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Deichsel A, Glasbrenner J, Raschke MJ, Klimek M, Peez C, Briese T, Herbst E, Kittl C. Interference screws manufactured from magnesium display similar primary stability for soft tissue anterior cruciate ligament graft fixation compared to a biocomposite material - a biomechanical study. J Exp Orthop 2023; 10:103. [PMID: 37815666 PMCID: PMC10564698 DOI: 10.1186/s40634-023-00663-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/20/2023] [Indexed: 10/11/2023] Open
Abstract
PURPOSE Biodegradable interference screws (IFS) can be manufactured from different biomaterials. Magnesium was previously shown to possess osteoinductive properties, making it a promising material to promote graft-bone healing in anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to compare IFS made from magnesium to a contemporary biocomposite IFS. METHODS In a porcine model of ACL reconstruction, deep porcine flexor tendons were trimmed to a diameter of 8 mm, sutured in Krackow technique, and fixed with either 8 × 30 mm biocomposite IFS (Bc-IFS) or 8 × 30 mm magnesium IFS (Mg-IFS) in an 8 mm diameter bone tunnel in porcine tibiae. Cyclic loading for 1000 cycles from 0 to 250 N was applied, followed by load to failure testing. Elongation, load to failure and stiffness of the tested constructs was determined. RESULTS After 1000 cycles at 250 N, elongation was 4.8 mm ± 1.5 in the Bc-IFS group, and 4.9 mm ± 1.5 in the Mg-IFS group. Load to failure was 649.5 N ± 174.3 in the Bc-IFS group, and 683.8 N ± 116.5 in the Mg-IFS group. Stiffness was 125.3 N/mm ± 21.9 in the Bc-IFS group, and 122.5 N/mm ± 20.3 in the Mg-IFS group. No significant differences regarding elongation, load to failure and stiffness between Bc-IFS and Mg-IFS were observed. CONCLUSION Magnesium IFS show comparable biomechanical primary stability in comparison to biocomposite IFS and may therefore be an alternative to contemporary biodegradable IFS.
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Affiliation(s)
- Adrian Deichsel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Münster, Germany
| | - Johannes Glasbrenner
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Münster, Germany
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Münster, Germany
| | - Matthias Klimek
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Münster, Germany
| | - Christian Peez
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Münster, Germany
| | - Thorben Briese
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Münster, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Münster, Germany
| | - Christoph Kittl
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Münster, Germany.
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Gibbs CM, Combs TN, Nelson BK, Kaufmann RA. Testing of a Novel Method for Securing Ligaments Against Bone During Simultaneous Medial and Lateral Elbow Ligament Reconstruction. J Hand Surg Am 2023:S0363-5023(23)00076-X. [PMID: 36966046 DOI: 10.1016/j.jhsa.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 01/18/2023] [Accepted: 02/08/2023] [Indexed: 03/27/2023]
Abstract
PURPOSE A ligament reconstruction method that simultaneously tensions the medial and lateral sides of the elbow and maintains tension with compression plates on the proximal ulna is proposed for the treatment of bidirectional elbow ligament instability. Graft slippage, catastrophic failure, and excessive displacement were evaluated. Biomechanical stability without graft slippage was hypothesized. METHODS Eight cadaveric ligament reconstruction simulations were created through the dissection of three cadaver arms. Each reconstruction was statically tested with 160 N in a manner where it was first augmented with an absorbable suture and then without. Then, 3 more ligament reconstruction simulations were created for dynamic testing with each undergoing testing at 80 N for 2,000 cycles at 2 Hz. Construct displacement and graft slippage were recorded for each load application. RESULTS No grafts failed catastrophically and no graft slippage was observed with either static or dynamic loading. Under static loading, the mean change in displacement between augmented and nonaugmented ligament reconstruction simulations was 28.7% ± 21% (augmented 3.95 ± 1.81 mm vs nonaugmented 4.89 ± 2.22 mm). The mean stiffness was 66.6 ± 26.6 N/mm for augmented and 64.6 ± 23.2 N/mm for nonaugmented simulations. With dynamic loading, the mean displacement for augmented graft ligament reconstruction simulations was 1.55 ± 0.16 mm compared with 2.18 ± 0.77 mm for nonaugmented reconstruction simulations. CONCLUSIONS This method of fixation to the proximal ulna for the simultaneous reconstruction of medial and lateral elbow ligaments successfully prevented graft slippage without excessive construct displacement during static and dynamic testing. Ligament augmentation with absorbable sutures decreased the construct displacement. CLINICAL RELEVANCE This ligament fixation method may be a viable alternative for the treatment of concomitant medial and lateral elbow instability.
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Affiliation(s)
| | | | | | - Robert A Kaufmann
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA.
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3
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Combs TN, Nelson BK, Jackucki M, Knopp B, Schneppendahl J, Moody D, Kaufmann RA. Testing of Novel Total Elbow Prostheses Using Active Motion Experimental Setup. J Hand Surg Am 2023; 48:312.e1-312.e10. [PMID: 34916115 DOI: 10.1016/j.jhsa.2021.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 07/19/2021] [Accepted: 10/06/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The goal of this study was to test a novel uncemented and unconstrained total elbow arthroplasty (Kaufmann total elbow) design that is stabilized through a ligament reconstruction. METHODS We quantified the implant stability after 25,000 cycles, which represents the time between implantation and when ligament and bone healing has occurred. We used an active motion experimental setup that applies tendon loads via pneumatic cylinders and reproduces the forearm-originating dynamic stabilizers of the elbow. The novel total elbow arthroplasty was actuated for 5,000 full flexion-extension cycles at 5 different shoulder positions. Four Sawbones and 4 cadaver elbows were employed. Angular laxity and implant stability were recorded prior to testing and after each 5,000-loading cycle. RESULTS Four Sawbones and 4 cadaver elbows were implanted with the uncemented total elbow arthroplasty and did not demonstrate fixation failure or substantial laxity after 25,000 cycles of loading imparted at different shoulder positions. CONCLUSIONS Our findings demonstrate that the Kaufmann total elbow replacement implanted into cadaver and Sawbones specimens did not exhibit fixation failure or excessive laxity after 25,000 cycles. CLINICAL RELEVANCE An uncemented, nonmechanically linked total elbow arthroplasty that gains component fixation using intramedullary screws and employs a ligament reconstruction to stabilize the elbow has the potential to be a valuable management option, particularly in younger patients.
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Affiliation(s)
| | | | | | | | - Johannes Schneppendahl
- Department of Orthopaedics and Trauma Surgery, University of Duesseldorf, Düsseldorf, Germany
| | | | - Robert A Kaufmann
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA.
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Maeztu Redin D, Caroux J, Rohan PY, Pillet H, Cermolacce A, Trnka J, Manassero M, Viateau V, Corté L. A wear model to predict damage of reconstructed ACL. J Mech Behav Biomed Mater 2022; 136:105426. [PMID: 36208581 DOI: 10.1016/j.jmbbm.2022.105426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/07/2022] [Accepted: 08/20/2022] [Indexed: 11/28/2022]
Abstract
Impingement with surrounding tissues is a major cause of failure of anterior cruciate ligament reconstruction. However, the complexity of the knee kinematics and anatomical variations make it difficult to predict the occurrence of contact and the extent of the resulting damage. Here we hypothesise that a description of wear between the reconstructed ligament and adjacent structures captures the in vivo damage produced with physiological loadings. To test this, we performed an in vivo study on a sheep model and investigated the role of different sources of damage: overstretching, excessive twist, excessive compression, and wear. Seven sheep underwent cranial cruciate ligament reconstruction using a tendon autograft. Necropsy observations and pull-out force measurements performed postoperatively at three months showed high variability across specimens of the extent and location of graft damage. Using 3D digital models of each stifle based on X-ray imaging and kinematics measurements, we determined the relative displacements between the graft and the surrounding bones and computed a wear index describing the work of friction forces underwent by the graft during a full flexion-extension movement. While tensile strain, angle of twist and impingement volume showed no correlation with pull-out force (ρ = -0.321, p = 0.498), the wear index showed a strong negative correlation (r = -0.902, p = 0.006). Moreover, contour maps showing the distribution of wear on the graft were consistent with the observations of damage during the necropsy. These results demonstrate that wear is a good proxy of graft damage. The proposed wear index could be used in implant design and surgery planning to minimise the risk of implant failure. Its application to sheep can provide a way to increase preclinical testing efficiency.
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Affiliation(s)
- Deyo Maeztu Redin
- Centre des Matériaux, Mines Paris, PSL University, Évry, France; Molecular, Macromolecular Chemistry and Materials, ESPCI Paris, PSL University, Paris, France.
| | - Julien Caroux
- Centre des Matériaux, Mines Paris, PSL University, Évry, France; Molecular, Macromolecular Chemistry and Materials, ESPCI Paris, PSL University, Paris, France
| | - Pierre-Yves Rohan
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
| | - Hélène Pillet
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
| | - Alexia Cermolacce
- Ecole Nationale Vétérinaire d'Alfort, Université Paris Est Sup, France
| | - Julien Trnka
- Ecole Nationale Vétérinaire d'Alfort, Université Paris Est Sup, France
| | - Mathieu Manassero
- Ecole Nationale Vétérinaire d'Alfort, Université Paris Est Sup, France; Laboratoire de Biologie, Bioingénierie et Bioimagerie Ostéo-Articulaire, UMR CNRS 7052, INSERM U1271, 75010, Paris, France
| | - Véronique Viateau
- Ecole Nationale Vétérinaire d'Alfort, Université Paris Est Sup, France; Laboratoire de Biologie, Bioingénierie et Bioimagerie Ostéo-Articulaire, UMR CNRS 7052, INSERM U1271, 75010, Paris, France
| | - Laurent Corté
- Centre des Matériaux, Mines Paris, PSL University, Évry, France; Molecular, Macromolecular Chemistry and Materials, ESPCI Paris, PSL University, Paris, France
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Early Clinical Outcomes of ACL Reconstruction Using Semitendinosus Tendon Combined with LARS Synthetic. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2845114. [PMID: 36238490 PMCID: PMC9553347 DOI: 10.1155/2022/2845114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/26/2022] [Accepted: 08/27/2022] [Indexed: 11/17/2022]
Abstract
Objective. To compare the early clinical outcomes of ACL reconstruction using the augmented semitendinosus tendon combined with LARS synthetic material and the autologous hamstring tendons. Methods. A total of 68 eligible patients with ACL rupture were reconstructed using either 4-strand autologous hamstring tendons, representing the control group, or the LARS synthetic material augmented grafts. The duration of postoperative swelling and recovery exercise was recorded. Lysholm and IKDC scores were used for evaluation of knee joint function. Lachman and pivot shift tests were conducted to evaluate stability. Results. The scores of the three knee functions in cases of the augmentation group were significantly higher than those of the control group 6 months after surgery (
). There were no significant differences in Tegner score in the two groups 12 months after surgery (
). In general, the augmentation group returned to exercise 12 weeks after surgery, while the control group required 30 weeks. Conclusions. The present study indicates that synthetic material augmentation grafts allow earlier return to exercise and display more satisfactory results compared with the control group.
