Ex vivo biomechanical evaluation of a bone-screw-fastener for tibial plateau leveling osteotomy.

Introduction: The objective of this study was to investigate the effect of a novel screw type on stiffness and failure characteristics of a tibial plateau leveling osteotomy (TPLO) construct under cyclic loading conditions. The authors hypothesized that bone-screw-fasteners (BSF) would result in superior biomechanical stability compared with locking buttress screws (LBS). Materials and Methods: Twelve pairs of canine cadaveric pelvic limbs were included in this ex vivo biomechanical study. A TPLO was performed using a 3.5mm locking TPLO plate and stabilized using either LBS or BSF. Cyclic loading was performed for 30,000 cycles at 4Hz with a peak-load of 1000N (50N valley). The cyclic test was then continued by stepwise incremental increase of peak-load at a rate of 75N per 500 cycles until failure. Results: Cycles to failure for LBS (44,260 ± 5,770) and BSF (41,540 ± 7,686) were not significantly different (p = 0.36). Maximum force for LBS (3,134 ± 797N) and BSF (2,940 ± 831N) was not significantly different either (p = 0.58). Dynamic stiffness for LBS (1,778 ± 932 N/mm) and BSF (1,574 ± 677 N/mm) was not significantly different (p = 0.58). Discussion: Stabilization of the TPLO with BSF provided similar biomechanical stability under cyclic axial loading conditions as the LBS. BSF may be an acceptable alternative to traditional locking screws for TPLO.

Biomechanical Comparison of a Headless Compression Screw Fastener and AO Cortical Bone Screw for Fixation of a Simulated Equine Third Carpal Bone Slab Fracture.

Frontal plane slab fractures account for the majority of third carpal bone (C3) fractures in racing and performance horses. Recommended treatment is stabilization with a lagged AO cortical screw. Associated complications are fragment splitting, fragment spinning, and irritation of dorsal soft tissue structures. A novel, headless, cannulated screw with interlocking threads the Headless Compression Screw Fastener (HCSF) has been developed to resist multidirectional forces and bending moments; however, it has not been applied in the horse. Simulated C3 frontal plane slab fractures were created in nine paired carpi from equine cadaver limbs, fixed with either the HCSF or AO cortical bone screw, and loaded in shear to failure. The effect of screw type on stiffness, maximum load to failure, and yield load was assessed in separate linear mixed models. No significant (P< .05) difference between screw types was detected in terms of maximum load to failure (P= .084), stiffness (P= .26), or yield load (P= .088). Mode of failure was screw bending in all specimens. For some samples in both groups, failure was associated with the sagittal fracture at the screw-bone interface. The HCSF was successfully used to repair simulated third carpal bone fractures. The different head and thread pitches of the HCSF effectively compressed the fracture. The headless design eliminates the need for counter sinking. There was no significant difference in maximum load to failure, stiffness, nor yield load compared to the cortical screws. These results invite clinical application to be investigated.

Ex vivo biomechanical comparison of four Center of Rotation Angulation Based Leveling Osteotomy fixation methods.

OBJECTIVE: To compare the strength of four constructs used to secure an osteotomy in a Center of Rotation Angulation (CORA)-Based Leveling Osteotomy (CBLO) in an ex vivo model. STUDY DESIGN: Ex vivo study. SAMPLE POPULATION: Thirty-two canine tibiae from 17 skeletally mature cadavers weighing between 18 and 33.2 kg. METHODS: Thirty-two paired tibiae with patella and patellar tendon were collected. Each tibia was randomly allocated to a construct group: plate and pin (Plate), plate with countersink compression screw (HCS), plate with tension band (TB), or plate with HCS and TB (HCSTB). Samples were loaded by distraction until failure. The stiffness, yield load, and ultimate load were compared between each fixation method. RESULTS: No difference in stiffness of the constructs was detected between groups (p = .6937). Yield load for the HCSTB group (1211.06 N) was greater than the TB group (1016.41 N), the HCS group (907.20 N), and the Plate group (787.73 N) (p = .0069). The ultimate load for the HCSTB group (1387.82 N) was greater than the TB group (1076.36 N), HCS group (926.62 N), and the Plate group (774.35 N) (p = .0004). CONCLUSIONS: CBLO fixation augmented with a TB and HCS provided a stronger construct that withstood a greater yield load and ultimate load than either augmentation strategy alone. CLINICAL SIGNIFICANCE: Augmenting a CBLO fixation with a TB and a HCS can provide increased construct strength.

