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[A new echographic method for the determination of the ossification centres in the fetal knee (author's transl)].

A method is described, which permits the determination of fetal maturity by ultrasonic measurement of the ossification centres. This method provides the same data as the x-ray examination without any irradiation and even at an earlier stage of pregnancy. The technique to determine the lower femoral and the upper tibial centre is explained and the advantages of this ultrasonic method for determination of fetal maturity are discussed.

Bone Development↗

Impaired endochondral ossification and angiogenesis in mice deficient in membrane-type matrix metalloproteinase I.

Membrane-type matrix metalloproteinase I (MT1-MMP)-deficient mice were found to have severe defects in skeletal development and angiogenesis. The craniofacial, axial, and appendicular skeletons were severely affected, leading to a short and domed skull, marked deceleration of postnatal growth, and death by 3 wk of age. Shortening of bones is a consequence of decreased chondrocyte proliferation in the proliferative zone of the growth plates. Defective vascular invasion of cartilage leads to enlargement of hypertrophic zones of growth plates and delayed formation of secondary ossification centers in long bones. In an in vivo corneal angiogenesis assay, null mice did not have angiogenic response to implanted FGF-2, suggesting that the defect in angiogenesis is not restricted to cartilage alone. In tissues from null mice, activation of latent matrix metalloproteinase 2 was deficient, suggesting that MT1-MMP is essential for its activation in vivo.

Animals↗

Simulation of the initial stage of endochondral ossification: in vitro sequential culture of growth cartilage cells and bone marrow cells.

Growth cartilage cells were isolated from the ribs of young rats and cultured at high cell density in Ham's F-12 medium supplemented with 10% fetal calf serum. During 7 days, glycosaminoglycans and proteoglycans were actively synthesized and secreted, forming a metachromatic matrix. When cultured together with growth cartilage cells precultured and biosynthetically prelabeled with 35SO4(2-) in their glycosaminoglycans, bone marrow cells caused release of 35S-labeled material into the culture medium. Glycosaminoglycan was also released by addition of conditioned medium obtained from cultures of bone marrow cells or peritoneal macrophages to the growth cartilage cell cultures. Electron microscopic studies of the extracellular matrix of growth cartilage cells cocultured with bone marrow cells showed that needles of apatite mineral were deposited within and in close apposition to the surfaces of matrix vesicles. These findings suggest that enzymes released from bone marrow cells or macrophages removed glycosaminoglycan or proteoglycans, which may be inhibitors of mineral growth, and consequently mineralization was initiated. From these findings, sequential culture of growth cartilage cells and bone marrow cells is promising as an experimental system for investigating the mechanism of the initial stage of endochondral ossification.

Animals↗

Oxygen tension regulates chondrocyte differentiation and function during endochondral ossification.

Cartilage functions at a lower oxygen tension than most other tissues. To determine the role of oxygen tension in chondrocyte differentiation and function, we investigated the influence of oxygen tension in the pluripotent mesenchymal cell line C3H10T1/2 and 14.5E mice embryo forelimb organ culture. 10T1/2 cells and embryo forelimbs were cultured under normoxia (20% O2) or hypoxia (5% O2) in the presence of recombinant human bone morphogenetic protein 2. To elucidate the mechanism by which oxygen tension influences chondrocyte differentiation, the Smad pathway was examined using Smad6 overexpression adenovirus and Smad6 transgenic mice embryo forelimbs. The p38 MAPK pathway was examined using dominant-negative MKK3 and FR167653, a specific p38 MAPK inhibitor. The transcriptional activities of Sox9 and Runx2 were also investigated. Hypoxia promoted bone morphogenetic protein 2-induced glycosaminoglycan production and suppressed alkaline phosphatase activity and mineralization of C3H10T1/2. Thus, hypoxia promoted chondrocytic commitment rather than osteoblastic differentiation. In the mice embryo forelimb organ culture, hypoxia increased cartilaginous matrix synthesis. These effects were primarily mediated by p38 MAPK activation, independent of Sox9. Hypoxia inhibited Col10a1 (type X collagen alpha1) expression via down-regulation of Runx2 activity by Smad suppression and histone deacetylase 4 activation. In conclusion, hypoxia promotes chondrocytic differentiation and cartilage matrix synthesis and suppresses terminal chondrocyte differentiation. These hypoxia-induced phenomena may act on chondrocytes to enhance and preserve their phenotype and function during chondrocyte differentiation and endochondral ossification.

