Tissue Nutrition and Viability PDF
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Tissue Nutrition and Viability Tissue Nutrition and Viability Edited by Alan R. Hargens With 138 Figures Springer-Verlag New York Berlin Heidelberg Tokyo Alan R. Hargens Professor of Surgery Division of Orthopaedics and Rehabilitation University of California, San Diego La Jolla, California 92093 USA Library of Congress Cataloging-in-Publication Data Main entry under title: Tissue nutrition and viability. Includes bibliographies and index. I. Stress (Physiology) 2. Tissues. 3. Nutrition. I. Hargens, Alan R. [DNLM: 1. Histology. 2. Stress, Mechanical. QS 532 T616] QP82.2.S8T57 1985 611'.018 85-17256 © 1986 by Springer-Verlag New York Inc. Softcover reprint of the hardcover 1st edition 1986 All rights reserved. No part of this book may be translated or reproduced in any form without written permission from Springer-Verlag, 175 Fifth Avenue, New York, New York 10010, USA. The use of general descriptive names, trade names, trademarks, etc. in this publication, even if the former are not especially identi fied, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Typeset by Bi-Comp, Inc., York, Pennsylvania. 9 8 7 6 5 4 3 2 1 ISBN-13: 978-1-4684-0631-3 e-ISBN-13: 978-1-4684-0629-0 DOl: 10.1007/978-1-4684-0629-0 Preface Recent research, especially in fields of orthopaedic surgery and rehabilita tion, point to the importance of periodic, moderate stress for maintaining normal structure and function of tissues. Moreover, growth and healing of load-bearing tissues such as bone, cartilage, and intervertebral disc are especially dependent upon stress-related stimuli. Extreme levels of stress, however, are usually detrimental to tissue integrity, and most treatment regimens today address problems related to trauma and other conditions of abnormally high stress. Therefore, the purpose of this book is to bring together experts in fields of tissue nutrition and growth in order to review previous work and examine new ideas and results concerning the importance of mechanical stress in tissues. This book is unique in that the topic of tissue nutrition and growth, especially related to possible benefits of periodic moderate stress, has never been addressed comprehensively, drawing together experts on vari ous tissues and organs. One objective is to focus attention on tissue nutrition where controversy still exists regarding basic mechanisms of metabolite transport and fluid homeostasis within the interstitium. An other objective is to examine the pathophysiology of tissue compression and discuss strategies to improve viability. Tissues which are treated in this book include bone, cartilage, intervertebral disc, lung, nerve, skeletal muscle, umbilical cord, synovium, skin, and subcutaneous tissues. Based upon these objectives, this book is primarily addressed to students, inves tigators, and teachers in fields of physiology, biochemistry, biomechan ics, exercise, orthopaedic surgery, rehabilitation, and sports medicine. Other groups interested in hypo kinetic states (bedrest and weightless ness) and mechanisms of healing will find the text of interest. Overall, the chapters provide summaries of recent findings and critical reviews of important issues in the nutrition, growth, and viability of tissues. Direc tions for future research and clinical applications are also presented. Alan R. Hargens Acknowledgments Along with the chapter authors, many individuals contributed to this en deavor. Manuscript preparation was aided by the skills of Dyan Williams and Jean Robison. Many of the figures and drawings were prepared by Kurt Smolen. Some of the clinical and experimental research in this book was supported by the Veterans Administration, USPHSINIH grants AM- 25501, AM-26344, my Research Career Development Award AM-00602, GM-24901, National Aeronautics and Space Administration, and by the Division of Orthopaedics and Rehabilitation at UCSD. A generous grant from the Kroc Foundation provided partial travel support for authors to attend a symposium, "Effects of Mechanical Stress on Tissue Transport and Viability," which was a part of the XII European Conference for Microcirculation in Jerusalem. This symposium laid the groundwork for subsequent preparation and revision of manuscripts. Finally, I wish to thank Professor Alexander Silberberg, Polymer Department, Weizmann Institute of Science, and his co-workers for their assistance and wonder ful hospitality during the Jerusalem meeting. Contents 1. Stress Effects on Tissue Nutrition and Viability Alan R. Hargens and Wayne H. Akeson ................... . 