Pathways of load-induced cartilage damage causing cartilage degeneration in the knee after meniscectomy

Results of both clinical and animal studies show that meniscectomy often leads to osteoarthritic degenerative changes in articular cartilage. It is generally assumed that this process of cartilage degeneration is due to changes in mechanical loading after meniscectomy. It is, however, not known why and where this cartilage degeneration starts. Load induced cartilage damage is characterized as either type (1)--damage without disruption of the underlying bone or calcified cartilage layer--or type (2), subchondral fracture with or without damage to the overlying cartilage. We asked the question whether cartilage degeneration after meniscectomy is likely to be initiated by type (1) and/or type (2) cartilage damage. To investigate that we applied an axisymmetric biphasic finite element analysis model of the knee joint. In this model the articular cartilage layers of the tibial and the femoral condyles, the meniscus and the bone underlying the articular cartilage of the tibia plateau were included. The model was validated with data from clinical studies, in which the effects of meniscectomy on contact areas and pressures were measured. It was found that both the maximal values and the distributions of the shear stress in the articular cartilage changed after meniscectomy, and that these changes could lead to both type (1) and type (2) cartilage damage. Hence it likely that the cartilage degeneration seen after meniscectomy is initiated by both type (1) and type (2) cartilage damage.     

Isokinetic rehabilitation after arthroscopic meniscectomy.

The aim of this study was to assess the effects in humans of early (2 weeks) and delayed (6 weeks) isokinetic strength training in the recovery of muscle strength following an arthroscopic partial meniscectomy. The peak torque developed in the quadriceps and hamstrings and the torque developed at a knee angle of 1.05 rad were evaluated in 16 subjects, pre-operatively (pre-op), and 2, 6, and 10 weeks post-operatively (post-op), on an isokinetic device at four different velocities (1.05, 2.09, 3.14, and 4.19 rad.s-1). The fatigue characteristics of the muscles were evaluated by having the subject perform 15 maximal contractions at 3.14 rad.s-1. Training was done on the same device (three times a week for 1-2 months), beginning either 2 or 6 weeks post-op. A repeated measures analysis of variance demonstrated a time effect but no differences between groups and no interactions. Torques developed by the knee flexors and extensors were significantly smaller 2 weeks post-op than pre-op, at all velocities tested. Torques developed in the quadriceps recovered to their pre-op values by 6 weeks, and further gained significantly in strength from 6 to 10 weeks. Quadriceps torques remained weaker than the contralateral side at 10 weeks. Hamstrings torques were either higher or similar to pre-op values by 6 weeks, and demonstrated increases from 6 to 10 weeks post-op at 1.05 and 4.19 rad.s-1 only. Total work and average power developed by the quadriceps and hamstrings during the fatigue protocol changed with time in a similar manner to torque.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cost-effectiveness study of outpatient physiotherapy after medial meniscectomy.

In a randomised controlled trial comparing the outcome of two groups of men aged 16-45 one group received outpatient physiotherapy after medial meniscectomy and the other did not. In clinical aspects of knee function there was no significant difference between the test group and control group measured at specified intervals up to 26 weeks postoperatively. Similarly, there was no significant difference between the groups in the time taken to return to work or in the mean fall in take-home pay as a result of meniscectomy. The mean cost per patient of providing outpatient physiotherapy in the test group was 23 pounds at 1976 prices. Thus the least costly way of returning male patients aged 16-45 to activity is by not providing routine outpatient physiotherapy after medial meniscectomy. Further randomised controlled trials are, however, required to determine the value of physiotherapy in other age groups and other conditions.     

Partial medial meniscectomy and rotational differences at the knee during walking

Loss of meniscal function due to injury or partial meniscectomy is common and represents a significant risk factor for premature osteoarthritis. The menisci can influence the transverse plane movements (anterior–posterior (AP) translation and internal–external (IE) rotation) of the knee during walking. While walking is the most frequent activity of daily living, the kinematic differences at the knee during walking associated with the meniscal injury are not well understood. This study examined the influence of partial medial meniscectomy (PMM) on the kinematics and kinetics of the knee during the stance phase of gait by testing the differences in anterior–posterior translation, internal–external rotation, knee flexion range of movement, peak flexion/extension moments, and adduction moments between the PMM and healthy contralateral limbs. Ten patients (45±9 years old, height 1.75±0.06 m, weight 76.7±13.5 kg) who had undergone partial medial meniscectomy (33±100 months post-op) in one limb with a healthy contralateral limb were tested during normal walking. The contralateral limb was compared to a matched control group and no differences were found. The primary kinematic difference was a significantly greater external rotation (3.2°) of the tibia that existed through stance phase, with 8 of 10 subjects demonstrating the same pattern. The PMM subjects also exhibited significantly lower peak flexion and extension moments in their PMM limbs. The altered rotational position found likely results in changes of tibio-femoral contact during walking and could cause the type of degenerative changes found in the articular cartilage following meniscal injury.     

