Effect of the accordion technique on bone regeneration during distraction osteogenesis: A computational study

Ruisen Fu; Yili Feng; Yang Liu; Xing Gao; David T Bertrand; Tianming Du; Youjun Liu; Bettina M Willie; Haisheng Yang

doi:10.1016/j.cmpb.2022.107232

Effect of the accordion technique on bone regeneration during distraction osteogenesis: A computational study

Comput Methods Programs Biomed. 2022 Dec:227:107232. doi: 10.1016/j.cmpb.2022.107232. Epub 2022 Nov 10.

Authors

Ruisen Fu¹, Yili Feng¹, Yang Liu¹, Xing Gao¹, David T Bertrand², Tianming Du¹, Youjun Liu¹, Bettina M Willie², Haisheng Yang³

Affiliations

¹ Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China.
² Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada; Research Centre, Shriners Hospital for Children-Canada, Montreal, Canada.
³ Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China. Electronic address: haisheng.yang@bjut.edu.cn.

PMID: 36371976
DOI: 10.1016/j.cmpb.2022.107232

Abstract

Background and objective: Distraction osteogenesis (DO), a bone lengthening technique, is widely employed to treat congenital and acquired limb length discrepancies and large segmental bone defects. However, a major issue of DO is the prolonged consolidation phase (10-36 months) during which patients must wear a cumbersome external fixator. Attempts have been made to accelerate the healing process of DO by an alternating distraction and compression mode (so-called "accordion" technique or AT). However, it remains unclear how varied AT parameters affect DO outcomes and what the most effective AT mode is.

Methods: Based on an experimentally-verified mechanobiological model, we performed a parametric analysis via in silico simulation of the bone regeneration process of DO under different AT modes, including combinations of varied application times (AT began at week 1-8 of the consolidation phase), durations (AT was used continuously for 1 week, 2 weeks or 4 weeks) and rates (distraction or compression at 0.25, 0.5, 0.75, and 1 mm/12 h). The control group had no AT applied during the consolidation phase.

Results: Compared with the control group (no AT), AT applied at an early consolidation stage (e.g. week 1 of the consolidation phase) significantly enhanced bone formation and reduced the overall healing time. However, the effect of AT on bone healing was dependent on its duration and rate. Specifically, a moderate rate of AT (e.g. 0.5 mm/12 h) lasting for two weeks promoted blood perfusion recovery and bone regeneration, ultimately shortening the healing time. Conversely, over-high rates (e.g. 1 mm/12 h) and longer durations (e.g. 4 weeks) of AT adversely affected bone regeneration and blood perfusion recovery, thereby delaying bone bridging.

Conclusions: These results suggest that the therapeutic effects of AT on DO are highly dependent of the AT parameters of choice. Under appropriate durations and rates, the AT applied at an early consolidation phase is beneficial for blood recovery and bone regeneration. These results may provide a basis for selecting effective AT modes to accelerate consolidation and reduce the overall treatment period of DO.

Keywords: Accordion technique; Bone regeneration; Distraction osteogenesis; Finite element analysis; Mechano-regulatory tissue differentiation.

MeSH terms

Bone Regeneration
Humans
Osteogenesis
Osteogenesis, Distraction* / methods
Wound Healing