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Rodríguez-Merchán EC. Anterior Cruciate Ligament Reconstruction: Is Biological Augmentation Beneficial? Int J Mol Sci 2021; 22:ijms222212566. [PMID: 34830448 PMCID: PMC8625610 DOI: 10.3390/ijms222212566] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 12/28/2022] Open
Abstract
Surgical reconstruction in anterior cruciate ligament (ACL) ruptures has proven to be a highly effective technique that usually provides satisfactory results. However, despite the majority of patients recovering their function after this procedure, ACL reconstruction (ACLR) is still imperfect. To improve these results, various biological augmentation (BA) techniques have been employed mostly in animal models. They include: (1) growth factors (bone morphogenetic protein, epidermal growth factor, granulocyte colony-stimulating factor, basic fibroblast growth factor, transforming growth factor-β, hepatocyte growth factor, vascular endothelial growth factor, and platelet concentrates such as platelet-rich plasma, fibrin clot, and autologous conditioned serum), (2) mesenchymal stem cells, (3) autologous tissue, (4) various pharmaceuticals (matrix metalloproteinase-inhibitor alpha-2-macroglobulin bisphosphonates), (5) biophysical/environmental methods (hyperbaric oxygen, low-intensity pulsed ultrasound, extracorporeal shockwave therapy), (6) biomaterials (fixation methods, biological coatings, biosynthetic bone substitutes, osteoconductive materials), and (7) gene therapy. All of them have shown good results in experimental studies; however, the clinical studies on BA published so far are highly heterogeneous and have a low degree of evidence. The most widely used technique to date is platelet-rich plasma. My position is that orthopedic surgeons must be very cautious when considering using PRP or other BA methods in ACLR.
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Affiliation(s)
- Emerito Carlos Rodríguez-Merchán
- Department of Orthopedic Surgery, La Paz University Hospital—IdiPaz, 28046 Madrid, Spain;
- Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research—IdiPAZ (La Paz University Hospital—Autonomous University of Madrid), 28046 Madrid, Spain
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Lai WC, Iglesias BC, Mark BJ, Wang D. Low-Intensity Pulsed Ultrasound Augments Tendon, Ligament, and Bone-Soft Tissue Healing in Preclinical Animal Models: A Systematic Review. Arthroscopy 2021; 37:2318-2333.e3. [PMID: 33621647 DOI: 10.1016/j.arthro.2021.02.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 01/29/2021] [Accepted: 02/04/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To appraise the available animal and human studies investigating low-intensity pulsed ultrasound stimulation (LIPUS) on tendon, ligament, and bone-soft tissue (B-ST) junction healing. METHODS A systematic review of PUBMED, EMBASE, and the Cochrane Library was performed for animal and human studies investigating the effects of LIPUS on tendon, ligament, and B-ST junction healing. The systematic search was performed using the key term "low intensity pulsed ultrasound" and any of the following: "tendon," "ligament," "tendon-bone," and "bone-tendon." Inclusion criteria consisted of (1) randomized controlled trials assessing the effect of LIPUS on bone, tendon, and soft tissue in animals or humans and (2) English-language articles. RESULTS A total of 28 animal and 2 human studies met inclusion criteria. Animal studies utilized various models, including Achilles and patellar tendon transections, medial collateral ligament transections, and surgical repair of patellar tendon, rotator cuff tendon, and anterior cruciate ligament, to evaluate the effects of LIPUS. Animal studies demonstrated significantly improved collagen content and organization, bone formation, fibrocartilage remodeling, and mechanical strength with LIPUS treatment compared with controls. In human trials, LIPUS treatment of chronic tendinopathies did not improve clinical outcomes. CONCLUSIONS In acute injury animal models, LIPUS augmented healing of acute tendon, ligament, and B-ST junction injuries through increased collagen content and organization; increased anti-inflammatory cellular signaling; and increased angiogenesis. However, in 2 human studies investigating chronic tendinopathy, LIPUS did not lead to superior outcomes compared with controls. CLINICAL RELEVANCE Animal models suggest that LIPUS may be a promising noninvasive treatment modality for accelerating patient recovery after acute tendon and ligament injuries, as well as after surgical repair of B-ST junction injuries, but this has not been demonstrated in human studies. Randomized clinical trials evaluating LIPUS for acute tendon and ligament injuries are warranted.