Partial meniscectomy changes fluid pressurization in articular cartilage in human knees

Partial meniscectomy is believed to change the biomechanics of the knee joint through alterations in the contact of articular cartilages and menisci. Although fluid pressure plays an important role in the load support mechanism of the knee, the fluid pressurization in the cartilages and menisci has been ignored in the finite element studies of the mechanics of meniscectomy. In the present study, a 3D fibril-reinforced poromechanical model of the knee joint was used to explore the fluid flow dependent changes in articular cartilage following partial medial and lateral meniscectomies. Six partial longitudinal meniscectomies were considered under relaxation, simple creep, and combined creep loading conditions. In comparison to the intact knee, partial meniscectomy not only caused a substantial increase in the maximum fluid pressure but also shifted the location of this pressure in the femoral cartilage. Furthermore, these changes were positively correlated to the size of meniscal resection. While in the intact joint, the location of the maximum fluid pressure was dependent on the loading conditions, in the meniscectomized joint the location was predominantly determined by the site of meniscal resection. The partial meniscectomy also reduced the rate of the pressure dissipation, resulting in even larger difference between creep and relaxation times as compared to the case of the intact knee. The knee joint became stiffer after meniscectomy because of higher fluid pressure at knee compression followed by slower pressure dissipation. The present study indicated the role of fluid pressurization in the altered mechanics of meniscectomized knees.     

Acute changes in knee cartilage transverse relaxation time after running and bicycling

PurposeTo compare the acute effect of running and bicycling of an equivalent cumulative load on knee cartilage composition and morphometry in healthy young men. A secondary analysis investigated the relationship between activity history and the change in cartilage composition after activity.MethodsIn fifteen men (25.8±4.2 years), the vertical ground reaction force was measured to determine the cumulative load exposure of a 15-min run. The vertical pedal reaction force was recorded during bicycling to define the bicycling duration of an equivalent cumulative load. On separate visits that were spaced on average 17 days apart, participants completed these running and bicycling bouts. Mean cartilage transverse relaxation times (T₂) were determined for cartilage on the tibia and weight-bearing femur before and after each exercise. T₂ was measured using a multi-echo spin-echo sequence and 3T MRI. Cartilage of the weight bearing femur and tibia was segmented using a highly-automated segmentation algorithm. Activity history was captured using the International Physical Activity Questionnaire.ResultsThe response of T₂ to bicycling and running was different (p=0.019; mean T₂: pre-running=34.27 ms, pre-bicycling=32.93 ms, post-running=31.82 ms, post-bicycling=32.36 ms). While bicycling produced no change (−1.7%, p=0.300), running shortened T₂ (−7.1%, p<0.001). Greater activity history predicted smaller changes in tibial, but not femoral, T₂.ConclusionsChanges in knee cartilage vary based on activity type, independent of total load exposure, in healthy young men. Smaller changes in T₂ were observed after bicycling relative to running. Activity history was inversely related to tibial T₂, suggesting cartilage conditioning.     

Degenerative changes in the digestive glands of rats bearing Leydig cell tumors

We undertook this study to determine the effects of a transplantable Leydig cell tumor on the major digestive glands of the host rats. It has been known that after bearing this tumor for only two weeks, the rats become anorexic and cathectic, develop hypercalcemia and osteolysis, and their peripheral bone marrow becomes hyperplastic. We now demonstrate that the parotid glands undergo marked degeneration including depletion of secretory product, apparent loss of acinar organization and the appearance of conjoined nuclei. The submandibular and sublingual glands and the pancreas are virtually unaffected. The liver undergoes fatty degeneration, the Kupffer cells become more prominent and more numerous, and the sinusoids sometimes contain small islets of hemopoietic tissue.     

Degenerative changes in the reproductive organs of female schistosomes during maintenance in vitro

Degenerative alteration of the reproductive organs of female schistosomes in correlation with the change in egg-laying rate of schistosome pairs in vitro was studied by electron microscopy. The production of normal eggs by adult S. japonicum pairs decreased after 4 days in vitro followed by an increase of abnormal egg laying up to day 8. In S. mansoni, the yield of both normal and abnormal eggs decreased gradually from the start of maintenance in vitro in spite of a much higher pairing rate than in S. japonicum. The vitelline gland of 14-day in vitro-maintained S. japonicum stained with Fast red B, while that of S. mansoni did not. The ovary of both species exhibited regressive features after 14 days of maintenance in vitro. Ultrastructural examination showed that the vitelline cells and oocytes of S. japonicum and S. mansoni had already lost their structural integrity after 2 days in vitro and continued to exhibit signs of structural degeneration throughout the 14-day in vitro maintenance period. The regressive changes in reproductive potential of female S. mansoni maintained in vitro for 4 days could be reversed by surgically implanting the parasites into mouse mesenteric veins.     

