Design characteristics for temporomandibular joint disc tissue engineering: learning from tendon and articular cartilage

Tissue engineering of chondrocytic or fibroblastic musculoskeletal tissues has been relatively well studied compared with that of the temporomandibular joint (TMJ) disc. Early attempts at tissue engineering the disc have been misguided owing to a lack of understanding of the composition and function of the TMJ disc. The objective of this review is to compare the TMJ disc with a chondrocytic tissue (hyaline articular cartilage) and a fibroblastic tissue (tendon) to understand better the properties of this fibrocartilaginous tissue. The TMJ disc has 25 times more glycosaminoglycan (GAG) per dry weight than tendon but half that of articular cartilage. The disc's tensile modulus is six times more than cartilage but orders less than tendon. The GAG content and tensile modulus suggest that the TMJ disc is characterized as a tissue between hyaline cartilage and tendon, but the disc appears more tendon like when considering its collagen make-up and cell content. Like tendon, the TMJ disc contains primarily collagen type I at 85 per cent per dry weight, while articular cartilage has 30 per cent less collagen, which is type II. Knowledge of quantitative comparisons between joint tissues can give extensive insight into how to improve tissue engineering of the TMJ disc.     

Gene therapy for articular cartilage repair

Articular cartilage serves as the gliding surface of joints. It is susceptible to damage from trauma and from degenerative diseases. Restoration of damaged articular cartilage may be achievable through the use of cell-regulatory molecules that augment the reparative activities of the cells, inhibit the cells' degradative activities, or both. A variety of such molecules have been identified. These include insulin-like growth factor I, fibroblast growth factor 2, bone morphogenetic proteins 2, 4, and 7, and interleukin-1 receptor antagonist. It is now possible to transfer the genes encoding such molecules into articular cartilage and synovial lining cells. Although preliminary, data from in-vitro and in-vivo studies suggest that gene therapy can deliver such potentially therapeutic agents to protect existing cartilage and to build new cartilage.     

Physico-chemical characterization of functional electrospun scaffolds for bone and cartilage tissue engineering

Mimicking the zonal organization of the bone-cartilage interface will aid the production of functional osteochondral grafts for regeneration of skeletal joint defects. This study investigates the potential of the electrospinning technique to build a three-dimensional construct recapitulating the zonal matrix of this interface. Poly(lactic-co-glycolic acid) (PLGA) and PLGA-collagen solutions containing different concentrations of hydroxyapatite nanoparticles (nHAp) were electrospun on a thin layer of phosphate buffer saline solution spread on the collector in order to facilitate membrane detachment and recovery. Incorporation of increasing amounts of nHAp in PLGA solutions did not affect significantly the average diameter of the fibres, which was about 700 nm. However, in the presence of collagen, fibres with diameters below 100 nm were generally observed and the number of these fibres was inversely proportional to the ratio PLGA:collagen and proportional to the content of nHAp. PLGA membranes were rather hydrophobic, although the aqueous drop contact angles progressively fell from 125 degrees to 110 degrees when the content of nHAp was increased from 0 per cent to 50 per cent (w/v). PLGA-collagen membranes were more hydrophilic with contact angles between 60 degrees and 110 degrees; the values being proportional to the ratio PLGA:collagen and the content of nHAp. Also, the addition of nHAp from 0 per cent to 50 per cent (w/v) in the absence of collagen resulted in decreasing dramatically both the Young's modulus (Ym), from 34.3 +/- 1.8 MPa to 0.10 +/- 0.06 MPa, and the ultimate tensile strain (epsilon max), from a value higher than 40 per cent to 5 per cent. However, the presence of collagen together with nHAp allowed the creation of membranes much stiffer, although more brittle, as shown for membranes made with a ratio 8:2 and 10 per cent of nHAp, for which Ym = 70.0 +/- 6.6 MPa and epsilon max = 7 per cent.     

