The Experts below are selected from a list of 732 Experts worldwide ranked by ideXlab platform
A C Hall - One of the best experts on this subject based on the ideXlab platform.
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Chondroprotection in models of cartilage injury by raising the temperature and osmolarity of irrigation solutions
Cartilage, 2018Co-Authors: N M Eltawil, Saima Ahmed, Luke H Chan, Hamish A R W Simpson, A C HallAbstract:ObjectivesDuring arthroscopic or open joint surgery, articular cartilage may be subjected to mechanical insults by accident or design. These may lead to chondrocyte death, cartilage breakdown and p...
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iatrogenic articular cartilage injury the elephant in the operating theatre the surgeons role in Chondroprotection
Journal of Bone and Joint Surgery-british Volume, 2017Co-Authors: A K Amin, A H R W Simpson, A C HallAbstract:Arthroscopy of the synovial joint is the most frequently performed orthopaedic procedure in the developed world.[1][1] A variety of soft-tissue and articular pathologies relating to the hip,[2][2] knee, ankle, shoulder, elbow and wrist joints can be treated arthroscopically.[1][1] While advances in
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the use of hyperosmotic saline for Chondroprotection implications for orthopaedic surgery and cartilage repair
Osteoarthritis and Cartilage, 2015Co-Authors: N M Eltawil, Sarah E M Howie, A H R W Simpson, Anish K Amin, A C HallAbstract:Summary Objective Articular cartilage may experience iatrogenic injury during routine orthopaedic/arthroscopic procedures. This could cause chondrocyte death, leading to cartilage degeneration and posttraumatic osteoarthritis. In an in vitro cartilage injury model, chondrocyte death was reduced by increasing the osmolarity of normal saline (NS), the most commonly-used irrigation solution. Here, we studied the effect of hyperosmolar saline (HS) on chondrocyte viability and cartilage repair in an in vivo injury model. Design Cartilage injury was induced by a single scalpel cut along the patellar groove of 8 week old rats in the absence of irrigation or with either NS (300 mOsm) or HS (600 mOsm). The percentage of cell death (PCD) within the injured area was assessed using confocal microscopy. Repair from injury was evaluated by histology/immunostaining, and inflammatory response by histology, cytokine array analysis and ELISA (enzyme-linked immunosorbent assay). Results The PCD in saline-irrigated joints was increased compared to non-irrigated (NI) joints [PCD = 20.8% (95%CI; 14.5, 27.1); PCD = 9.14% (95%CI; 6.3, 11.9); P = 0.0017]. However, hyperosmotic saline reduced chondrocyte death compared to NS (PCD = 10.4% (95%CI; 8.5, 12.3) P = 0.0024). Repair score, type II collagen and aggrecan levels, and injury width, were significantly improved with hyperosmotic compared to NS. Mild synovitis and similar changes in serum cytokine profile occurred in all operated joints irrespective of experimental group. Conclusions Hyperosmotic saline significantly reduced the chondrocyte death associated with scalpel-induced injury and enhanced cartilage repair. This irrigation solution might be useful as a simple chondroprotective strategy and may also reduce unintentional cartilage injury during articular reconstructive surgery and promote integrative cartilage repair, thereby reducing the risk of posttraumatic osteoarthritis.
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temperature changes and chondrocyte death during drilling in a bovine cartilage model and Chondroprotection by modified irrigation solutions
International Orthopaedics, 2014Co-Authors: Muhamed M H Farhanalanie, A C HallAbstract:Purpose Drilling into cartilage/bone is often required for orthopaedic surgery. While drilling into bone has been studied, the response of cartilage has received little attention. We have measured cartilage and drill bit temperatures during drilling and quantified the zone of chondrocyte death (ZCD) around the hole in the presence/absence of irrigation solutions.
Joseph J Crisco - One of the best experts on this subject based on the ideXlab platform.
