, tendon, and muscle from young and aged male and female C57BL/6J mice. Our results demonstrate significant age- and sex-dependent differences in cytokine secretion, with aged males and females showing altered inflammatory profiles. We observed a general increase in pro-inflammatory cytokine secretion in monocultures, with aging amplifying this response. Tissue co-cultures revealed that crosstalk between bone and tendon was primarily mediated through secreted factors, while muscle-tendon communication required physical proximity or contact, suggesting a distinct mode of interaction between these tissues. Sex differences were evident in both the individual tissue responses and in the patterns of inter-tissue communication. Importantly, our findings suggest that tendon plays a crucial role in mediating inter-tissue communication, with aging disrupting this crosstalk. However, these sex differences diminished with aging, indicating that the age-related decline in tissue-specific signaling may override sex-based distinctions.

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.

Purpose of this studyThe anterior cruciate ligament (ACL) has been believed to have a low spontaneous healing capacity; growing evidence has suggested that ACL could heal spontaneously. While the healed ACL has reduced mechanical properties and incomplete tissue maturation, the mechanisms underlying these problems remain unknown. We aimed to elucidate the effect of mechanical stresses during the early phase of spontaneous ACL healing. Materials and MethodsMale and female C57BL/6 mice were subjected to ACL rupture and randomly classified into three groups: Tight-CATT; tightly controlled anterior tibial translation (ATT), Loose-CATT; loosely controlled ATT and mild increasing mechanical stress compared to Tight-CATT, and ACL-Rupture (ACL-R) group; not controlled ATT. Mice were sacrificed and analyzed immediately after injury and at 4 and 8 weeks. We evaluated the effect of controlling the braking force of the ATT of each knee, the success rate of the ACL healing, collagen maturation, COL1A1 expression in the healed ACL, and the mechanical properties of the healed ACL. ResultsThe Tight-CATT group showed a higher success rate of ACL healing than the Loose-CATT group at 4 and 8 weeks. However, collagen maturation and the mechanical properties of healed ACL did not differ between the Tight-CATT and Loose-CATT groups. ConclusionOur results suggested that loose ATT braking immediately after injury is a negative factor for the healing of the completely ruptured ACL, and that it may be necessary to apply higher mechanical stress in the later stages to achieve greater healing.

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.

Tendon rupture can occur at any age and is commonly treated non-operatively, yet can result in persisting symptoms. Thus, a need exists to improve non-operative treatments of injured tendons. Photobiomodulation (PBM) therapy has shown promise in the clinic and is hypothesized to stimulate mitochondrial-related metabolism and improve healing. However, the effect of PBM therapy on mitochondrial function during tendon maturation and healing are unknown, and its effect on tendon structure and function remain unclear. In this study, near-infrared light (980:810nm blend, 2.5J/cm2) was applied at low (30mW/cm2) or high (300mW/cm2) irradiance to unilateral Achilles tendons of CD-1 mice during postnatal growth (maturation) as well as adult mice with bilateral Achilles tenotomy (healing). The chronic effect of PBM therapy on tendon structure and function was determined using histology and mechanics, and the acute effect of PBM therapy on mitochondrial-related gene expression was assessed. During maturation and healing, collagen alignment, cell number, and nuclear shape were unaffected by chronic PBM therapy. We found a sex-dependent effect of PBM therapy during healing on mechanical outcomes (e.g., increased stiffness and Youngs modulus for PBM-treated females, and increased strain at ultimate stress for PBM-treated males). Mitochondria-related gene expression was marginally influenced by PBM therapy for both maturation and healing studies. This study was the first to implement PBM therapy during both growth and healing of the murine tendon. PBM therapy resulted in marginal and sex-dependent effects on murine tendon.

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

Musculoskeletal function declines with aging, resulting in an increased incidence of trips and falls. Both bone and muscle experience age-related losses in tissue mass that alter their mechanical interactions in a well characterized manner, but changes in the biochemical interactions between bone and muscle with aging are not well understood. Of note, insulin-like growth factor 1 (IGF-1), a potent growth factor for bone and muscle, can be negatively altered with aging and may help explain losses in these tissues. We recently developed a co-culture system for simultaneous growth of bone mesenchymal stem cells (MSCs) and muscle satellite cells (SCs) to investigate the biochemical crosstalk between the two cell types. Here, we utilized an aging rat model to study cellular changes between young and old rat MSCs and SCs, in particular whether 1) young MSCs and SCs have increased proliferation and differentiation compared to old MSCs and SCs; 2) young cells have increased IGF-1 and collagen expression as a measure of crosstalk compared to old cells; and 3) young cells can mitigate the aging phenotype of old cells in co-culture. Rat MSCs and SCs were either mono- or co-cultured in Transwell(R) plates, grown to confluence, and allowed to differentiate for 14 days. Across the 14 days, cell proliferation was measured, with differentiation and crosstalk measurements evaluated at 14 days. The results suggest that in both young and old, proliferation is greater in mono-cultures compared to co-cultures, yet age and cell type did not have a significant effect. Differentiation did not differ between young and old cells, yet MSCs and SCs demonstrated the greatest amount of differentiation in co-culture. Finally, age, cell type, and culture type did not have a significant effect on collagen or IGF-1 expression. These results suggest co-culture may have a controlling effect, with the two cell types acting together to promote differentiation more than in mono-cultures, yet this response was not altered by age. In general, results for old cells had higher variability, suggesting a wider variety in the aging phenotypes demonstrated in these animals. This study was the first to use this rat aging model to investigate changes between bone and skeletal muscle cells, however further investigations are required to determine what signaling changes occur in response to age. Determining these signaling changes could lead to new targets for mitigating the progression of aging.