2. Distribution and Transport of Fluid as Related to Tissue Structure Frank A. Meyer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 3. Mechanisms of Fluid Transport in Cartilaginous Tissues Alice Maroudas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 4. Compression Effects on Cartilage Permeability Mark H. Holmes, W. Michael Lai, and Van C. Mow........ 73 5. Intervertebral Disc Nutrition as Related to Spinal Movements and Fusion Jill P.G. Urban and Sten H. Holm. . . . . . . . . . . . . . . . . . . . . . . .. 101 6. Growth Induction of Bone and Cartilage Cells by Physical Forces Itzhak Binderman, Dalia Somjen, and Zvi Shimshoni ........ 121 7. Pathophysiology of Nerve Entrapments and Nerve Compression Injuries Lars B. Dahlin, Bjorn Rydevik, and Goran Lundborg. . . . . . .. 135 8. Pressure Effects on Human Peripheral Nerve Function Richard H. Gelberman, Robert M. Szabo, and Alan R. Hargens. .. . . . . .. . . . . . . . . .. . . .. . . .. .. . . . . .. . . . . .. 161 9. Edema and the Tissue Resistance Safety Factor Aubrey E. Taylor, James C. Parker, and Bengt Rippe. . . . . . .. 185 x Contents 10. Fluid Dynamics and Stress in Synovial Joints with Special Reference to the Immature Hip David H. Gershuni and Alan R. Hargens................... 197 11. Mechanical Stress and Viability of Skin and Subcutaneous Tissue Narender P. Reddy....................................... 215 12. Lymph Transport in Skeletal Muscle Thomas C. Skalak, Geert W. Schmid-Schonbein, and Benjamin W. Zweifach ................................... 243 13. Regional Pressure and Nutrition of Skeletal Muscle during Isometric Contraction Ole M. Sejersted and Alan R. Hargens. . . . . . . . . . . . . . . . . . . .. 263 14. Hyperbaric Oxygen and Tissue Viability Michael B. Strauss and George B. Hart .................. ,. 285 Index.... ............ ........................ ............... 301 Contributors Wayne H. Akeson, M.D., Professor and Head, Division of Orthopaedics and Rehabilitation, University of California Medical Center, San Diego, California, USA Itzhak Binderman, D.M.D., Associate Professor of Dentistry, Tel-Aviv University School of Dental Medicine; Head, Dental Unit and Hard Tissues Lab, Medical Center of Tel-Aviv, Israel Lars B. Dahlin, M.D., Postdoctoral Fellow, Laboratory of Experimental Biology, Department of Anatomy, University of Goteborg, Goteborg, Sweden Richard H. Gelberman, M.D., Associate Professor of Surgery, Division of Orthopaedics and Rehabilitation, University of California Medical Center, San Diego, California, USA David H. Gershuni, M.D., F.R.C.S. (England), F.R.C.S. (Edinberg), As sociate Professor of Surgery, Division of Orthopaedics and Rehabilita tion, University of California, San Diego, California, USA Alan R. Hargens, Ph.D., Professor of Surgery, Department of Surgery/ Orthopaedics, V A and University of California Medical Centers, San Diego, California, USA George B. Hart, M.D., Assistant Clinical Professor of Surgery, Univer sity of California, Irvine, California; Director, Baromedical Depart ment, Memorial Hospital Medical Center of Long Beach, Long Beach, California, USA Sten H. Holm, Ph.D., Associate Professor of Experimental Ortho paedics, Department of Orthopaedic Surgery I, Sahlgren Hospital, Uni versity of Goteborg, Goteborg, Sweden Mark iI. Holmes, Ph.D., Associate Professor of Mathematics, Depart ment of Mathematical Sciences, Rensselaer Polytechnic Institute, Troy, New York, USA W. Michael Lai, Ph.D., Professor of Mechanics, Department of Mechani cal Engineering, Rensselaer Polytechnic Institute, Troy, New York, USA Goran Lundborg, M.D., Ph.D., Associate Professor, Division of Hand Surgery, Department of Orthopaedic Surgery, University Hospital, Lund, Sweden xii Contributors Alice Maroudas, Ph.D., Professor, Department of Bio-Medical Engineer ing, Technion, Israel Institute of Technology, Haifa, Israel Frank A. Meyer, Ph.D., Senior Scientist, Polymer Department, Weiz mann Institute of Science, Rehovot, Israel Van C. Mow, Ph.D., Clark and Crossan Professor of Engineering, De partment of Mechanical Engineering, Rensselaer