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cyclic loading increases friction and changes cartilage surface integrity in lubricin mutant mouse knees
Arthritis & Rheumatism, 2012Co-Authors: Elizabeth I. Drewniak, Braden C Fleming, Matthew L Warman, Ling Zhang, Joseph J CriscoAbstract:Lubricin, a major component of synovial fluid and the articular cartilage surface, is a mucinous glycoprotein encoded by the gene Prg4 (1). To understand the in vivo function of lubricin, lubricin-null mice (Prg4−/−) were generated. Prg4−/− mice appear normal at birth, but develop precocious clinical, radiologic, and histologic signs of joint disease as they age (2). These features recapitulate findings in patients with the camptodactyly-arthropathy–coxa vara–pericarditis syndrome (CACP) due to hereditary lubricin deficiency. Based on in vivo studies in Prg4−/− mice, lubricin was postulated to provide Chondroprotection by acting as a boundary lubricant, a cell adhesion inhibitor, and a synoviocyte growth regulator (2, 3). While the precocious cartilage failure observed in patients with CACP and in Prg4−/− mice indicates that lubricin is essential for Chondroprotection, it is not known whether lubricin dosage that is below wild-type (Prg4+/+) levels, but not completely absent, can also impair Chondroprotection. In vitro studies that measured boundary lubrication at different concentrations of lubricin, and clinical studies showing that lubricin levels fall in humans and other mammals following traumatic joint injury, suggest that a correlation may exist between lubricin concentration and Chondroprotection (3–19). This work seeks to directly test this hypothesis. Cyclic loading has been used in many studies to better understand the mechanical and material properties of articular cartilage (14, 19–22). Pin-on-disc systems rub cartilage samples against apposing cartilage plugs or man-made surfaces. Such systems have been used to collect information on friction, deformation, and wear, among other properties (19–21, 23, 24). In vitro pin-on-disc testing methods allow for focal tissue-specific investigation of articular cartilage; however, they are challenging to implement when studying whole-joint function and health. For this study, we developed an active pendulum system to apply cyclic loading to intact mouse knee joints in order to assess the role of lubricin in preventing cartilage wear. We previously showed that mice completely lacking lubricin had higher coefficient of friction values and more extensive surface damage than wild-type mice (13). The objectives of the present study were to examine the effects of lubricin dosage and cyclic loading on whole-joint frictional properties and the surface integrity of articular cartilage in knees from wild-type mice (Prg4+/+), mice with one allele that expresses lubricin (Prg4+/−), and mice with no alleles that express lubricin (Prg4−/−).
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Cyclic loading increases friction and changes cartilage surface integrity in lubricin‐mutant mouse knees
Arthritis & Rheumatism, 2012Co-Authors: Elizabeth I. Drewniak, Braden C Fleming, Matthew L Warman, Ling Zhang, Joseph J CriscoAbstract:Lubricin, a major component of synovial fluid and the articular cartilage surface, is a mucinous glycoprotein encoded by the gene Prg4 (1). To understand the in vivo function of lubricin, lubricin-null mice (Prg4−/−) were generated. Prg4−/− mice appear normal at birth, but develop precocious clinical, radiologic, and histologic signs of joint disease as they age (2). These features recapitulate findings in patients with the camptodactyly-arthropathy–coxa vara–pericarditis syndrome (CACP) due to hereditary lubricin deficiency. Based on in vivo studies in Prg4−/− mice, lubricin was postulated to provide Chondroprotection by acting as a boundary lubricant, a cell adhesion inhibitor, and a synoviocyte growth regulator (2, 3). While the precocious cartilage failure observed in patients with CACP and in Prg4−/− mice indicates that lubricin is essential for Chondroprotection, it is not known whether lubricin dosage that is below wild-type (Prg4+/+) levels, but not completely absent, can also impair Chondroprotection. In vitro studies that measured boundary lubrication at different concentrations of lubricin, and clinical studies showing that lubricin levels fall in humans and other mammals following traumatic joint injury, suggest that a correlation may exist between lubricin concentration and Chondroprotection (3–19). This work seeks to directly test this hypothesis. Cyclic loading has been used in many studies to better understand the mechanical and material properties of articular cartilage (14, 19–22). Pin-on-disc systems rub cartilage samples against apposing cartilage plugs or man-made surfaces. Such systems have been used to collect information on friction, deformation, and wear, among other properties (19–21, 23, 24). In vitro pin-on-disc testing methods allow for focal tissue-specific investigation of articular cartilage; however, they are challenging to implement when studying whole-joint function and health. For this study, we developed an active pendulum system to apply cyclic loading to intact mouse knee joints in order to assess the role of lubricin in preventing cartilage wear. We previously showed that mice completely lacking lubricin had higher coefficient of friction values and more extensive surface damage than wild-type mice (13). The objectives of the present study were to examine the effects of lubricin dosage and cyclic loading on whole-joint frictional properties and the surface integrity of articular cartilage in knees from wild-type mice (Prg4+/+), mice with one allele that expresses lubricin (Prg4+/−), and mice with no alleles that express lubricin (Prg4−/−).