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Affiliation(s)
- Wilson C Lai
- Department of Orthopaedic Surgery, University of California Irvine, Orange, California, U.S.A
| | - Brenda C Iglesias
- David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Bryan J Mark
- Department of Orthopaedic Surgery, University of California Irvine, Orange, California, U.S.A
| | - Dean Wang
- Department of Orthopaedic Surgery, University of California Irvine, Orange, California, U.S.A..
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Tei MM, Placella G, Sbaraglia M, Tiribuzi R, Georgoulis A, Cerulli G. Does Manual Drilling Improve the Healing of Bone-Hamstring Tendon Grafts in Anterior Cruciate Ligament Reconstruction? A Histological and Biomechanical Study in a Rabbit Model. Orthop J Sports Med 2020; 8:2325967120911600. [PMID: 32284946 PMCID: PMC7139185 DOI: 10.1177/2325967120911600] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 11/08/2019] [Indexed: 11/16/2022] Open
Abstract
Background: Heat necrosis due to motorized drilling during anterior cruciate ligament
(ACL) reconstruction could be a factor in delayed healing at the bone–tendon
graft interface. Hypothesis: The process of osteointegration could be enhanced using manual drilling. It
reduces the invasiveness of mechanical-thermal stress normally caused by the
traditional motorized drill bit. Study Design: Controlled laboratory study. Methods: ACL reconstruction using semitendinosus tendon autografts was performed in 28
skeletally mature female New Zealand white rabbits, which were randomly
divided into 3 groups. In group A (n = 12), the tunnels were drilled using a
motorized device; in group B (n = 12), the tunnels were drilled using a
manual drill bit; and group C (n = 4) served as a control with sham surgical
procedures. The healing process in the tunnels was assessed histologically
at 2, 4, 8, and 12 weeks and graded according to the Tendon–Bone Tunnel
Healing (TBTH) scoring system. In addition, another 25 rabbits were used for
biomechanical testing. The structural properties of the femur–ACL
graft–tibia complex, from animals sacrificed at 8 weeks postoperatively,
were determined using uniaxial tests. Stiffness (N/mm) and ultimate load to
failure (N) were determined from the resulting load-elongation curves. Results: The time course investigation showed that manual drilling (group B) had a
higher TBTH score and improved mechanical behavior, reflecting better
organized collagen fiber continuity at the bone–fibrous tissue interface,
better integration between the graft and bone, and early mineralized
chondrocyte-like tissue formation at all the time points analyzed with a
maximum difference at 4 weeks (TBTH score: 5.4 [group A] vs 12.3 [group B];
P < .001). Stiffness (23.1 ± 8.2 vs 17.8 ± 6.3 N/mm,
respectively) and ultimate load to failure (91.8 ± 60.4 vs 55.0 ± 18.0 N,
respectively) were significantly enhanced in the specimens treated with
manual drilling compared with motorized drilling (P <
.05 for both). Conclusion: The use of manual drilling during ACL reconstruction resulted in better
tendon-to-bone healing during the crucial early weeks. Manual drilling was
able to improve the biological and mechanical properties of bone–hamstring
tendon graft healing and was able to restore postoperative graft function
more quickly. Tunnel drilling results in bone loss and deficient tendon-bone
healing, and heat necrosis after tunnel enlargement may cause mechanical
stress, contributing to a delay in healing. Manual drilling preserved the
bone stock inside the tunnel, reduced heat necrosis, and offered a better
microenvironment for faster healing at the interface. Clinical Relevance: Based on study results, manual drilling could be used successfully in human
ACL reconstruction, but further clinical studies are needed. A clinical
alternative, called the original “all-inside” technique, has been developed
for ACL reconstruction. In this technique, the femoral and tibial tunnels
are manually drilled only halfway through the bone for graft fixation,
reducing bone loss. Data from this study suggest that hamstring
tendon–to–bone healing can be improved using a manual drilling technique to
form femoral and tibial tunnels.
