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Zhang X, Qian Y, Gao F, He C, Guo S, Gao Q, Zhou J. High anteromedial insertion reduced anteroposterior and rotational knee laxity on mid-term follow-up after anatomic anterior cruciate ligament reconstruction. PeerJ 2023; 11:e15898. [PMID: 37609439 PMCID: PMC10441525 DOI: 10.7717/peerj.15898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023] Open
Abstract
Background The position of the femoral insertion has a great influence on the laxity of the knee joint after ACLR, especially for rotational laxity. Purpose To compare the effects of different femoral tunnel positions on knee stability after arthroscopic anterior cruciate ligament reconstruction (ACLR). Methods The clinical outcomes of 165 patients after autograft ACLR were analyzed retrospectively. The patients were separated into three groups according to the position of the femoral tunnel, as follows: low center (LC) group, 53 patients; high center (HC) group, 45 patients; and high anteromedial (HAM) group, 67 patients. The side-to-side differences (SSDs) in anteroposterior knee laxity measured using a KT-2000 arthrometer and the pivot shift test (PST) pre- and postoperatively were compared among the three groups and analyzed. Results After 5 years postoperatively, the SSD in the anteroposterior knee laxity in the three groups was significantly decreased postoperatively compared with preoperatively in knees; meanwhile, the negative PST rate was significantly increased in the three groups. The postoperative SSD in anteroposterior knee laxity was significantly increased in the HC group compared with the LC and HAM groups (1.5 ± 1.3 VS 1.0 ± 1.1 VS 1.0 ± 1.0, P<0.05). The negative postoperative PST rate was higher in both the LC and HAM groups than in the HC group (84.9% VS 91.0% VS 71.1%, P<0.05), and there was no significant difference in the negative PST rate between the LC and HAM groups (84.9% VS 91.0%, P>0.05). The negative postoperative PST rate was significantly higher in the HAM group than in the LC and HC groups for patients with a high degree of laxity preoperatively (31.3% VS 3.3% VS 14.4%, P>0.05). Conclusion Patients in HAM group showed better control over anteroposterior laxity, rotational laxity, and subjective knee function compared to other groups post operation. Therefore, the HAM point is the closest to the I.D.E.A.L point concept, and is recommended as the preferred location for the femoral tunnel in ACLR.
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Affiliation(s)
- Xiaohan Zhang
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Yi Qian
- National Institute of Sports Medicine, Beijing, China
| | - Feng Gao
- National Institute of Sports Medicine, Beijing, China
| | - Chen He
- National Institute of Sports Medicine, Beijing, China
| | - Sen Guo
- National Institute of Sports Medicine, Beijing, China
| | - Qi Gao
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Jingbin Zhou
- National Institute of Sports Medicine, Beijing, China
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Tian B, Zhang M, Kang X. Strategies to promote tendon-bone healing after anterior cruciate ligament reconstruction: Present and future. Front Bioeng Biotechnol 2023; 11:1104214. [PMID: 36994361 PMCID: PMC10040767 DOI: 10.3389/fbioe.2023.1104214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/02/2023] [Indexed: 03/16/2023] Open
Abstract
At present, anterior cruciate ligament (ACL) reconstruction still has a high failure rate. Tendon graft and bone tunnel surface angiogenesis and bony ingrowth are the main physiological processes of tendon-bone healing, and also the main reasons for the postoperative efficacy of ACL reconstruction. Poor tendon-bone healing has been also identified as one of the main causes of unsatisfactory treatment outcomes. The physiological process of tendon-bone healing is complicated because the tendon-bone junction requires the organic fusion of the tendon graft with the bone tissue. The failure of the operation is often caused by tendon dislocation or scar healing. Therefore, it is important to study the possible risk factors for tendon-bone healing and strategies to promote it. This review comprehensively analyzed the risk factors contributing to tendon-bone healing failure after ACL reconstruction. Additionally, we discuss the current strategies used to promote tendon-bone healing following ACL reconstruction.