Braden C Fleming - One of the best experts on this subject based on the ideXlab platform.
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cyclic loading increases friction and changes cartilage surface integrity in lubricin mutant mouse knees
Arthritis & Rheumatism, 2012Co-Authors: Elizabeth I. Drewniak, Braden C Fleming, Matthew L Warman, Ling Zhang, Joseph J CriscoAbstract:Lubricin, a major component of synovial fluid and the articular cartilage surface, is a mucinous glycoprotein encoded by the gene Prg4 (1). To understand the in vivo function of lubricin, lubricin-null mice (Prg4−/−) were generated. Prg4−/− mice appear normal at birth, but develop precocious clinical, radiologic, and histologic signs of joint disease as they age (2). These features recapitulate findings in patients with the camptodactyly-arthropathy–coxa vara–pericarditis syndrome (CACP) due to hereditary lubricin deficiency. Based on in vivo studies in Prg4−/− mice, lubricin was postulated to provide Chondroprotection by acting as a boundary lubricant, a cell adhesion inhibitor, and a synoviocyte growth regulator (2, 3). While the precocious cartilage failure observed in patients with CACP and in Prg4−/− mice indicates that lubricin is essential for Chondroprotection, it is not known whether lubricin dosage that is below wild-type (Prg4+/+) levels, but not completely absent, can also impair Chondroprotection. In vitro studies that measured boundary lubrication at different concentrations of lubricin, and clinical studies showing that lubricin levels fall in humans and other mammals following traumatic joint injury, suggest that a correlation may exist between lubricin concentration and Chondroprotection (3–19). This work seeks to directly test this hypothesis. Cyclic loading has been used in many studies to better understand the mechanical and material properties of articular cartilage (14, 19–22). Pin-on-disc systems rub cartilage samples against apposing cartilage plugs or man-made surfaces. Such systems have been used to collect information on friction, deformation, and wear, among other properties (19–21, 23, 24). In vitro pin-on-disc testing methods allow for focal tissue-specific investigation of articular cartilage; however, they are challenging to implement when studying whole-joint function and health. For this study, we developed an active pendulum system to apply cyclic loading to intact mouse knee joints in order to assess the role of lubricin in preventing cartilage wear. We previously showed that mice completely lacking lubricin had higher coefficient of friction values and more extensive surface damage than wild-type mice (13). The objectives of the present study were to examine the effects of lubricin dosage and cyclic loading on whole-joint frictional properties and the surface integrity of articular cartilage in knees from wild-type mice (Prg4+/+), mice with one allele that expresses lubricin (Prg4+/−), and mice with no alleles that express lubricin (Prg4−/−).