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Affiliation(s)
- Matteo Maria Tei
- Istituto di Ricerca Traslazionale per l'Apparato Locomotore Nicola Cerulli, Arezzo, Italy
| | - Giacomo Placella
- Istituto di Ricerca Traslazionale per l'Apparato Locomotore Nicola Cerulli, Arezzo, Italy.,Department of Orthopaedic Surgery, Ospedale San Raffaele, Milan, Italy
| | - Marta Sbaraglia
- Istituto di Ricerca Traslazionale per l'Apparato Locomotore Nicola Cerulli, Arezzo, Italy.,Department of Pathology, Azienda Ospedaliera di Padova, Padua, Italy
| | - Roberto Tiribuzi
- Istituto di Ricerca Traslazionale per l'Apparato Locomotore Nicola Cerulli, Arezzo, Italy
| | - Anastasios Georgoulis
- Istituto di Ricerca Traslazionale per l'Apparato Locomotore Nicola Cerulli, Arezzo, Italy.,Department of Orthopaedic Surgery, Ospedale San Raffaele, Milan, Italy.,Department of Pathology, Azienda Ospedaliera di Padova, Padua, Italy.,Orthopaedic Sports Medicine Center, University of Ioannina, Ioannina, Greece
| | - Giuliano Cerulli
- Istituto di Ricerca Traslazionale per l'Apparato Locomotore Nicola Cerulli, Arezzo, Italy
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Jiang X, Savchenko O, Li Y, Qi S, Yang T, Zhang W, Chen J. A Review of Low-Intensity Pulsed Ultrasound for Therapeutic Applications. IEEE Trans Biomed Eng 2019; 66:2704-2718. [DOI: 10.1109/tbme.2018.2889669] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Itaya N, Yabe Y, Hagiwara Y, Kanazawa K, Koide M, Sekiguchi T, Yoshida S, Sogi Y, Yano T, Tsuchiya M, Saijo Y, Itoi E. Effects of Low-Intensity Pulsed Ultrasound for Preventing Joint Stiffness in Immobilized Knee Model in Rats. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1244-1256. [PMID: 29573888 DOI: 10.1016/j.ultrasmedbio.2018.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/30/2018] [Accepted: 02/03/2018] [Indexed: 06/08/2023]
Abstract
The purpose of this study was to examine the effect of low-intensity pulsed ultrasound (LIPUS) in preventing joint stiffness. Unilateral knee joints were immobilized in two groups of rats (n = 6/period/group). Under general anesthesia, the immobilized knee joints were exposed to LIPUS for 20 min/d, 5 d/wk, using an existing LIPUS device (LIPUS group, 1.5-MHz frequency, 1.0-kHz repetition cycle, 200-µs burst width and 30-mW/cm2 power output) until endpoints (2, 4 or 6 wk). In the control group, general anesthesia alone was administered in the same manner as in the other group. The variables compared between the groups included joint angles; histologic, histomorphometric and immunohistochemical analyses; quantitative reverse transcription polymerase chain reactions; and tissue elasticity. LIPUS had a preventive effect on joint stiffness, resulting in decreased adhesion, fibrosis and inflammation and hypoxic response after joint immobilization.
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Affiliation(s)
- Nobuyuki Itaya
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Aoba-ku, Sendai, Japan
| | - Yutake Yabe
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Aoba-ku, Sendai, Japan
| | - Yoshihiro Hagiwara
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Aoba-ku, Sendai, Japan.