Animals↗

Pathology of spinal cord lesions caused by ossification of the posterior longitudinal ligament, with special reference to reversibility of the spinal cord lesion.

This report describes pathological findings of the spinal cord damage, with ossification of the posterior longitudinal ligament (OPLL), with special reference to reversibility of such lesions. Twenty-five autopsy cases associated with OPLL were examined, and the spinal cord damage was pathologically classified into four categories based on degree of destruction (stage 0-3). In stage 0 and stage 1, major pathological changes in the gray matter and the degree of compression on the spinal cord were well correlated to deformity of the anterior horn. In stage 2 and stage 3, neurons were almost completely obliterated and necrosis with cavitation were frequently observed. Destruction of the spinal cord in stage 2 and stage 3 is considered to be irreversible; therefore, surgical treatment is recommended at stage 0 or stage 1.

Calcinosis↗

Role of proteoglycans in endochondral ossification: immunofluorescent localization of link protein and proteoglycan monomer in bovine fetal epiphyseal growth plate.

The hypothesis is widely held that, in growth plate during endochondral ossification, proteoglycans in the extracellular matrix of the lower hypertrophic zone are degraded by proteases and removed before mineralization, and that this is the mechanism by which a noncalcifiable matrix is transformed into a calcifiable matrix. We have evaluated this hypothesis by examining the immunofluorescent localization and concentrations of proteoglycan monomer core protein and link protein, and the concentrations of glycosaminoglycans demonstrated by safranin 0 staining, in the different zones of the bovine fetal cartilage growth plate. Monospecific antibodies were prepared to proteoglycan monomer core protein and to link protein. The immunofluorescent localization of these species was examined in decalcified and undecalcified sections containing the zones of proliferating and hypertrophic chondrocytes and in sections containing the zones of proliferating and hypertrophic chondrocytes and the metaphysis, decalcified in 0.5 M EDTA, pH 7.5, in the presence of protease inhibitors. Proteoglycan monomer core protein and link protein are demonstrable without detectable loss throughout the extracellular matrix of the longitudinal septa of the hypertrophic zone and in the calcified cartilage of the metaphysis. In fact, increased staining is observed in the calcifying cartilage. Contrary to the prevailing hypothesis, our results indicate that there is no net loss of proteoglycans during mineralization and that the proteoglycans become entombed in the calcified cartilage which provides a scaffolding on which osteoid and bone are formed. Proteoglycans appear to persist unaltered in the calcified cartilage core of the trabeculae, until at last the entire trabeculae are eroded from their surfaces and removed by osteoclasts, when the primary spongiosa is replaced by the secondary spongiosa.

Animals↗

Visualization of early intramembranous ossification by electron microscopic and spectroscopic imaging.

We present electron microscopic and electron spectroscopic images of putative nucleation sites and early mineral deposits during intramembranous ossification of the murine perichondrial ring. Electron spectroscopic imaging (ESI) permits the quantitative determination and direct visualization of spatial distribution of atomic elements within specimens at high spatial resolution. In this study ESI was used to determine the elemental distributions of phosphorus, sulfur, and calcium. Nucleation and subsequent mineralization in the perichondrial ring occurred sequentially along the longitudinal axis. Proximal regions of the ring contained a matrix with only a few nucleation sites that are characterized in conventional electron micrographs as small loci of low-density material in which dense particles are located. Elemental maps of these sites that we obtained by ESI reveal a sulfur-containing matrix in which localized concentrations of phosphorus occur. With further maturation the loci became centers for the genesis of numerous dense rods or crystals. These mineral deposits contained increased concentrations of P, S, and Ca, compared with the surrounding matrix. The appearance of S at nucleation sites and its persistence in developing mineral deposits suggests that a sulfur-containing moiety may serve as a locus within the osteoid matrix to attain high local concentrations of Ca and P, which leads to the controlled local formation of calcium phosphates. Calcification of the perichondrial ring has been found to occur in the absence of matrix vesicles, which illustrates that these membrane-bounded organelles are not obligatory sites for nucleation in this matrix.

