Estimation of the Youngʹs modulus of articular cartilage using an arthroscopic indentation instrument and ultrasonic measurement of tissue thickness

We evaluated whether the use of cartilage thickness measurement would improve the ability of the arthroscopic indentation technique to estimate the intrinsic stiffness of articular cartilage. First, cartilage thickness and ultrasound reflection from the surface of bovine humeral head were registered in situ using a high-frequency ultrasound probe. Subsequently, cartilage was indented in situ at the sites of the ultrasound measurements using arthroscopic instruments with plane-ended and spherical-ended indenters. Finally, full-thickness cartilage disks (n=30) were extracted from the indented sites (thickness=799–1654 μm) and the equilibrium Youngʹs modulus was determined with a material testing device in unconfined compression geometry. We applied analytical and numerical indentation models for the theoretical correction of experimental indentation measurements. An aspect-ratio (the ratio of indenter radius to cartilage thickness) correction improved the correlation of the indenter force with the equilibrium Youngʹs modulus from r2=0.488 to r2=0.642–0.648 (n=30) for the plane-ended indenter (diameter=1.000 mm, HEIGHT=0.300 mm) and from r2=0.654 to r2=0.684–0.692 (n=30) for the spherical-ended indenter (diameter=0.500 mm, HEIGHT=0.100 mm), depending on the indentation model used for the correction. The linear correlation between the ultrasound reflection and the Youngʹs modulus was r2=0.400 (n=30). These results suggest that with large indenters, knowledge of the cartilage thickness improves the reliability of the indentation measurements, especially in pathological situations where cartilage thickness may be significantly lower than normal. Ultrasound measurements also provide diagnostically important information about cartilage thickness as well as knowledge of the integrity of the superficial zone of cartilage.