Characterization of compressive deformation behavior of multi-layer porous composite materials for articular tissue engineering

Regeneration of articular layered tissues consisting of cartilage and cancellous bone has been a critical issue in orthopedics. Tissue engineering technology for such large-scale damaged layered tissue may be developed by using layered scaffold with stem cells. In this study, therefore, a novel multi-layer scaffold consisting of a porous poly (?-caprolactone) (PCL) layer for cartilage regeneration and a porous composite layer of poly (L-lactic acid) (PLLA) and hydroxyapatite (HAp) for bone regeneration was developed. The microstructure of the scaffold was characterized by a field emission scanning electron microscope (FE-SEM). Compression tests were also performed to understand the stress-strain behavior. FE-SEM observation clearly showed that an interlayer exists between the PCL and the composite layers. The compressive stress-strain relation is characterized by a stepwise behavior including the first and the second steps. The first modulus corresponding to the first step is mainly related to the deformation of the PCL layer; on the other hand, the second modulus is related to both solidified PCL layer and the composite layer and increases with increase of HAp content of the composite layer. It is also found that the classical mechanics theory and three-dimensional finite element model can predict the first modulus reasonably well.     

Load-displacement-time characteristics of articular cartilage

The load-displacement-time characteristics of cartilage are modelled in a simple analytical way, and the behavior under steady and oscillating loads is predicted numerically. Comparison with constant-load creep experiments shows fairly good agreement. The model predicts that under oscillating loads of typical physiological magnitude and frequency, the effect on displacement of fluid transport through the matrix is negligible in any one cycle.     

Development of artificial articular cartilage

Attempts have been made to develop an artificial articular cartilage on the basis of a new viewpoint of joint biomechanics in which the lubrication and load-bearing mechanisms of natural and artificial joints are compared. Polyvinyl alcohol hydrogel (PVA-H), 'a rubber-like gel', was investigated as an artificial articular cartilage and the mechanical properties of this gel were improved through a new synthetic process. In this article the biocompatibility and various mechanical properties of the new improved PVA-H is reported from the perspective of its usefulness as an artificial articular cartilage. As regards lubrication, the changes in thickness and fluid pressure of the gap formed between a glass plate and the specimen under loading were measured and it was found that PVA-H had a thicker fluid film under higher pressures than polyethylene (PE) did. The momentary stress transmitted through the specimen revealed that PVA-H had a lower peak stress and a longer duration of sustained stress than PE, suggesting a better damping effect. The wear factor of PVA-H was approximately five times that of PE. Histological studies of the articular cartilage and synovial membranes around PVA-H implanted for 8-52 weeks showed neither inflammation nor degenerative changes. The artificial articular cartilage made from PVA-H could be attached to the underlying bone using a composite osteochondral device made from titanium fibre mesh. In the second phase of this work, the damage to the tibial articular surface after replacement of the femoral surface in dogs was studied. Pairs of implants made of alumina, titanium or PVA-H on titanium fibre mesh were inserted into the femoral condyles. The two hard materials caused marked pathological changes in the articular cartilage and menisci, but the hydrogel composite replacement caused minimal damage. The composite osteochondral device became rapidly attached to host bone by ingrowth into the supporting mesh. The clinical implications of the possible use of this material in articular resurfacing and joint replacement are discussed.     

A new bioreactor for the controlled application of complex mechanical stimuli for cartilage tissue engineering

Mechanical stimuli have been shown to enhance chondrogenesis on both animal and human chondrocytes cultured in vitro. Different mechanical stimuli act simultaneously in vivo in cartilage tissue and their effects have been extensively studied in vitro, although often in a separated manner. A new bioreactor is described where different mechanical stimuli, i.e. shear stress and hydrostatic pressure, can be combined in different ways to study the mechanobiology of tissue engineered cartilage. Shear stress is imposed on cells by forcing the culture medium through the scaffolds, whereas a high hydrostatic pressure up to 15 MPa is generated by pressurizing the culture medium. Fluid-dynamic experimental tests have been performed and successful validation of the bioreactor has been carried out by dynamic culture of tissue-engineered cartilage constructs. The bioreactor system allows the investigation of the combined effects of different mechanical stimuli on the development of engineered cartilage, as well as other possible three-dimensional tissue-engineered constructs.     

