Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Basic Research 173 articles


The In Vitro Elution Characteristics of Vancomycin from Tendons

Jane E. Grayson PhD, Gary D. Grant PhD, Shailendra Dukie PhD, Christopher J. Vertullo MBBS, FRACS

Infection after ACL reconstruction is uncommon but catastrophic. Prophylactic graft saturation in vancomycin reportedly reduces infection rates.

Infrared Assessment of Bone Quality: A Review

Eleftherios P. Paschalis PhD, Richard Mendelsohn PhD, Adele L. Boskey PhD

Bone strength depends on both bone quantity and quality. The former is routinely estimated in clinical settings through bone mineral density measurements but not the latter. Bone quality encompasses the structural and material properties of bone. Although its importance is appreciated, its contribution in determining bone strength has been difficult to precisely quantify partly because it is multifactorial and requires investigation of all bone hierarchical levels. Fourier transform infrared spectroscopy provides one way to explore these levels.

Emerging Ideas: Treatment of Precollapse Osteonecrosis Using Stem Cells and Growth Factors

Quanjun Cui MD, MSc, Edward A. Botchwey PhD

Osteonecrosis (ON) of the femoral head is a devastating disease affecting young patients at their most productive age, causing major socioeconomic burdens. ON is associated with various etiologic factors, and the pathogenesis of the disease is unknown. Most investigators believe the disease is the result of secondary microvascular compromise with subsequent bone and marrow cell death and defective bone repair.

Emerging Ideas: Matrix Metalloproteinase-2 in Muscle Atrophy

Xuhui Liu MD

Muscle atrophy impacts almost every patient seen for orthopaedic conditions. Unfortunately, no effective treatment is available to date. Matrix metalloproteinases (MMPs), especially MMP-2, are involved in skeletal muscle atrophy. MMP-2 null mice reportedly have substantially reduced muscle atrophy after tendon transection compared with wild-type mice, suggesting MMP-2 plays an important role in muscle atrophy. Although the exact mechanisms remain unknown, a newly-discovered intracellular form of MMP-2 suggests a possible novel mechanism of MMP-2 digesting muscle matrix during muscle atrophy. I propose a new pharmacologic treatment for muscle atrophy using selective MMP-2 inhibitors.

Anabolic Agents and Bone Quality

Tarek Sibai MD, Elise F. Morgan PhD, Thomas A. Einhorn MD

The definition of bone quality is evolving particularly from the perspective of anabolic agents that can enhance not only bone mineral density but also bone microarchitecture, composition, morphology, amount of microdamage, and remodeling dynamics.

Cartilage-mimicking, High-density Brush Structure Improves Wear Resistance of Crosslinked Polyethylene: A Pilot Study

Masayuki Kyomoto PhD, Toru Moro MD, Yoshio Takatori MD, Hiroshi Kawaguchi MD, Kazuhiko Ishihara PhD

In natural synovial joints under physiologic conditions, fluid thin-film lubrication by a hydrated layer of the cartilage is essential for the smooth motion of the joints. The considerably less efficient lubrication of artificial joints of polyethylene is prone to wear, leading to osteolysis and aseptic loosening and limiting the longevity of THA. A nanometer-scale layer of poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC) with cartilage-mimicking brushlike structures on a crosslinked polyethylene (CLPE) surface may provide hydrophilicity and lubricity resembling the physiologic joint surface.

Vitamin E-stabilized UHMWPE for Total Joint Implants: A Review

Pierangiola Bracco MD, Ebru Oral PhD

Osteolysis due to wear of UHMWPE limits the longevity of joint arthroplasty. Oxidative degradation of UHMWPE gamma-sterilized in air increases its wear while decreasing mechanical strength. Vitamin E stabilization of UHMWPE was proposed to improve oxidation resistance while maintaining wear resistance and fatigue strength.

Crack Propagation Resistance Is Similar Under Static and Cyclic Loading in Crosslinked UHMWPE: A Pilot Study

Jevan Furmanski PhD, Clare M. Rimnac PhD

Recent work suggests crack phenomena (eg, crack initiation and propagation) in UHMWPE do not depend on cyclic damage mechanisms. Materials for which crack phenomena occur in static (noncyclic) mode should exhibit similar crack propagation behavior under static and cyclic loading conditions.

Emerging Ideas: The Effect of Hypercholesterolemia on Tendons

Joseph A. Abboud MD, David P. Beason MS, Louis J. Soslowsky PhD

High levels of total cholesterol, triglycerides, and low-density lipoprotein are toxic to the vascular endothelium and thus have long been associated with atherosclerosis. Several clinical studies have suggested that elevated cholesterol also has a negative effect on tendon structure and function. Data from our preliminary studies show that the patellar tendons of hypercholesterolemic knockout mice exhibit reduced baseline elastic modulus and strength postinjury compared with controls.

Emerging Ideas: Prevention of Posttraumatic Arthritis Through Interleukin-1 and Tumor Necrosis Factor-alpha Inhibition

J. Todd R. Lawrence MD, PhD, James Birmingham MD, Alison P. Toth MD

Despite surgical and mechanical stabilization of an acutely injured joint through ligament reconstruction, meniscus repair, or labral repair, the risk of posttraumatic arthritis remains high. Joint injury triggers three phases of pathogenic events: the early (acute) phase involves joint swelling, hemarthrosis, expression of inflammatory cytokines (especially interleukin-1 [IL-1] and tumor necrosis factor-α [TNF-α]), and biomarkers of cartilage catabolism; an intermediate phase is characterized by reduction of joint inflammation, ongoing joint catabolism, but no evidence yet for typical features of radiographic osteoarthritis (OA); and a late phase characterized by radiographic OA.