Osteoarthritis is a highly prevalent, debilitating disease characterized by the wear and degradation of articular cartilage. While many surgical interventions exist, few are consistently effective and those that are effective are not necessarily suitable for all patients. The objective of this dissertation is to improve patient care through the development of a new surgical technique and through basic science studies which seek to better understand articular cartilage wear initiation. Four studies, which address this objective are summarized below.
Osteochondral allograft transplantation provides a safe and effective treatment option for large cartilage defects, but its use is limited partly due to the difficulty of matching articular surface curvature between donor and recipient. We hypothesize that bendable osteochondral allografts may provide better curvature matching for patella transplants in the patellofemoral joint. The finite element study presented in Chapter 2 investigates patellofemoral joint congruence for unbent and bendable osteochondral allografts, at various flexion angles. Finite element models were created for 12 femur-patella osteochondral allograft pairings. Two grooves were cut into the bony substrate of each allograft, allowing the articular layer to bend. Patellofemoral joints with either unbent (OCA) or permanently bent (BOCA) allografts were articulated from 40 to 70 degrees flexion and contact area was calculated. OCAs and BOCAs were then shifted 6 mm distally toward the tibia (S-OCA, S-BOCA) to investigate the influence of proximal-distal alignment on congruence. On average, no significant difference in contact area was found between native patellofemoral joints and either OCAs or BOCAs (p > 0.25), indicating that both types of allografts restored native congruence. This result provides biomechanical support in favor of an emerging surgical procedure. S-BOCAs resulted in a significant increase in contact area relative to the remaining groups (p < 0.02). The fact that bendable osteochondral allografts produced equally good results implies that these bendable allografts may prove useful in future surgical procedures, with the possibility of transplanting them with a small distal shift. Surgeons who are reluctant to use osteochondral allografts for resurfacing patellae based on curvature matching capabilities may be more amenable to adopting bendable osteochondral allografts.
The recent development of bendable osteochondral allografts provides the potential for improved osteoarthritis treatment for joints whose current treatment is unsatisfactory. One such joint is the carpometacarpal joint in the thumb. While the current standard of care for carpometacarpal osteoarthritis, ligament reconstruction and tendon interposition, can reduce pain in the joint, it does not restore full joint function and mobility. A proposed alternative includes using an osteochondral allograft harvested from the femoral trochlea in a donor knee, machining grooves in the bone to allow the allograft to bend, and replacing the trapezium with this bent osteochondral allograft [1,2]. Chapter 3 of this dissertation discusses adjustments to the original design of the bendable allograft and the design of a custom surgical tool to perform the proposed surgery. Specification changes of the allograft included an overall size reduction in order to better fit within the carpometacarpal joint, minimum bone thickness requirements to avoid bone cracking during the surgical procedure, and a reduction from three grooves to two grooves, which provided sufficient bending yet avoided fracture of the allograft. The surgical tool was designed to be a custom forceps device, whose primary features included (1) jaws with an angled face to match the angle of allograft bending and (2) insertion holes for the Kirschner wire and compression screws used to anchor the allograft in the bent position. These customizations allow the tool to be used to bend the allograft, fix it in the bent configuration, and place the allograft in its proper position in the hand during anchoring of the bent allograft to the native trapezium.
The final two studies presented in this dissertation focus on furthering our current understanding of wear and structure-function relationships of articular cartilage. We hypothesize that cartilage wears due to fatigue failure in reciprocating compression instead of reciprocating friction. Chapter 4 compares reciprocating sliding of immature bovine articular cartilage against glass in two testing configurations: (1) a stationary contact area configuration (SCA), which results in static compression, interstitial fluid depressurization and increasing friction coefficient during reciprocating sliding, and (2) a migrating contact area configuration (MCA), which maintains fluid pressurization and low friction while producing reciprocating compressive loading during reciprocating sliding. Contact stress, sliding duration, and sliding distance were controlled to be similar between test groups. SCA tests exhibited an average friction coefficient of μ=0.084±0.032, while MCA tests exhibited a lower average friction coefficient of μ=0.020±0.008 (p<10^(-4)).
Despite the lower friction, MCA cartilage samples exhibited clear surface damage with a significantly greater average surface deviation from a fitted plane after wear testing (R_q=0.125±0.095 mm) than cartilage samples slid in a SCA configuration (R_q=0.044±0.017 mm, p=0.002), which showed minimal signs of wear. Polarized light microscopy confirmed that delamination damage occurred between the superficial and middle zones of the articular cartilage in MCA samples. The greatest wear was observed in the group with lowest friction coefficient, subjected to cyclical instead of static compression, implying that friction is not the primary driver of cartilage wear. Delamination between superficial and middle zones imply the main mode of wear is fatigue failure under cyclical compression, not fatigue or abrasion due to reciprocating frictional sliding.
The final study of this dissertation, presented in Chapter 5, investigates the importance of collagen fibril distribution in articular cartilage computational models. Finite element models were created to approximate a bovine humeral head and replicate previous experimental loading conditions [3]. Five different finite element analyses were run, each using a different fibril distribution model. Three of the models used two, four, or eight discrete fibril bundles, while two models used continuous fibril distributions with either isotropic or depth-dependent ellipsoidal distributions.
Two primary findings arose from this investigation. The first was the discovery that as the fibril distribution became more isotropic, the strain throughout the tissue decreased, even though the contact area between the articular surface and rigid platen remained relatively equal across distribution models. This suggests that computational models which approximate the collagen fibrils with an isotropic distribution may be underestimating the strain through the depth of the tissue. The second primary finding was that in the discrete distribution model with two fibril bundles, which followed the classically described Benninghoff structure [4], the greatest magnitude of shear strain during compressive loading was observed in the middle zone. However, the highest magnitude of shear strain observed in the isotropic fibril distribution model occurred in the deep zone near the subchondral surface. The observed results suggest that the type of fibril distribution used to model collagen in articular cartilage plays a role in depth-dependent strain magnitude and strain distribution.
| Identifer | oai:union.ndltd.org:columbia.edu/oai:academiccommons.columbia.edu:10.7916/ac74-y769 |
| Date | January 2023 |
| Creators | Petersen, Courtney A. |
| Source Sets | Columbia University |
| Language | English |
| Detected Language | English |
| Type | Theses |
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