Biomechanical Comparison of External Fixation and Double Plating for Stabilization of a Canine Cadaveric Supracondylar Humeral Fracture Gap Model.

OBJECTIVE: Successful stabilization of comminuted supracondylar humeral fractures is challenging, and biomechanical studies are scarce. This study compares double-plate (DB-PLATE) and linear external fixator with an intramedullary pin tie-in (ESF-IMP) fixation techniques in a cadaveric gap model. The hypothesis was the DB-PLATE construct would be stiffer, stronger and more resistant to repeated loading than the ESF-IMP construct in both cyclic and load-to-failure axial compression testing. STUDY DESIGN: A 2 cm ostectomy was performed on 10 pairs of canine cadaveric humeri proximal to the supratrochlear foramen. Stabilization was with DB-PLATE (n = 10) or ESF-IMP (n = 10). Cyclic testing was performed by applying a 200 N load at 2 Hz for 63,000 cycles. Axial compressive load to failure testing followed. Data analysed included dynamic stiffness, stiffness and yield load. RESULTS: No constructs failed during cyclic testing or lost stiffness over time. Mean dynamic stiffness over the final 100 cycles was greater for DB-PLATE compared with ESF-IMP. Mean stiffness of DB-PLATE in load-to-failure testing was not different than ESF-IMP. Yield load of DB-PLATE was higher than ESF-IMP. CONCLUSION: Both DB-PLATE and ESF-IMP survived cyclic testing with no change in dynamic stiffness. DB-PLATE was stronger than ESF-IMP in load-to-failure testing, which may make this construct preferable when prolonged healing or poor patient compliance is anticipated. Results suggest that either method may be appropriate for fixation of comminuted supracondylar humeral fractures.

Ex vivo biomechanical comparison of 2.7 mm string-of-pearl plate versus screw/wire/Polymethylmethacrylate composite fixation and 2.7 mm veterinary acetabular plate for repair of simulated canine acetabular fractures.

BACKGROUND: Acetabular fractures comprise 12-30% of canine pelvic fractures and require accurate anatomic reduction and rigid stability to ensure proper healing and minimize future osteoarthritis. Many techniques have been used to repair these fractures, with common techniques including veterinary acetabular plates or use of screw/wire/polymethylmethacrylate constructs. String-of-Pearl™ plating systems have also been used clinically but there is a lack of research supporting their use for these fractures. The purpose of this study was to compare fracture reduction accuracy, biomechanical characteristics, and mode of failure between String-of-Pearls™, veterinary acetabular plates, screw/wire/polymethylmethacrylate constructs in a simulated, ex-vivo acetabular fracture model. We hypothesized that the String-of-Pearls™ constructs would have equivalent or greater mechanical properties and reduction compared to the other constructs. RESULTS: The mean craniocaudal acetabular diameter before fixation (mean 25.2 mm; range 20 mm - 30.1 mm) was not significantly different from after fixation (mean 23.9 mm; range 20 mm - 28.3 mm) for any fixation method. Comparison of reduction scores between groups revealed no significant differences. No significant differences were noted for cyclical displacement or stiffness. There was significant difference with superior failure load of String-of-Pearls™ compared to screw/wire/polymethylmethacrylate in the 75th percentile of animal weight (P = 0.0021), and superior failure load of String-of-Pearls™ compared to veterinary acetabular plates in the 50th (P = 0.0232) and 75th percentiles (P = 0.0058). Stiffness of the String-of-Pearls™ construct was significantly greater than the veterinary acetabular plate construct (P = 0.0417). For ultimate load, String-of-Pearls™ constructs were significantly greater than screw/wire/polymethylmethacrylate (P = 0.0331) and veterinary acetabular plates (P = 0.0218). CONCLUSION: Although the ease of application for the String-of-Pearls™ implant was subjectively better than other implants, no significant differences were found in fracture reduction scores. The String-of-Pearls™ constructs were stiffer than veterinary acetabular plates and exhibited greater failure and ultimate loads compared to veterinary acetabular plates and screw/wire/polymethylmethacrylate fixations. The String-of-Pearls™ implant appears to be a suitable fixation choice for simple canine acetabular fractures.

