Biomedical subjects

A A van Valburg

Publications and source records attributed to A A van Valburg.

8 recordsLinked to original sources

PubMed2000

Joint distraction in treatment of osteoarthritis (II): effects on cartilage in a canine model.

OBJECTIVE: From a clinical point of view, joint distraction as a treatment for osteoarthritis (OA) of hip and ankle has been demonstrated to be very promising. Pain, joint mobility and functional ability, the most important factors for a patient with severe OA, all improved. Although radiographic joint space enlargement in a significant number of patients suggested cartilage repair, actual cartilage repair remains difficult to evaluate. Therefore the present study was initiated to evaluate the actual effects of joint distraction on cartilage. METHODS: For this purpose a canine model for OA, anterior cruciate ligament transection (ACLT) was used. Sixteen weeks after ACLT articulating Ilizarov joint distraction of the knee was carried out. Absence of mechanical contact between articular surfaces and presence of intra-articular intermittent fluid pressure, characteristics of Ilizarov joint distraction, were confirmed. Twenty-five weeks after ACLT joint tissue of the dogs was analyzed. RESULTS: Biochemical analysis showed that after joint distraction the abnormal cartilage proteoglycan (PG) metabolism, characteristic for OA, had changed to a level found in control joints. Moreover, a mild degree of inflammation, present after ACLT, was reduced upon joint distraction. PG-content and histological cartilage degeneration had not (yet) improved within the time of treatment. DISCUSSION: Results suggest that the promising clinical results of Ilizarov joint distraction in patients with OA are accompanied by changes in cartilage metabolism. A change in proteoglycan turnover, indicating normalization of overall chondrocyte function, might in the long term, with normal joint use, lead to actual repair of cartilage.

Animals↗

PubMed1999

Joint distraction in treatment of osteoarthritis: a two-year follow-up of the ankle.

OBJECTIVE: Osteoarthritis (OA) is a degenerative joint disease with an incidence exceeding 10% of the adult population. In end stages, OA can result in severe restriction of activity and consequent disability. For these severe cases of OA, no effective remedy is available yet. Joint distraction is a new experimental approach in treatment of OA. Studied in retrospect it appeared that this treatment results in prolonged clinical improvement in the case of ankle OA. Presently the results of a prospective two-year follow-up are given. METHODS: Patients with severe ankle OA, who were considered for joint fusion (arthrodesis), were treated with distraction, by use of an Ilizarov external ring fixator. Distraction was carried out for 3 months during which full weight bearing (walking) was allowed. Standardized clinical examination was conducted before and at yearly intervals after treatment, including physical examination, functional ability questionnaire, pain scale, joint mobility, and radiographic evaluation. RESULTS: More than two thirds of the patients improved significantly as shown by physical examination, functional ability questionnaires and pain scale; effects were progressive in the second year of follow-up. On average, joint mobility and radiographic joint space were preserved, whilst improvement was observed in a significant number of patients. DISCUSSION: Results of the present prospective study confirm the findings of the previous retrospective study and suggest that Ilizarov joint distraction is a promising treatment for severe ankle OA, at least delaying the need for a joint fusion. Considering the high prevalence of OA and the lack of a remedy for this disorder, Ilizarov joint distraction as a treatment for OA may have great medical, social and economic impact.

Adolescent↗

PubMed1998

Beneficial effects of intermittent fluid pressure of low physiological magnitude on cartilage and inflammation in osteoarthritis. An in vitro study.

OBJECTIVE: To investigate the in vitro effects of low physiological levels of intermittent fluid pressure (0-13 kPa; 0.33 Hz), in the absence of mechanical stress, on articular cartilage, inflammatory cells, and on the combination of these components, present in the osteoarthritic (OA) joint. METHODS: Normal and OA cartilage was obtained at autopsy. Mononuclear cells (MNC) were isolated from synovial fluid of patients with osteoarthritis (OA-SF) or peripheral blood from healthy donors (PB). Cartilage and MNC were cultured alone and in co-culture; cultures were carried out with and without exposure to intermittent fluid pressure. Levels of intermittent fluid pressure varied from 0 to 13 kPa (0.33 Hz), comparable with levels present during joint distraction in treatment of OA. Changes in cartilage proteoglycan metabolism and MNC cytokine production were analyzed. RESULTS: Cartilage matrix synthesis was stimulated by intermittent fluid pressure in OA cartilage, while normal cartilage was not affected. No effects on proteoglycan release were detected. Inhibition of cartilage proteoglycan synthesis, induced by OA synovial fluid MNC (OA-SF-MNC) in co-culture, was reduced when cultures had been exposed to intermittent fluid pressure. Analysis of conditioned media of OA-SF-MNC revealed that the beneficial effect of intermittent fluid pressure was accompanied by a decrease in production of the catabolic cytokines interleukin 1 and tumor necrosis factor-alpha. Similar effects were observed for MNC isolated from PB. CONCLUSION: Low levels of intermittent fluid pressure, as occur in vivo during joint distraction, have beneficial effects on joint tissue in OA, indicating that this factor could be useful in treatment of OA.