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Khan MJ, Asif N, Aziz MH, Raza A, Anwar S, Nuhmani S, Alghadir AH, Khan M. Does an Adjustable-Loop Device Loosen following ACL Reconstruction with a Hamstring Graft? A Retrospective Study with a Follow-Up of Two Years. J Clin Med 2022; 11:jcm11133648. [PMID: 35806933 PMCID: PMC9267585 DOI: 10.3390/jcm11133648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022] Open
Abstract
Arthroscopic anatomic anterior cruciate ligament reconstruction (ACLR) is the gold standard treatment for an ACL tear and requires the use of fixed or adjustable-loop devices to fix a femoral-side graft. Although the adjustable mechanism is designed to provide one-way tensioning, there is a concern that the adjustable loop will loosen and lengthen during cyclic loads, creating graft laxity. The present paper is a retrospective study of patients who underwent ACLR with the fixation of a hamstring graft with an adjustable loop on the femoral side from November 2016 to October 2018. The knee’s functional outcome was evaluated using an International Knee Documentation Committee (IKDC) score, Lysholm score, Lachman test, and pivot shift test. The patients were assessed preoperatively and finally postoperatively after two years of surgery. Thirty-two patients were analyzed. Significant improvement was obtained in the final clinical outcome of the patients. Twenty-seven patients (84.4%) were Lachman negative, and twenty-eight patients (87.5%) were pivot shift test negative, the mean Lysholm score was 96.91, and the IKDC score was 91.47 (p < 0.001). There was no infection, graft failure, or flexion restriction. Arthroscopic ACLR with an adjustable-loop suspensory device is a successful fixation method for femoral-side graft fixation and offers a similar functional outcome as with fixed-loop devices.
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Affiliation(s)
- Mohammad Jesan Khan
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh 202002, Uttar Pradesh, India; (M.J.K.); (N.A.); (M.H.A.); (A.R.)
| | - Naiyer Asif
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh 202002, Uttar Pradesh, India; (M.J.K.); (N.A.); (M.H.A.); (A.R.)
| | - Mohd Hadi Aziz
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh 202002, Uttar Pradesh, India; (M.J.K.); (N.A.); (M.H.A.); (A.R.)
| | - Ariz Raza
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh 202002, Uttar Pradesh, India; (M.J.K.); (N.A.); (M.H.A.); (A.R.)
| | - Shahzad Anwar
- Department of TB and Chest, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh 202002, Uttar Pradesh, India;
| | - Shibili Nuhmani
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman bin Faisal University, Dammam 34221, Saudi Arabia;
| | - Ahmad H. Alghadir
- Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia;
| | - Masood Khan
- Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia;
- Correspondence: or ; Tel.: +966-11-469-8544
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Dehestani P, Farahmand F, Borjali A, Bashti K, Chizari M. Bone density may affect primary stability of anterior cruciate ligament reconstruction when organic core bone plug fixation technique used. J Exp Orthop 2022; 9:5. [PMID: 34989893 PMCID: PMC8739403 DOI: 10.1186/s40634-021-00441-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose Core Bone Plug Fixation (CBPF) technique is an implant-less methodology for ACL reconstruction. This study investigates the effect of bone density on CBPF stability to identify the bone quality that is likely to benefit from this technique. Methods Artificial blocks with 160 (Group 1), 240 (Group 2), and 320 (Group 3) kg/m3 densities were used to simulate human bone with diverse qualities. These groups are representative of the elderly, middle age and young people, respectively. A tunnel was made in each test sample using a cannulated drill bit which enabled harvesting the core bone plug intact. Fresh animal tendon grafts were prepared and passed through the tunnel, so the core bone was pushed in to secure the tendon. The fixation stability was tested by applying a cyclic load following by a pullout load until the failure occurred. The selected group was compared with interference screw fixation technique as a gold standard method in ACL reconstruction. Results The Group 2 stiffness and yield strength were significantly larger than Group 1. The graft slippage of Group 1 was significantly less than Group 3. The ultimate strengths were 310 N and 363 N, in Groups 2 and 3, significantly larger than that of Group 1. The ultimate strength in fixation by interference screw was 693.18 N, significantly larger than the bone plug method. Conclusions The stability of CBPF was greatly affected by bone density. This technique is more suitable for young and middle-aged people. With further improvements, the CBPF might be an alternative ACL reconstruction technique for patients with good bone quality. Clinical relevance The CBPF technique offers an implant-less organic ACL reconstruction technique with numerous advantages and likely would speed up the healing process by using the patient’s own bones and tissues rather than any non-biologic fixations.
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Affiliation(s)
- Pouya Dehestani
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Farzam Farahmand
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.,Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Borjali
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Kaveh Bashti
- Department of Orthopedics, Division of Knee Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Chizari
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.,School of Physics, Engineering and Computer Sciences, University of Hertfordshire, College Ln, Hatfield, AL10 9AB, UK
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Remnants-preserving ACL reconstruction using direct tendinous graft fixation: a new rat model. J Orthop Surg Res 2022; 17:7. [PMID: 34986843 PMCID: PMC8729105 DOI: 10.1186/s13018-021-02890-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) repair techniques are new emerging strategies prevailing, in selected cases, over standard reconstruction of the ACL with excision of its remnants. Mid-substance ACL tears represent a challenge for ACL repair techniques, and remnants-preserving ACL reconstruction (rp-ACLR) using an autograft remains the recommended treatment in this situation. However, morbidity associated with the autograft harvesting prompts the need for alternative surgical strategies based on the use of synthetic scaffolds. Relevant small animal models of mid-substance tears with ACL remnants preservation and reconstruction are necessary to establish the preliminary proof of concept of these new strategies. METHODS A rat model of rp-ACLR using a tendinous autograft after complete mid-substance ACL transection was established. Twelve weeks following surgery, clinical outcomes and knee joints were assessed through visual gait analysis, Lachman tests, thigh perimeter measurements, magnetic resonance imaging, micro-computed tomography, and histology, to evaluate the morbidity of the procedure, accuracy of bone tunnel positioning, ACL remnants fate, osteoarthritis, and autograft bony integration. Results were compared with those obtained with isolated ACL transection without reconstruction and to right non-operated knees. RESULTS AND DISCUSSION Most operated animals were weight-bearing the day following surgery, and no adverse inflammatory reaction has been observed for the whole duration of the study. Autograft fixation with cortical screws provided effective graft anchorage until sacrifice. Healing of the transected ACL was not observed in the animals in which no graft reconstruction was performed. rp-ACLR was associated with a reduced degeneration of the ACL remnants (p = 0.004) and cartilages (p = 0.0437). Joint effusion and synovitis were significantly lower in the reconstructed group compared to the transected ACL group (p = 0.004). Most of the bone tunnel apertures were anatomically positioned in the coronal and/or sagittal plane. The most deviated bone tunnel apertures were the tibial ones, located in median less than 1 mm posteriorly to anatomical ACL footprint center. CONCLUSION This study presents a cost-effective, new relevant and objective rat model associated with low morbidity for the preliminary study of bio-implantable materials designed for remnants-preserving ACL surgery after mid-substance ACL tear.
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Edwards JH, Jones GL, Herbert A, Fisher J, Ingham E. Integration and functional performance of a decellularised porcine superflexor tendon graft in an ovine model of anterior cruciate ligament reconstruction. Biomaterials 2021; 279:121204. [PMID: 34736146 PMCID: PMC8683753 DOI: 10.1016/j.biomaterials.2021.121204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 10/10/2021] [Accepted: 10/20/2021] [Indexed: 12/30/2022]
Abstract
The objective was to evaluate the performance of decellularised porcine superflexor tendon (pSFT) as an anterior cruciate ligament (ACL) reconstruction device. The ACL of adult sheep was reconstructed with decellularised pSFT or ovine allograft SFT and animals sacrificed at 4, 12 and 26 weeks (n = 4 per group) for biological evaluation and 26 weeks (n = 6) for biomechanical evaluation of the grafts. Both grafts showed good in vivo performance with no major differences at macroscopic evaluation post euthanasia. Histopathology revealed an inflammatory reaction to both grafts at 4 weeks, which reduced by 26 weeks. There was advanced cellular ingrowth from 12 weeks, ligamentisation of intra-articular grafts, ossification and formation of Sharpey's fibers at the graft/bone junctions. Immunohistochemistry showed that at 4 and 12 weeks, the host response was dominated by CD163+ M2 macrophages and a cell infiltrate comprising α-SMA + myofibroblasts, CD34+ and CD271+ progenitor cells. At 26 weeks the biomechanical properties of decellularised pSFT and oSFT grafts were comparable, with all grafts failing in the intra-articular region. This study provides new insight into constructive remodelling of tendons used for ACL replacement and evidence of integration and functional performance of a decellularised xenogeneic tendon with potential as an alternative for ACL reconstruction.
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Affiliation(s)
- Jennifer Helen Edwards
- Institute of Medical and Biological Engineering, School of Biomedical Sciences, University of Leeds, Leeds, LS2 9JT, UK; Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, LS2 9JT, UK.
| | - Gemma Louise Jones
- Institute of Medical and Biological Engineering, School of Biomedical Sciences, University of Leeds, Leeds, LS2 9JT, UK.
| | - Anthony Herbert
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, LS2 9JT, UK.
| | - John Fisher
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, LS2 9JT, UK.
| | - Eileen Ingham
- Institute of Medical and Biological Engineering, School of Biomedical Sciences, University of Leeds, Leeds, LS2 9JT, UK.
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Stodolak-Zych E, Ficek K, Wieczorek J, Kajor M, Gryń K, Rapacz-Kmita A, Rajca J, Kosenyuk Y, Stolarz M, Błażewicz S. Assessment of sheep knee joint after ACL replacement with Achilles tendon autograft and PLA-based implant. J Mech Behav Biomed Mater 2021; 125:104923. [PMID: 34753103 DOI: 10.1016/j.jmbbm.2021.104923] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 09/24/2021] [Accepted: 10/24/2021] [Indexed: 11/28/2022]
Abstract
In this study, we propose a new approach in the anterior cruciate ligament (ACL) replacement to provide stability and integration with bone tunnel. A polylactide (PLA)-based tubular implant was used to support the graft stabilization in femoral and tibial bones and to stimulate the healing process after (ACL) replacement on a sheep model. The ACL was replaced with an autologous Achilles tendon split graft. The tendon-to-bone healing in the model was analyzed after 6 and 12 weeks. Two groups of animals were compared, i.e. the group with the PLA-based implant used in the ACL replacement and the control group without the implant. The knee joints were mechanically and clinically evaluated, including the histopathology tests, to determine their stability and integrity. The results indicated that the bioresorbable PLA-based tubular implant may facilitate integration of the tendon graft with bone. Remodeling the allograft inside the implant improves the joint mobility from the first week of healing: no pathological changes were observed at the surgery site and in the animals' mobility. After 6 and 12 weeks of healing no significant changes in the mechanical parameters of the knee joint were observed, regarding the joint failure force, knee displacement, angular mobility range and joint stiffness. Relatively small values of the non-destructive tests in the knee displacement, already 6 weeks after surgery, indicated the early stabilization of the knee joint. The studies showed that the failure forces of knee joints after the ACL replacement with the PLA-based implant are lower than those of an intact joint, although their biomechanical features, including strain-at- failure, are similar. The biomechanical parameters of the knee joint were significantly improved due to the selected method of attaching the autograft ends to the femoral and tibial bone surfaces. After 12 weeks the intra-tunnel tendon-bone site with the PLA implant revealed the better tibia-femur joint mechanical stability, linear force-strain function and the decreasing strain-to-failure value, as compared to the control group.