Effects of antigen removal on a porcine osteochondral xenograft for articular cartilage repair.

Given the limited availability of fresh osteochondral allografts and uncertainty regarding performance of decellularized allografts, this study was undertaken as part of an effort to develop an osteochondral xenograft for articular cartilage repair. The purpose was to evaluate a simple antigen removal procedure based mainly on treatment with SDS and nucleases. Histology demonstrated a preservation of collagenous structure and removal of most nuclei. Immunohistochemistry revealed the apparent retention of α-Gal within osteocyte lacunae unless the tissue underwent an additional α-galactosidase processing step. Cytoplasmic protein was completely removed as shown by Western blot. Quantitatively, the antigen removal protocol was found to extract approximately 90% of DNA from cartilage and bone, and it extracted over 80% of glycosaminoglycan from cartilage. Collagen content was not affected. Mechanical testing of cartilage and bone were performed separately, in addition to testing the cartilage-bone interface, and the main effect of antigen removal was an increase in cartilage hydraulic permeability. In vivo immunogenicity was assessed by subcutaneous implantation into DBA/1 J mice, and the response was typical of a foreign body rather than immune reaction. Thus, an osteochondral xenograft produced as described has the potential for further development into a treatment for osteochondral lesions in the human knee. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 2251-2260, 2018.

Comparison of limited-contact dynamic compression plate and locking compression plate constructs for proximal interphalangeal joint arthrodesis in the horse.

This study compared in vitro monotonic and cyclic mechanical properties of equine proximal interphalangeal joint arthrodeses stabilized using an open or closed technique combined with axial 4.5 mm narrow limited-contact dynamic compression plate (LC-DCP) or 4.5 mm narrow locking compression plate (LCP). Ten forelimb pairs were randomly assigned to LCP or LC-DCP groups. One limb in each pair was assigned to either open or closed technique. Limbs were tested for cyclic fatigue at 20 000 cycles and then single-cycle to failure under 3-point dorsopalmar bending. There was no significant difference in stiffness of constructs during cyclic fatigue testing or on force or stiffness at failure in single cycle to failure testing between open and closed techniques or between plate types. Both implants, surgical technique, or combinations thereof are suitable for clinical use. More work is necessary to define the interaction between implant type and surgical technique.

Comparaison des constructions de plaques de compression dynamique à contact limité et de plaques de compression à verrouillage pour l'arthrodèse de l'articulation interphalangienne proximale chez les chevaux. Cette étude a comparé les propriétés mécaniques monotoniques et cycliques in vitro des arthrodèses interphalangiennes proximales équines stabilisées à l'aide d'une technique ouverte ou fermée combinée à une plaque de compression dynamique axiale étroite à contact limité de 4,5 mm (LC-DCP) ou à une plaque de compression étroite à verrouillage de 4,5 mm (LCP). Dix paires de pattes avant ont été assignées au hasard à des groupes LCP ou LC-DCP. Une patte de chaque paire était assignée soit à la technique ouverte ou fermée. Les pattes ont été évaluées pour la fatigue cyclique à 20 000 cycles, puis à un cycle unique jusqu'à l'échec à l'aide d'une flexion dorsopalmaire à 3 points. Il n'y avait pas de différence significative dans la rigidité des constructions durant l'évaluation de fatigue cyclique ou sur la force ou la rigidité à l'échec durant l'évaluation dans un cycle unique jusqu'à l'échec entre les techniques ouvertes et fermées ou entre les types de plaques. Les deux implants, techniques chirurgicales ou une combinaison des deux sont appropriés à l'usage clinique. Il est nécessaire d'effectuer des recherches additionnelles pour définir l'interaction entre le type d'implant et la technique chirurgicale.(Traduit par Isabelle Vallières).

