Background: A microscopic layer of surface active phospholipids overlays the articular cartilage of the knee. Its depletion in osteoarthritic joints results in loss of lubrication and load-bearing efficiency. We hypothesize that exposure of articular cartilage to the dominant unsaturated phospholipid component of knee surfactant can regenerate the load-bearing properties of the tissue. This was evaluated by studying the stress-strain and stiffness characteristics of normal intact and lipid-depleted cartilage exposed to lipid-based surfactants for known durations.
Methods: Normal intact, lipid-depleted and surfactant-treated bovine articular cartilage specimens were compressed at 0.5mm/min to a maximum strain of 40% and their stress-strain and stiffness data were compared.
Findings: The stiffness of lipid-depleted samples increased by 40% on average relative to the normal; after exposure of the same samples to saturated surfactant for one and 24h, the average stiffness decreased by 25% and 62%, respectively from this high value. On the other hand, exposure of delipidized specimens to a mixture of selected unsaturated surfactant species for one and 24h resulted in a reduction of 85% and 90% in the stiffness of the depilidized samples respectively, largely reversing the effect of lipid removal to a level much closer to that of the normal intact cartilage and therefore better than that obtained with incubation in the saturated surfactant.
Interpretation: Lipid loss in articular cartilage results in a consistent increase in stiffness relative to normal tissue stiffness. This consequence of lipid loss can be partially reversed by the reintroduction of surface active phospholipids. The results of this study show that the lipid components of cartilage play an important role in determining the compliance of the loaded tissue.