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Affiliation(s)
- Ewa Stodolak-Zych
- Faculty of Materials Science and Ceramics, University of Science and Technology, 30-059, Krakow, Poland.
| | - Krzysztof Ficek
- The Jerzy Kukuczka Academy of Physical Education, 40-065, Katowice, Poland; Galen - Orthopaedics, 43-150, Bierun, Poland
| | | | - Maciej Kajor
- Medical University of Silesia, Ul. Medyków 18, 40-752, Katowice, Poland
| | - Karol Gryń
- Faculty of Materials Science and Ceramics, University of Science and Technology, 30-059, Krakow, Poland
| | - Alicja Rapacz-Kmita
- Faculty of Materials Science and Ceramics, University of Science and Technology, 30-059, Krakow, Poland
| | | | - Yuriy Kosenyuk
- National Research Institute of Animal Production, 32-083, Balice, Poland
| | | | - Stanisław Błażewicz
- Faculty of Materials Science and Ceramics, University of Science and Technology, 30-059, Krakow, Poland
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Pauly H, Fischenich K, Kelly D, Popat K, Easley J, Palmer RH, Haut Donahue TL. The Effect of Anterior Cruciate Ligament Reconstruction with an Electropsun Scaffold on Tibiofemoral Contact Mechanics. Ann Biomed Eng 2021; 49:3748-3759. [PMID: 34668099 DOI: 10.1007/s10439-021-02874-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 09/29/2021] [Indexed: 11/28/2022]
Abstract
Surgical reconstruction of the torn ACL is performed to restore native contact mechanics. Drawbacks to traditional ACL repair techniques motivate the development of a tissue engineered ACL scaffold. Our group has developed a hierarchical electrospun polycaprolactone (PCL) scaffold that consists of rolled nanofiber bundles attached at each end with solvent-case blocks of PCL. The goal of this study was to compare ovine cadaver tibiofemoral contact mechanics after ACL reconstruction with the electrospun scaffold to a clinically applicable ACL reconstruction with a soft tissue graft and the ACL transected condition (ACLX). In the ACLX group and after ACL reconstruction with either the electrospun scaffold or soft tissue graft, pressure sensors were inserted under the menisci. Loads up to 890 N were applied at various flexion angles. The scaffold performed the best at restoring contact mechanics in the medial hemijoint to that of the native ACL. The scaffold was good at maintaining a medial-lateral balance of pressures as in the native joint whereas the ACLX shifted pressure off the lateral and on to the medial hemijoint. While the ACL scaffold didn't restore mechanics to that of the native condition, it improved contact mechanics compared to the standard graft replacement and ACLX condition.
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Affiliation(s)
- Hannah Pauly
- School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Kristine Fischenich
- School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA.,Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Daniel Kelly
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Ketul Popat
- School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA.,Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Jeremiah Easley
- Clinical Sciences Department, Colorado State University, Fort Collins, CO, USA
| | - Ross H Palmer
- Clinical Sciences Department, Colorado State University, Fort Collins, CO, USA
| | - Tammy L Haut Donahue
- School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA. .,Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA. .,Department of Biomedical Engineering, University of Memphis, 330 Engineering Technology, Memphis, TN, 38114, USA.
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Aujla RS, Ebert JR, Annear PT. Anterior Cruciate Ligament Reconstruction Using Autologous Hamstrings Augmented With the Ligament Augmentation and Reconstruction System Versus Hamstrings Alone: A Comparative Cohort Study. Orthop J Sports Med 2021; 9:23259671211046631. [PMID: 34708141 PMCID: PMC8543570 DOI: 10.1177/23259671211046631] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/08/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Few studies have reported the return-to-sports (RTS) rate in patients after augmentation of autologous anterior cruciate ligament reconstruction (ACLR) with the Ligament Augmentation and Reconstruction System (LARS). PURPOSE/HYPOTHESIS The purpose of this study was to compare postoperative outcomes in patients who underwent ACLR with single-bundle 4-strand hamstring autograft either without augmentation (HA-ACLR group) or with LARS augmentation (AUG-ACLR group). It was hypothesized that clinical outcomes and RTS rates would be better in the AUG-ACLR group at the 1-year follow-up, with similar outcomes in both cohorts by 2 years. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients who underwent ACLR between April 2014 and December 2017 were included in the current comparative study if they were skeletally mature and had 1- and 2-year follow-up outcomes; patients with concomitant meniscal surgery were also included. Included were 66 patients with AUG-ACLR (mean age, 26.8 years; 67% male) and 130 patients with HA-ACLR (mean age, 27.5 years; 61% male). Subjective outcome measures included the International Knee Documentation Committee Subjective Knee Evaluation Form, Knee injury and Osteoarthritis Outcome Score, Lysholm scale, Tegner activity scale, and the Noyes sports activity rating scale. Objective measures included knee laxity, maximal isokinetic knee flexion and extension strength, and the results of 4 functional hop tests. RESULTS There were no significant differences between the study groups in age, sex distribution, body mass index, time to surgery, or number of concurrent meniscal surgeries. At the 1-year follow-up, the AUG-ACLR group had a significantly higher Tegner score (P = .001) and rates of RTS (P = .029) and return to preinjury level of sport (P = .003) compared with the HA-ACLR group. At the 2-year follow-up, there were no differences in these measures between groups. There were no between-group differences in other subjective outcomes, knee laxity, or strength and hop test results at either postoperative time point. There were also no differences in rerupture rates or other complications between the groups. CONCLUSION Patients with AUG-ACLR had higher 1-year postoperative Tegner scores and rates of RTS and preoperative sport level compared with the HA-ACLR group. The 2-year rerupture rate for the AUG-ACLR group was low, and no intra-articular inflammatory complications were noted.
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Affiliation(s)
- Randeep S. Aujla
- Perth Orthopaedic and Sports Medicine Centre, Perth, Western Australia, Australia
| | - Jay R. Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Crawley, Western Australia, Australia
- HFRC Rehabilitation Clinic, Nedlands, Western Australia, Australia
| | - Peter T. Annear
- Perth Orthopaedic and Sports Medicine Centre, Perth, Western Australia, Australia
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Daneshvarhashjin N, Chizari M, Mortazavi J, Rouhi G. Can the body slope of interference screw affect initial stability of reconstructed anterior cruciate ligament?: An in-vitro investigation. BMC Musculoskelet Disord 2021; 22:556. [PMID: 34144682 PMCID: PMC8214255 DOI: 10.1186/s12891-021-04446-8] [Citation(s) in RCA: 4] [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: 01/09/2021] [Accepted: 06/08/2021] [Indexed: 01/12/2023] Open
Abstract
Background Superior biomechanical performance of tapered interference screws, compared with non-tapered screws, with reference to the anterior cruciate ligament (ACL) reconstruction process, has been reported in the literature. However, the effect of tapered interference screw’s body slope on the initial stability of ACL is poorly understood. Thus, the main goal of this study was to investigate the effect of the interference screw’s body slope on the initial stability of the reconstructed ACL. Methods Based on the best screw-bone tunnel diameter ratios in non-tapered screws, two different tapered interference screws were designed and fabricated. The diameters of both screws were equal to bone tunnel diameter in one-third of their length from screw tip, then they were gradually increased by 1mm, in the lower slope (LSTIS), and 2 mm, in the higher slope (HSTIS) screws. To simulate the ACL reconstruction, sixteen soft tissue grafts were fixed, using HSTIS and LSTIS, in synthetic bone blocks. Through applying sub-failure cyclic incremental tensile load, graft-bone-screw construct’s stiffness and graft laxity in each cycle, also through applying subsequent step of loading graft to the failure, maximum load to failure, and graft’s mode of failure were determined. Accordingly, the performance of the fabricated interference screws was compared with each other. Results HSTIS provides a greater graft-bone-screw construct stiffness, and a lower graft laxity, compared to LSTIS. Moreover, transverse rupture of graft fibers for LSTIS, and necking of graft in the HSTIS group were the major types of grafts’ failure. Conclusions HSTIS better replicates the intact ACL’s behavior, compared to LSTIS, by causing less damage in graft’s fibers; reducing graft laxity; and increasing fixation stability. Nonetheless, finding the optimal slope remains as an unknown and can be the subject of future studies.
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Affiliation(s)
- Nazanin Daneshvarhashjin
- Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran.,Institute for Orthopaedic Research and Training, Department of Biomedical science, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Mahmoud Chizari
- Faculty of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.,School of Physics, Engineering and Computer Sciences, University of Hertfordshire, Hatfield, UK
| | - Javad Mortazavi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Rouhi
- Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran.
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Zhong H, Jin Y, Wu S, Liu Y. [Study on reconstruction of posterior cruciate ligament with autologous peroneus longus tendon under arthroscopy]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:166-170. [PMID: 33624468 DOI: 10.7507/1002-1892.202008051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To discuss the effectiveness of posterior cruciate ligament (PCL) reconstruction with autologous peroneus longus tendon under arthroscopy. Methods Between January 2016 and December 2018, 46 patients with PCL injuries were enrolled. There were 34 males and 12 females, with an average age of 40.7 years (range, 20-58 years). There were 43 cases of acute injury and 3 cases of old injury. The anterior drawer test and the posterior tibia sign were positive in 4 cases, the posterior drawer tests and the posterior tibia sign were positive in 46 cases, the varus stress tests were positive in 10 cases, and the valgus stress tests were positive in 6 cases. The difference of dial-test at 30° knee flexion between affected and healthy sides was (5.20±3.91)°. The tibia posterior displacement under posterior stress position was (12.03±2.38) mm. The Lysholm score of the knee joint was 36.68±7.89, the International Knee Documentation Committee (IKDC) score was 33.58±5.97, and the American Orthopaedic Foot and Ankle Association (AOFAS) score of the ankle joint was 97.60±1.85. PCL was reconstructed with autologous peroneus longus tendon under arthroscopy, and the combined meniscus injury, posterolateral complex injury, and anterior cruciate ligament injury were all treated according to the degree of injury. Results All incisions healed by first intention. Forty patients were followed up 12-26 months, with an average of 16.0 months. At last follow-up, the Lysholm score of the knee joint was 84.85±7.03, and the IKDC score was 87.13±6.27, which were significant different from preoperative ones ( t=-13.45, P=0.00; t= -39.12, P=0.00); the AOFAS score of ankle joint was 93.98±2.14, which was not significant different from preoperative one ( t=8.09, P=0.90). The tibia posterior displacement under posterior stress position was (2.75±1.76) mm and the difference of dial-test at 30° knee flexion between affected and healthy sides was (1.75±2.09)°, which were significant different from preoperative ones ( t=29.00, P=0.00; t=4.96, P=0.00). The posterior drawer test and the posterior tibia sign were positive in 1 case and negative in 39 cases; the anterior drawer test and the varus and valgus stress tests were all negative. Conclusion Reconstruction of PCL with autologous peroneus longus tendon under arthroscopy can significantly improve the stability and function of the knee joint, with satisfactory clinical results.
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Affiliation(s)
- Hehe Zhong
- Department of Joint Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563003, P.R.China
| | - Ying Jin
- Department of Joint Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563003, P.R.China
| | - Shuhong Wu
- Department of Joint Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563003, P.R.China
| | - Yi Liu
- Department of Joint Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563003, P.R.China
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Beisbayeva Z, Zhanbassynova A, Kulzhanova G, Mukasheva F, Erisken C. Change in Collagen Fibril Diameter Distribution of Bovine Anterior Cruciate Ligament upon Injury Can Be Mimicked in a Nanostructured Scaffold. Molecules 2021; 26:molecules26051204. [PMID: 33668154 PMCID: PMC7956598 DOI: 10.3390/molecules26051204] [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: 01/20/2021] [Revised: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 11/24/2022] Open
Abstract
More than 200,000 people are suffering from Anterior Cruciate Ligament (ACL) related injuries each year in the US. There is an unmet clinical demand for improving biological attachment between grafts and the host tissue in addition to providing mechanical support. For biological graft integration, it is important to provide a physiologically feasible environment for the host cells to enable them to perform their duties. However, behavior of cells during ACL healing and the mechanism of ACL healing is not fully understood partly due to the absence of appropriate environment to test cell behavior both in vitro and in vivo. This study aims at (i) investigating the change in fibril diameter of bovine ACL tissue upon injury and (ii) fabricating nanofiber-based scaffolds to represent the morphology and structure of healthy and injured ACL tissues. We hypothesized that distribution and mean diameter of ACL fibrils will be altered upon injury. Findings revealed that the collagen fibril diameter distribution of bovine ACL changed from bimodal to unimodal upon injury with subsequent decrease in mean diameter. Polycaprolactone (PCL) scaffold fiber diameter distribution exhibited similar bimodal and unimodal distribution behavior to qualitatively represent the cases of healthy and injured ACL, respectively. The native ACL tissue demonstrated comparable modulus values only with the aligned bimodal PCL scaffolds. There was significant difference between mechanical properties of aligned bimodal and unaligned unimodal PCL scaffolds. We believe that the results obtained from measurements of diameter of collagen fibrils of native bovine ACL tissue can serve as a benchmark for scaffold design.