Animals↗

Dendriform pulmonary ossification. Report of two cases with unique findings.

Dendriform pulmonary ossification (DPO) is a rare condition characterized by branching bony spicules found in association with pulmonary fibrosis. The authors report two cases, the first of which occurred in a patient with acute myeloblastic leukemia and was associated with the unique finding of leukemic involvement of marrow spaces in the metaplastic bone. The second case showed DPO in combination with asbestosis, a heretofore unreported association.

Aged↗

Comparison of ossification of demineralized bone, hydroxyapatite, Gelfoam, and bone wax in cranial defect repair.

Demineralized bone allografts in the repair of calvarial defects are compared with other common bone fillers. This study uses a video-digitizing radiographic analysis of calvarial defect ossification to determine calcification of bone defects and its relation to postoperative clinical examination and regional controls. The postoperative clinical results at 3 months demonstrated that bony healing was greatest in bur holes filled with demineralized bone and hydroxyapatite. Radiographic analysis demonstrated calcification of demineralized bone-filled defects compared to bone wax- and Gelfoam-filled regions. Hydroxyapatite granules are radiographically dense, thus not allowing accurate measurement of true bone healing. The results suggest that demineralized bone and hydroxyapatite provide better structural support via bone healing to defined calvarial defects than do Gelfoam and bone wax.

Bone Regeneration↗

Ossification of the ligamentum flavum causing thoracic myelopathy: a case report.

Ossification of the ligamentum flavum is a well reported clinicopathologic entity causing narrowing of the spinal canal and subsequent spinal cord compression. The patient described in this case report complained of 9 mo of middle and lower back pain, difficulty with balance, progressive gait disturbance, and recent onset of bladder retention. Magnetic resonance imaging and computed tomographic scan revealed a bone density mass at the T2-3 level causing 25% cord compression and edema. A decompressive laminectomy was performed at T-2. The etiology of the compression was found to be attributable to an ossified ligamentum flavum at the T-2 level, which was confirmed by histologic examination. His neurologic signs and symptoms and functional status markedly improved after surgery and subsequent comprehensive rehabilitation. The patient was able to ambulate independently with a walker as opposed to previously being wheelchair-bound. Prompt surgical intervention and appropriate rehabilitation management play a key role in improving the functional outcome of myelopathy caused by ossified ligamentum flavum. This article acquaints rehabilitation personnel with the clinical features, proposed etiologies, association with other diseases, work-up, treatment, and rehabilitation concerns of patients with myelopathy caused by ossified ligamentum flavum.

Adult↗

The surgical management of ossification of the posterior longitudinal ligament in 51 patients.

Ossification of the posterior longitudinal ligament (OPLL) in the cervical spine warrants unique clinical, radiographic, and surgical management. OPLL patients presenting with severe myelopathy require full assessment with both magnetic resonance imaging (MRI) and computed tomography-based (noncontrast CT, myelo-CT, three-dimensional CT) examinations to document the full extent of their disease. Whether better surgical outcomes are attained after anterior resection (diskectomy/corpectomy), rather than posterior decompression (laminectomy/laminoplasty) of OPLL remains controversial. However, our recent experience with 51 OPLL patients indicates superior results after anterior (41 patients) versus posterior (10 patients) surgery. Continuous intraoperative somatosensory evoked potential (SSEP) monitoring also appears to limit operative morbidity.

Adult↗

Ossification of the ligamentum flavum as a cause of myelopathy in North America: report of three cases.

