Mark T. Ehrensberger

Influence of Suture Material on the Biomechanical Behavior of Suture-Tendon Specimens A Controlled Study in Bovine Rotator Cuff

Background Despite technical advances in rotator cuff surgery, recurrent or persistent defects in the repaired tendon continue to occur. Improved strength of sutures and suture anchors has resulted in the most common site of failure being the suture-tendon interface. Hypothesis The type of suture material used has a significant effect on the biomechanics of the suture-tendon interface. Study Design Controlled laboratory study. Methods Thirty-two bovine infraspinatus specimens were randomly assigned to simple suture fixation using No. 2 Fiberwire, Ultrabraid, Orthocord, or Ethibond. Each specimen was subjected to cyclic testing from 5 to 30 N for 30 cycles, followed by load-to-failure testing. Results Cyclic testing revealed significantly greater elongation with Ultrabraid, whereas peak-to-peak displacements were lowest for Fiberwire and greatest for Orthocord. Load-to-failure testing revealed no significant differences between any suture material for ultimate tensile load. Fiberwire and Orthocord repairs had the highest stiffness. The most common failure mode during load-to-failure testing was suture breakage in Ethibond specimens and suture cutting through the tendon in the polyblend suture specimens. Conclusion The type of suture material has a significant effect on the biomechanical behavior of the suture-tendon interface. Clinical Relevance The type of suture may influence early gap formation and ultimate healing of rotator cuff repairs.

Effects of medial meniscal posterior horn avulsion and repair on meniscal displacement

Medial meniscal posterior root avulsion (MMRA) leads to deleterious alteration of medial joint compartment loading profiles and increased risk of medial degenerative changes. Surgical repair restores more normal biomechanics to the knee. Our hypothesis is that MMRA will cause medial meniscal (MM) extrusion and gap formation between the root attachment site and MM. Meniscal root repair will restore the ability of the meniscus to resist extrusion, and reduce gap formation at the defect. Seven fresh frozen human cadaveric knees were dissected and mechanically loaded using a servo-hydraulic load frame (MTS ®) with 0 and 1800 N. The knees were tested under three conditions: native, avulsed, and repaired. Four measurements were obtained: meniscal displacement anteriorly, medially, posteriorly, and gap distance between the root attachment site and MM after transection and repair. The medial displacement of the avulsed MM (3.28 mm) was significantly greater (p < 0.001) than the native knee (1.60mm) and repaired knee (1.46 mm). Gap formation is significantly larger in the avulsed compared to repaired state at 0 (p < 0.02) and 1800N (p < 0.02) and also larger with loading in both avulsed (p < 0.05) and repaired (p < 0.02) conditions. Therefore, MMRA results in MM extrusion from the joint and gap formation between the MM root and the MM. Subsequent surgical repair reduces meniscal displacement and gap formation at the defect.

Titanium is not "the most biocompatible metal" under cathodic potential: The relationship between voltage and MC3T3 preosteoblast behavior on electrically polarized cpTi surfaces.

An electrochemically controlled system has been developed which allows for cell culture directly on electrically polarized metal surfaces with simultaneous control and assessment of the electrochemical current, potential, and impedance of the interface. This system was utilized in this study to assess the interactions between electrochemically polarized commercially pure titanium (cpTi) and MC3T3 preosteoblast cells. Cells were cultured on CpTi for 24 h at static potentials between -1000 mV and +1000 mV vs. Ag/AgCl and cell morphology (SEM and cell area) and viability (MTT and Live-Dead assay) were assessed along with the electrochemical current densities and surface oxide impedance properties. The results indicate that cathodic polarization in the range of -600 mV to -1000 mV markedly reduces the spreading and viability of cells cultured directly on cpTi within 24 h, while anodic polarization (-300 mV to +1000 mV) out to 72 h shows no difference in cell behavior as compared to the OCP condition. Analysis of the relationship between the cell outcomes and the electrochemical current densities and impedance indicated the presence of voltage-dependent electrochemical thresholds (cathodic current density, i(c) > 1.0 microA/cm(2), R(p) < 10(5) Omega cm(2)) which may control the biocompatibility of cpTi. In addition, these outcomes have direct clinical significance for modular orthopedic implants whose potential can shift, via fretting corrosion, down into the range of potentials exhibiting poor cell behavior.