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Affiliation(s)
- Zhuldyz Beisbayeva
- Department of Chemical and Materials Engineering, School of Engineering & Digital Sciences, Nazarbayev University, 53 Kabanbay Batyr, Nur-Sultan 010000, Kazakhstan; (Z.B.); (A.Z.); (F.M.)
| | - Ainur Zhanbassynova
- Department of Chemical and Materials Engineering, School of Engineering & Digital Sciences, Nazarbayev University, 53 Kabanbay Batyr, Nur-Sultan 010000, Kazakhstan; (Z.B.); (A.Z.); (F.M.)
| | - Gulzada Kulzhanova
- Department of Biological Sciences, Nazarbayev University, 53 Kabanbay Batyr, Nur-Sultan 010000, Kazakhstan;
| | - Fariza Mukasheva
- Department of Chemical and Materials Engineering, School of Engineering & Digital Sciences, Nazarbayev University, 53 Kabanbay Batyr, Nur-Sultan 010000, Kazakhstan; (Z.B.); (A.Z.); (F.M.)
| | - Cevat Erisken
- Department of Chemical and Materials Engineering, School of Engineering & Digital Sciences, Nazarbayev University, 53 Kabanbay Batyr, Nur-Sultan 010000, Kazakhstan; (Z.B.); (A.Z.); (F.M.)
- Correspondence:
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16
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Lai VJ, Reynolds AW, Kindya M, Konicek J, Akhavan S. The Use of Suture Augmentation for Graft Protection in ACL Reconstruction: A Biomechanical Study in Porcine Knees. Arthrosc Sports Med Rehabil 2020; 3:e57-e63. [PMID: 33615248 PMCID: PMC7879175 DOI: 10.1016/j.asmr.2020.08.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/22/2020] [Indexed: 12/01/2022] Open
Abstract
Purpose To biomechanically evaluate the use of the suture augmentation construct at time 0 of ACL reconstruction. Methods Eighty porcine knees underwent ACL reconstruction using 2 techniques for graft fixation: a single suspensory construct (SSC), performed with a femoral button and tibial interference screw; and a double suspensory construct (DSC), with a femoral and tibial button. Each fixation technique was performed on 40 porcine knees divided into 4 subgroups. The first group had a nonaugmented ACL reconstruction, the second group had an ACL reconstruction with suture augmentation, and the third and fourth groups were the same as the first and second groups, with the graft resected 80% to simulate graft weakening. Ultimate load, yield load, stiffness, cyclic displacement values, and mode of failure were recorded for each graft. Results In a weakened graft model with 80% graft resection, there was a significant increase in ultimate strength (P < .001), yield strength (P < .001), and cyclic displacement (P < .001) with suture augmentation. There was no significant increase in stiffness with suture augmentation with either construct (P = .278). In the setting of an intact graft, there were no differences in either SSC or DCS groups with or without suture augmentation. Conclusions The addition of a suture to ACL reconstruction techniques resulted in minimal changes in baseline biomechanical characteristics while improving ultimate load, yield load, and cyclic displacement in a weakened graft model. Clinical Relevance Suture augmentation of ACL reconstruction may confer improved integrity of the graft and is worth consideration and future clinical study.
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Affiliation(s)
- Vince J Lai
- Department of Orthopaedic Surgery, Allegheny Health Network, Pittsburgh, Pennsylvania, U.S.A
| | - Alan W Reynolds
- Department of Orthopaedic Surgery, Allegheny Health Network, Pittsburgh, Pennsylvania, U.S.A
| | - Michael Kindya
- Orthopaedic Associates of Osceola, Kissimmee, Florida, U.S.A
| | | | - Sam Akhavan
- Department of Orthopaedic Surgery, Allegheny Health Network, Pittsburgh, Pennsylvania, U.S.A
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17
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He X, Li Y, Guo J, Xu J, Zu H, Huang L, Tim-Yun Ong M, Shu-Hang Yung P, Qin L. Biomaterials developed for facilitating healing outcome after anterior cruciate ligament reconstruction: Efficacy, surgical protocols, and assessments using preclinical animal models. Biomaterials 2020; 269:120625. [PMID: 33395579 DOI: 10.1016/j.biomaterials.2020.120625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 12/17/2022]
Abstract
Anterior cruciate ligament (ACL) reconstruction is the recommended treatment for ACL tear in the American Academy of Orthopaedic Surgeons (AAOS) guideline. However, not a small number of cases failed because of the tunnel bone resorption, unsatisfactory bone-tendon integration, and graft degeneration. The biomaterials developed and designed for improving ACL reconstruction have been investigated for decades. According to the Food and Drug Administration (FDA) and the International Organization for Standardization (ISO) regulations, animal studies should be performed to prove the safety and bioeffect of materials before clinical trials. In this review, we first evaluated available biomaterials that can enhance the healing outcome after ACL reconstruction in animals and then discussed the animal models and assessments for testing applied materials. Furthermore, we identified the relevance and knowledge gaps between animal experimental studies and clinical expectations. Critical analyses and suggestions for future research were also provided to design the animal study connecting basic research and requirements for future clinical translation.
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Affiliation(s)
- Xuan He
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory of Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Ye Li
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory of Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Jiaxin Guo
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory of Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Jiankun Xu
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory of Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Haiyue Zu
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory of Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Le Huang
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory of Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Michael Tim-Yun Ong
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory of Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Patrick Shu-Hang Yung
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory of Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Ling Qin
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory of Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
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Smith PA, Stannard JP, Bozynski CC, Kuroki K, Cook CR, Cook JL. Patellar Bone-Tendon-Bone Autografts versus Quadriceps Tendon Allograft with Synthetic Augmentation in a Canine Model. J Knee Surg 2020; 33:1256-1266. [PMID: 31461759 DOI: 10.1055/s-0039-1695040] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Patellar bone-tendon-bone (pBTB) autografts are often considered the "gold standard" for complete anterior cruciate ligament (ACL) reconstruction and are also associated with significant complications and early-onset knee osteoarthritis (OA). A novel quadriceps tendon allograft with synthetic augmentation, or "internal brace" (QTIB), has been reported to have potential advantages for ACL reconstruction based on animal model data. In this preclinical canine comparison study, we hypothesized that QTIB allograft compared with pBTB autograft would provide superior durability for knee stability, function, and prevention of OA. Under approval from our Institutional Animal Care and Use Committee, adult purpose-bred research hounds (n = 10) underwent arthroscopic complete transection of the ACL followed by either an arthroscopic-assisted all-inside ACL reconstruction using the QTIB allograft (n = 5) or pBTB autograft (n = 5). Contralateral knees were used as nonoperated controls (n = 10). Radiographic and arthroscopic assessments were performed at 2 and 6 months, respectively, after surgery. Anterior drawer, internal rotation, lameness, kinetics, pain, effusion, and comfortable range of knee motion were measured at 2, 3, and 6 months. Biomechanical and histologic assessments were performed at 6 months. All reconstructed knees were stable and had intact ACL grafts 6 months after surgery. At 6 months, QTIB reconstructed knees had significantly less lameness, lower pain, less effusion, and increased range of motion when compared with BTB knees (p < 0.05). BTB knees had significantly higher radiographic OA scores than QTIB knees at 6 months (p < 0.05). Superior outcomes associated with QTIB allograft may be due to the lack of donor site morbidity, the use of a robust tendon graft, and/or protection of the graft from the synthetic augmentation. Robust tendon grafts combined with a synthetic internal brace and platelet-rich plasma (PRP) may allow for more rapid and robust tendon-bone healing and graft "ligamentization," which protects the graft from early failure and rapid OA development that can plague commonly-used allografts.
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Affiliation(s)
- Patrick A Smith
- Department of Orthopedic Surgery, University of Missouri, Columbia, Missouri.,Department of Orthopedic Surgery, Columbia Orthopedic Group, Columbia, Missouri
| | - James P Stannard
- Department of Orthopedic Surgery, University of Missouri, Columbia, Missouri.,Thompson Laboratory for Regenerative Orthopedics, University of Missouri, Columbia, Missouri
| | - Chantelle C Bozynski
- Department of Orthopedic Surgery, University of Missouri, Columbia, Missouri.,Thompson Laboratory for Regenerative Orthopedics, University of Missouri, Columbia, Missouri
| | - Keiichi Kuroki
- Thompson Laboratory for Regenerative Orthopedics, University of Missouri, Columbia, Missouri
| | - Cristi R Cook
- Department of Orthopedic Surgery, University of Missouri, Columbia, Missouri.,Thompson Laboratory for Regenerative Orthopedics, University of Missouri, Columbia, Missouri
| | - James L Cook
- Department of Orthopedic Surgery, University of Missouri, Columbia, Missouri.,Thompson Laboratory for Regenerative Orthopedics, University of Missouri, Columbia, Missouri
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19
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吴 市, 林 文, 徐 伟, 李 洪. [Clinical study on reconstruction of posterior cruciate ligament with platelet rich plasma combined with 3-strand peroneus longus tendons]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:713-719. [PMID: 32538561 PMCID: PMC8171524 DOI: 10.7507/1002-1892.201910115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/21/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the effectiveness of the reconstruction of posterior cruciate ligament (PCL) with platelet rich plasma (PRP) and 3-strand peroneal longus tendons under arthroscope. METHODS Between June 2014 and December 2017, 58 patients with PCL rupture were randomly divided into two groups: the trial group (PRP assisted reconstruction of 3-strand peroneal longus tendons) and the control group (4-strand hamstring tendon reconstruction alone), 29 cases in each group. There was no significant difference in gender, age, injury side, Kellgren-Lawrence grade, time from injury to operation, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, International Knee Documentation Committee (IKDC) score, Lysholm score between the two groups ( P>0.05). Before operation, at 3 months and 12 months after operation, the IKDC score and Lysholm score of the two groups were recorded to evaluate the knee joint function, AOFAS ankle-hindfoot score was used to evaluate ankle function; KT-2000 examination (knee flexion of 90°, 30 lbs) was used to evaluate the difference of bilateral knee joint posterior relaxation at 12 months after operation, and MRI was used to evaluate ligament reconstruction; CT was used to evaluate the bone tunnel expansion of femur and tibia at 3 months and 12 months after operation. RESULTS The operation was completed successfully in both groups, there was no complication in the donor tendon area. All the incisions healed by first intention. All the patients were followed up for more than 1 year. The follow-up time of the trial group was 13-17 months, with an average of 15.0 months; that of the control group was 15-20 months, with an average of 15.4 months. At 3 and 12 months after operation, there was no significant difference in AOFAS ankle-hindfoot score when compared with preoperative score and between the two groups ( P>0.05). At 3 and 12 months after operation, the IKDC score and Lysholm score of the two groups were significantly improved, and further improvement was found at 12 months when compared with at 3 months ( P<0.05); the scores in the trial group were significantly better than those of the control group ( P<0.05). At 12 months after operation, the difference of the posterior relaxation of the bilateral knees in the trial group was less than 5 mm in 27 cases, 6-10 mm in 2 cases; in the control group was less than 5 mm in 20 cases, 6-10 mm in 6 cases, and >10 mm in 3 cases; the difference between the two groups was not significant ( Z=0.606, P=0.544). At 12 months after operation, MRI of knee joint showed that all patients had good PCL graft. The MRI score of the trial group was better than that of the control group ( t=2.425, P=0.019). CT examination at 3 and 12 months after operation showed that the bone tunnel expansion of femur and tibia in the trial group were significantly better than those in the control group ( P<0.05). CONCLUSION PRP combined with 3-stand peroneal longus tendons can significantly improve the function and stability of knee joint, effectively promote graft remodeling, and promote tendon bone healing, reduce the expansion of bone tunnel. The effectiveness is satisfactory.