Tribology-optimised silk protein hydrogels for articular cartilage repair

Porous hydrogels were made from silk fibre as potential materials for cartilage repair. The aim was to develop materials which mimicked the tribological behaviour of cartilage, with controlled pore-sizes and optimised mechanical properties. Mechanical tests showed hydrogels had a comparable compressive modulus to cartilage, with stiffness improved by decreasing pore size. Under static loading and during shear hydrogels demonstrated significant interstitial fluid support. Friction testing showed the hydrogels had a cartilage-like frictional response, dominated by this interstitial fluid support. Silk hydrogels showed little wear, early signs of which were changes in surface morphology that did not correlate with the equilibrium friction coefficient. Consequently both wear and friction should be monitored when assessing the tribological performance of hydrogels.     

Microwave-enhanced fixation of rabbit articular cartilage

Cartilage, being highly aqueous, is difficult to preserve for electron microscopy without artefacts. Microwave-enhanced fixation is suggested as a standard method for block samples of this material, with dimensions of up to 12 × 7 × 3 mm. Cartilage samples from the tibial plateau of adult rabbits were fixed by conventional, cryo- or microwave-enhanced fixation. Constant or cyclical microwave irradiation of samples, immersed in fixatives, was carried out to varying final solution temperatures. Microwave-enhanced fixation and staining is shown to be both rapid and reproducible, giving fine structural preservation. Below 323 K microwave fixation always gave excellent preservation of the fine structure within seconds. At higher temperatures thermal artefacts were introduced. In this study the microwave-enhanced fixation is equal in quality to the best conventional immersion fixation and is nearly as fast as cryo-preservation. It provides a standardized, reproducible fixation for morphological studies on cartilage with good process control.     

Influence of proteoglycan contents and of tissue hydration on the frictional characteristics of articular cartilage

In this work, the hypothesis that water content and substances present on the articular surface play an important role in lubrication through the formation of a layer with a high content of water on the articular surface is analysed. The hydrophilic properties of proteoglycans exposed at the articular surface and hydration of tissue are the main responsible factors for the formation of this layer. The role of the articular surface in the frictional characteristics of articular cartilage was examined using specimens (femoral condyles of pigs) with intact and wiped surfaces tested in intermittent friction tests. Results indicated that the intact condition presented low friction in comparison with the wiped condition. The measured water loss of the articular cartilage after sliding and loading indicated a gradual decrease in the water content as the time evolved, and rehydration was observed after the submersion of unloaded specimens in the saline bath solution. Micrographic analyses indicated the presence of a layer covering the articular surface, and histological analyses indicated the presence of proteoglycans in this superficial layer. The hydration of the cartilage surface layer and proteoglycan in this layer influence lubrication.     

The preparation of human articular cartilage for scanning electron microscopy

This paper compares sixteen preparative techniques thought to be of advantage in the study by scanning electron microscopy (SEM) of human articular cartilage surfaces. The adequacy of surface preservation obtained with the techniques, was judged subjectively, first, by the reproducibility of secondary electron images of normal cartilage, and second, by comparing the results with those obtained by reflected light microscopy of the fresh unfixed cartilage surface over a magnification range of × 20 – × 240. Adequate surface preservation was confirmed when cartilage surfaces had been dehydrated through ethanol to propylene oxide and vacuum dried; dehydrated through amyl acetate and quenched in Freon before freeze-drying; dehydrated and passed through amyl acetate at low temperature before freeze drying. Valuable information can be obtained from different specimens by varying the technique of preparation. At different ages, different surface features are best preserved. In a systematic study it has been found essential to adopt a uniform preparative method and to control the results by reflected light microscopy. Even with the most perfect preparation, the surface appearances cannot be identical with those that function under load in vivo.     