Myelopathy caused by ossification of the ligamentum flavum is a rare condition in North America. The authors describe three patients whose myelopathy was attributed to posterior cord compression warranting laminectomy to decompress the cervical spine (in one patient) and the thoracic spine (in two patients). The spinal computed tomographic scan (especially after myelography) can be instrumental in guiding the management of this condition.

Aged↗

Effects of fracture fixation stability on ossification in healing fractures.

Temporal distribution of intramembranous and endochondral bone formation was studied in experimental fracture defects in rats under different stability of fracture fixation and fracture environments. Animals were surgically treated with a specially developed external fixation construct: Group 1 had 42 rats with a 0-mm fracture gap with bone ends touching corresponding to an axial stiffness of 265.00 +/- 34.00 N/mm and Group 2 had 42 rats with a 2-mm fracture gap corresponding to an axial stiffness of 30.38+/- 2.07 N/mm. From each group, six animals were sacrificed at 4 days and 1, 2, 3, 4, 6, and 12 weeks. Qualitative histologic and morphometric analyses revealed that less fixation rigidity and increased fracture gap induces a later response of bone formation and greater endochondral bone formation leading to prolonged time for full ossification. Furthermore, in the early phase of fracture healing temporal distribution and histologic characteristics of periosteal and intramedullary bone formation are similar and not influenced by rigidity and fracture environment. Results also showed that if tissues associated with the intramedullary region are preserved, intramedullary bone formation is substantial. Finally, histologic data indicate that woven bone might be a prerequisite for the differentiation process of endochondral bone formation.

Animals↗

Intrauterine fetal constraint induces chondrocyte apoptosis and premature ossification of the cranial base.

BACKGROUND: The spheno-occipital synchondrosis is an important growth center of the craniofacial skeleton and a primary site of malformation in syndromic forms of craniosynostosis. Clinical and laboratory investigations have demonstrated that premature closure of cranial vault sutures in nonsyndromic craniosynostosis is associated with characteristic alterations in cranial base morphology. However, a causal link between premature fusion of calvarial sutures and changes in the cranial base remains elusive. The purpose of these experiments was to test the hypothesis that intrauterine head constraint produces ultrastructural changes in the spheno-occipital synchondroses of fetal mice. METHODS: Fetal constraint was induced through uterine cerclage of six pregnant C57Bl/6 mice on the eighteenth day of gestation. Fetuses were harvested after growing to 24, 48, and 72 hours beyond the normal 20-day gestational period. Between six and nine fetuses were harvested at all time points in both treatment and control groups. The morphology and cell biology of the spheno-occipital synchondroses, in constrained fetuses and unconstrained controls, were examined using hematoxylin and eosin-stained sections. Chondrocyte apoptosis was examined using terminal deoxynucleotidyl transferase-mediated dUDP end-labeling assays and electron microscopy. RESULTS: In nonconstrained animals, the spheno-occipital synchondrosis demonstrated normal architecture and normal chondrocyte morphology at all time points. In contrast, intrauterine constraint resulted in a progressive disruption of the normal cellular architecture of the spheno-occipital synchondrosis over 72 hours, with premature ossification of the synchondrosis. Widespread chondrocyte apoptosis within the synchondrosial growth center was demonstrated by terminal deoxynucleotidyl transferase-mediated dUDP end-labeling assays and electron microscopy. CONCLUSION: These experiments confirm the ability of intrauterine constraint to induce changes in the morphology and cell biology of the cranial base in synostotic fetuses.

Animals↗

Development of hip dysplasia in puberty due to delayed ossification of femoral nucleus, growth plate and triradiate cartilage.