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Cyclic loading increases friction and changes cartilage surface integrity in lubricin‐mutant mouse knees
Arthritis & Rheumatism, 2012Co-Authors: Elizabeth I. Drewniak, Braden C Fleming, Matthew L Warman, Ling Zhang, Joseph J CriscoAbstract:Lubricin, a major component of synovial fluid and the articular cartilage surface, is a mucinous glycoprotein encoded by the gene Prg4 (1). To understand the in vivo function of lubricin, lubricin-null mice (Prg4−/−) were generated. Prg4−/− mice appear normal at birth, but develop precocious clinical, radiologic, and histologic signs of joint disease as they age (2). These features recapitulate findings in patients with the camptodactyly-arthropathy–coxa vara–pericarditis syndrome (CACP) due to hereditary lubricin deficiency. Based on in vivo studies in Prg4−/− mice, lubricin was postulated to provide Chondroprotection by acting as a boundary lubricant, a cell adhesion inhibitor, and a synoviocyte growth regulator (2, 3). While the precocious cartilage failure observed in patients with CACP and in Prg4−/− mice indicates that lubricin is essential for Chondroprotection, it is not known whether lubricin dosage that is below wild-type (Prg4+/+) levels, but not completely absent, can also impair Chondroprotection. In vitro studies that measured boundary lubrication at different concentrations of lubricin, and clinical studies showing that lubricin levels fall in humans and other mammals following traumatic joint injury, suggest that a correlation may exist between lubricin concentration and Chondroprotection (3–19). This work seeks to directly test this hypothesis. Cyclic loading has been used in many studies to better understand the mechanical and material properties of articular cartilage (14, 19–22). Pin-on-disc systems rub cartilage samples against apposing cartilage plugs or man-made surfaces. Such systems have been used to collect information on friction, deformation, and wear, among other properties (19–21, 23, 24). In vitro pin-on-disc testing methods allow for focal tissue-specific investigation of articular cartilage; however, they are challenging to implement when studying whole-joint function and health. For this study, we developed an active pendulum system to apply cyclic loading to intact mouse knee joints in order to assess the role of lubricin in preventing cartilage wear. We previously showed that mice completely lacking lubricin had higher coefficient of friction values and more extensive surface damage than wild-type mice (13). The objectives of the present study were to examine the effects of lubricin dosage and cyclic loading on whole-joint frictional properties and the surface integrity of articular cartilage in knees from wild-type mice (Prg4+/+), mice with one allele that expresses lubricin (Prg4+/−), and mice with no alleles that express lubricin (Prg4−/−).
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the impact of anterior cruciate ligament injury on lubricin metabolism and the effect of inhibiting tumor necrosis factor α on Chondroprotection in an animal model
Arthritis & Rheumatism, 2009Co-Authors: Khaled A Elsaid, Jason T Machan, Kimberly A Waller, Braden C FlemingAbstract:Objective To examine the effects of ACL transection (ACLT) in a rat model on lubricin metabolism and its relationship to markers of inflammation and cartilage damage, and to determine if blocking the metabolic effects of tumor necrosis factor-alpha (TNF-α), by etanercept increases Chondroprotection provided by lubricin.
Lutz Duerselen - One of the best experts on this subject based on the ideXlab platform.