Polytechnic Institute, Troy, New York, USA James C. Parker, Ph.D., Associate Professor, Department of Physiology, College of Medicine, University of South Alabama, Mobile, Alabama, USA Narender P. Reddy, Ph.D., Associate Professor, Institute for Biomedical Engineering Research, University of Akron, Ohio, USA Bengt Rippe, M.D., Ph.D., Associate Professor, Department of Physiol ogy, Faculty of Medicine, University of Goteborg, Goteborg, Sweden Bjorn Rydevik, M.D., Ph.D., Associate Professor, Department of Ortho paedic Surgery I, Sahlgren Hospital, University of Goteborg, Gote borg, Sweden Geert W. Schmid-Schonbein, Ph.D., Associate Professor of Bioengineer ing, Department of Applied Mechanics and Engineering Sciences, Uni versity of California, San Diego, California, USA Ole M. Sejersted, M.D., Ph.D., Director, Institute of Muscle Physiology, Oslo, Norway Zvi Shimshoni, D.M.D., Hard Tissues Unit, Tel-Aviv Medical Center, Tel-Aviv, Israel Thomas C. Skalak, Ph.D., Postgraduate Research Bioengineer, Depart ment of Applied Mechanics and Engineering Sciences, University of California, San Diego, California, USA Dalia Somjen, Ph.D., Hard Tissues Unit, Tel-Aviv Medical Center, Tel Aviv, Israel Michael B. Strauss, M.D., Clinical Assistant Professor, Orthopaedic Sur gery, Harbor-UCLA, Torrance, California; Associate Director, Baro medical Department, Memorial Hospital Medical Center of Long Beach, Long Beach, California, USA Robert M. Szabo, M.D., Assistant Professor and Chief of Hand Surgery Service, Department of Orthopaedic Surgery, University of California, Davis; Sacramento Medical Center, Sacramento, California, USA Aubrey E. Taylor, Ph.D., Professor and Chairman, Department of Physi ology, College of Medicine, University of South Alabama, Mobile, Ala bama, USA Jill P.G. Urban, Ph.D., Bone and Joint Research Unit, London Hospital Medical College, London, England; University Laboratory of Physiol ogy, University of Oxford, Oxford, England Benjamin W. Zweifach, Ph.D., Professor of Bioengineering, Department of Applied Mechanics and Engineering Sciences, University of Califo r nia, San Diego, California, USA CHAPTER 1 Stress Effects on Tissue Nutrition and Viability Alan R. Hargens and Wayne H. Akeson Introduction An early theory of cellular adaptation to altered mechanical force was proposed by Wolff (1892) and states that tissue architecture is strength ened by increased activity. Wolff emphasized clinical studies of patholog ical specimens. Although Wolff's Law originally treated adaptations of the hip joint, femur and vertebrae to alterations of externally applied mechanical loads, it is evident that this principle is more general and applies to many other tissues as well. For example, joint contractures due to immobilization (Akeson et aI., 1980) are often prevented by early pas sivejoint motion (Frank et al., 1984). Continuous passive motion also aids clearance of hemarthrosis from synovial fluid (O'Driscoll et aI., 1983). Ligaments (Tipton et al., 1975; Amiel et al., 1983, Akeson et aI., 1985), tendons (Tipton et aI., 1975; Gelberman et al., 1981), bone (Woo et aI., 1981) and skeletal muscle (Booth and Gollnick, 1983) benefit from early mechanical stress in terms of healing and hypertrophy as compared to immobilized tissues. However, as pointed-out by Brickley-Parsons and Glimcher (1984), tissue adaptations to increased mechanical loads may be favorable or unfavorable, depending on the specific tissue and magnitude of mechanical stress as depicted in Figure 1.1. Tissues, particularly those facilitating motion and load bearing, un dergo periodic stress and deformation that may promote nutrition, growth and viability of these tissues. Recent reviews of the effects of continuous passive motion on healing (Frank et aI., 1984; Gelberman and Manske, 1985) and tissue deformation on nutrition (Mow et aI., 1984) provide strong evidence that periodic, moderate stress is essential for tissue via bility. On the other hand, extraordinary levels of stress traumatize tissue and are detrimental to long-term viability (Fig. 1.1). Relatively avascular tissues, which absorb high and variable loads, may be particularly depen dent on benefits of periodic moderate stress, possibly for mediation of cellular metabolic rate and for pumping interstitial fluid into and out of the
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