| | - Kenji Kanazawa
- Department of Orthopaedic Surgery, Iwate Prefectural Central Hospital, Morioka, Iwate, Japan
| | - Masashi Koide
- Department of Orthopaedic Surgery, Matsuda Hospital, Izumi-ku, Sendai, Japan
| | - Takuya Sekiguchi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Aoba-ku, Sendai, Japan
| | - Shinichirou Yoshida
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Aoba-ku, Sendai, Japan
| | - Yasuhito Sogi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Aoba-ku, Sendai, Japan
| | - Toshihisa Yano
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Aoba-ku, Sendai, Japan
| | | | - Yoshihumi Saijo
- Department of Biomedical Imaging, Tohoku University Graduate School of Biomedical Engineering, Aoba-ku, Sendai, Japan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Aoba-ku, Sendai, Japan
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Hexter AT, Thangarajah T, Blunn G, Haddad FS. Biological augmentation of graft healing in anterior cruciate ligament reconstruction: a systematic review. Bone Joint J 2018; 100-B:271-284. [PMID: 29589505 DOI: 10.1302/0301-620x.100b3.bjj-2017-0733.r2] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Aims The success of anterior cruciate ligament reconstruction (ACLR) depends on osseointegration at the graft-tunnel interface and intra-articular ligamentization. Our aim was to conduct a systematic review of clinical and preclinical studies that evaluated biological augmentation of graft healing in ACLR. Materials and Methods In all, 1879 studies were identified across three databases. Following assessment against strict criteria, 112 studies were included (20 clinical studies; 92 animal studies). Results Seven categories of biological interventions were identified: growth factors, biomaterials, stem cells, gene therapy, autologous tissue, biophysical/environmental, and pharmaceuticals. The methodological quality of animal studies was moderate in 97%, but only 10% used clinically relevant outcome measures. The most interventions in clinical trials target the graft-tunnel interface and are applied intraoperatively. Platelet-rich plasma is the most studied intervention, but the clinical outcomes are mixed, and the methodological quality of studies was suboptimal. Other biological therapies investigated in clinical trials include: remnant-augmented ACLR; bone substitutes; calcium phosphate-hybridized grafts; extracorporeal shockwave therapy; and adult autologus non-cultivated stem cells. Conclusion There is extensive preclinical research supporting the use of biological therapies to augment ACLR. Further clinical studies that meet the minimum standards of reporting are required to determine whether emerging biological strategies will provide tangible benefits in patients undergoing ACLR. Cite this article: Bone Joint J 2018;100-B:271-84.
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Affiliation(s)
- A T Hexter
- Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, and Royal National Orthopaedic Hospital Brockley Hill, Stanmore, Middlesex HA7 4LP, UK
| | - T Thangarajah
- Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, and Royal National Orthopaedic Hospital Brockley Hill, Stanmore, Middlesex HA7 4LP, UK
| | - G Blunn
- Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, and Royal National Orthopaedic Hospital Brockley Hill, Stanmore, Middlesex HA7 4LP, UK
| | - F S Haddad
- University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK and NIHR University College London Hospitals Biomedical Research Centre, UK
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Best TM, Wilk KE, Moorman CT, Draper DO. Low Intensity Ultrasound for Promoting Soft Tissue Healing: A Systematic Review of the Literature and Medical Technology. ACTA ACUST UNITED AC 2016; 2. [PMID: 30198009 DOI: 10.18103/imr.v2i11.271] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Therapeutic ultrasound has been studied and used for the past seven decades to treat musculoskeletal injuries. Recently, a significant body of animal and human research has focused on the biomechanical effects of daily-applied, low intensity therapeutic ultrasound (LITUS) on soft tissue recovery. We performed a systematic review of the last two decades of LITUS literature to examine the effects on tendon, skeletal muscle, ligament, and tendon-bone junction injuries. LITUS facilitated tendon healing, with increased tensile strength and improved collagen alignment. For skeletal muscle and ligament injuries, LITUS increased cell proliferation during myoregeneration and improved tissue biomechanics (ultimate load, stiffness, energy absorption). LITUS aided tendon-bone junction healing through improved tissue function. Scientific evidence supports the use of LITUS to treat soft tissue injuries, and improve outcomes for musculoskeletal injuries and post-operative recovery. Lastly, we discuss the use of LITUS devices facilitating daily applied therapy in the home setting.
