title: Induction of a neoarthrosis by precisely controlled motion in an experimental mid-femoral defect.
abstract: Bone regeneration during fracture healing has been demonstrated repeatedly, yet the regeneration of articular cartilage and joints has not yet been achieved. It has been recognized however that the mechanical environment during fracture healing can be correlated to the contributions of either the endochondral or intramembranous processes of bone formation, and to resultant tissue architecture. Using this information, the goal of this study was to test the hypothesis that induced motion can directly regulate osteogenic and chondrogenic tissue formation in a rat mid-femoral bone defect and thereby influence the anatomical result. Sixteen male Sprague Dawley rats (400 +/- 20 g) underwent production of a mid-diaphyseal, non-critical sized 3.0 mm segmental femoral defect with rigid external fixation using a custom designed four pin fixator. One group of eight animals represented the controls and underwent surgery and constant rigid fixation. In the treatment group the custom external fixator was used to introduce daily interfragmentary bending strain in the eight treatment animals (12 degree angular excursion), with a hypothetical symmetrical bending load centered within the gap. The eight animals in the treatment group received motion at 1.0 Hz, for 10 min a day, with a 3 days on, one day off loading protocol for the first two weeks, and 2 days on, one day off for the remaining three weeks. Data collection included histological and immunohistological identification of tissue types, and mean collagen fiber angles and angular conformity between individual fibers in superficial, intermediate, and deep zones within the cartilage. These parameters were compared between the treatment group, rat knee articular cartilage, and the control group as a structural outcome assessment. After 35 days the control animals demonstrated varying degrees of osseous union of the defect with some animals showing partial union. In every individual within the mechanical treatment group the defect completely failed to unite. Bony arcades developed in the experimental group, capping the termini of the bone segments on both sides of the defect in four out of six animals completing the study. These new structures were typically covered with cartilage, as identified by specific histological staining for Type II collagen and proteoglycans. The distribution of collagen within analogous superficial, intermediate, and deep zones of the newly formed cartilage tissue demonstrated preferred fiber angles consistent with those seen in articular cartilage. Although not resulting in complete joint development, these neoarthroses show that the induced motion selectively controlled the formation of cartilage and bone during fracture repair, and that it can be specifically directed. They further demonstrate that the spatial organization of molecular components within the newly formed tissue, at both microanatomical and gross levels, are influenced by their local mechanical environment, confirming previous theoretical models.
authors.affiliation: Department of Orthopaedic Surgery, Boston University Medical Center, MA, USA.
authors.forename: Dennis M
authors.initials: DM
authors.lastname: Cullinane
authors.forename: Amy
authors.initials: A
authors.lastname: Fredrick
authors.forename: Solomon R
authors.initials: SR
authors.lastname: Eisenberg
authors.forename: Donna
authors.initials: D
authors.lastname: Pacicca
authors.forename: Michael V
authors.initials: MV
authors.lastname: Elman
authors.forename: Cassandra
authors.initials: C
authors.lastname: Lee
authors.forename: Kristy
authors.initials: K
authors.lastname: Salisbury
authors.forename: Louis C
authors.initials: LC
authors.lastname: Gerstenfeld
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Einhorn
mesh_terms: D000818:Animals; D020219:Chondrogenesis; D005264:Femoral Fractures / Q000503:physiopathology* / Q000628:therapy; D005269:Femur / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005592:Fracture Fixation / Q000379:methods; D017102:Fracture Healing; D016268:Internal Fixators; D008297:Male; D009038:Motion; D010012:Osteogenesis; D011859:Radiography; D051381:Rats; D017207:Rats, Sprague-Dawley