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.

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.

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.

ObjectiveMeniscus degeneration and subchondral bone changes contribute to the development and progression of knee OA. The purpose of this study was to reveal the relationship between medial meniscus degeneration and characteristics of subchondral bone changes in different models DesignWe used the anterior cruciate ligament transection (ACL-T) model, destabilization of the medial meniscus (DMM) model, controlled abnormal tibial translation (CATT) model and a controlled abnormal tibial rotation (CATR) model with different mechanical stresses. We performed histological analysis and micro computed tomography analysis, at 4 and 6 weeks. In addition, we divided the tibial subchondral bone into four compartments and set the regions of interest ResultsMeniscus degeneration was observed in all groups, but there was no significant difference. The ACL-T group showed posterior displacement of the contact area, and the DMM and CATR groups showed lateral deviation of the medial meniscus. The region-specific subchondral bone changes in each model showed that changes in mechanical stress due to ACL and meniscus dysfunction, as well as changes in the contact area, affect the bony structure of the subchondral bone differently in each region. ConclusionsSubchondral bone changes in different models of mechanical stress were different in each region. In particular, changes in the contact area and increased compressive stress due to meniscus dysfunction were suggested to promote bone formation. The results of this study indicate that changes in alignment and contact area in the PTOA model may cause region-specific characteristics of the subchondral bone changes.

The supraspinatus is the most frequently injured rotator cuff muscle, but its anatomical characteristics such as larger size, complex fiber architecture, and a single exposed tendon have limited the development of reproducible ex vivo contractility assays. In this study, we establish a robust method for ex vivo assessment of murine supraspinatus contractile function and characterize its physiological properties across age and injury conditions. We additionally adapt a barium chloride (BaCl2)-induced injury protocol for the supraspinatus, an approach not previously described, to evaluate how acute myofiber degeneration affects muscle performance. Male C57BL/6 mice (4 months) underwent 1.2% BaCl2 injection directly into the supraspinatus to induce controlled myofiber necrosis, allowing comparison of contractile behavior between injured and uninjured muscles. Using our injury ex vivo physiological testing protocol, we quantified optimal length (L0), twitch kinetics, force-frequency responses, peak tetanic force, and preliminary fatigue-recovery dynamics. Our protocol consistently generated fused tetanic contractions and reproducible force-frequency curves in the supraspinatus. We observed differences in supraspinatus contractility between young and old mice, consistent with well-established age-related changes in hindlimb muscle contractility. In addition, BaCl2 injury produced significant impairments in contractility 48 hours post-injection, demonstrating the sensitivity of this method to acute muscle damage. This study provides a novel and reliable method for evaluating the contractile function of the murine supraspinatus muscle ex vivo, overcoming previous anatomical challenges.

BackgroundChronic lateral ankle instability stems from laxity in the anterior talofibular (ATFL) and calcaneofibular (CFL) ligaments. While suture repair is standard, added reinforcement is often needed to restore native strength. This study evaluates the biomechanics bio-inductive implant augmentation (Bio-Aug) of suture repair. MethodsEight fresh-frozen human ankle specimens were tested under three ATFL and CFL conditions, including: (1) Intact, (2) Suture-Repair, and (3) Bio-Aug, (BioBrace(R), CONMED Co, Largo, FL). Biomechanical testing included a 500-cycle loading protocol, with creep, primary stiffness, and final stiffness as outcomes. ResultsOnly 32% of Suture-Repair specimens completed all 500 cycles, compared to full completion in other groups (P = .04). Bio-Aug results were comparable to Intact, while Suture-Repair showed lower final stiffness than Bio-Aug (P = .049). The Intact group had the least creep, although Suture-Repair showed high variability. ConclusionBio-inductive implant appears to provide comparable stiffness to native ligaments by reinforcing suture repair.

The repair of articular cartilage after damage is challenging, and clinical interventions to promote regeneration remain elusive. The most effective treatment for cartilage defects utilizes viable osteochondral allografts from young donors, but unfortunately suffers from severe source limitations and short storage time. Decellularized tissue offers the potential to utilize native tissue structure and composition while also overcoming source limitations, but the long-term efficacy of acellular allografts is unknown. Here, we show that acellular osteochondral allografts improve functional and integrative cartilage repair in defect regions after 6 months in a preclinical (sheep) animal model. Functional measures of intratissue strain and structure assessed by MRI demonstrate similar biomechanical performance between implants and native cartilage. Compared to native tissue, the structure, composition, and tribology of acellular allografts conserve surface roughness and lubrication, native cartilage material properties under compression and relaxation, and compositional ratios of collagen:glycosaminoglycan and collagen:phosphate. However, while high cellularity was observed in the integration zones between native cartilage and acellular allografts, recellularization throughout the chondral implant was largely lacking, potentially limiting long-term cellular maintenance in the graft and repair success. Our results advance a suite of joint-to-cellular functional assays, demonstrate the biomechanical efficacy of acellular allografts for at least six months in vivo, and suggest that long-term implant success may suffer from a lack of cell migration into the dense decellularized chondral tissue.