Vitrification of articular cartilage by high-pressure freezing

For more than 20 years, high-pressure freezing has been used to cryofix bulk biological specimens and reports are available in which the potential and limits of this method have been evaluated mostly based on morphological criteria. By evaluating the presence or absence of segregation patterns, it was postulated that biological samples of up to 600 μm in thickness could be vitrified by high-pressure freezing. The cooling rates necessary to achieve this result under high-pressure conditions were estimated to be of the order of several hundred degrees kelvin per second. Recent results suggest that the thickness of biological samples which can be vitrified may be much less than previously believed. It was the aim of this study to explore the potential and limits of high-pressure freezing using theoretical and experimental methods. A new high-pressure freezing apparatus (Lei?a EM HPF), which can generate higher cooling rates at the sample surface than previously possible, was used. Using bovine articular cartilage as a model tissue system, we were able to vitrify 150-μm-thick tissue samples. Vitrification was proven by subjecting frozen-hydrated cryosections to electron diffraction analysis and was found to be dependent on the proteoglycan concentration and water content of the cartilage. Only the lower radical zone (with a high proteoglycan concentration and a low water content compared to the other zones) could be fully vitrified. Our theoretical calculations indicated that applied surface cooling rates in excess of 5000 K/s can be propagated into specimen centres only if samples are relatively thin (<200 μm). These calculations, taken together with our zone-dependent attainment of vitrification in 150-μm-thick cartilage samples, suggest that the critical cooling rates necessary to achieve vitrification of biological samples under high-pressure freezing conditions are significantly higher (1000–100 000 K/s) than previously proposed, but are reduced by about a factor of 100 when compared to cooling rates necessary to vitrify biological samples at ambient pressure.     

Extracellular matrix of ostrich articular cartilage.

The composition and organization of the extracellular matrix of ostrich articular cartilage was investigated, using samples from the proximal and distal surfaces of the tarsometatarsus. For morphological analysis, sections were stained with toluidine blue and analyzed by polarized light microscopy. For biochemical analysis, extracellular matrix components were extracted with 4 M guanidinium chloride, fractionated on DEAE-Sephacel and analyzed by SDS-PAGE. Glycosaminoglycans were analyzed by electrophoresis in agarose gels. Structural analysis showed that the fibrils were arranged in different directions, especially on the distal surface. The protein and glycosaminoglycan contents of this region were higher than in the other regions. SDS-PAGE showed the presence of proteins with molecular masses ranging from 17 to 121 kDa and polydisperse components of 67, 80-100, and 250-300 kDa in all regions. The analysis of glycosaminoglycans in agarose-propylene diamine gels revealed the presence of only chondroitin-sulfate. The electrophoretic band corresponding to putative decorin was a small proteoglycan containing chondroitin-sufate and not dermatan-sulfate, unlike other cartilages. The higher amounts of proteins and glycosaminoglycans and the multidirectional arrangement of fibrils seen in the distal region may be correlated with the higher compression normally exerted on this region.     

Improved techniques for measuring the indentation and thickness of articular cartilage

A review of the techniques previously employed in the indentation and measurement of the thickness of articular cartilage has led to new and improved techniques for performing both measurements. By utilizing high-speed, microcomputer-controlled data logging techniques, simultaneous monitoring of signals from a dynamic load cell and a displacement transducer could be made throughout an indentation test. The position of the indenter as it touched the articular surface could thus be determined automatically by identifying the moment at which a positive change in the load signal occurred. Less accurate and more time consuming techniques previously required for determining the position of the cartilage surface were hence avoided. The apparatus also included a critically damped dashpot which prevented any transient loads being applied to the cartilage. Depths of indentation could be measured to an accuracy of 0.005 mm with a measurement repeatability of 2.14 per cent. By replacing the indenter with a sharp needle, the apparatus was also capable of measuring the undeformed thickness of cartilage. An accuracy of +/- 0.012 mm could be achieved with a measurement repeatability of 1.2 per cent. The apparatus is particularly suited to survey work where large numbers of indentation tests are to be performed.     

The potential of hydrogels as synthetic articular cartilage

The relatively poor mechanical properties of conventional synthetic hydrogels are illustrated and compared with those of articular cartilage. By using the composite structure of the natural material as a model a new family of hydrogels, based on interpenetrating polymer network (IPN) technology, has been developed. The underlying synthetic strategies are discussed and the properties of a novel representative network presented. IPN formation produces networks that are stiffer and stronger than the hydrogel copolymers of similar water content. In this behaviour these simple IPNs begin to mimic the properties of biological hydrogel composites. Thus, these materials have exciting potential for demanding in vivo applications.     