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Lu H, Chen C, Qu J, Chen H, Chen Y, Zheng C, Wang Z, Xu D, Zhou J, Zhang T, Qin L, Hu J. Initiation Timing of Low-Intensity Pulsed Ultrasound Stimulation for Tendon-Bone Healing in a Rabbit Model. Am J Sports Med 2016; 44:2706-2715. [PMID: 27358283 DOI: 10.1177/0363546516651863] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Low-intensity pulsed ultrasound stimulation (LIPUS) has been proven to be a beneficial biophysical therapy for tendon-bone (T-B) healing. However, the optimal time to initiate LIPUS treatment has not been determined yet. LIPUS initiated at different stages of the inflammatory phase may profoundly affect T-B healing. PURPOSE An established rabbit model was used to preliminarily investigate the effect of LIPUS initiation timing on T-B healing. STUDY DESIGN Controlled laboratory study. METHODS A total of 112 mature rabbits that underwent partial patellectomy were randomly assigned to 4 groups: daily mock sonication (control group) and daily ultrasonication started immediately postoperatively (immediate group), on postoperative day 7 (7-day delayed group), or on postoperative day 14 (14-day delayed group). Peripheral leukocyte counts at the inflammatory phase were used to assess postoperative inflammation. The rabbits were sacrificed at 8 or 16 weeks postoperatively for microarchitectural, histological, and mechanical evaluations of the patella-patellar tendon (PPT) junction. RESULTS The biomechanical properties of the PPT junction were significantly improved in the LIPUS-treated groups. Significantly higher ultimate strength and stiffness were seen in the 7-day delayed group compared with the other groups at 8 weeks postoperatively (P < .05 for all). Newly formed bone expansion from the remaining patella in the ultrasonic treatment groups was significantly increased and remodeled compared with the control group. Micro-computed tomography analysis showed that the 7-day delayed group had significantly more bone volume and bone mineral content at the interface as compared with the other groups at 8 weeks postoperatively (P < .05 for all). Histologically, the ultrasonic treatment groups exhibited a significantly better PPT junction, as shown by more formation and remodeling of the fibrocartilage layer and newly formed bone. Additionally, peripheral leukocyte counts displayed a significant increase from postoperative day 1 to day 3 in the immediate group as compared with the other groups. Furthermore, postoperative hydrarthrosis was more likely in the immediate group. CONCLUSION LIPUS started at postoperative day 7 had a more prominent effect on T-B healing compared with the other treatment regimens in this study. CLINICAL RELEVANCE The findings of the study may help optimize the initiation timing of LIPUS for T-B healing.
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Affiliation(s)
- Hongbin Lu
- Department of Sports Medicine, Research Center of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Can Chen
- Department of Sports Medicine, Research Center of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Jin Qu
- Department of Sports Medicine, Research Center of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Huabin Chen
- Department of Sports Medicine, Research Center of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Yong Chen
- Department of Sports Medicine, Research Center of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China Department of Pediatric Orthopaedics, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Cheng Zheng
- Department of Sports Medicine, Research Center of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China Department of Orthopaedics, Hospital of Wuhan Sports University, Wuhan Sports University, Wuhan, China
| | - Zhanwen Wang
- Department of Sports Medicine, Research Center of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Daqi Xu
- Department of Sports Medicine, Research Center of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Jingyong Zhou
- Department of Sports Medicine, Research Center of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Tao Zhang
- Department of Sports Medicine, Research Center of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Ling Qin
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Jianzhong Hu
- Department of Sports Medicine, Research Center of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China Department of Spine Surgery, Research Center of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
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Chen CH, Lee CH. Biological fixation in anterior cruciate ligament surgery. Asia Pac J Sports Med Arthrosc Rehabil Technol 2014. [DOI: 10.1016/j.asmart.2014.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Fu SC, Cheuk YC, Yung SH, Rolf CG, Chan KM. Systematic Review of Biological Modulation of Healing in Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2014; 2:2325967114526687. [PMID: 26535311 PMCID: PMC4555564 DOI: 10.1177/2325967114526687] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: Whether biological modulation is effective to promote healing in anterior cruciate ligament (ACL) reconstruction remains unclear. Purpose: To perform a systematic review of both clinical and experimental evidence of preclinical animal studies on biological modulation to promote healing in ACL reconstruction. Study Design: Systematic review; Level of evidence, 2. Methods: A systematic search was performed using the PubMed, Ovid, and Scopus search engines. Inclusion criteria were clinical and animal studies involving subjects with ACL injury with the use of biological modulation to promote healing outcomes. Methodological quality of clinical studies was evaluated using the Critical Appraisal Skill Programme (CASP) appraisal tool, and animal studies were evaluated by a scoring system based on a published checklist of good animal studies. Results: Ten clinical studies and 50 animal studies were included. Twenty-five included studies were regarded as good quality, with a methodological score ≥5. These studies suggested that transforming growth factor–beta (TGF-β), mesenchymal stem cells, osteogenic factors, and modalities that reduce local inflammation may be beneficial to promote graft healing in ACL reconstruction. Conclusion: This systematic review suggests that biological modulation is able to promote healing on top of surgical treatment for ACL injuries. This treatment strategy chiefly works through promotion of healing at the tunnel-graft interface, but the integrity of the intra-articular midsubstance of the graft would be another target for biological modulation.