In-vitro comparison of 3 knotting techniques for lateral fabellotibial suture stabilization.

This study evaluated the biomechanical characteristics of a single self-locking knot (sSLK) and a double self-locking knot (dSLK) compared with the square knot (SQ) for stabilization of cranial cruciate ligament rupture. Each knot underwent monotonic tensile and cyclical loading. Starting tension, elongation, stiffness, and load to failure were all evaluated. A value of P < 0.05 was considered significant. Starting tension, overall stiffness, and load to failure were all significantly greater in both the sSLK and dSLK compared with the SQ. There was no difference in elongation among the knots. There were no significant differences in starting tension, elongation, stiffness, and load to failure between the sSLK and the dSLK. The self-locking knots were stronger and stiffer than the SQ; there is no biomechanical advantage in using the dSLK compared with the sSLK.

Comparaison in vitro de 3 techniques de nœuds pour la stabilisation des sutures fabello-tibiales latérales. Cette étude a évalué les caractéristiques d'un nœud auto-serrant unique (NASu) et d'un nœud auto-serrant double (NASd) comparativement à un nœud plat (NP) pour la stabilisation d'une rupture d'un ligament croisé crânial. Chaque nœud a subi un effort de tension monotonique et cyclique. La tension de départ, l'élongation, la rigidité et la charge avant la rupture ont toutes été évaluées. Une valeur de P < 0,05 était considérée significative. La tension de départ, la rigidité générale et la charge avant la rupture ont toutes été de beaucoup supérieures avec NASu et NASd comparativement à NP. Il n'y avait pas de différence au niveau de l'élongation parmi les nœuds. Il n'y avait pas de différences importantes dans la tension de départ, l'élongation, la rigidité et la charge avant rupture entre NASu et NASd. Les nœuds auto-serrants étaient plus forts et plus rigides que le NP; il n'y avait pas d'avantage biomécanique à utiliser le NASd comparativement au NASu.(Traduit par Isabelle Vallières).

Construction of a tissue-engineered annulus fibrosus.

The intervertebral disc is composed of load-bearing fibrocartilage that may be subjected to compressive forces up to 10 times the body weight. The multilaminated outer layer, the annulus fibrosus (AF), is vulnerable to damage and its regenerative potential is limited, sometimes leading to nuclear herniation. Scaffold-based tissue engineering of AF using stem cell technology has enabled the development of bi-laminate constructs after 10 weeks of culture. It is difficult to know if these constructs are limited by the differentiation state of the stem cells or the culture system. In this study, we have characterized an expandable scaffold-free neoconstruct using autologous AF cells. The construct was prepared from pellet cultures derived from monolayer cultures of AF cells from mature pigs that became embedded in their own extracellular matrix. The pellet cultures were incubated for 24 h in a standardized conical tube and then carefully transferred intact to a culture flask and incubated for 21 days to allow continued matrix synthesis. Cell viability was maintained above 90% throughout the culture period. The engineered scaffold-free construct was compared with the native AF tissue by characterization of gene expression of representative markers, histological architecture, and biochemical composition. The morphological and biochemical characteristics of the cultured disc construct are very similar to that of native AF. The cell number per gram of construct was equal to that of native AF. Expression of aggrecan was elevated in the engineered construct compared with RNA extracted from the AF. The glycosaminoglycan content in the engineered construct showed no significant difference to that from native construct. These data indicate that scaffold-free tissue constructs prepared from AF cells using a pellet-culture format may be useful for in vitro expansion for transplantation into damaged discs.

Fabrication of cardiac patch with decellularized porcine myocardial scaffold and bone marrow mononuclear cells.