3D finite element model of meniscectomy: changes in joint contact behavior

The goal of this study is to quantify changes in knee joint contact behavior following varying degrees of the medial partial meniscectomy. A previously validated 3D finite element model was used to simulate 11 different meniscectomies. The accompanying changes in the contact pressure on the superior surface of the menisci and tibial plateau were quantified as was the axial strain in the menisci and articular cartilage. The percentage of medial meniscus removed was linearly correlated with maximum contact pressure, mean contact pressure, and contact area. The lateral hemi-joint was minimally affected by the simulated medial meniscectomies. The location of maximum strain and location of maximum contact pressure did not change with varying degrees of partial medial meniscectomy. When 60% of the medial meniscus was removed, contact pressures increased 65% on the remaining medial meniscus and 55% on the medial tibial plateau. These data will be helpful for assessing potential complications with the surgical treatment of meniscal tears. Additionally, these data provide insight into the role of mechanical loading in the etiology of post-meniscectomy osteoarthritis.     

Degenerative changes in lymphatic endothelium of jirds infected with Brugia pahangi

The quantitative changes of cytoplasmic vesicles and vacuoles in lymphatic endothelial cells of the mongolian jirds associated with Brugia pahangi infections were observed by transmission electron microscopy. The present study revealed a decrease in the proportion of cytoplasm occupied by vesicles and in the number of cytoplasmic vesicles in endothelial cells from lymphatic vessels harboring B. pahangi at 3, 4, and 10 mo after infection (3.55, 3.36, and 2.55 vesicles/micron 2, respectively) when compared with cells from uninfected control vessels (7.03 vesicles/micron 2). On the contrary, there was an increase in the area of vacuoles in endothelial cells of jirds at 3, 4, and 10 mo postinfection. The mean +/- SD diameter of vesicles in cells from lymphatic vessels at 10 mo after infection was significantly smaller (78.6 +/- 5.6 nm) compared to vesicles in uninfected vessels (87.5 +/- 9.7 nm).     

Degenerative changes in properties of the mitochondrial inner membrane in pea cotyledons during germination

Mitochondria isolated from 5-day-old pea cotyledons had lowrespiration activity and did not respond to exogenous ADP, whilethose from 1-day-old cotyledons respired actively and respondedto ADP. The former mitochondria, but not the latter, were verysusceptible to destruction during extraction and purification.The mitochondrial inner membrane isolated from 5-day-old cotyledonswas less dense than that from 1-day-old cotyledons. The specificactivity of SDH in the former membrane was lower than that inthe latter, while both membranes were similar to each otherwith respect to the specific activity of Cyt ox. Disc electrophoresisof solubilized membrane on polyacrylamide gel containing SDSshowed that the mitochondrial inner membrane from 5-day-oldcotyledons contained lesser amounts of several polypeptidescompared with that from 1-day-old cotyledons. Such alterationsin the mitochondrial inner membrane were not observed with theexcised cotyledons cultivated for 5 days. (Received June 17, 1977; )     

Motion of the knee after condylar resurfacing--an in vivo study.

The purpose of this study was determine the amounts of rotation and displacement occurring in a relatively unconstrained condylar replacement knee, and to compare the motion with a matched group of normal knees. The motion was measured using an electromagnetic device, the 3-Space Tracker, for various common activities, for 25 normal volunteers and 25 total knee patients. The main variables studied were internal-external rotation of the tibia about its long axis and anterior-posterior displacement of the femoral origin with respect to the tibia, as a function of flexion angle or per cent of gait cycle. The motion of the total knees was very similar to that of the normals. For sitting, standing and free-swing, the knee rotated internally by 5-10 degrees and the femur displaced posteriorly by 9-14 mm, as the knee was flexed from 0 to 90 degrees. For walking and going upstairs and downstairs the absolute values of the rotations and displacements were similar to the above. However, the mean values of rotation were less due to greater variation in the rotation patterns, due probably to the increased laxity of the knee during the swing phases. From these data, taking the mean motions and one standard deviation (S.D.), it is suggested that a knee prosthesis should allow a rotation from minus to plus 12 degrees (a total range of 24 degrees) and an anterior-posterior displacement of 13 mm. It is suggested that these motions be subject to progressive restraint from the neutral position in the manner of the natural knee.     

Ultrastructural changes in the synovial membrane in experimentally-induced osteoarthritis of rabbit knee joint.

Rabbit knee joint osteoarthritis was induced by intraarticular injections of a 10% sterile NaCl solution. Within 30 days the synovial membrane had undergone hyperplasia resulting in activated synovial fibroblasts. Transitional forms of synoviocytes as well as activated synovial macrophages were a very common finding. At 60 days a thickening of the synovial intima was perceptible. Most of the synoviocytes were of the fibroblast type. Transitional cell forms abounded. An increase in collagen fibres and capillaries of the fenestrated type occurred in the intercellular spaces. In the deep layer collagen bundles had formed between which activated fibroblasts and macrophages were noticed. The described changes point to an active participation of the synovial membrane in the destruction of articular cartilage in osteoarthritis.