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Affiliation(s)
- 市春 吴
- 福建医科大学附属漳州市医院骨科(福建漳州 363000)Department of Orthopaedics, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou Fujian, 363000, P.R.China
| | - 文祥 林
- 福建医科大学附属漳州市医院骨科(福建漳州 363000)Department of Orthopaedics, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou Fujian, 363000, P.R.China
| | - 伟华 徐
- 福建医科大学附属漳州市医院骨科(福建漳州 363000)Department of Orthopaedics, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou Fujian, 363000, P.R.China
| | - 洪瀚 李
- 福建医科大学附属漳州市医院骨科(福建漳州 363000)Department of Orthopaedics, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou Fujian, 363000, P.R.China
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Beyzadeoglu T, Pehlivanoglu T, Yildirim K, Buldu H, Tandogan R, Tuzun U. Does the Application of Platelet-Rich Fibrin in Anterior Cruciate Ligament Reconstruction Enhance Graft Healing and Maturation? A Comparative MRI Study of 44 Cases. Orthop J Sports Med 2020; 8:2325967120902013. [PMID: 32128315 PMCID: PMC7036517 DOI: 10.1177/2325967120902013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 09/28/2019] [Indexed: 01/03/2023] Open
Abstract
Background: Anterior cruciate ligament (ACL) reconstruction performed with growth factors
and activated platelets has been suggested to accelerate tendon
ligamentization, leading to earlier return to daily activities and
sports. Hypotheses: Platelet-rich fibrin (PRF) will result in improved graft maturation and
healing as evaluated by magnetic resonance imaging (MRI) in patients
undergoing hamstring ACL reconstruction. Hemostatic and analgesic properties
of PRF will lead to less postoperative blood loss and pain. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 44 patients with isolated ACL injuries who underwent arthroscopic
all-inside anatomic single-bundle ACL reconstruction with semitendinosus
tendon graft were enrolled. Group 1 included 23 patients who had PRF sprayed
to the surface of the graft; group 2 included 21 patients for whom no PRF
was used. Patients were discharged after 24 hours and examined for
hemarthrosis that needed to be aspirated. MRI was performed at the fifth
postoperative month. A blinded radiologist evaluated graft maturation
according to its signal intensity and the presence of synovial fluid at the
tunnel-graft interface. Results: PRF-treated grafts demonstrated lower MRI signal intensity and less fluid in
the graft-tunnel interface as compared with controls for the entire length
of the graft. The mean full-length MRI signal intensities were 9.19 versus
16.59 (P = .047) for groups 1 and 2, respectively. Subgroup
analysis of the semitendinosus grafts demonstrated a signal intensity of
11.57 versus 23.98 (P = .044) for the proximal third, 9.53
versus 13.83 (P = .237) for the midbody, and 6.48 versus
11.98 (P = .087) for the distal third. Synovial fluid at
the graft-tunnel interface was detected in 1 patient in group 1 (4.3%) and 3
patients in group 2 (14.3%; P < .001). Patients in group
1 had significantly less hemarthrosis that needed to be aspirated
(P = .003), while postoperative analgesia requirements
were similar in both groups (P = .08). No clinical benefit
of PRF could be demonstrated in clinical outcomes. Conclusion: Application of PRF led to superior graft integration and maturation in the
proximal third of the ACL graft. There was no significant difference in MRI
signal intensity in the midbody or distal tibial graft. Application of PRF
also resulted in significantly lower rates of postoperative hemarthrosis
that needed to be aspirated.
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Affiliation(s)
- Tahsin Beyzadeoglu
- Beyzadeoglu Clinic, Department of Orthopaedics and Traumatology, Istanbul, Turkey.,Department of Sports Medicine, Faculty of Health Sciences, Halic University, Istanbul, Turkey
| | - Tuna Pehlivanoglu
- Department of Orthopaedic Surgery and Traumatology, Istanbul Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Kerem Yildirim
- Beyzadeoglu Clinic, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Halil Buldu
- Beyzadeoglu Clinic, Department of Orthopaedics and Traumatology, Istanbul, Turkey.,Department of Sports Medicine, Faculty of Health Sciences, Halic University, Istanbul, Turkey
| | - Reha Tandogan
- Cankaya Ortopedi, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Umit Tuzun
- Department of Radiology, Sonomed Imaging Center, Istanbul, Turkey
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21
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Götschi T, Rosenberg G, Li X, Zhang C, Bachmann E, Snedeker JG, Fucentese SF. Biomechanical Evaluation of a Novel Loop Retention Mechanism for Cortical Graft Fixation in ACL Reconstruction. Orthop J Sports Med 2020; 8:2325967120904322. [PMID: 32133387 PMCID: PMC7042561 DOI: 10.1177/2325967120904322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/08/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Implant fixation by means of a cortical fixation device (CFD) has become a routine procedure in anterior cruciate ligament reconstruction. There is no clear consensus whether adjustable-length CFDs are more susceptible to loop lengthening when compared with pretied fixed-length CFDs. PURPOSE To assess biomechanical performance measures of 3 types of CFDs when subjected to various loading protocols. STUDY DESIGN Controlled laboratory study. METHODS Three types of CFDs underwent biomechanical testing: 1 fixed length and 2 adjustable length. One of the adjustable-length devices is based on the so-called finger trap mechanism, and the other is based on a modified sling lock mechanism. A device-only test of 5000 cycles (n = 8 per group) and a tendon-device test of 1000 cycles (n = 8 per group) with lower and upper force limits of 50 and 250 N, respectively, were applied, followed by ramp-to-failure testing. Adjustable-length devices then underwent further cyclic testing with complete loop unloading (n = 5 per group) at each cycle, as well as fatigue testing (n = 3 per group) over a total of 1 million cycles. Derived mechanical parameters were compared among the devices for statistical significance using Kruskal-Wallis analysis of variance followed by post hoc Mann-Whitney U testing with Bonferroni correction. RESULTS All CFDs showed elongation <2 mm after 5000 cycles when tested in an isolated manner and withstood ultimate tensile forces in excess of estimated peak in vivo forces. In both device-only and tendon-device tests, differences in cyclic performance were found among the devices, favoring adjustable-length fixation devices over the fixed-length device. Completely unloading the suspension loops, however, led to excessive loop lengthening of the finger trap device, whereas the modified sling lock device remained stable throughout the test. The fixed-length device displayed superior ultimate strength over both adjustable-length devices. Both adjustable-length devices showed adequate fatigue behavior during high-cyclic testing. CONCLUSION All tested devices successfully prevented critical construct elongation when tested with constant tension and withstood ultimate loads in excess of estimated in vivo forces during the rehabilitation phase. The finger trap device gradually lengthened excessively when completely unloaded during cyclic testing. CLINICAL RELEVANCE Critical loop lengthening may occur if adjustable-length devices based on the finger trap mechanism are repeatedly unloaded in situ.
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Affiliation(s)
- Tobias Götschi
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
- Department of Orthopedics, Balgrist University Hospital, Zurich,
Switzerland
| | | | - Xiang Li
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Chen Zhang
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
- Department of Orthopedics, Second Affiliated Hospital of Xi’an
Jiaotong University, Xi’an, China
| | - Elias Bachmann
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
- Department of Orthopedics, Balgrist University Hospital, Zurich,
Switzerland
| | - Jess G. Snedeker
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
- Department of Orthopedics, Balgrist University Hospital, Zurich,
Switzerland
| | - Sandro F. Fucentese
- Department of Orthopedics, Second Affiliated Hospital of Xi’an
Jiaotong University, Xi’an, China
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22
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Singh S, Shaunak S, Shaw SCK, Anderson JL, Mandalia V. Adjustable Loop Femoral Cortical Suspension Devices for Anterior Cruciate Ligament Reconstruction: A Systematic Review. Indian J Orthop 2020; 54:426-443. [PMID: 32549958 PMCID: PMC7270319 DOI: 10.1007/s43465-019-00022-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/19/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury is a common sports injury. Symptomatic knee instability after this injury is usually treated operatively through ACL reconstruction. The surgery involves a tendon graft being fixed in bony tunnels drilled through femur and tibia. The fixation of the graft is of critical importance to achieving good results. One of the commonest devices used to fix the graft in the femoral bony tunnel is a fixed loop cortical suspensory device. More recently, adjustable loop cortical suspension devices have been introduced, and have gained popularity for ACL reconstruction. These allow for adjusting the length of the suspension loop after insertion. There is currently much debate concerning whether the adjustable loop devices are superior or inferior to the fixed loop devices. PURPOSE To critique and review the current biomechanical and clinical evidence on the use of adjustable loop devices in hamstring ACL reconstruction. To our knowledge, there have been no previous reviews of this topic. STUDY DESIGN Systematic review. METHODS This systematic review was conducted in accordance with PRISMA. Five databases were searched using multiple search terms and MeSH terms where possible. The following limits were applied: papers published in English and papers published in the last 21 years. RESULTS Eleven laboratory and six clinical studies were reviewed. The laboratory-based studies have frequently shown elongation of adjustable loop devices to more than 3 mm under loading protocols, whereas the clinical studies have not shown any significant differences between the patients with fixed loop and the ones with adjustable loop devices. CLINICAL SIGNIFICANCE This review shows a discrepancy between laboratory-based and clinical studies. The review of clinical studies in our paper would give future researchers confidence and act as a prompt to construct randomised clinical trials to investigate these devices further. CONCLUSION We feel that more robust clinical randomised studies and trials are needed to evaluate these new devices.