Cathodic voltage-controlled electrical stimulation of titanium implants as treatment for methicillin-resistant Staphylococcus aureus periprosthetic infections

Effective treatment options are often limited for implant-associated orthopedic infections. In this study we evaluated the antimicrobial effects of applying cathodic voltage-controlled electrical stimulation (CVCES) of -1.8 V (vs. Ag/AgCl) to commercially pure titanium (cpTi) substrates with preformed biofilm-like structures of methicillin-resistant Staphylococcus aureus (MRSA). The in vitro studies showed that as compared to the open circuit potential (OCP) conditions, CVCES of -1.8 V for 1 h significantly reduced the colony-forming units (CFU) of MRSA enumerated from the cpTi by 97% (1.89 × 106 vs 6.45 × 104 CFU/ml) and from the surrounding solution by 92% (6.63 × 105 vs. 5.15 × 104 CFU/ml). The in vivo studies, utilizing a rodent periprosthetic infection model, showed that as compared to the OCP conditions, CVCES at -1.8 V for 1 h significantly reduced MRSA CFUs in the bone tissue by 87% (1.15 × 105 vs. 1.48 × 104 CFU/ml) and reduced CFU on the cpTi implant by 98% (5.48 × 104 vs 1.16 × 103 CFU/ml). The stimulation was not associated with histological changes in the host tissue surrounding the implant. As compared to the OCP conditions, the -1.8 V stimulation significantly increased the interfacial capacitance (18.93 vs. 98.25 μF/cm(2)) and decreased polarization resistance (868,250 vs. 108 Ω-cm(2)) of the cpTi. The antimicrobial effects are thought to be associated with these voltage-dependent electrochemical surface properties of the cpTi.

Is It Safe to Perform Aggressive Rehabilitation After Distal Biceps Tendon Repair Using the Modified 2-Incision Approach? A Biomechanical Study

Background Despite improved methods of fixation, there is still a delay in early active motion after distal biceps repair. Hypothesis Distal biceps repairs using the modified 2-incision technique can be treated with early motion, and there is no difference in the cyclic performance of Ethibond and Fiberwire when used for the repair. Study Design Controlled laboratory study. Methods Nine matched pairs of cadaveric elbows had release of the distal biceps followed by repair with either No. 5 Ethibond or Fiberwire through a bone tunnel. The repairs were cyclically loaded for 3000 cycles (1000 cycles from 10-50 N, 1000 cycles from 10-75 N, 1000 cycles from 10-100 N) followed by single-load displacement to failure in surviving specimens. Results There was no difference in the displacement or stiffness between surviving repairs at any point measured. Ethibond repairs survived significantly more cycles than did Fiberwire repairs, particularly at higher loads. Conclusion Distal biceps repair using the 2-incision technique with Ethibond should allow early active motion, but early active motion may not be possible with Fiberwire.

The effect of static applied potential on the 24-hour impedance behavior of commercially pure titanium in simulated biological conditions

Potential step impedance analysis was utilized to evaluate the electrochemical impedance of commercially pure titanium (cpTi) samples that were polarized to static potentials (range from -1000 mV to +1000 mV vs. Ag/AgCl) and immersed in physiologically relevant electrolytes [phosphate buffered saline (PBS) and cell culture medium with 10% fetal bovine serum (AMEM + FBS)] for 24 hrs. The cpTi impedance outcomes were a complex function of voltage, solution constituents, and immersion time. In the 0 mV to +1000 mV range, oxide growth was observed over 24 hr immersion in both solutions based on decreasing current density (approximately 10(-6) A/cm(2) to approximately 10(-8) A/cm(2)) and increasing R(p) (200 kOmega cm(2) to approximately 10 MOmega cm(2)). Below 0 mV, the 24 hr R(p) decreased with negative potential to approximately 15 kOmega cm(2). After 24 hr immersion, oxide dissolution and/or adsorption of organic species caused the capacitance to increase at -1000 mV (AMEM + FBS & PBS) and at -600 mV (AMEM + FBS only). Twenty-four hours of immersion in AMEM + FBS at -1000 mV and -600 mV produced a surface coloration that is likely due to alteration of oxide valance state and/or doping level. This work shows that Ti surface oxide and its electrochemical behavior can be altered dramatically under sustained cathodic potentials.

The influence of cathodic polarization and simulated inflammation on titanium electrochemistry

This study evaluated the influence of simulated inflammation and cathodic polarization on the electrochemical properties of commercially pure titanium (CpTi) and titanium-6%aluminum-4%vanadium (Ti6Al4V). Normal conditions immersed the metals in phosphate buffered saline at open circuit potential (OCP). Inflammatory conditions immersed the metals in a 150 mM hydrogen peroxide titrated to pH = 5.0 at OCP. Cathodic inflammatory conditions immersed the metals in the inflammatory electrolyte at -1 V versus Ag/AgCl. Cathodic polarization scans revealed a more electropositive corrosion potential (Ecorr ) and an increased corrosion current density (Icorr ) for both metals after incubation at inflammatory conditions (CpTi: Ecorr  = 171 mV, Icorr  = 147 nA/cm(2) and Ti6Al4V: Ecorr  = 241 mV and Icorr  = 413 nA/cm(2) ) as compared to normal conditions (CpTi: Ecorr  = -249 mV, Icorr  = 19 nA/cm(2) and Ti6Al4V: Ecorr  = -263 mV and Icorr  = 11 nA/cm(2) ). Electrochemical impedance spectroscopy showed the polarization resistance (Rp ) decreases and constant phase element (CPE) magnitude increases for both metals when comparing normal (CpTi: Rp  = 3.5 MΩ cm(2) , CPE = 35 µS s(α) /cm(2) and Ti6Al4V: Rp  = 6.5 MΩ cm(2) and CPE = 30 µS s(α) /cm(2) ) to inflammatory (CpTi: Rp  = 79 kΩ cm(2) , CPE = 55 µS s(α) /cm(2) and Ti6Al4V: Rp  = 230 kΩ cm(2) and CPE = 56 µS s(α) /cm(2) ) to cathodic inflammatory (CpTi: Rp =24 kΩ cm(2) , CPE = 290 µS s(α) /cm(2) and Ti6Al4V: Rp  = 12 kΩ cm(2) and CPE = 250 µS s(α) /cm(2) ) conditions. These observed changes are consistent with the formation of a thin and defective oxide film. Inductively coupled plasma mass spectroscopy revealed that inflammatory conditions increased dissolution of both metals and that the addition of cathodic potential significantly increased the dissolution of the beta phase elements of Ti6Al4V.