Tissue engineered cardiac grafts are a promising therapeutic mode for ventricular wall reconstruction. Recently, it has been found that acellular tissue scaffolds provide natural ultrastructural, mechanical, and compositional cues for recellularization and tissue remodeling. We thus assess the potential of decellularized porcine myocardium as a scaffold for thick cardiac patch tissue engineering. Myocardial sections with 2-mm thickness were decellularized using 0.1% sodium dodecyl sulfate and then reseeded with differentiated bone marrow mononuclear cells. We found that thorough decellularization could be achieved after 2.5 weeks of treatment. Reseeded cells were found to infiltrate and proliferate in the tissue constructs. Immunohistological staining studies showed that the reseeded cells maintained cardiomyocyte-like phenotype and possible endothelialization was found in locations close to vasculature channels, indicating angiogenesis potential. Both biaxial and uniaxial mechanical testing showed a stiffer mechanical response of the acellular myocardial scaffolds; however, tissue extensibility and tensile modulus were found to recover in the constructs along with the culture time, as expected from increased cellular content. The cardiac patch that we envision for clinical application will benefit from the natural architecture of myocardial extracellular matrix, which has the potential to promote stem cell differentiation, cardiac regeneration, and angiogenesis.

In vitro biomechanical evaluation and comparison of FiberWire, FiberTape, OrthoFiber, and nylon leader line for potential use during extraarticular stabilization of canine cruciate deficient stifles.

OBJECTIVE: To compare biomechanical properties of 3 new generation polyethylene sutures (FiberTape [FT], FiberWire [FW], and OrthoFiber [OF]) with nylon leader line (NL) for use during extraarticular fixation of cranial cruciate deficient stifles. STUDY DESIGN: In vitro biomechanical testing of suture loops under monotonic tensile and cyclical loading until failure. SAMPLE POPULATION: Constructs of FT, FW, OF, and NL. METHODS: Twenty loops of each of 12 combinations of fixation and suture had monotonic tensile and cyclical loading. Two knotting techniques (square knot [SQ], slip knot [SL]) and a crimp clamp (CR) system were evaluated. Elongation, stiffness, and strength of constructs was tested. The main effects of group, loop material, and their interaction were evaluated. RESULTS: Knotted FT, FW, and OF had less elongation than knotted NL under monotonic tensile and cyclical loading. Under monotonic tensile loading, knotted FT and OF were stiffer than knotted NL. CR FT, CR FW, and CR OF were stiffer than CR NL and CR FT, CR FW, and CR OF were stiffer than knotted FT, FW, and OF. FW and OF knotted loops were weaker than knotted NL. CR FT was stronger than CR NL. CR FT and CR OF were weaker than knotted FT and OF. CONCLUSIONS: Polyethylene sutures are stronger, stiffer and elongate less than nylon leader. Crimping suture alters the biomechanical properties of the loop. CLINICAL RELEVANCE: FW, FT, and OF may perform better in reconstructive procedures, where increased strength and stiffness are considered to be beneficial.

Chitosan: potential use as a bioactive coating for orthopaedic and craniofacial/dental implants.

Chitosan is a biopolymer that exhibits osteoconductive, enhanced wound healing and antimicrobial properties which make it attractive for use as a bioactive coating to improve osseointegration of orthopaedic and craniofacial implant devices. Coatings made from 91.2% de-acetylated chitosan were chemically bonded to titanium coupons via silane-glutaraldehyde molecules. The bond strength of the coatings was evaluated in mechanical tensile tests, and their dissolution and cytocompatibility were evaluated in vitro using cell-culture medium and UMR 106 osteoblastic cells, respectively. The results showed that the chitosan coatings were chemically bonded to the titanium substrate and that the bond strengths (1.5-1.8 MPa) were not affected by gas sterilization. However, the chitosan bond strengths were less than those reported for calcium-phosphate coatings. The gas-sterilized coatings exhibited little dissolution over 8 weeks in cell-culture solution, and the attachment and growth of the UMR 106 osteoblast cells was greater on the chitosan-coated samples than on the uncoated titanium. These results indicated that chitosan has the potential to be used as a biocompatible, bioactive coating for orthopaedic and craniofacial implant devices.