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Takahashi T, Takahashi M. The improved cortical button shows better breaking strength of sutures compared with 10 original cortical button after cyclic loading. J Exp Orthop 2020; 7:17. [PMID: 32222847 PMCID: PMC7103022 DOI: 10.1186/s40634-020-00232-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/10/2020] [Indexed: 01/01/2023] Open
Abstract
Background Suspensory cortical buttons are widely used for fixation of reconstructed ligaments during anterior cruciate ligament (ACL) reconstruction because they have high usability and a favorable fixing force. However, it is not always easy to fix a reconstructed ACL while maintaining appropriate ligament tension. Therefore, we developed an improved cortical button that provides temporary tension until suturing is completed. Methods Button holes of our improved EndoButton are not perpendicular to the bone surface on which the button is placed, but have an angle of 45 degrees so that the button can be temporarily fixed by applying tension to the suture. The improved EndoButton and the original EndoButton (Smith & Nephew Inc., Andover, Massachusetts) were each tied to FiberWire 5/7 metric (5 M) (manufactured by Arthrex). Ten cycles of preliminary loading (0–50 N) were applied to each suture, followed by test loading (0–250 N) for 500 or 1000 cycles. Then, a tensile test was performed at a displacement velocity of 20 mm/min. Results The breaking strength of the sutures of the improved EndoButton were tend to higher than those of the sutures of the original EndoButton after 1000 loading cycles (p = 0.067, d = 0.883). The moduli of rigidity of the sutures of the improved EndoButton were higher than those of the sutures of the original EndoButton after 500 loading cycles (p = 0.027) and remained almost the same regardless of the number of loading cycles. Conclusion We found that compared with the original cortical button, the improved cortical button was better able to retain suture breaking strength and modulus of rigidity, regardless of the number of load cycles.
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Affiliation(s)
- Toshiaki Takahashi
- Department of Sports and Health Science, Faculty of Collaborative Regional Innovation, Ehime University, 3 Bunkyo-cho, Matsuyama, Ehime, 790-8577, Japan.
| | - Manabu Takahashi
- Department of Industrial Innovation, Faculty of Collaborative Regional Innovation, Ehime University, 3 Bunkyo-cho, Matsuyama, Ehime, 790-8577, Japan
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Spragg LM, Prentice HA, Morris A, Funahashi TT, Maletis GB, Csintalan RP. Femoral-tibial fixation affects risk of revision and reoperation after anterior cruciate ligament reconstruction using hamstring autograft. Knee Surg Sports Traumatol Arthrosc 2019; 27:3518-3526. [PMID: 30824978 DOI: 10.1007/s00167-019-05431-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 02/19/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE Newer fixation devices for hamstring (HS) autograft have been introduced over the years, yet the impact of these devices on ACLR outcomes requiring surgical intervention remains unclear. We sought to evaluate the risk of aseptic revision and reoperation after HS autograft ACLR according to various femoral-tibial fixation methods. METHODS A cohort study was conducted using the Kaiser Permanente ACLR Registry. Primary isolated unilateral ACLR patients who received a HS autograft were identified (2007-2014). Fixation devices were categorized as crosspin, interference, suspensory, or combination (defined as more than one fixation device used on the same side) and femoral-tibial fixation groups used in more than 500 ACLR were evaluated. Cox proportional-hazard regression was used to evaluate the association between femoral-tibial fixation method and outcomes while adjusting for confounders. RESULTS 6,593 primary ACLR were included. Four femoral-tibial fixation groups had more than 500 ACLR: suspensory-interference (n = 3004, 45.6%), interference-interference (n = 1659, 25.2%), suspensory-combination (n = 1103, 16.7%), and crosspin-interference (n = 827, 12.5%). After adjusting for covariates, revision risk was lower for crosspin-interference (HR = 0.43, 95% CI 0.29-0.65) and interference-interference (HR = 0.63, 95% CI 0.41-0.95) methods compared to the suspensory-interference. In contrast, reoperation risk was higher for crosspin-interference (HR = 2.13, 95% CI 1.37-3.32) and suspensory-combination (HR = 1.68, 95% CI 1.04-2.69) methods compared to suspensory-interference. CONCLUSIONS ACLR using HS autograft appears to have the lowest risk of aseptic revision when crosspin or interference fixation is used on the femoral side and is coupled with an interference screw on the tibial side. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Lindsey M Spragg
- Department of Orthopaedics, Southern California Permanente Medical Group, 6670 Alton Pkwy, Irvine, CA, 92618, USA
| | | | - Andrew Morris
- Department of Orthopaedics, University of California Irvine, Irvine, CA, USA
| | - Tadashi T Funahashi
- Department of Orthopaedics, Southern California Permanente Medical Group, 6670 Alton Pkwy, Irvine, CA, 92618, USA
| | - Gregory B Maletis
- Department of Orthopaedics, Southern California Permanente Medical Group, Baldwin Park, CA, USA
| | - Rick P Csintalan
- Department of Orthopaedics, Southern California Permanente Medical Group, 6670 Alton Pkwy, Irvine, CA, 92618, USA.