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Affiliation(s)
- Sai-Chuen Fu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China. ; Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yau-Chuk Cheuk
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China. ; Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shu-Hang Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China. ; Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Christer Gustav Rolf
- Department of Orthopaedic Surgery, Huddinge University Hospital, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Kai-Ming Chan
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China. ; Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Nikitovic D, Aggelidakis J, Young MF, Iozzo RV, Karamanos NK, Tzanakakis GN. The biology of small leucine-rich proteoglycans in bone pathophysiology. J Biol Chem 2012; 287:33926-33. [PMID: 22879588 DOI: 10.1074/jbc.r112.379602] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The class of small leucine-rich proteoglycans (SLRPs) is a family of homologous proteoglycans harboring relatively small (36-42 kDa) protein cores compared with the larger cartilage and mesenchymal proteoglycans. SLRPs have been localized to most skeletal regions, with specific roles designated during all phases of bone formation, including periods relating to cell proliferation, organic matrix deposition, remodeling, and mineral deposition. This is mediated by key signaling pathways regulating the osteogenic program, including the activities of TGF-β, bone morphogenetic protein, Wnt, and NF-κB, which influence both the number of available osteogenic precursors and their subsequent development, differentiation, and function. On the other hand, SLRP depletion is correlated with degenerative diseases such as osteoporosis and ectopic bone formation. This minireview will focus on the SLRP roles in bone physiology and pathology.
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Affiliation(s)
- Dragana Nikitovic
- Department of Histology-Embryology, Medical School, University of Crete, Greece
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Lai CH, Chuang CC, Li JKJ, Chen SC, Chang WHS. Effects of ultrasound on osteotomy healing in a rabbit fracture model. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:1635-1643. [PMID: 21821345 DOI: 10.1016/j.ultrasmedbio.2011.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 06/16/2011] [Accepted: 06/23/2011] [Indexed: 05/31/2023]
Abstract
This study investigated the effects of ultrasound (US) at different frequencies on fracture healing over a three-week period in a rabbit fibular fracture model. Forty-five adult New Zealand White rabbits were divided into five groups: a control group and four groups treated with US frequencies of 0.5, 1.0, 1.5 and 2.0 MHz (0.5 W/cm(2), 200-μs burst, pulsed 1:4). After anesthesia, transverse osteotomy was performed on the fibula bone. This was followed by intravital staining and fluorescence microscopic examination of new bone formation and biomechanical tests of torsional stiffness at the osteotomy site. Results showed that total new bone formation and torsional stiffness of the fibula were greater in all US-treated groups than in the control group. No significant difference was found between any of the four US-treated groups. The US treatment also enhanced bone growth of the sham-treated contralateral fracture site. These results suggest that US treatment at 0.5, 1.0, 1.5 or 2.0 MHz can enhance fracture healing in a rabbit model. Furthermore, the effects of US on fracture healing at present parameters might not be confined locally.
