The meniscus is a soft, fibrocartilaginous tissue critical for the maintenance of normal knee biomechanics, providing shock absorbance and overall joint lubrication and stability. The adult tissue is highly avascular with a poor autonomous repair capacity in response to injury. Despite the estimated 850,000 arthroscopic surgeries performed per year to repair torn menisci and the increasing evidence showing a high incidence of meniscal degeneration during very early stages of osteoarthritis, little is currently known of the responses of meniscal fibrochondrocytes to physiological stimuli. Therefore, this work explored the responses of meniscal fibrochondrocytes to exogenous biomechanical and biochemical stimuli in an effort to better understand the sensitivity of these cells in their native tissue matrix as well as in a 3-D scaffold environment. Using the immature bovine model, the changes in biosynthesis of fibrochondrocytes in tissue explants and in an agarose scaffold due to unconfined oscillatory compression were explored. This biomechanical stimulus, previously identified to stimulate matrix production of chondrocytes of articular cartilage, stimulated total protein synthesis in both culture environments. In contrast, the synthesis of proteoglycans, matrix components important in mechanical stiffness and hydration of the tissue, was not affected by these compression protocols. However, the use of a biochemical stimulus in the form of anabolic cytokines significantly enhanced both protein and proteoglycan synthesis as a function of culture environment as well as type of cytokine used. The superposition of oscillatory compression in addition to the use of these potent biochemical stimulators, insulin-like growth factor-I or transforming growth factor-beta 1, did not further enhance matrix synthesis of fibrochondrocytes in agarose culture, suggesting an insensitivity of the fibrochondrocytes to biomechanical stimuli during early stages of matrix maturation within the agarose scaffold. As a combination of biomechanical and biochemical stimuli are responsible for directing the development, maintenance, and repair of the tissue, these findings aid in understanding fibrocartilage maintenance through studying responses in a tissue explant model. Additionally, studying agarose scaffolds aid in the understanding fibrocartilage development and deposition of a de novo matrix.

Extrinsic repair techniques for the treatment of acute chondral injuries continue to yield suboptimal repair. The inability of these techniques to produce hyaline cartilage underscores the limitations in our understanding of basic chondrocyte biology. Conversely, intrinsic repair tissue has not been extensively studied despite the fact that it can yield hyaline-like cartilage and is commonly observed in osteoarthritis. Attempts at extrinsic repair could therefore benefit from a better understanding of the successes and failures inherent in the intrinsic repair process. Chondrocyte culture has typically been conducted under non-physiologic conditions whereby chondrocytes readily dedifferentiate. Consequently, much of the knowledge gained about chondrocytes has been misleading thus hindering advancements in chondrocyte biology and attempts at extrinsic articular cartilage (AC) repair. Hypoxic culture conditions, which are beneficial towards the preservation of the chondrocyte phenotype, remain insufficient due to elevated collagen I gene expression. As such, an appropriate model system does not yet exist in which to study physiologically-relevant chondrocyte biology. The presence and prevalence of collagen I in both degenerate and de novo osteoartritic tissue was examined immunohistochemically. Collagen I deposition during osteoarthritic progression was compared against IHC staining for collagen II and aggrecan. A novel model system was also evaluated for chondrocytic phenotype retention. To this end, hypoxic, high-density-monolayer-chondrocyte (HDMC) cultures were compared to freshly isolated chondrocytes for their ability to maintain a chondrocytic extracellular matrix (ECM) gene expression profile. HDMC culture conditions prevented the severe loss of the phenotype typically associated with conventional monolayer culture. Moreover, prolonged HDMC culture resulted in the formation of a complex ECM and a marked suppression of collagen I expression. This study also demonstrated that collagen I deposition occurs in osteoarthritic AC at the onset of structural damage and increases in response to increasing structural damage. Collagen I deposition was also found in different types of de novo cartilage associated with osteoarthritic joints and suggests that it plays an important role in intrinsic cartilage repair. Taken together, this work demonstrates that collagen I is a common feature in the ECM of structurally immature and structurally damaged AC and hence may play a role in tissue stabilization. / Experimental Surgery

No description available.

No description available.

