The development of skeletal tissues has been shown to guide and regulate the develpment of skeletal tissues and organs. In similar, consistant ways mechanical loading has also been shown to greatly effect the growth and differentiation of regenerating skeletal tissues during fracture healing, distraction osteogenesis, and virtually all skeletal repair processes. Theoretical and experimental work has led to the development of a consistent theory that can explain the early differentiation of multipotent regenerating tissue under a variety of biomechanical conditions. It has been proposed that intramembranous bone forms as the default condition in a traumatized bone bed, provided that the tissue is exposed to minimal loading and there is good vascularity. Slight hydrostatic tension improves angiogenesis and bone formation. Local cyclic hydrostatic pressure, however, leads to chondrogenesis and local tension or shear leads to the formation of fibrous tissue. Finite element computer models have been implemented with this theory to predict patterns of primary and secondary fracture healing, tissue formation at implant interfaces, bone and cartilage formation in distraction osteogenesis, development of pseudarthroses, and neochondrogenesis in articular cartilage repair. These theoretical models are now beginning to gain support from experiments that explore tissue differentiation and gene expression in different mechanical environments.
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