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The challenge of implant integration in partial meniscal replacement: an experimental study on a silk fibroin scaffold in sheep
Knee Surgery Sports Traumatology Arthroscopy, 2019Co-Authors: Svenja Emmi Catherine Stein, Falk Von Luebken, Daniela Warnecke, Cristina Gentilini, Nick Skaer, Oliver Kessler, Anita Ignatius, Robert Walker, Lutz DuerselenAbstract:Purpose To restore meniscal function after excessive tissue damage, a silk fibroin implant for partial meniscal replacement was developed and investigated in an earlier sheep model. After 6 months implantation, it showed promising results in terms of Chondroprotection and biocompatibility. To improve surgical fixation, the material was subjected to optimisation and a fibre mesh was integrated into the porous matrix. The aim of the study was the evaluation of this second generation of silk fibroin implants in a sheep model. Methods Nine adult merino sheep received subtotal meniscal replacement using the silk fibroin scaffold. In nine additional animals, the defect was left untreated. Sham surgery was performed in another group of nine animals. After 6 months of implantation macroscopic, biomechanical and histological evaluations of the scaffold, meniscus, and articular cartilage were conducted. Results Macroscopic evaluation revealed no signs of inflammation of the operated knee joint and most implants were located in the defect. However, there was no solid connection to the remaining peripheral meniscal rim and three devices showed a radial rupture at the middle zone. The equilibrium modulus of the scaffold increased after 6 months implantation time as identified by biomechanical testing (before implantation 0.6 ± 0.3 MPa; after implantation: 0.8 ± 0.3 MPa). Macroscopically and histologically visible softening and fibrillation of the articular cartilage in the meniscectomy- and implant group were confirmed biomechanically by indentation testing of the tibial cartilage. Conclusions In the current study, biocompatibility of the silk fibroin scaffold was reconfirmed. The initial mechanical properties of the silk fibroin implant resembled native meniscal tissue. However, stiffness of the scaffold increased considerably after implantation. This might have prevented integration of the device and Chondroprotection of the underlying cartilage. Furthermore, the increased stiffness of the material is likely responsible for the partial destruction of some implants. Clinically, we learn that an inappropriate replacement device might lead to similar cartilage damage as seen after meniscectomy. Given the poor acceptance of the clinically available partial meniscal replacement devices, it can be speculated that development of a total meniscal replacement device might be the less challenging option.
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The challenge of implant integration in partial meniscal replacement: an experimental study on a silk fibroin scaffold in sheep.
Knee Surgery Sports Traumatology Arthroscopy, 2018Co-Authors: Svenja Stein, Falk Von Luebken, Daniela Warnecke, Cristina Gentilini, Nick Skaer, Robert S. Walker, Oliver Kessler, Anita Ignatius, Lutz DuerselenAbstract:To restore meniscal function after excessive tissue damage, a silk fibroin implant for partial meniscal replacement was developed and investigated in an earlier sheep model. After 6 months implantation, it showed promising results in terms of Chondroprotection and biocompatibility. To improve surgical fixation, the material was subjected to optimisation and a fibre mesh was integrated into the porous matrix. The aim of the study was the evaluation of this second generation of silk fibroin implants in a sheep model. Nine adult merino sheep received subtotal meniscal replacement using the silk fibroin scaffold. In nine additional animals, the defect was left untreated. Sham surgery was performed in another group of nine animals. After 6 months of implantation macroscopic, biomechanical and histological evaluations of the scaffold, meniscus, and articular cartilage were conducted. Macroscopic evaluation revealed no signs of inflammation of the operated knee joint and most implants were located in the defect. However, there was no solid connection to the remaining peripheral meniscal rim and three devices showed a radial rupture at the middle zone. The equilibrium modulus of the scaffold increased after 6 months implantation time as identified by biomechanical testing (before implantation 0.6 ± 0.3 MPa; after implantation: 0.8 ± 0.3 MPa). Macroscopically and histologically visible softening and fibrillation of the articular cartilage in the meniscectomy- and implant group were confirmed biomechanically by indentation testing of the tibial cartilage. In the current study, biocompatibility of the silk fibroin scaffold was reconfirmed. The initial mechanical properties of the silk fibroin implant resembled native meniscal tissue. However, stiffness of the scaffold increased considerably after implantation. This might have prevented integration of the device and Chondroprotection of the underlying cartilage. Furthermore, the increased stiffness of the material is likely responsible for the partial destruction of some implants. Clinically, we learn that an inappropriate replacement device might lead to similar cartilage damage as seen after meniscectomy. Given the poor acceptance of the clinically available partial meniscal replacement devices, it can be speculated that development of a total meniscal replacement device might be the less challenging option.
Ruggero Cadossi - One of the best experts on this subject based on the ideXlab platform.