Residual dysfunction after a fracture of the distal radius is most often mild but may give rise to significant impairment especially in the younger active population. The symptoms often manifest around the distal ulna when loading the hand or rotating the forearm. In this region are found articular and soft tissue connections running from the distal ulna to the distal radius as well as to the ulnar side of the carpus. The aims of this thesis were to investigate the effects of distal radius fractures on the structures about the distal ulna and to what extent malunion and ulnar soft tissue lesions affect function. Both patients and cadaver specimens were used in the five different studies. In a retrospective study of 17 malunited distal radius fractures supination impairment improved significantly by correction of the skeletal malunion. This highlights the importance of distal radioulnar joint congruity for forearm rotation in a subset of cases. The pathomechanisms of injury to the triangular fibrocartilage complex (TFCC) were studied. In a cadaveric distal radius fracture model different restraining properties and injury patterns were investigated. Similar patterns of injury were then observed in 20 patients with a displaced distal radius fracture. It was found that a TFCC injury can be expected with dorsal displacement of the distal radius fragment of 32o or more from the anatomically correct position. The distribution of a TFCC injury apparently differs depending on the size of an associated ulnar styloid fracture. In cases of an intact ulnar styloid or a concomitant tip fracture (Type 1) the first stage of injury seems to be extensor carpi ulnaris subsheath separation from the distal ulna and the dorsal radioulnar ligament. Thereafter follows a disruption of the deep insertions into the fovea of the ulna starting from the palmar and extending dorsally and radially. An extensive injury can be detected with a novel non-invasive test called the ‘bald ulnar head test’, which is performed under anaesthesia. Diagnosis of an acute TFCC injury is difficult using non-invasive methods. In a prospective study of 48 patients, CT scanning to detect pathologic subluxation was found to be of little use in both acute and chronic cases, and is therefore not endorsed on this indication. A radioulnar stress test, which in previous studies has correlated well to a deep TFCC injury, was found to be highly reliable but not to correspond with significant disability in self-administered questionnaires of functional outcome two years or more after injury. This indicates that the subset of patients possibly benefiting from acute repair must be identified by other means.

Fibrocartilages in the body, including the temporomandibular joint (TMJ) disc and knee meniscus, lack intrinsic healing capacity following trauma or disease. Current treatments only address the symptoms of fibrocartilage damage and do nothing to prevent further degradation of the joint. A tissue engineered replacement, with biochemical and biomechanical properties approaching those of native tissue, could provide a solution. This thesis investigates two components critical to the generation of a tissue engineered TMJ disc: 1) characterization of the native disc to identify a suitable animal model and create design parameters, and 2) development of approaches to use human embryonic stem cells (hESCs) in fibrocartilage tissue engineering. The first step to achieving this goal was to identify an animal model for the human TMJ disc based on quantitative biochemical and biomechanical properties. To this end, rabbit, goat, pig, cow, and human discs were analyzed, and the pig disc was shown to possess properties most similar to the human. The next step was to further characterize the pig TMJ, as many aspects of the joint were still poorly understood. Though the TMJ disc is anchored to the surrounding bony tissue on all sides by discal attachments, little was known about their properties. Biochemical and histological analysis was performed on these attachments and indicated that they are similar to the disc but possess distinct regional matrix content related to joint biomechanics. Finally, though the contribution of collagen to the mechanical properties of the TMJ disc was well characterized, the contribution of the glycosaminoglycans (GAGs) was unknown. By removing sulfated GAGs with chondroitinase ABC, it was found that these molecules contribute to the viscoelastic compressive properties of the disc, but only in regions with the highest native GAG content. The second aspect of this thesis involved producing fibrocartilage tissue from hESCs. The pluripotency and unlimited self-renewal of these cells makes them ideally suited for producing fibrocartilages that contain a spectrum of matrix components. This work began by investigating what factors are necessary for fibrochondrogenic differentiation of hESCs in embryoid bodies (EBs). Growth factors and co-cultures with primary fibrochondrocytes were both shown to be potent modulators of fibrochondrogenesis, although differentiation of hESCs consistently produced a heterogeneous cell population. To purify populations of fibrochondrocytes differentiated form hESCs, two inexpensive and novel techniques were investigated. First, density gradient separation was the first technique attempted. This technique was able to isolate distinct subpopulations of cells, some of which were mechanically similar to native chondrocytes. Second, a chondrogenic tuning technique was applied to differentiated hESCs. Following fibrochondrogenesis in EBs, cells were expanded in monolayer in chondrocyte specific media before being used for tissue engineering. Chondrogenic tuning produced several distinct cell populations during expansion, and, as a result, a spectrum of different cartilaginous tissues was achieved for tissue engineering. Three of the cell populations produced tissues similar to the native TMJ disc, outer meniscus, and inner meniscus. Overall, this thesis identified an animal model for TMJ characterization and in vivo studies, furthered understanding of structure-function relationships of the TMJ disc and its attachments, and developed a technique for producing a spectrum of engineered fibrocartilages from hESCs.