ObjectiveOsteoarthritis (OA) is the most prevalent joint disorder with incidence increasing worldwide. Mechanistic insights into OA pathophysiology are still evolving and there are currently no disease-modifying OA drugs available. It is well established that an increase in proteolytic enzyme activity is linked to progressive degradation of the cartilage in OA. Proteolytic enzymes can also trigger inflammation through activation of a family of G-protein coupled receptors (GPCRs) called the Proteinase Activated Receptors (PARs). Here we sought to characterize the PAR activating enzyme repertoire in human OA knee joint fluids. MethodsHuman knee joint synovial fluids derived from twenty-five OA patients and four healthy donors were screened for PAR cleavage activity using novel genetically encoded human PAR biosensor expressing cells. The class or type of enzymes cleaving the PARs was further characterized using enzyme-selective inhibitors and enzyme-specific fluorogenic substrates. ResultsActivity of PAR1, PAR2 and PAR4 activating enzymes were identified at substantially different levels in OA patients relative to healthy knee joint synovial fluids. Using enzyme class or type selective inhibitors and fluorogenic substrates we found that serine proteinases, including thrombin-like enzymes, trypsin-like enzymes, and matrix metalloproteinases are the major PAR activating enzymes present in the OA knee synovial fluids. ConclusionsMultiple enzymes activating PAR1, PAR2 and PAR4 are present in OA joint fluids. PAR signalling can trigger pro-inflammatory responses and targeting PARs has been proposed as a therapeutic approach in OA. Knowledge of the PAR activators present in the human knee joint will guide study of relevant signaling events and enable future development of novel PAR targeted therapies for OA and other inflammatory joint diseases.

Many transgender youth seek gender affirming care, such as puberty suppression, to prolong decision-making and to align their physical sex characteristics with their gender identity. During peripubertal growth, connective tissues such as tendon rapidly adapt to applied mechanical loads (e.g., exercise) yet if and how tendon adaptation is influenced by sex and gender affirming hormone therapy during growth remains unknown. The goal of this study was to understand the how pubertal suppression influences the structural and functional properties of the Achilles tendon using an established mouse model of transmasculine gender affirming hormone therapy. C57BL/6N female-born mice were assigned to experimental groups to mimic gender-affirming hormone therapy in human adolescents, and treatment was initiated prior to the onset of puberty (at postnatal day 26, P26). Experimental groups included controls and mice serially treated with gonadotropin release hormone analogue (GnRHa), delayed Testosterone (T), or GnRHa followed by T. We found that puberty suppression using GnRHa, with and without T, improved the overall tendon load capacity in female-born mice. Treatment with T resulted in an increase in the maximum load that tendon can withstand before failure. Additionally, we found that GnRHa, but not T, treatment resulted in a significant increase in cell density at the Achilles enthesis. NEW & NOTEWORTHYThese findings demonstrate that puberty suppression or testosterone does not negatively influence tendon structural or functional properties in a mouse model of transmasculine gender affirming care. In all treatment groups, the ability of the tendon to withstand load was significantly increased. Puberty suppression with GnRHa significantly increased enthesis cell density, suggesting an extended growth phase. These findings elucidate the effects of gender affirming care on the structural and functional properties of the tendon and enthesis.

Brachial plexus birth injury (BPBI) causes functional arm impairment in 30-40% of those affected due to altered loading on the glenohumeral joint. While gross morphological osseous deformities have been seen in the humerus and scapula, alterations in the underlying trabecular bone microstructure and mineralization are not clear. Using a murine model of BPBI, trabecular bone alterations were explored in the proximal humerus and distal scapula, which surround the articulating surface of the joint. Samples were scanned using micro-CT, reoriented, and analyzed for standard trabecular metrics. The regions of interest closest to the articulating surface showed the greatest detriments. In the scapula, the scapular neck region showed less robust trabecular bone in the neurectomy group with decreased BV/TV (p=0.001), BMD (p=0.001), Conn.D (p=0.006), Tb.N (p<0.0001), and DA (p=0.033), and increased Tb.Sp (p<0.0001) compared to sham. In the humerus, the epiphysis showed less robust trabecular bone in neurectomy group, but to a much lesser extent than the scapular neck. The neurectomy group showed reduced BMD (p=0.007) and Tb.N (p=0.029) compared to sham. Data suggest deformities are worse near the articulating surface, likely due to the greater amount of mechanical loading. The reduction in trabecular microstructure and mineralization may compromise bone strength of the affected limb following BPBI. Further investigation of the underlying trabecular bone deformities following injury are necessary to eventually inform better treatments to limit the development of deformities.

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.