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Affiliation(s)
- Sarvpreet Singh
- Department of Trauma and Orthopaedics, North West Anglia NHS Foundation Trust, Cambridgeshire, UK
| | | | - Sebastian C. K. Shaw
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, East Sussex UK
| | | | - Vipul Mandalia
- Western Sussex Hospitals NHS Foundation Trust, West Sussex, UK
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23
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Patel NA, Choi JH, Wang D. Tibial Fixation Techniques for Soft-Tissue Grafts in Anterior Cruciate Ligament Reconstruction. JBJS Rev 2019; 7:e7. [PMID: 31880625 DOI: 10.2106/jbjs.rvw.19.00047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Nilay A Patel
- Department of Orthopaedic Surgery, University of California Irvine, Orange, California
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24
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Ficek K, Rajca J, Stolarz M, Stodolak-Zych E, Wieczorek J, Muzalewska M, Wyleżoł M, Wróbel Z, Binkowski M, Błażewicz S. Bioresorbable Stent in Anterior Cruciate Ligament Reconstruction. Polymers (Basel) 2019; 11:polym11121961. [PMID: 31795412 PMCID: PMC6960761 DOI: 10.3390/polym11121961] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/19/2019] [Accepted: 11/25/2019] [Indexed: 11/16/2022] Open
Abstract
The exact causes of failure of anterior cruciate ligament (ACL) reconstruction are still unknown. A key to successful ACL reconstruction is the prevention of bone tunnel enlargement (BTE). In this study, a new strategy to improve the outcome of ACL reconstruction was analyzed using a bioresorbable polylactide (PLA) stent as a catalyst for the healing process. The study included 24 sheep with 12 months of age. The animals were randomized to the PLA group (n = 16) and control group (n = 8), subjected to the ACL reconstruction with and without the implantation of the PLA tube, respectively. The sheep were sacrificed 6 or 12 weeks post-procedure, and their knee joints were evaluated by X-ray microcomputed tomography with a 50 μm resolution. While the analysis of tibial and femoral tunnel diameters and volumes demonstrated the presence of BTE in both groups, the enlargement was less evident in the PLA group. Also, the microstructural parameters of the bone adjacent to the tunnels tended to be better in the PLA group. This suggested that the implantation of a bioresorbable PLA tube might facilitate osteointegration of the tendon graft after the ACL reconstruction. The beneficial effects of the stent were likely associated with osteogenic and osteoconductive properties of polylactide.
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Affiliation(s)
- Krzysztof Ficek
- Department of Science, Innovation and Development, Galen-Orthopaedics, 43-150 Bierun, Poland; (K.F.); (M.S.)
- Department of Physiotherapy, Academy of Physical Education, 40-065 Katowice, Poland
| | - Jolanta Rajca
- Department of Science, Innovation and Development, Galen-Orthopaedics, 43-150 Bierun, Poland; (K.F.); (M.S.)
- Correspondence:
| | - Mateusz Stolarz
- Department of Science, Innovation and Development, Galen-Orthopaedics, 43-150 Bierun, Poland; (K.F.); (M.S.)
- Department of Orthopedics and Traumatology, City Hospital in Zabrze, 41-803 Zabrze, Poland
| | - Ewa Stodolak-Zych
- Department of Biomaterials and Composites, Faculty of Materials Science and Ceramics, AGH University of Science and Technology, 30-059 Krakow, Poland; (E.S.-Z.); (S.B.)
| | - Jarosław Wieczorek
- University Center of Veterinary Medicine UJ-UR, University of Agriculture in Krakow, 30-059 Krakow, Poland;
| | - Małgorzata Muzalewska
- Institute of Fundamentals of Machinery Design, Faculty of Mechanical Engineering, Silesian University of Technology, 44-100 Gliwice, Poland; (M.M.); (M.W.)
| | - Marek Wyleżoł
- Institute of Fundamentals of Machinery Design, Faculty of Mechanical Engineering, Silesian University of Technology, 44-100 Gliwice, Poland; (M.M.); (M.W.)
| | - Zygmunt Wróbel
- Institute of Biomedical Engineering, Faculty of Science and Technology, University of Silesia, 41-205 Sosnowiec, Poland;
| | - Marcin Binkowski
- X-ray Microtomography Lab, Department of Computer Biomedical Systems, Institute of Computer Science, Faculty of Computer and Materials Science, University of Silesia, 41-200 Sosnowiec, Poland;
| | - Stanisław Błażewicz
- Department of Biomaterials and Composites, Faculty of Materials Science and Ceramics, AGH University of Science and Technology, 30-059 Krakow, Poland; (E.S.-Z.); (S.B.)
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25
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Häberli J, Bieri KS, Aghayev E, Eggli S, Henle P. Dynamic intraligamentary stabilization of anterior cruciate ligament repair: hardware removal has no effect on knee laxity at 2-year follow-up. Arch Orthop Trauma Surg 2019; 139:639-644. [PMID: 30649589 DOI: 10.1007/s00402-019-03113-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Dynamic intraligamentary stabilization (DIS) stabilizes the knee joint during anterior cruciate ligament (ACL) healing. After 6 months, tibial hardware removal is offered to the patients if local discomfort at the implant site is present. AIM This study compared knee laxity and functional scores 2 years after DIS between patients with and without hardware removal. It is hypothesized that it does not affect ACL healing. MATERIALS AND METHODS The study retrospectively analyzed prospectively collected data from 173 patients with either hardware removal (n = 47) or no additional intervention (n = 126). Inverse probability of treatment weighting using the propensity score was applied to balance the groups for baseline characteristics. The primary outcome was the side-to-side difference in knee laxity measured with the rolimeter at manual maximum force (Δ-Lachman). Secondary outcomes were the pivot-shift test and subjective scores. RESULTS Mean age was 34 years in both groups, and female gender was 47% (hardware removal group) and 50% (control group), respectively. No significant differences were found for Δ-Lachman (p = 0.09), pivot-shift test (p = 0.41), and subjective scores (p > 0.10) two years after DIS. CONCLUSION Knee laxity 2 years after DIS in patients with tibial hardware removal and patients without hardware removal was not significantly different. The groups were also similar regarding all the assessed functional scores. This study confirms the hypothesis that the healing ACL resumes its stabilizing role, and the hardware can be removed beginning 6 months after surgery without adverse consequences for joint stability. LEVEL OF EVIDENCE Case-control study, Level III.
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Affiliation(s)
- Janosch Häberli
- Sonnenhof Orthopaedic Center, Buchserstrasse 30, 3006, Bern, Switzerland
| | - Kathrin Susan Bieri
- Swiss RDL, Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.
| | - Emin Aghayev
- Swiss RDL, Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.,Spine Center, Schulthess Klinik, Lennghalde 2, 8008, Zurich, Switzerland
| | - Stefan Eggli
- Sonnenhof Orthopaedic Center, Buchserstrasse 30, 3006, Bern, Switzerland
| | - Philipp Henle
- Sonnenhof Orthopaedic Center, Buchserstrasse 30, 3006, Bern, Switzerland
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26
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Pauly H, Kelly D, Popat K, Easley J, Palmer R, Haut Donahue TL. Mechanical properties of a hierarchical electrospun scaffold for ovine anterior cruciate ligament replacement. J Orthop Res 2019; 37:421-430. [PMID: 30474882 DOI: 10.1002/jor.24183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 10/30/2018] [Indexed: 02/04/2023]
Abstract
The anterior cruciate ligament (ACL) acts to stabilize the knee and prevent excessive motion of the tibia relative to the femur. Tears of the ACL are common and can result in pain and damage to surrounding tissues. Thus a torn ACL is often surgically replaced with an autograft or allograft material. Drawbacks to clinically available ACL grafts motivate the development of a tissue engineered ACL replacement. Our group has previously developed a polycaprolactone electrospun scaffold that mimics the hierarchical structure of the ACL. The goal of this study was to investigate the mechanical properties of the electrospun scaffold as an ACL replacement. Scaffold mechanical properties were assessed prior to implantation via stress relaxation and pull to failure testing. Following in vitro characterization, electrospun scaffolds and soft tissue grafts were implanted into ovine cadaver stifle joints as ACL replacements. Stifle joints with ACL replacements were tested via a simulated anterior drawer test as well as in situ stress relaxation and pull to failure tests and compared to stifle joints with the native ACL intact. Prior to implantation the scaffold matched the native ovine ACL well in the range of functional strains as evidenced by stress relaxation measures and the toe region stiffness. After implantation the scaffold was more similar to the native ACL than the soft tissue graft, particularly when it came to reducing joint laxity and matching stress relaxation measures. These results demonstrate that the electrospun scaffold has the potential to be a suitable material for ACL replacement. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:421-430, 2019.
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Affiliation(s)
- Hannah Pauly
- School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado
| | - Daniel Kelly
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.,Department of Mechanical and Manufacturing Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland.,Department of Anatomy, Royal College of Surgeons in Ireland, Dublin 2, Ireland.,Advanced Materials and Bioengineering Research Centre, Royal College of Surgeons in Ireland and Trinity College Dublin, Dublin, Ireland
| | - Ketul Popat
- School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado.,Department of Mechanical Engineering, Colorado State University, Fort Collins, Colorado
| | - Jeremiah Easley
- Clinical Sciences Department, Colorado State University, Fort Collins, Colorado
| | - Ross Palmer
- Clinical Sciences Department, Colorado State University, Fort Collins, Colorado
| | - Tammy L Haut Donahue
- School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado.,Department of Mechanical Engineering, Colorado State University, Fort Collins, Colorado.,Department of Biomedical Engineering, University of Massachusetts, 130 Natural Resources Rd., Amherst, Massachusetts 01003
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27
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Gwinner C, Jung TM, Schatka I, Weiler A. Posterior laxity increases over time after PCL reconstruction. Knee Surg Sports Traumatol Arthrosc 2019; 27:389-396. [PMID: 29968188 DOI: 10.1007/s00167-018-5035-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 06/25/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Restoration of posterior tibial translation (PTT) after reconstruction of the posterior cruciate ligament (PCL) is deemed necessary to restore physiological knee kinematics. However, current surgical techniques have failed to show a complete reduction of posterior laxity. It was hypothesized that early postoperative PTT increases over time. METHODS The study comprised of 46 patients (10 female, 36 male; 30 ± 9 years), who underwent PCL reconstruction in a single-surgeon series. Patients were evaluated by bilateral stress radiographs in a prospective manner preoperatively; at 3, 6, 12 and 24 months; and at a final follow-up (FFU) of at least 5 years. Covariants included age, gender, BMI, tibial slope (TS) and the number of operated ligaments. Two blinded observers reviewed all radiographs, evaluating the TS and the posterior tibial translation. RESULTS All patients were evaluated at a mean final follow-up of 102 (range 65-187) months. Mean side-to-side difference of the PTT significantly improved from preoperative to 3-month postoperative values (10.9 ± 3.1 vs. 3.6 ± 3.8 mm; P < 0.0001). The PTT increased to 4.6 ± 3.7 mm at 6 months, to 4.8 ± 3.3 mm at 12 months, to 4.8 ± 3.2 mm at 24 months, to 5.4 ± 3.4 mm at FFU. Consequently, there was a significant increase of PTT between 3-month and final follow-up (3.6 ± 3.8 vs. 5.4 ± 3.4 mm; P = 0.02). Flattening of the TS resulted in a significantly higher PTT compared to subjects with a high TS at 24 months and FFU. There was no significant influence by BMI, age, gender and the number of operated ligaments. CONCLUSIONS Early results after PCL reconstruction seem promising as posterior tibial translation is significantly improved. However, there is a significant increase in PTT from early postoperative values to the final follow-up of at least 5 years. This is particularly notable in patients with flattening of the TS. As a consequence, surgeons and patients need to be aware that initial posterior stability should not be equated with the final outcome. LEVEL OF EVIDENCE Cohort study, Level III.