Besides hip dysplasia diagnosed after birth, there are dysplasias that do not develop until puberty, causing subluxation of the femoral head to occur late in the skeletal growth period. These dysplasias have various causes. In the two siblings described in this study, the boy showed a conspicuous delay in the appearance of the femoral nuclei and the fusion of the triradiate cartilages. The fusion occurred at 16 years of age in the boy and at 13-14 years in the girl. This was preceded by conspicuous structural changes, especially in the posterior triradiate cartilage and acetabular roof but also affecting the lateral growth plate of the femoral neck, which was horizontal over two-thirds of the diameter. We know from animal studies that the growth of the triradiate cartilage increases the diameter of the acetabulum but not the depth. The acetabulum is deepened by pressure from the femoral head. As a result of coxa valga and a prolonged period of acetabular expansion, combined with abnormalities of the superior acetabular rim, the femoral heads in these children finally subluxate. Whenever development of the femoral ossific nucleus is delayed during the first year of life, radiographic follow-ups should be instituted at 8 years of age.

Acetabulum↗

Tripartite patella: late appearance of a third ossification center in childhood.

Bilateral radiographic progression of the supero-lateral fragment of a bipartite- into a tripartite patella with unilateral symptoms. An 8 year old girl presented a bilateral bipartite patella Stage III as an incidental finding after fall on the flexed right knee. Serial radiographs two years later revealed a bilateral progression of the bipartite- into a tripartite patella with complaints only on the post-traumatic right side. Observation was opted as therapy. There was no correlation of symptoms and radiological findings of the fragmentation of the bipartite- into a tripartite patella. Therefore we conclude the etiology of a bilateral late appearance of a third ossification center.

Child↗

Accessory ossification patterns and injuries of the malleoli.

An accessory, distal focus of epiphyseal ossification may develop in either malleolus. These foci are not anatomically separate entities, even though they appear to be radiographically. They usually are asymptomatic. However, they may be injured, either acutely or chronically. The diagnosis of such injury by conventional radiography is limited. Bone scintigraphy may be positive if there is a stress fracture. The fracture pattern, a type 7 growth mechanism injury, extends through a segment of the malleolus. An ossicle may also be avulsed as a ligament failure analogue, similar to a sleeve fracture of the patella. This is more common in the lateral than in the medial malleolus. These avulsions, if not adequately diagnosed and treated, may progress to delayed union, nonunion, or a chronically painful ankle.

Adolescent↗

Identification and location of bone-forming cells within cartilage canals on their course into the secondary ossification centre.

Osteoblasts and osteocytes derive from the same precursors, and osteocytes are terminally differentiated osteoblasts. These two cell types are distinguishable by their morphology, localization and levels of expression of various bone cell-specific markers. In the present study on the chicken femur we investigated the properties of the mesenchymal cells within cartilage canals on their course into the secondary ossification centre (SOC). We examined several developmental stages after hatching by means of light microscopy, electron microscopy, immunohistochemistry and in situ hybridization. Cartilage canals appeared as extensions of the perichondrium into the developing distal epiphysis and they were arranged in a complex network. Within the epiphysis an SOC was formed and cartilage canals penetrated into it. In addition, they were successively incorporated into the SOC during its growth in the radial direction. Thus, the canals provided this centre with mesenchymal cells and vessels. It should be emphasized that regression of cartilage canals could never be observed in the growing bone. Outside the SOC the mesenchymal cells of the canals expressed type I collagen and periostin and thus these cells had the characteristics of preosteoblasts. Periostin was also expressed by numerous chondrocytes. Within the SOC the synthesis of periostin was down-regulated and the majority of osteoblasts were periostin negative. Furthermore, osteocytes did not secret this protein. Tissue-non-specific alkaline phosphatase (TNAP) staining was only detectable where matrix vesicles were present. These vesicles were found around the blind end of cartilage canals within the SOC where newly formed osteoid started to mineralize. The vesicles originated from osteoblasts as well as from late osteoblasts/preosteocytes and thus TNAP was only expressed by these cells. Our results provide evidence that the mesenchymal cells of cartilage canals express various bone cell-specific markers depending on their position. We suggest that these cells differentiate from preosteoblasts into osteocytes on their course into the SOC and consider that cartilage canals are essential for normal bone development within the epiphysis. Furthermore, we propose that the expression of periostin by preosteoblasts and several chondrocytes is required for adhesion of these cells to the extracellular matrix.

Alkaline Phosphatase↗