A p-type finite element solution for the simulation of O2 transport in articular cartilage tissue: heterogeneous and porous media

The partial pressure of oxygen (pO2) is suggested to have a regulatory effect on chondrocyte biosynthetic activities, and its effect during expansion is unknown. The authors hypothesize that oxygen tension due to mechanical deformation or swelling could be as important as direct mechanical effects on cell biosynthetic activities. While there are plenty of studies on measuring and/or modelling pO2 in articular cartilage (AC) for static (rest) conditions, to the best of the authors' knowledge there are very few such studies on pO2 in AC for dynamic conditions such as swelling or tissue deformation. In this study, it is attempted to develop a model to study the dynamics of oxygen transport in AC. A high-precision hybrid element is designed using the p-type finite element method, by which diffusion and convection are incorporated as a single element. A domain decomposition method is used that allows the use of a different type of discretization with independent discretization variables in non-overlapping sub-domains, for a generic three-dimensional approach to elliptic boundary value problems of order 2 or higher. The formulation developed in this study might be used in determining the necessary flow conditions to cultivate tissue constructs in tissue repair and tissue engineering.     

Bioreactors for bone tissue engineering

Engineering bone tissue for use in orthopaedics poses multiple challenges. Providing the appropriate growth environment that will allow complex tissues such as bone to grow is one of these challenges. There are multiple design factors that must be considered in order to generate a functional tissue in vitro for replacement surgery in the clinic. Complex bioreactors have been designed that allow different stress regimes such as compressive, shear, and rotational forces to be applied to three-dimensional (3D) engineered constructs. This review addresses these considerations and outlines the types of bioreactor that have been developed and are currently in use.     

Helium ion microscopy for high-resolution visualization of the articular cartilage collagen network

The articular cartilage collagen network is an important research focus because network disruption results in cartilage degeneration and patient disability. The recently introduced helium ion microscope (HIM), with its smaller probe size, longer depth of field and charge neutralization, has the potential to overcome the inherent limitations of electron microscopy for visualization of collagen network features, particularly at the nanoscale. In this study, we evaluated the capabilities of the helium ion microscope for high-resolution visualization of the articular cartilage collagen network. Images of rabbit knee cartilage were acquired with a helium ion microscope; comparison images were acquired with a field emission scanning electron microscope (FE-SEM) and a transmission electron microscope (TEM). Sharpness of example high-resolution helium ion microscope and field emission scanning electron microscope images was quantified using the 25-75% rise distance metric. The helium ion microscope was able to acquire high-resolution images with unprecedented clarity, with greater sharpness and three-dimensional-like detail of nanoscale fibril morphologies and fibril connections, in samples without conductive coatings. These nanoscale features could not be resolved by field emission scanning electron microscopy, and three-dimensional network structure could not be visualized with transmission electron microscopy. The nanoscale three-dimensional-like visualization capabilities of the helium ion microscope will enable new avenues of investigation in cartilage collagen network research.     

Predictive rheological models for the consolidation behaviour of articular cartilage under static loading

This paper evaluates an existing rheological model of articular cartilage and explores the representative capacity of other phenomenological models of the tissue's matrix within the framework of mechanical consolidation. A unique feature is the introduction of a swelling element in tandem with 'fluid-filled' hyperelastic rheological elements to predict the transient load-induced behaviour of the tissue and evaluate the role of swelling in determining its load-carriage mechanism. The rheological models proposed have been used to predict the dependence of the one-dimensional consolidation response of the articular cartilage matrix, and the results obtained have been compared with published experimental results. This comparison demonstrates that the hydrostatic excess pore pressure, especially in the initial stages of deformation cannot be predicted without an adequate representation of swelling and its non-linear interaction with mechanical governing parameters such as permeability and stiffness.     

The fate of implanted autologous chondrocytes in regenerated articular cartilage

Autologous chondrocyte implantation (ACI) is used to treat some articular cartilage defects. However, the fate of the cultured chondrocytes after in-vivo transplantation and their role in cartilage regeneration remains unclear. To monitor the survival and fate of such cells in vivo, the chondrocytes were labelled with a lipophilic dye and the resultant regenerated tissue in dogs examined. It was found that, 4 weeks after implantation, the osteochondral defects were filled with regenerative tissue that resembled hyaline cartilage. Fluorescence microscopy of frozen sections of the regenerated tissue revealed that the majority of cells were derived from the DiI-labelled implanted chondrocytes. From these results, it was concluded that a large population of implanted autologous chondrocytes can survive at least 4 weeks after implantation and play a direct role in cartilage regeneration. However, it remains unknown whether other cells, such as periosteal cells or bone marrow stromal stem cells, are involved in the regeneration of cartilage after ACI.