A time-based potential step analysis of electrochemical impedance incorporating a constant phase element: a study of commercially pure titanium in phosphate buffered saline.

The measurement of electrochemical impedance is a valuable tool to assess the electrochemical environment that exists at the surface of metallic biomaterials. This article describes the development and validation of a new technique, potential step impedance analysis (PSIA), to assess the electrochemical impedance of materials whose interface with solution can be modeled as a simplified Randles circuit that is modified with a constant phase element. PSIA is based upon applying a step change in voltage to a working electrode and analyzing the subsequent current transient response in a combined time and frequency domain technique. The solution resistance, polarization resistance, and interfacial capacitance are found directly in the time domain. The experimental current transient is numerically transformed to the frequency domain to determine the constant phase exponent, alpha. This combined time and frequency approach was tested using current transients generated from computer simulations, from resistor-capacitor breadboard circuits, and from commercially pure titanium samples immersed in phosphate buffered saline and polarized at -800 mV or +1000 mV versus Ag/AgCl. It was shown that PSIA calculates equivalent admittance and impedance behavior over this range of potentials when compared to standard electrochemical impedance spectroscopy. This current transient approach characterizes the frequency response of the system without the need for expensive frequency response analyzers or software.

Effects of simulated inflammation on the corrosion of 316L stainless steel

Stainless steel alloys, including 316L, find use in orthopaedics, commonly as fracture fixation devices. Invasive procedures involved in the placement of these devices will provoke a local inflammatory response that produces hydrogen peroxide (H2O2) and an acidic environment surrounding the implant. This study assessed the influence of a simulated inflammatory response on the corrosion of 316L stainless steel. Samples were immersed in an electrolyte representing either normal or inflammatory physiological conditions. After 24h of exposure, electrochemical impedance spectroscopy (EIS) and inductively coupled plasma mass spectroscopy (ICPMS) were used to evaluate differences in corrosion behavior and ion release induced by the inflammatory conditions. Scanning electron microscopy (SEM) and energy-dispersive x-ray spectroscopy (EDX) were used to evaluate surface morphology and corrosion products formed on the sample surface. Inflammatory conditions, involving the presence of H2O2 and an acidic pH, significantly alter the corrosion processes of 316L stainless steel, promoting aggressive and localized corrosion. It is demonstrated that particular consideration should be given to 316L stainless steel implants with crevice susceptible areas (ex. screw-head/plate interface), as those areas may have an increased probability of rapid and aggressive corrosion when exposed to inflammatory conditions.

The effect of scanning electrochemical potential on the short-term impedance of commercially pure titanium in simulated biological conditions.

The electrochemical history (voltage-time variations) of titanium oxide-solution interfaces can vary widely in vivo, particularly where oxide abrasion is present, and it is important to assess the effects of voltage on the impedance behavior of the interface. Potential step impedance analysis (PSIA) utilizes a time and frequency domain methodology to assess the electrochemical impedance of electrified interfaces over a range of voltages. The PSIA method was used to study the combined effects of scanning electrical potential and the presence of solution-born organic species (protein, amino acids, etc.) on the electrochemical properties of cpTi. The specific solutions used in these scanning PSIA experiments were phosphate buffered saline and cell culture medium supplemented with 10% fetal bovine serum. The results show that electrochemical impedance properties of cpTi are voltage-time history dependent and strongly influenced by electrical potential within the -1000 mV to +1000 mV range studied. Moreover, the presence of biologically relevant molecules in the electrolyte solution alters the impedance properties only at cathodic potentials. Specifically, at cathodic potentials, these organic species have been shown to suppress the cathodic current density, shift the zero current potential in the cathodic direction, and increase the interfacial capacitance, polarization resistance, and the distribution of surface relaxation times. At anodic potentials, the presence of the organic species does not alter any of the electrochemical properties examined. Overall, these results show the importance of understanding of the variation in electrochemical potentials achievable in vivo and the effects voltage history has on interfacial electrochemical behavior.