Aged↗

PubMed1998

Function of stiff joints may be restored by Ilizarov joint distraction.

Three patients with joint stiffness caused by trauma or infection are reported. The involved joints are the interphalangeal joint of the thumb, patellofemoral joint, and ankle joint. As an alternative for the indicated arthrodesis in these patients, treatment with articulating joint distraction was performed. By use of adapted Ilizarov external ring fixators, gradual distraction was applied to loosen the joint, followed after loosening by a period of exercise during distraction. In all three patients this experimental approach led to a decrease in pain and improvement of joint function that persisted for at least 2 years after treatment. With the use of Ilizarov joint distraction, joint function in cases of joint stiffness may be restored, and the need for an arthrodesis can be postponed.

Adolescent↗

PubMed1997

Degenerated human articular cartilage at autopsy represents preclinical osteoarthritic cartilage: comparison with clinically defined osteoarthritic cartilage.

OBJECTIVE: To investigate whether macroscopically fibrillated human articular knee cartilage observed at autopsy can be considered an early, preclinical phase of osteoarthritis (OA). METHODS: Histological and biochemical characteristics of 3 types of articular knee cartilage were compared: macroscopically degenerated knee cartilage obtained at autopsy (6 donors) from donors without clinical history of OA, normal healthy knee cartilage obtained at autopsy (6 donors), and OA cartilage obtained during joint replacement surgery from patients (n = 6) with clinically defined OA of the knee. From the same donors synovial tissue and synovial fluid were obtained and analyzed for features of inflammation. RESULTS: Histological changes of OA were comparable for degenerated and OA cartilage and significantly different from normal cartilage. Content and synthesis of proteoglycans showed intermediate levels for degenerated tissue compared to normal and OA cartilage. Analysis of synovial tissue revealed a low, mild, and moderate degree of inflammation for joints with normal, degenerated, and OA cartilage, respectively. The same sequence was found for metalloproteinase activity in synovial fluid. CONCLUSION: In general, all changes observed in OA joints were, to a lesser extent, observed in the joints with degenerated cartilage and were significantly different from joints with normal cartilage. We conclude that cartilage degeneration observed at autopsy can be considered a preclinical phase of OA, suitable for studying the process of cartilage degeneration in OA.

Aged↗

PubMed1996

Quantification of morphometric changes in murine experimental osteoarthritis using image analysis.

The aim of this study was to evaluate a method for the quantification of cartilage erosions and osteophyte sizes in a murine model of osteoarthritis (OA). Mice in which OA was induced in the knee joint by intra-articular injection of bacterial collagenase were used. With an interactive image analysis system, the areas occupied by osteophytes and the areas of erosions of the articular cartilage were measured on histological sections by two independent observers at two time points. Measurements of osteophyte areas and cartilage loss at the tibial plateau showed good reproducibility, whereas measurement of cartilage loss at the femoral condyles was less reproducible. Measurement of three frontal total knee joint sections from the middle part of the joint provided a reliable measure for cartilage damage and osteophyte size in the total joint. A cumulative score was developed, composed of both cartilage loss and osteophyte size, which can be used as a general measure for OA of the knee joint. The presented method of quantitative scoring makes it possible to perform correlation studies and to investigate the effect of therapeutic interventions on the osteoarthritis process.

Animals↗

PubMed1996

The relation between cartilage damage and osteophyte size in a murine model for osteoarthritis in the knee.

The aim of this study was to investigate the relationship between location and size of osteophytes and cartilage loss in an instability-induced experimental model for osteoarthritis. Osteoarthritis was induced in murine knee joints by injection of highly purified bacterial collagenase, causing joint instability. The size of the osteophytes and the cartilage loss were measured at different locations in the joint using image analysis on histological sections of total kees. Cartilage damage did not occur without osteophytes. Osteophytes were located on both medial and lateral sides, independent of the location of cartilage damage, but the size of the osteophytes was related to the amount of cartilage damage on the corresponding side. Cartilage loss on the lateral tibial plateau correlated well with the size of lateral osteophytes, in particular with the osteophyte at the margin of the lateral tibial plateau. Cartilage loss on the medial tibial plateau appeared to have a good correlation with the size of medial osteophytes, which was most pronounced for the osteophyte on the medial margin of the tibial plateau. This side-specific correlation between cartilage damage and osteophyte formation suggests compartmentalization of the osteoarthritic process.

Animals↗

PubMed1995

Can Ilizarov joint distraction delay the need for an arthrodesis of the ankle? A preliminary report.

We applied joint distraction using an Ilizarov apparatus in 11 patients with post-traumatic osteoarthritis of the ankle to try to delay the need for an arthrodesis. Distraction for three months resulted in clinical improvement in pain and mobility for a mean of two years, with an increase in the joint space. We considered that these effects may be produced by the absence of mechanical stress on the cartilage combined with the intra-articular hydrostatic pressures during distraction. We measured these pressures during walking with distraction, and found levels very similar to those reported to improve osteoarthritic cartilage when applied in vitro.

Adult↗