This study was motivated by a theoretical formulation on mechanobiology of soft and hard skeletal tissue differentiation. To prove this formulation experimentally, I hypothesized that cartilaginous phenotype can be induced in vitro in a seemingly non-cartilaginous cell source from fibrous tissue. In testing this hypothesis, I have focused on cartilage as a target and fibrous tissue as an origin or the source of cell. Four different trials were pursued with one supposition in common, i.e. hydrostatic pressure is one of the main driving forces for chondroinduction in vitro. The first and second trials pertained to the influence of a relatively short and long duration cyclic hydrostatic compression on rat Achilles tendon fibroblasts. The third trial was to examine the effect of two different drugs on cytoskeletal elements of mesenchymal stem cells or mouse embryonic fibroblast lines in pellet cultures combined with the similar duration and/or frequency of cyclic hydrostatic pressure adopted in the aforesaid trials with no pharmacological agents added. Last, attempts were made to implement an advanced technique in molecular biology called 'PCR array' to further quantify expression levels of eighty four pathway-specific genes in mouse TGFbeta/BMP signaling traffic under the same physiological regimen of hydrostatic compression. Results demonstrated that transdifferentation in phenotype from tendon to fibrocartilage may have occurred in vitro in tendon fibroblasts in pellet cultures exposed to hydrostatic pressure. Experiments on the role of the cytoskeleton in mechanotransduction of the applied level of hydrostatic pressure demonstrated that disruption of microfilaments in the presence of cytochalasin-D did not significantly interfere with the anabolic effect of cyclic pressure. However, disruption of microtubule assembly by nocodazole abolished the pressure-induced stimulation in cartilage marker genes. These findings suggest that microtubules, but not microfilaments, are involved in mechanotransduction of hydrostatic pressure by mesenchymal stem cells.

No description available.

Les fibrocartilages sont des tissus repartis largement dans l'organisme dont la structure histologique est étroitement liée à la fonction. Ils jouent un role fondamental dans la transmission des forces de compression ou de traction et sont un composant majeur de l' appareil musculo‐squelettique. Parmi les différents fibrocartilages se dégage l'enthèse qui vient attacher les tendons autour des articulations et dont le vieillissement aboutit à un arrachement des tendons. Afin d'étudier les possibilités thérapeutiques, nous avons developpé chez le petit animal, un modèle de lésion de l'enthèse qui se veut proche du vieillissement, afin de recréer un modèle translationnel le plus proche possible de la réalité clinique, ce modèle nous permettant d'évaluer le taux global de cicatrisation. Le modèle que nous avons développé nous a permis d'obtenir un taux de cicatrisation, après réparation chirurgicale d'une lésion de l'enthèse du tendon de rat, un taux de cicatrisation proche de celui obtenu en pratique clinique. En injectant, lors des réparations chirurgicales, des chondrocytes dans un groupe, et des cellules souches mésenchymateuses de la moelle osseuse dans l'autre nous avons montré une différence statistiquement significative en terme de taux global de cicatrisation, de résistance à l'arrachement, et de regénération histologique de l'enthèse à 45 jours

Disease and degeneration of articular cartilage and fibrocartilage tissues severely compromise the quality of life for millions of people. Although current surgical repair techniques can address symptoms in the short term, they do not adequately treat degenerative joint diseases such as osteoarthritis. Thus, novel tissue engineering strategies may be necessary to combat disease progression and repair or replace damaged tissue. Both articular cartilage and the meniscal fibrocartilage in the knee joint are subjected to a complex mechanical environment consisting of compressive, shear, and tensile forces. Therefore, engineered replacement tissues must be both mechanically and biologically competent to function after implantation. The goal of this work was to investigate the effects of oscillatory tensile loading on three dimensional engineered cartilaginous tissues in an effort to elucidate important aspects of chondrocyte and fibrochondrocyte mechanobiology. To investigate the metabolic responses of articular chondrocytes and meniscal fibrochondrocytes to oscillatory tensile loading, various protocols were used to identify stimulatory parameters. Several days of continuously applied tensile loading inhibited extracellular matrix metabolism, whereas short durations and intermittently applied loading could stimulate matrix production. Subpopulations of chondrocytes, separated based on their zonal origin within the tissue, differentially responded to tensile loading. Proteoglycan synthesis was enhanced in superficial zone cells, but the molecular structure of these molecules was not affected. In contrast, neither total proteoglycan nor protein synthesis levels of middle and deep zone chondrocytes were substantially affected by tensile loading; however, the sizes of these new matrix molecules were altered. Up to 14 days of intermittently applied oscillatory tensile loading induced modest increases in construct mechanical properties, but longer durations adversely affected these mechanical properties and increased degradative enzyme activity. These results provide insights into cartilage and fibrocartilage mechanobiology by elucidating cellular responses to tensile mechanical stimulation, which previously had not been widely explored for these tissues. Understanding the role that mechanical stimuli such as tension can play in the generation of engineered cartilaginous tissues will further the goal of developing successful treatment strategies for degenerative joint diseases.