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Takahashi T, Kimura M, Takeshita K. MRI evaluation of the ACL remnant tissue in ACL-deficient knee. J Orthop Surg (Hong Kong) 2018; 25:2309499017739479. [PMID: 29137565 DOI: 10.1177/2309499017739479] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
PURPOSE To clarify the relationship between anterior cruciate ligament (ACL) remnant tissue at the time of surgery and preoperative evaluation of ACL-injured knee. METHODS A total of 123 patients were enrolled and classified into four groups based on the classification of ACL remnant tissue. To quantify the signal-noise quotient (SNQ), five regions of interest (ROIs), such as tibial, mid, femoral ACL remnant, tendon of quadriceps femoris to normalize the signal intensity of ACL remnant tissue, and background measurements, were measured. Preoperative side-to-side difference (SSD) and SNQ were analyzed. RESULTS Significant differences were observed in preoperative SSD of the four groups ( p = 0.021), and a post hoc analysis revealed that SSD in Crain type 2 was significantly smaller than that in Crain type 4 ( p = 0.014). SSD in Crain type 3 was also significantly smaller than that in Crain type 4 ( p = 0.0030). There were significant differences in SNQ at the tibial, mid, and femoral portion in Crain types 2 and 3 ( p < 0.001); SNQ at the tibial portion in Crain type 2 was significantly lower than that at the mid portion ( p = 0.024); and SNQ at the tibial portion in Crain type 3 was significantly lower than that at the mid portion ( p = 0.016). Furthermore, significant differences were observed in SNQ at the tibial portions in the four groups ( p = 0.034), and SNQ at the tibial portions in Crain type 2 was significantly lower than that in Crain type 1 ( p = 0.044). Also, SNQ at the tibial portions in Crain type 3 was significantly lower than that in Crain type 1 ( P = 0.035). CONCLUSION The femoral attachment of the ACL remnant tissue may influence the SNQ of the tibial remnant tissue and the stability of the ACL-injured knee.
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Affiliation(s)
- Tsuneari Takahashi
- 1 Gunma Sports Medicine Research Center, Zenshukai Hospital, Maebashi, Japan.,2 Department of Orthopaedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Masashi Kimura
- 1 Gunma Sports Medicine Research Center, Zenshukai Hospital, Maebashi, Japan
| | - Katsushi Takeshita
- 2 Department of Orthopaedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
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Sampatacos N, Gillette BP, Snyder SJ, Henninger HB. Biomechanics of a novel technique for suprapectoral intraosseous biceps tenodesis. J Shoulder Elbow Surg 2016; 25:149-57. [PMID: 26344873 DOI: 10.1016/j.jse.2015.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 07/20/2015] [Accepted: 07/23/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Caspari-Weber (C.W.) tenodesis is a standard miniopen intraosseous technique to fix the long head of the biceps tendon. The suprapectoral intraosseous biceps tenodesis (SPIBiT) is a novel arthroscopic, intraosseous, tendon-sparing alternative using a cortical button. No biomechanical data exist comparing the time-zero performance of the SPIBiT and C.W. constructs. METHODS Nine pairs of human cadaver shoulders were tested. The SPIBiT used a finger-trap suture pattern holding the tendon inside a humeral tunnel above the pectoralis tendon, anchored with a cortical button on the anterior humerus distal to the bicipital groove. The subpectoral C.W. used a Krackow suture technique. Specimens underwent 500 cycles of uniaxial loading, followed by ultimate failure testing. RESULTS The SPIBiT was placed in 5 left and 4 right humeri (5 female, 4 male; 59 ± 6 years). The C.W. was initially stiffer (P = .003), whereas the SPIBiT exhibited higher energy dissipation (hysteresis; P = .006). Metrics decreased for both constructs over 500 cycles (P ≤ .050). Constructs failed through suture bunching and tendon tearing within the main suture bundle. The SPIBiT exhibited a novel failure in 2 specimens, with the cortical button pulling distally and suture cutting through cortical bone. Failure occurred at 272.0 ± 114.3 N and 282.3 ± 59.4 N for the SPIBiT and C.W., respectively (P = .766). The C.W. was stiffer (P < .001). CONCLUSION The SPIBiT is an arthroscopic suprapectoral intraosseous alternative to the C.W. biceps tenodesis, but in light of the novel failure mode, clinical use is not recommended. Future investigations should quantify the impact of construct compliance on healing, and future constructs should avoid suture point loading on thin cortical bone.
