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Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_11 | Pages 133 - 133
1 Jul 2014
O'Kane C Vrancken A O'Rourke D Janssen D Ploegmakers M Buma P Fitzpatrick D Verdonschot N
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Summary. Our statistical shape analysis showed that size is the primary geometrical variation factor in the medial meniscus. Shape variations are primarily focused in the posterior horn, suggesting that these variations could influence cartilage contact pressures. Introduction. Variations in meniscal geometry are known to influence stresses and strains inside the meniscus and the articulating cartilage surfaces. This geometry-dependent functioning emphasizes that understanding the natural variation in meniscus geometry is essential for a correct selection of allograft menisci and even more crucial for the definition of different sizes for synthetic meniscal implants. Moreover, the design of such implants requires a description of 3D meniscus geometry. Therefore, the aim of this study was to quantify 3D meniscus geometry and to determine whether variation in medial meniscus geometry is size or shape driven. Patients & Methods. Sagittal knee MR images (n=35; 15 males, 20 females, aged 33±12) were acquired at 3 Tesla using a 3D SPACE sequence with isotropic resolution of 0.5×0.5×0.5mm. 3D models were generated by manual segmentation of the medial menisci from the MR scans. The surface of a reference meniscus was then described by 250 landmarks. Using an affine iterative closest point transformation, these landmarks were registered onto the full set of 3D models. Based on the set of corresponding landmarks, a point distribution model was created using the Shapeworks software (NITRC, University of Utah), an open source algorithm for constructing correspondence-based statistical models of sets of similar shapes. Several modules from Shapeworks and the Arthron software (UCD, Dublin) were used to perform principal component analysis (PCA) upon the set of landmarks. The results of the PCA enabled quantification and visualisation of the primary modes of variation in meniscal geometry. Results. The majority (77%) of variation in medial meniscus geometry was found to be due to sizing (principal component (PC) 1). Including the shape-related PC's 2 to 4, increased the cumulative percentage of represented geometry variation to over 90%. The independent shape variations described by PCs 2–4 all display larger variations in geometry of the posterior meniscal horn than the anterior section. Discussion. From this study, we can conclude that geometry variation of the medial meniscus is mainly determined by differences in size. However, since the posterior aspect of the medial meniscus experiences higher loads during daily activities than the anterior part, the shape variations described by PCs 2–4 may have a significant influence on cartilage contact pressures. Therefore, PCA alone does not provide sufficient information to define the number of implant sizes to cover a majority of the population. Analysis of the sensitivity of cartilage contact pressures to the shape variations identified in this analysis could provide the additional information needed


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_11 | Pages 102 - 102
1 Jul 2014
Chang H Docheva D Knothe U Tate MK
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Summary Statement. Progenitor cells from the periosteal niche are of great clinical interest due to their remarkable regenerative capacity. Here we report on progenitor cells from arthritic patients whose femoral neck periosteum was resected over the course of hip replacement. Introduction. This study aims to determine whether periosteum derived cells (PDCs) can be isolated from tissue resected in the normal course of hip arthroplasty. Further, it aims to determine how different isolation protocols affect PDC behavior (surface marker expression, proliferation, and differentiation). In addition, the study aims to characterise the populations of PDCs, isolated through either enzymatic digestion or migration, and their relative capacity to differentiate down multiple capacities; direct comparison with commercially available human marrow-derived stromal cells cultured under identical conditions will enable the placement of the PDC data in context of the current state of the field. Methods. Proximal femoral head/neck explants (n=4) were acquired from patients within 8 h of hip replacement surgery (IRB 12–335, Cleveland Clinic), after examination and diagnosis by pathology. To isolate digested PDCs (dPDCS), the minced tissue is suspended in 3 mg/ml collagenase II (Gibco) solution in alpha-MEM with Glutamax (Invitrogen) with 1% antibioticantimycotic (Invitrogen) overnight in a 37°C incubator. Any undigested tissue is filtered from the cells using a 100 μm filter, and isolated cells are cultured in standard culture media. To isolate migrated PDCs (mPDCs), the minced tissue is directly plated into tissue culture flasks in alpha-MEM with Glutamax supplemented with 10% FBS (Invitrogen), 1% antibioticantimycotic overnight, and cultured in standard culture media. The cells are left to egress from the tissue for one week. Finally, validated bone marrow derived hMSCs (BMSCs) are purchased from four independent vendors (Lonza, PromoCell, ScienCell, Cell Applications) as standards for comparison. Cell cohorts are compared using proliferation assays, cell population analysis using flow cytometry, and quantitative adipogenesis, osteogenesis and chondrogenesis assays. Results. PDCs and BMSCs exhibit similar proliferation rate, morphology, and surface receptor expression. PDCs showed no significant differences to BMSCs with regard to osteo- and adipogenic differentiation capacity. Chondrogenic assay of PDCs showed increased pellet size with pellets exhibiting staining indicative of hyaline cartilage for BMSC, and immature fibrocartilage for dPDCs and mPDCs. This study demonstrates, for the first time to our knowledge, the feasibility of isolating PDCs from the femoral neck of patients undergoing joint replacement surgery. PDCs and BMSCs exhibit similar surface marker expression and equivalent adipogenic and osteogenic capacity. Interestingly, cell cohorts from the same tissue albeit different isolation protocols show intrinsic differences in their differentiation capacities. Additionally, all cell types display marked intraindividual differences in their capacity to differentiate down different lineages, with no significant correlation to age. Discussion/Conclusion. The femoral neck periosteum offers a feasible source for isolation and a possible source for banking of autologous multipotent cells with similar potential as BMSCs. Further in vivo studies will determine the regenerative capacity of these cells in a more physiological context