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Biophysical stimulation of bone and cartilage: state of the art and future perspectives
International Orthopaedics, 2019Co-Authors: Leo Massari, Franco Benazzo, Francesco Falez, Dario Perugia, Luca Pietrogrande, Stefania Setti, Raffaella Osti, Enrico Vaienti, Carlo Ruosi, Ruggero CadossiAbstract:Introduction Biophysical stimulation is a non-invasive therapy used in orthopaedic practice to increase and enhance reparative and anabolic activities of tissue. Methods A sistematic web-based search for papers was conducted using the following titles: (1) pulsed electromagnetic field (PEMF), capacitively coupled electrical field (CCEF), low intensity pulsed ultrasound system (LIPUS) and biophysical stimulation; (2) bone cells, bone tissue, fracture, non-union, prosthesis and vertebral fracture; and (3) chondrocyte, synoviocytes, joint Chondroprotection, arthroscopy and knee arthroplasty. Results Pre-clinical studies have shown that the site of interaction of biophysical stimuli is the cell membrane. Its effect on bone tissue is to increase proliferation, synthesis and release of growth factors. On articular cells, it creates a strong A_2A and A_3 adenosine-agonist effect inducing an anti-inflammatory and chondroprotective result. In treated animals, it has been shown that the mineralisation rate of newly formed bone is almost doubled, the progression of the osteoarthritic cartilage degeneration is inhibited and quality of cartilage is preserved. Biophysical stimulation has been used in the clinical setting to promote the healing of fractures and non-unions. It has been successfully used on joint pathologies for its beneficial effect on improving function in early OA and after knee surgery to limit the inflammation of periarticular tissues. Discussion The pooled result of the studies in this review revealed the efficacy of biophysical stimulation for bone healing and joint Chondroprotection based on proven methodological quality. Conclusion The orthopaedic community has played a central role in the development and understanding of the importance of the physical stimuli. Biophysical stimulation requires care and precision in use if it is to ensure the success expected of it by physicians and patients.
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Biophysical stimulation of bone and cartilage: state of the art and future perspectives
International Orthopaedics, 2019Co-Authors: Leo Massari, Franco Benazzo, Francesco Falez, Dario Perugia, Luca Pietrogrande, Stefania Setti, Raffaella Osti, Enrico Vaienti, Carlo Ruosi, Ruggero CadossiAbstract:INTRODUCTION: Biophysical stimulation is a non-invasive therapy used in orthopaedic practice to increase and enhance reparative and anabolic activities of tissue. METHODS: A sistematic web-based search for papers was conducted using the following titles: (1) pulsed electromagnetic field (PEMF), capacitively coupled electrical field (CCEF), low intensity pulsed ultrasound system (LIPUS) and biophysical stimulation; (2) bone cells, bone tissue, fracture, non-union, prosthesis and vertebral fracture; and (3) chondrocyte, synoviocytes, joint Chondroprotection, arthroscopy and knee arthroplasty. RESULTS: Pre-clinical studies have shown that the site of interaction of biophysical stimuli is the cell membrane. Its effect on bone tissue is to increase proliferation, synthesis and release of growth factors. On articular cells, it creates a strong A2A and A3 adenosine-agonist effect inducing an anti-inflammatory and chondroprotective result. In treated animals, it has been shown that the mineralisation rate of newly formed bone is almost doubled, the progression of the osteoarthritic cartilage degeneration is inhibited and quality of cartilage is preserved. Biophysical stimulation has been used in the clinical setting to promote the healing of fractures and non-unions. It has been successfully used on joint pathologies for its beneficial effect on improving function in early OA and after knee surgery to limit the inflammation of periarticular tissues. DISCUSSION: The pooled result of the studies in this review revealed the efficacy of biophysical stimulation for bone healing and joint Chondroprotection based on proven methodological quality. CONCLUSION: The orthopaedic community has played a central role in the development and understanding of the importance of the physical stimuli. Biophysical stimulation requires care and precision in use if it is to ensure the success expected of it by physicians and patients.