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Affiliation(s)
- Clemens Gwinner
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Tobias M Jung
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Imke Schatka
- Center for Diagnostic and Interventional Radiology and Nuclear Medicine, Charité-University Medicine Berlin, Berlin, Germany
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28
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Hong CC, Lee WT, Murphy DP, Tan KJ. Anatomic Basis for Minimally Invasive Flexor Hallucis Longus Transfer in Chronic Achilles Tendon Rupture. J Foot Ankle Surg 2019; 57:938-941. [PMID: 29891130 DOI: 10.1053/j.jfas.2018.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Indexed: 02/03/2023]
Abstract
The present cadaveric study was designed to measure the flexor hallucis longus (FHL) tendon length and obtain anatomic data regarding the graft-to-tunnel length ratio in an interference screw fixation model for the FHL short-harvest single-incision technique to the calcaneus. Ten fresh-frozen paired cadaveric specimens were used for the FHL short-harvest technique. The length of the osseous tunnel in the calcaneus was measured. At harvesting of the FHL tendon, the length of the tendon that traverses the osseous tunnel was measured with the ankle in neutral and maximal plantarflexion from the tip of the osseous tunnel to the transected end of the tendon within the bone tunnel. The mean length of the osseous tunnel was 42.7 ± 2.3 (range 38 to 46) mm. With the ankle in neutral position, the mean length of the FHL tendon traversing the bone tunnel was 31 ± 1.7 (range 29 to 34) mm. This mean length increased to 38.8 ± 1.6 (range 36 to 41) mm with the ankle placed in maximal plantarflexion. The ratio of the mean length of the tendon graft to the mean length of the osseous tunnel with the ankle in neutral was 0.727 ± 0.046 (range 0.667 to 0.81), and the ratio was 0.91 ± 0.042 (range 0.864 to 0.976) when the ankle was maximally plantarflexed. To the best of our knowledge, we report for the first time that the short-harvest technique provides >70% (ratio 0.727) of the FHL tendon graft in the osseous tunnel at all times, even when then ankle is in neutral, resulting in sufficient tendon length for FHL tendon transfer to the calcaneus for chronic Achilles tendon rupture.
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Affiliation(s)
- Choon Chiet Hong
- Senior Resident, Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore.
| | - Wei Ting Lee
- Associate Consultant, Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore
| | - Diarmuid Paul Murphy
- Assistant Professor and Senior Consultant, Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore
| | - Ken Jin Tan
- Consultant, OrthoSports-Clinic for Orthopedic Surgery and Sports Medicine, Mt. Elizabeth Novena Specialist Centre, Singapore
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29
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Hanzlíková I, Richards J, Hébert-Losier K, Smékal D. The effect of proprioceptive knee bracing on knee stability after anterior cruciate ligament reconstruction. Gait Posture 2019; 67:242-247. [PMID: 30380509 DOI: 10.1016/j.gaitpost.2018.10.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/24/2018] [Accepted: 10/19/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Injury to the anterior cruciate ligament (ACL) is common among young athletes and can impact knee stability and control. Wearing proprioceptive knee braces can improve knee control and may reduce the risk factors associated with injury and re-injury, although the effect of such braces after ACL reconstruction (ACLR) is unclear. RESEARCH QUESTION This study aimed to determine the effect of proprioceptive knee bracing on knee control and subjective rating of participants post ACLR during three dynamic tasks. METHODS Fifteen participants 2-10 years post ACLR performed a slow step down, single leg drop jump, and pivot turn jump with and without a proprioceptive knee brace. Knee kinematics in the sagittal (flexion - extension), coronal (abduction - adduction), and transverse (internal - external rotation) planes were collected using a 3D infrared system. Paired t-tests were performed to explore differences in knee angles and angular velocities between the no brace and brace conditions during the three tasks. After each task, subjective ratings regarding ease of the task were recorded. RESULTS The brace reduced the peak knee external rotation angle and range of motion in the transverse plane during the pivot turn jump task, and significantly increased the maximum knee flexion angular velocity during the single leg drop jump task. The majority of participants reported that tasks were easier to perform with the proprioceptive brace than without. SIGNIFICANCE This study confirms that proprioceptive knee braces can significantly influence knee kinematics during dynamic tasks post ACLR. The observed effects were clinically relevant.
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Affiliation(s)
- I Hanzlíková
- Faculty of Physical Culture, Palacký University, Olomouc, Czech Republic; Faculty of Health, Sport and Human Performance, Adams Centre for High Performance, The University of Waikato, New Zealand.
| | - J Richards
- Allied Health Research Unit, University of Central Lancashire, United Kingdom
| | - K Hébert-Losier
- Faculty of Health, Sport and Human Performance, Adams Centre for High Performance, The University of Waikato, New Zealand
| | - D Smékal
- Faculty of Physical Culture, Palacký University, Olomouc, Czech Republic
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30
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Masuda H, Taketomi S, Inui H, Shimazaki N, Nishihara N, Toyooka S, Kawano H, Nakagawa T. Bone-to-bone integrations were complete within 5 months after anatomical rectangular tunnel anterior cruciate ligament reconstruction using a bone-patellar tendon-bone graft. Knee Surg Sports Traumatol Arthrosc 2018; 26:3660-3666. [PMID: 29663013 DOI: 10.1007/s00167-018-4938-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 04/04/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE Anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BTB) graft is known to provide secure fixation due to the direct bone-to-bone integration of the bone plug and bone tunnel. It is important to know the time required for bone integration when designing the postoperative rehabilitation protocol or deciding when the patient can return to competition-level activity, especially if the patient is an athlete. However, because reports are scarce, the period necessary for bone-to-bone integration after ACL reconstruction using a BTB graft remains unclear. The purpose of this study was to clarify this issue. It was hypothesised that ACL reconstruction using a BTB graft via an anatomical rectangular tunnel would help in the integration between bone plugs and bone tunnels on both the femoral and tibial sides after at least 6 months, at which point basic exercises similar to pre-injury sporting activity levels can be resumed. METHODS This study included 40 knees treated with ACL reconstruction using a BTB graft via anatomical rectangular tunnel reconstruction between 2013 and 2014 in a single institute. The integration between bone plugs and bone tunnels was evaluated using multi-slice tomosynthesis, which is a technique for producing slice images using conventional radiographic systems, at 1, 3, and 5 months postoperatively. All procedures were performed by two experienced surgeons. Bone integration was evaluated by two orthopaedic doctors. RESULTS The rates of integration of the bone plug and femoral bone tunnel on tomosynthesis at 1, 3, and 5 months postoperatively were 0, 55, and 100%, respectively. On the tibial side, the corresponding rates were 0, 75, and 100%, respectively. The rate of integration on the tibial side was significantly higher than that on the femoral side at 3 months postoperatively (p = 0.031). CONCLUSIONS Bone-to-bone integration on the femoral and tibial sides was complete within 5 months after surgery in all cases. Since the time required for bone integration is important in designing the postoperative rehabilitation approach, these results will serve as a useful guideline for planning rehabilitation protocols. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Hironari Masuda
- Department of Orthopaedic Surgery, Teikyo University, Kaga 2-11-1, Itabashi-ku, Tokyo, 117-0003, Japan
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Tokyo University, Tokyo, Japan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Tokyo University, Tokyo, Japan
| | | | - Nobuhiro Nishihara
- Department of Orthopaedic Surgery, Teikyo University, Kaga 2-11-1, Itabashi-ku, Tokyo, 117-0003, Japan
| | - Seikai Toyooka
- Department of Orthopaedic Surgery, Teikyo University, Kaga 2-11-1, Itabashi-ku, Tokyo, 117-0003, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Teikyo University, Kaga 2-11-1, Itabashi-ku, Tokyo, 117-0003, Japan
| | - Takumi Nakagawa
- Department of Orthopaedic Surgery, Teikyo University, Kaga 2-11-1, Itabashi-ku, Tokyo, 117-0003, Japan.
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Tsai PI, Chen CY, Huang SW, Yang KY, Lin TH, Chen SY, Sun JS. Improvement of bone-tendon fixation by porous titanium interference screw: A rabbit animal model. J Orthop Res 2018; 36:2633-2640. [PMID: 29727018 DOI: 10.1002/jor.24037] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 04/27/2018] [Indexed: 02/04/2023]
Abstract
The interference screw is a widely used fixation device in the anterior cruciate ligament (ACL) reconstruction surgeries. Despite the generally satisfactory results, problems of using interference screws were reported. By using additive manufacturing (AM) technology, we developed an innovative titanium alloy (Ti6 Al4 V) interference screw with rough surface and inter-connected porous structure designs to improve the bone-tendon fixation. An innovative Ti6 Al4 V interference screws were manufactured by AM technology. In vitro mechanical tests were performed to validate its mechanical properties. Twenty-seven New Zealand white rabbits were randomly divided into control and AM screw groups for biomechanical analyses and histological analysis at 4, 8, and 12 weeks postoperatively; while micro-CT analysis was performed at 12 weeks postoperatively. The biomechanical tests showed that the ultimate failure load in the AM interference screw group was significantly higher than that in the control group at all tested periods. These results were also compatible with the findings of micro-CT and histological analyses. In micro-CT analysis, the bone-screw gap was larger in the control group; while for the additive manufactured screw, the screw and bone growth was in close contact. In histological study, the bone-screw gaps were wider in the control group and were almost invisible in the AM screw group. The innovative AM interference screws with surface roughness and inter-connected porous architectures demonstrated better bone-tendon-implant integration, and resulted in stronger biomechanical characteristics when compared to traditional screws. These advantages can be transferred to future interference screw designs to improve their clinical performance. The AM interference screw could improve graft fixation and eventually result in better biomechanical performance of the bone-tendon-screw construct. The innovative AM interference screws can be transferred to future interference screw designs to improve the performance of implants. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2633-2640, 2018.
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Affiliation(s)
- Pei-I Tsai
- Department of Materials Science and Engineering, National Chiao-Tung University, Hsinchu City, Taiwan.,Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Chutung, Hsinchu County, Taiwan
| | - Chih-Yu Chen
- Department of Orthopedics, Shuang-Ho Hospital, College of Medicine, Taipei Medical University, New Taipei City, Taiwan
| | - Shu-Wei Huang
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Kuo-Yi Yang
- Material and Chemical Research Laboratories, Industrial Technology Research Institute, Chutung, Hsinchu County, Taiwan
| | - Tzu-Hung Lin
- Material and Chemical Research Laboratories, Industrial Technology Research Institute, Chutung, Hsinchu County, Taiwan
| | - San-Yuan Chen
- Department of Materials Science and Engineering, National Chiao-Tung University, Hsinchu City, Taiwan
| | - Jui-Sheng Sun
- Department of Orthopedic Surgery, College of Medicine, National Taiwan University Hospital, Taipei City, Taiwan
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Ettinger M, Karkosch R, Horstmann H, Savov P, Calliess T, Smith T, Petri M. Biomechanical properties of adjustable extracortical graft fixations in ACL reconstruction. J Exp Orthop 2018; 5:41. [PMID: 30269194 PMCID: PMC6163122 DOI: 10.1186/s40634-018-0154-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/13/2018] [Indexed: 11/16/2022] Open
Abstract
Background Reliable biomechanical data about the strength of different tibial extracortical graft fixation devices is sparse. This biomechanical study compares the properties of tibial graft fixation in ACL reconstruction with either the ACL Tight Rope™ or the Rigid Loop Adjustable™ device. The hypothesis was that both fixation devices would provide comparable results concerning gap formation during cyclic loading and ultimate failure load. Methods Sixteen sawbone tibiae (Sawbones™) underwent extracortical fixation of porcine flexor digitorum profundus grafts for ACL reconstruction. Either the ACL Tight Rope™ (Arthrex) or the Rigid Loop Adjustable™ (DePuy Mitek) fixation device were used, resulting in 2 groups with 8 specimens per group. Biomechanical analysis included pretensioning the constructs 10 times with 0.75 Hz, then cyclic loading of 1,000 position-controlled cycles and 1,000 force-controlled cycles applied with a servohydraulic testing machine. Elongation during cyclic loading was recorded. After this, ultimate failure load and failure mode analysis were performed. Results No statistically significant difference could be noted between the groups regarding gap formation during cyclic loading (4.6 ± 2.6 mm for the Rigid Loop Adjustable™ vs. 6.6 ± 1.5 mm for the ACL Tight Rope™ (p > 0.05)), and ultimate failure loads (980 ± 101.9 N for the Rigid Loop Adjustable™ vs. 861 ± 115 N ACL Tight Rope™ (p > 0.05)). Conclusion ACL Tight Rope™ and the Rigid Loop Adjustable™ fixation devices yield comparable biomechanical results for tibial extracortical graft fixation in ACL reconstruction. These findings may be of relevance for the future surgical decision-making in ACL reconstruction. Randomized controlled clinical trials comparing both fixation devices are desirable for the future.