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Affiliation(s)
| | | | | | - Heath B Henninger
- Department of Orthopaedics, Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA; Department of Bioengineering, University of Utah, Salt Lake City, UT, USA.
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Persson A, Kjellsen AB, Fjeldsgaard K, Engebretsen L, Espehaug B, Fevang JM. Registry data highlight increased revision rates for endobutton/biosure HA in ACL reconstruction with hamstring tendon autograft: a nationwide cohort study from the Norwegian Knee Ligament Registry, 2004-2013. Am J Sports Med 2015; 43:2182-8. [PMID: 25977524 DOI: 10.1177/0363546515584757] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Compared with a patellar tendon autograft (PT), a hamstring tendon autograft (HT) has an increased risk of revision after anterior cruciate ligament reconstruction (ACLR). There are no studies analyzing whether this can be explained by inferior fixation devices used in HT reconstruction or whether the revision risk of ACLR with an HT or a PT is influenced by the graft fixation. PURPOSE To compare the risk of revision and the revision rates between the most commonly used combinations of fixation for HTs with PTs. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS This study included all patients registered in the Norwegian Knee Ligament Registry from 2004 through 2013 who underwent primary PT or HT ACLR with no concomitant ligament injury and known graft fixation. The 2-year revision rates were calculated using the Kaplan-Meier analysis. Hazard ratios (HRs) for revision at 2 years were calculated using multivariate Cox regression models. RESULTS A total of 14,034 patients with primary ACLR were identified: 3806 patients with PTs and 10,228 patients with HTs; the mean follow-up time was 4.5 years. In the HT group, 5 different combinations of fixation in the femur/tibia were used in more than 500 patients: Endobutton/RCI screw (n = 2339), EZLoc/WasherLoc (n = 1352), Endobutton/Biosure HA (n = 1209), Endobutton/Intrafix (n = 687), and TransFix II/metal interference screw (MIS) (n = 620). The crude 2-year revision rate for patients with PTs was 0.7% (95% CI, 0.4%-1.0%), and for patients with HTs, it ranged between the groups from 1.5% (95% CI, 0.5%-2.4%) for TransFix II/MIS to 5.5% (95% CI, 4.0%-7.0%) for Endobutton/Biosure HA. When adjusted for detected confounding factors and compared with patients with PTs, the HR for revision at 2 years was increased for all HT combinations used in more than 500 patients, and the combinations Endobutton/Biosure HA and Endobutton/Intrafix had the highest HRs of 7.3 (95% CI, 4.4-12.1) and 5.5 (95% CI, 3.1-9.9), respectively. CONCLUSION The choice of fixation after ACLR with an HT has a significant effect on a patient's risk of revision. In this study population, none of the examined combinations of HT fixation had a revision rate as low as that for a PT.
