In vivo cartilage strain increases following medial meniscal tear and correlates with synovial fluid matrix metalloproteinase activity

Abstract

Meniscal tears are common injuries, and while partial meniscectomy is a frequent treatment option, general meniscus loss is a risk factor for the development of osteoarthritis. The goal of this study was to measure the in vivo tibiofemoral cartilage contact patterns in patients with meniscus tears in relation to biomarkers of cartilage catabolism in the synovial fluid of these joints. A combination of magnetic resonance imaging and biplanar fluoroscopy was used to determine the in vivo motion and cartilage contact mechanics of the knee. Subjects with isolated medial meniscus tears were analyzed while performing a quasi-static lunge, and the contralateral uninjured knee was used as a control. Synovial fluid was collected from the injured knee and matrix metalloproteinase (MMP) activity, sulfated glycosaminoglycan, cartilage oligomeric matrix protein, prostaglandin E2, and the collagen type II cleavage biomarker C2C were measured. Contact strain in the medial compartment increased significantly in the injured knees compared to contralateral control knees. In the lateral compartment, the contact strain in the injured knee was significantly increased only at the maximum flexion angle (105°). The average cartilage strain at maximum flexion positively correlated with total MMP activity in the synovial fluid. These findings show that meniscal injury leads to loss of normal joint function and increased strain of the articular cartilage, which correlated to elevated total MMP activity in the synovial fluid. The increased strain and total MMP activity may reflect, or potentially contribute to, the early development of osteoarthritis that is observed following meniscal injury.

In Vivo Tibial Cartilage Strains in Regions of Cartilage-to-Cartilage Contact and Cartilage-to-Meniscus Contact in Response to Walking

“…The present study has the ability to evaluate regions of cartilage-to-cartilage contact as well as cartilage-to-meniscus contact. Furthermore, prior studies measured deformation that reflected the instantaneous strain response during the selected activity, 6, 22, 32 while the present study measured the cumulative strain response after multiple gait cycles.…”

“…6 Previous work using biplanar fluoroscopy has shown that medial meniscal injury results in elevated cartilage deformation in regions of cartilage-to-cartilage contact. 6 However, there is a lack of in vivo data regarding regions of cartilage-to-meniscus contact.…”

Epidemiology of Posttraumatic Osteoarthritis

“…4 Increased presence of inflammatory markers and biomarkers of cartilage degradation have also been reported after ACL injury and reconstruction 50 and meniscal injury. 51 However, the prognostic importance of these biomarkers is presently unknown, as it is unclear if the elevated concentrations of these markers are a healthy or pathologic adaptation to injury. 50 Altered loading about the injured joint has also been suggested to contribute to PTOA development.…”

Analysis of in-vivo articular cartilage contact surface of the knee during a step-up motion

“…Numerous studies have investigated the tibiofemoral cartilage contact using both in-vitro and in-vivo experimental set ups, including cadaveric knee tests (D'Agata et al, 1993; Guettler et al, 2005), in silico three dimensional (3D) knee joint modeling (Halonen et al, 2014; Shim et al, 2016), in-vivo imaging measurements (Bingham et al, 2008; Carter et al, 2015; Chan et al, 2016; Coleman et al, 2013; Eckstein et al, 2005; Henak et al, 2013; Kaiser et al, 2016; Lad et al, 2016; Liu et al, 2010; Sutter et al, 2015). While these studies have greatly advanced our knowledge on human knee joint biomechanics, no data has been reported on the articular surface geometry at the contact locations.…”