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Affiliation(s)
- Chien-Hung Lai
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Wu F, Shao ZY, Zhai BJ, Zhao CL, Shen DM. Ultrasound reverses multidrug resistance in human cancer cells by altering gene expression of ABC transporter proteins and Bax protein. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:151-159. [PMID: 21084157 DOI: 10.1016/j.ultrasmedbio.2010.10.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 09/26/2010] [Accepted: 10/07/2010] [Indexed: 05/30/2023]
Abstract
Multidrug resistance (MDR) is the major obstacle to successful chemotherapy of human malignancies and strategies for overcoming MDR phenomena are still unavailable to clinical use. Previous results showed that ultrasound (US) exposure could make MDR cancer cells become more sensitive to anticancer drugs, and the physical parameters of US exposure could adjust the uptake and retention of rhodamine 123 in MDR cells. In this study, we investigated the mechanisms of therapeutic ultrasound as a physical approach to overcoming MDR in a multidrug resistant human hepatocarcinoma cell line (HepG2/ADM). Our results demonstrated that the percentage of P-glycoprotein(+) (P-gp), multidrug resistance-associated protein(+) (MRP) and lung resistance-related protein(+) (LRP) cells was 96.97% ± 2.41%, 20.84% ± 3.12% and 1.16% ± 0.59% in HepG2/ADM cells, and 62.84% ± 3.42%, 10.26% ± 1.18% and 3.05% ± 0.37% in US-exposed HepG2/ADM cells, respectively. A significant decrease in the number of P-gp(+) and MRP(+) cells was observed between US-exposed HepG2/ADM and HepG2/ADM cells (p < 0.05). Using RT-PCR technique, we found that US could significantly downregulate the expression of P-glycoprotein (P-gp) and (MRP) at the mRNA level in HepG2/ADM cells. Compared with the control, the percentage of apoptotic cell death was significantly increased in HepG2/ADM after ultrasound exposure. Using immunocytochemistry, the percentage of Bcl-2(+) and Bax(+) cells was 21.7% and 4.1% in the control, and 18.46% and 8.1% in the US-exposed cells, respectively. The percentage of Bax(+) cells was significantly higher in US-exposed HepG2/ADM cells (p < 0.05), suggesting that US exposure could lead to cellular apoptosis in HepG2/ADM cells. It is concluded that US exposure could reverse MDR in HepG2/ADM cells via decreasing P-gp and MRP levels and their mRNA expressions and increasing expression of Bax protein. It may lead to the development of a novel strategy of using a targeted, noninvasive physical approach for the induction of MDR reversal in cancer cells.
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Affiliation(s)
- Feng Wu
- Institute of Ultrasonic Engineering in Medicine, Chongqing Medical University, Chongqing, China.
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15
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Lai CH, Chen SC, Chiu LH, Yang CB, Tsai YH, Zuo CS, Chang WHS, Lai WF. Effects of low-intensity pulsed ultrasound, dexamethasone/TGF-beta1 and/or BMP-2 on the transcriptional expression of genes in human mesenchymal stem cells: chondrogenic vs. osteogenic differentiation. ULTRASOUND IN MEDICINE & BIOLOGY 2010; 36:1022-1033. [PMID: 20510190 DOI: 10.1016/j.ultrasmedbio.2010.03.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 03/17/2010] [Accepted: 03/17/2010] [Indexed: 05/29/2023]
Abstract
The effects of low-intensity pulsed ultrasound (LIPUS) on the differentiation of human mesenchymal stem cells (hMSCs) were investigated in this study. hMSCs were subjected to LIPUS with or without dexamethasone/transforming growth factor-beta1 (TD) or bone morphogenetic protein-2 (BMP-2) and the effects of this treatment were assessed. TD-treated hMSCs exhibited characteristic chondrogenic morphology and increased messenger RNA (mRNA) expression of chondrogenic markers and LIPUS enhanced the chondrogenic differentiation of hMSCs treated with TD. The expression of Runx2, an osteogenic transcription factor was not altered in either TD treatment group; however, a significant increase was detected in the LIPUS only group. The osteogenic appearance exhibited 3 days after LIPUS and/or BMP-2 treatment. Increases in the mRNA expression levels of osteogenic markers, Runx2 and ALP were also detected. There was no additive or altered effect with combined LIPUS and BMP-2 treatment. LIPUS alone can increase osteogenic differentiation of hMSCs and LIPUS enhances TD-mediated chondrogenic differentiation of hMSCs. Clinically, LIPUS may differentially influence bone vs. cartilage repair.
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Affiliation(s)
- Chien-Hung Lai
- Department of Biomedical Engineering, Chung Yuan Christian University, Chung Li, Taiwan, ROC.
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Ramanujam CL, Belczyk R, Zgonis T. Bone growth stimulation for foot and ankle nonunions. Clin Podiatr Med Surg 2009; 26:607-18. [PMID: 19778691 DOI: 10.1016/j.cpm.2009.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
During the last few decades, electrical current stimulation has gone from an investigational modality to an accepted method of treatment to assist with bone healing. This article provides an overview of electrical bone stimulation for nonunions in the foot and ankle.
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Affiliation(s)
- Crystal L Ramanujam
- Division of Podiatric Medicine and Surgery, Department of Orthopaedic Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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