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Affiliation(s)
- Andreas Persson
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Asle B Kjellsen
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Knut Fjeldsgaard
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Lars Engebretsen
- Department of Orthopaedic Surgery, University of Oslo, Oslo, Norway Oslo Sports Trauma Research Center, Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Birgitte Espehaug
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Jonas M Fevang
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
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German MJ, Osei-Bempong C, Knuth CA, Deehan DJ, Oldershaw RA. Investigating the biological response of human mesenchymal stem cells to titanium surfaces. J Orthop Surg Res 2014; 9:135. [PMID: 25496535 PMCID: PMC4269958 DOI: 10.1186/s13018-014-0135-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 12/01/2014] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND We have investigated the behaviour of a newly characterised population of haemarthrosis fluid-derived human mesenchymal stem cells (HF-hMSCs) with titanium (Ti) surfaces. METHODS HF-hMSCs were seeded onto round cannulated interference (RCI; Smith and Nephew) screws or control Ti discs and cultured under pro-osteogenic conditions. RESULTS Electron microscopy showed the attachment and spreading of HF-hMSCs across both Ti surfaces during the early stages of osteogenic culture; however, cells were exclusively localised to the basal regions within the vertex of the Ti screws. In the later stages of culture, an osteoid matrix was deposited on the Ti surfaces with progressive culture expansion and matrix deposition up the sides and the top of the Ti Screws. Quantification of cellular content revealed a significantly higher number of cells within the Ti screw cultures; however, there was no difference in the cellular health. Conversely, alizarin red staining used as both a qualitative and quantitative measure of matrix calcification was significantly increased in Ti disc cultures compared to those of Ti screws. CONCLUSIONS Our results suggest that the gross topography of the metal implant is able to create microenvironment niches that have an influence on cellular behaviour. These results have implications for the design of advanced tissue engineering strategies that seek to use cellular material to enhance biological remodelling and healing following tissue reconstruction.
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Affiliation(s)
- Matthew J German
- Centre for Oral Health Research, School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4BW, UK.
| | - Charles Osei-Bempong
- Institute of Genetic Medicine, Faculty of Medical Sciences, Newcastle University, International Centre for Life, Times Square, Newcastle upon Tyne, NE1 4EP, UK.
| | - Callie A Knuth
- North East England Stem Cell Institute, Faculty of Medical Sciences, Newcastle University, International Centre for Life, Times Square, Newcastle upon Tyne, NE1 4EP, UK.
| | - David J Deehan
- Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne NHS Hospitals Foundation Trust, Freeman Road, High Heaton, Newcastle upon Tyne, NE7 7DN, UK.
| | - Rachel A Oldershaw
- North East England Stem Cell Institute, Faculty of Medical Sciences, Newcastle University, International Centre for Life, Times Square, Newcastle upon Tyne, NE1 4EP, UK. .,Department of Musculoskeletal Biology, Institute of Ageing and Chronic Disease, Faculty of Health and Life Sciences, The University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, UK.
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Rogers CM, Deehan DJ, Knuth CA, Rose FRAJ, Shakesheff KM, Oldershaw RA. Biocompatibility and enhanced osteogenic differentiation of human mesenchymal stem cells in response to surface engineered poly(D,L-lactic-co-glycolic acid) microparticles. J Biomed Mater Res A 2013; 102:3872-82. [PMID: 24339408 DOI: 10.1002/jbm.a.35063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 11/15/2013] [Accepted: 12/09/2013] [Indexed: 01/13/2023]
Abstract
Tissue engineering strategies can be applied to enhancing osseous integration of soft tissue grafts during ligament reconstruction. Ligament rupture results in a hemarthrosis, an acute intra-articular bleed rich in osteogenic human mesenchymal stem cells (hMSCs). With the aim of identifying an appropriate biomaterial with which to combine hemarthrosis fluid-derived hMSCs (HF-hMSCs) for therapeutic application, this work has investigated the biocompatibility of microparticles manufactured from two forms of poly(D,L-lactic-co-glycolic acid) (PLGA), one synthesized with equal monomeric ratios of lactic acid to glycolic acid (PLGA 50:50) and the other with a higher proportion of lactic acid (PLGA 85:15) which confers a longer biodegradation time. The surfaces of both types of microparticles were functionalized by plasma polymerization with allylamine to increase hydrophilicity and promote cell attachment. HF-hMSCs attached to and spread along the surface of both forms of PLGA microparticle. The osteogenic response of HF-hMSCs was enhanced when cultured with PLGA compared with control cultures differentiated on tissue culture plastic and this was independent of the type of polymer used. We have demonstrated that surface engineered PLGA microparticles are an appropriate biomaterial for combining with HF-hMSCs and the selection of PLGA is relevant only when considering the biodegradation time for each biomedical application.
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Affiliation(s)
- Catherine M Rogers
- School of Pharmacy, Centre for Biomolecular Sciences, The University of Nottingham, University Park, Nottingham, NG7 2RD, United Kingdom
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