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Cartilage Chondroprotection and repair with pulsed electromagnetic fields: I-ONE therapy
The Environmentalist, 2011Co-Authors: Ruggero Cadossi, Stefania Setti, Milena FiniAbstract:Articular cartilage is a complex tissue characterised by chondrocytes that are embedded within an organised dense extracellular matrix of collagen and proteoglycan. Under physiologic condition, articular metabolism is slow, but under pathological condition turnover can increase and the matrix undergoes faster mechanical failure and deterioration, resulting in cartilage degeneration. Moreover, modest damage of the articular cartilage, resulting from trauma or less invasive surgical procedure, produces an inflammatory reaction of the joint cartilage, which can cause irreversible degeneration through the increase in catabolic cytokines synthesis and the decrease in anabolic activity of chondrocytes. Pro-inflammatory cytokines increase the synthesis of matrix-degrading enzymes and limit the production of proteoglycans. It is known that physical stimuli modulate cartilage metabolism. In particular, pulsed electromagnetic fields (I-ONE therapy, Igea, Carpi, Italy) allow to treat homogenously the whole cartilage surface and thickness and the underlying subchondral bone. In vitro I-ONE therapy increases the binding between adenosine and A_2A adenosine receptor on human neutrophils cell membrane, on bovine chondrocytes and on fibroblast-like synoviocytes. It has been shown that drugs with A_2A adenosine receptor agonist activity prevent articular cartilage degeneration in animals. We hypothesised that the adenosine agonist effect of I-ONE therapy can also prevent cartilage degeneration. In a recent study, De Mattei et al. demonstrated how I-ONE therapy can strongly inhibit the release of PGE_2 in bovine synovial fibroblasts exerting an anti-apoptotic effect on cells. Ex vitro , in bovine full thickness articular cartilage explants, I-ONE therapy induces the largest increase in proteoglycan synthesis and in IGF-1 synthesis, when cartilage is exposed to specific parameters of pulsed electromagnetic fields. These effective parameters were subsequently used in in vivo experiments. The effect of I-ONE therapy was investigated on Dunkin Hartley osteoarthritic knee by Mankin score and by histomorphometric and densitometric analysis; I-ONE therapy prevented cartilage degeneration and subchondral bone sclerosis. Osteochondral grafts were performed in the knees of sheep; I-ONE therapy favoured osteochondral grafts integration and prevented cyst-like resorption area formation, which can compromise the stability of graft and the success of the technique. To support the in vitro results, biochemical analyses of the synovial fluid were also performed in this animal model. The amount of inflammatory catabolic cytokines (IL-1β and TNF-α) in the synovial fluid of I-ONE treated animals was significantly lower than in control animals. On the contrary, TGF-β1 was significantly higher in stimulated animals than it was in controls. These results demonstrate not only the capability of I-ONE therapy to control the inflammatory reaction but also its capability to favour cartilage anabolic activity. These results provide the rational to design clinical studies to demonstrate the possibility to transfer the treatment to humans. Two randomised, prospective, double-blind clinical studies (Level I), one conducted to patients treated by arthroscopy with condroabrasion and/or perforations at the knee and the other after anterior cruciate ligament reconstruction, demonstrated that biophysical stimulation with I-ONE therapy leads to complete patient’s recovery in a significantly shorter time ( P
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cartilage Chondroprotection and repair with pulsed electromagnetic fields i one therapy
The Environmentalist, 2011Co-Authors: Ruggero Cadossi, Stefania Setti, Milena FiniAbstract:Articular cartilage is a complex tissue characterised by chondrocytes that are embedded within an organised dense extracellular matrix of collagen and proteoglycan. Under physiologic condition, articular metabolism is slow, but under pathological condition turnover can increase and the matrix undergoes faster mechanical failure and deterioration, resulting in cartilage degeneration. Moreover, modest damage of the articular cartilage, resulting from trauma or less invasive surgical procedure, produces an inflammatory reaction of the joint cartilage, which can cause irreversible degeneration through the increase in catabolic cytokines synthesis and the decrease in anabolic activity of chondrocytes. Pro-inflammatory cytokines increase the synthesis of matrix-degrading enzymes and limit the production of proteoglycans. It is known that physical stimuli modulate cartilage metabolism. In particular, pulsed electromagnetic fields (I-ONE therapy, Igea, Carpi, Italy) allow to treat homogenously the whole cartilage surface and thickness and the underlying subchondral bone. In vitro I-ONE therapy increases the binding between adenosine and A2A adenosine receptor on human neutrophils cell membrane, on bovine chondrocytes and on fibroblast-like synoviocytes. It has been shown that drugs with A2A adenosine receptor agonist activity prevent articular cartilage degeneration in animals. We hypothesised that the adenosine agonist effect of I-ONE therapy can also prevent cartilage degeneration. In a recent study, De Mattei et al. demonstrated how I-ONE therapy can strongly inhibit the release of PGE2 in bovine synovial fibroblasts exerting an anti-apoptotic effect on cells. Ex vitro, in bovine full thickness articular cartilage explants, I-ONE therapy induces the largest increase in proteoglycan synthesis and in IGF-1 synthesis, when cartilage is exposed to specific parameters of pulsed electromagnetic fields. These effective parameters were subsequently used in in vivo experiments. The effect of I-ONE therapy was investigated on Dunkin Hartley osteoarthritic knee by Mankin score and by histomorphometric and densitometric analysis; I-ONE therapy prevented cartilage degeneration and subchondral bone sclerosis. Osteochondral grafts were performed in the knees of sheep; I-ONE therapy favoured osteochondral grafts integration and prevented cyst-like resorption area formation, which can compromise the stability of graft and the success of the technique. To support the in vitro results, biochemical analyses of the synovial fluid were also performed in this animal model. The amount of inflammatory catabolic cytokines (IL-1β and TNF-α) in the synovial fluid of I-ONE treated animals was significantly lower than in control animals. On the contrary, TGF-β1 was significantly higher in stimulated animals than it was in controls. These results demonstrate not only the capability of I-ONE therapy to control the inflammatory reaction but also its capability to favour cartilage anabolic activity. These results provide the rational to design clinical studies to demonstrate the possibility to transfer the treatment to humans. Two randomised, prospective, double-blind clinical studies (Level I), one conducted to patients treated by arthroscopy with condroabrasion and/or perforations at the knee and the other after anterior cruciate ligament reconstruction, demonstrated that biophysical stimulation with I-ONE therapy leads to complete patient’s recovery in a significantly shorter time (P < 0.005). Moreover, a significant number of treated patients made lower use of anti-inflammatory drugs than the patients in the placebo group. We did not observe negative side effects, patient’s compliance was good and treatment was well accepted. I-ONE therapy significantly reduces patients’ recovery time, joint swelling and has a chondroprotective effect over articular cartilage. I-ONE treatment is a new therapy for the joint preservation.
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Low-frequency pulsed electromagnetic fields in orthopedic practice: Bone and cartilage repair
2011 XXXth URSI General Assembly and Scientific Symposium, 2011Co-Authors: Ruggero Cadossi, Stefania SettiAbstract:The use of biophysical stimulation, with low-frequency pulsed electromagnetic fields, to modulate osteogenetic response and favour fracture healing has been the subject of wide-ranging research. Current orthopaedics reviews the different modalities of biophysical treatment in search of solutions most adequate to the pathology, the characteristics of the fracture and those of the patient. It is up to the orthopaedist to assess whether the biomechanical conditions of stability of the fracture site are such as not to jeopardize the osteogenetic process. Moreover, experimental studies on articular cartilage have demonstrated that low-frequency pulsed electromagnetic fields control inflammation, protect extracellular matrix and favour chondrocytes metabolic activity. The results of two level I clinical study on patients underwent arthroscopic procedures demonstrated that low-frequency pulsed electromagnetic fields favour patients' recovery both in the short (90 days) and in the long term (3 years). The long term benefit results from biophysical Chondroprotection of articular cartilage and from prevention of the fibrotic stimuli exerted by pro-inflammatory cytokines on wound tissue. Biophysical stimulation plays a central role also in regenerative medicine, protecting the repair of tissue from catabolic effects of the inflammatory reaction elicited by the surgical implantation procedure.