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Affiliation(s)
- M Ettinger
- Orthopaedic Surgery Department, Hannover Medical School (MHH), Anna-von-Borries-Str. 1-7, D-30625, Hannover, Germany.
| | - R Karkosch
- Orthopaedic Surgery Department, Hannover Medical School (MHH), Anna-von-Borries-Str. 1-7, D-30625, Hannover, Germany
| | - H Horstmann
- Orthopaedic Surgery Department, Hannover Medical School (MHH), Anna-von-Borries-Str. 1-7, D-30625, Hannover, Germany
| | - P Savov
- Orthopaedic Surgery Department, Hannover Medical School (MHH), Anna-von-Borries-Str. 1-7, D-30625, Hannover, Germany
| | - T Calliess
- Orthopaedic Surgery Department, Hannover Medical School (MHH), Anna-von-Borries-Str. 1-7, D-30625, Hannover, Germany
| | - T Smith
- Orthopaedic Surgery Department, Hannover Medical School (MHH), Anna-von-Borries-Str. 1-7, D-30625, Hannover, Germany
| | - M Petri
- Orthopaedic Surgery Department, Hannover Medical School (MHH), Anna-von-Borries-Str. 1-7, D-30625, Hannover, Germany
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Offerhaus C, Albers M, Nagai K, Arner JW, Höher J, Musahl V, Fu FH. Individualized Anterior Cruciate Ligament Graft Matching: In Vivo Comparison of Cross-sectional Areas of Hamstring, Patellar, and Quadriceps Tendon Grafts and ACL Insertion Area. Am J Sports Med 2018; 46:2646-2652. [PMID: 30059247 DOI: 10.1177/0363546518786032] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recent literature correlated anterior cruciate ligament (ACL) reconstruction failure to smaller diameter of the harvested hamstring (HS) autograft. However, this approach may be a simplification, as relation of graft size to native ACL size is not typically assessed and oversized grafts may impart their own complications. PURPOSE To evaluate in vivo data to determine if the commonly used autografts reliably restore native ACL size. STUDY DESIGN Descriptive laboratory study. METHODS Intraoperative data of the tibial insertion area and HS graft diameter were collected and retrospectively evaluated for 46 patients who underwent ACL reconstruction with HS autografts. Magnetic resonance imaging measurements of the cross-sectional area (CSA) of the possible patellar tendon (PT) and quadriceps tendon (QT) autografts were also done for each patient. The percentages of tibial insertion site area restored by the 3 possible grafts were then calculated and compared for each individual. RESULTS The mean ACL tibial insertion area was 107.2 mm2 (60.5-155.5 mm2). The mean CSAs of PT, HS, and QT were 33.2, 55.3, and 71.4 mm2, respectively. When all grafts were evaluated, the percentage reconstruction of the insertion area varied from 16.2% to 123.1% on the tibial site and from 25.5% to 176.7% on the femoral site, differing significantly for each graft type ( P < .05). On average, 32.8% of the tibial insertion area would have been filled with PT, 53.6% by HS, and 69.5% by QT. Based on previous cadaveric studies indicating that graft size goal should be 50.2% ± 15% of the tibial insertion area, 82.7% of patients in the HS group were within this range (36.9%, QT; 30.5%, PT), while 65.2% in the PT group were below it and 60.9% in the QT group were above it. CONCLUSION ACL insertion size and the CSAs of 3 commonly used grafts vary greatly for each patient and are not correlated with one another. Thus, if the reconstructed ACL size is determined by the harvested autograft size alone, native ACL size may not be adequately restored. PT grafts tended to undersize the native ACL, while QT might oversize it. CLINICAL RELEVANCE These results may help surgeons in preoperative planning, as magnetic resonance imaging measurements can be helpful in determining individualized graft choice to adequately restore the native ACL.
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Affiliation(s)
- Christoph Offerhaus
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department for Trauma, Orthopaedics, Hand, and Reconstructive Surgery, HELIOS-Spital Überlingen, Überlingen, Germany.,Sportsclinic Cologne, University of Witten-Herdecke, Cologne, Germany
| | - Márcio Albers
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kanto Nagai
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Justin W Arner
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jürgen Höher
- Sportsclinic Cologne, University of Witten-Herdecke, Cologne, Germany
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Tan H, Wang D, Lebaschi AH, Hutchinson ID, Ying L, Deng XH, Rodeo SA, Warren RF. Comparison of Bone Tunnel and Cortical Surface Tendon-to-Bone Healing in a Rabbit Model of Biceps Tenodesis. J Bone Joint Surg Am 2018; 100:479-486. [PMID: 29557864 PMCID: PMC6221377 DOI: 10.2106/jbjs.17.00797] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Many orthopaedic surgical procedures involve reattachment of a single tendon to bone. Whether tendon-to-bone healing is better facilitated by tendon fixation within a bone tunnel or on a cortical surface is unknown. The purpose of this study was to evaluate tendon-healing within a bone tunnel compared with that on the cortical surface in a rabbit model of biceps tenodesis. METHODS Thirty-two rabbits (24 weeks of age) underwent unilateral proximal biceps tenodesis with tendon fixation within a bone tunnel (BT group) or on the cortical surface (SA [surface attachment] group). Postoperatively, rabbits were allowed free-cage activity without immobilization. All rabbits were killed 8 weeks after surgery. Healing was assessed by biomechanical testing, microcomputed tomography (micro-CT), and histomorphometric analysis. RESULTS Biomechanical testing demonstrated no significant difference between the groups in mean failure loads (BT: 56.8 ± 28.8 N, SA: 55.8 ± 14.9 N; p = 0.92) or stiffness (BT: 26.3 ± 16.6 N/mm, SA: 32.3 ± 9.6 N/mm; p = 0.34). Micro-CT analysis demonstrated no significant difference between the groups in mean volume of newly formed bone (BT: 69.3 ± 13.9 mm, SA: 65.5 ± 21.9 mm; p = 0.70) or tissue mineral density of newly formed bone (BT: 721.4 ± 10.9 mg/cm, SA: 698.6 ± 26.2 mg/cm; p = 0.07). On average, newly formed bone within the tunnel represented only 5% of the total new bone formed in the BT specimens. Histological analysis demonstrated tendon-bone interdigitation and early fibrocartilaginous zone formation on the outer cortical surface in both groups. In contrast, minimal tendon-bone bonding was observed within the tunnel in the BT specimens. CONCLUSIONS Tendon fixation in a bone tunnel and on the cortical surface resulted in similar healing profiles. For tendons placed within a bone tunnel, intratunnel healing was minimal compared with the healing outside the tunnel on the cortical surface. CLINICAL RELEVANCE The creation of large bone tunnels, which can lead to stress risers and increase the risk of fracture, may not be necessary for biceps tenodesis procedures.
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Affiliation(s)
- Hongbo Tan
- Laboratory for Joint Tissue Repair and Regeneration, Orthopaedic Soft Tissue Research Program (H.T., D.W., A.H.L., I.D.H., L.Y., X.-H.D., S.A.R., and R.F.W.) and Sports Medicine and Shoulder Service (D.W., S.A.R., and R.F.W.), Hospital for Special Surgery, New York, NY
| | - Dean Wang
- Laboratory for Joint Tissue Repair and Regeneration, Orthopaedic Soft Tissue Research Program (H.T., D.W., A.H.L., I.D.H., L.Y., X.-H.D., S.A.R., and R.F.W.) and Sports Medicine and Shoulder Service (D.W., S.A.R., and R.F.W.), Hospital for Special Surgery, New York, NY
| | - Amir H. Lebaschi
- Laboratory for Joint Tissue Repair and Regeneration, Orthopaedic Soft Tissue Research Program (H.T., D.W., A.H.L., I.D.H., L.Y., X.-H.D., S.A.R., and R.F.W.) and Sports Medicine and Shoulder Service (D.W., S.A.R., and R.F.W.), Hospital for Special Surgery, New York, NY
| | - Ian D. Hutchinson
- Laboratory for Joint Tissue Repair and Regeneration, Orthopaedic Soft Tissue Research Program (H.T., D.W., A.H.L., I.D.H., L.Y., X.-H.D., S.A.R., and R.F.W.) and Sports Medicine and Shoulder Service (D.W., S.A.R., and R.F.W.), Hospital for Special Surgery, New York, NY
| | - Liang Ying
- Laboratory for Joint Tissue Repair and Regeneration, Orthopaedic Soft Tissue Research Program (H.T., D.W., A.H.L., I.D.H., L.Y., X.-H.D., S.A.R., and R.F.W.) and Sports Medicine and Shoulder Service (D.W., S.A.R., and R.F.W.), Hospital for Special Surgery, New York, NY
| | - Xiang-Hua Deng
- Laboratory for Joint Tissue Repair and Regeneration, Orthopaedic Soft Tissue Research Program (H.T., D.W., A.H.L., I.D.H., L.Y., X.-H.D., S.A.R., and R.F.W.) and Sports Medicine and Shoulder Service (D.W., S.A.R., and R.F.W.), Hospital for Special Surgery, New York, NY
| | - Scott A. Rodeo
- Laboratory for Joint Tissue Repair and Regeneration, Orthopaedic Soft Tissue Research Program (H.T., D.W., A.H.L., I.D.H., L.Y., X.-H.D., S.A.R., and R.F.W.) and Sports Medicine and Shoulder Service (D.W., S.A.R., and R.F.W.), Hospital for Special Surgery, New York, NY
| | - Russell F. Warren
- Laboratory for Joint Tissue Repair and Regeneration, Orthopaedic Soft Tissue Research Program (H.T., D.W., A.H.L., I.D.H., L.Y., X.-H.D., S.A.R., and R.F.W.) and Sports Medicine and Shoulder Service (D.W., S.A.R., and R.F.W.), Hospital for Special Surgery, New York, NY
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Omini L, Martin S, Tambella AM. Innovative, intra-articular, prosthetic technique for cranial cruciate ligament reconstruction in dogs: a cadaveric study. J Vet Med Sci 2018; 80:583-589. [PMID: 29459502 PMCID: PMC5938183 DOI: 10.1292/jvms.16-0483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study was to describe and assess the feasibility of a new intra-articular approach in the treatment of cranial cruciate ligament deficiency in dogs using an artificial ligament and a new bone-anchor system. Twelve canine cadavers weighting 26 to 45 kg were used in this ex-vivo study. Special tibial and femoral screws, two helicoils, and a high resistance artificial fiber compose the implant. Surgery was performed using the cranio-lateral approach to the stifle joint. Helicoil and tibial screw, connected to the fiber, were inserted in the center of the tibial insertion area of the cranial cruciate ligament. The fiber was passed over-the-top, tensioned, and fixed to the femoral screw, previously inserted with the helicoil in the distal part of the femur. Surgery was completed in all the cases. Occasional problems found during the insertion of the helicoils and screws were resolved with simple procedures. Post-operative clinical assessment showed negative cranial drawer test, negative cranial tibial thrust, and normal range of motion. Radiographic evaluation showed an appropriate positioning of both tibial and femoral implants in all the cases. The results of the first surgical appraisal of this new technique are encouraging, although further studies are necessary to demonstrate the in vivo efficacy of this procedure.
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Affiliation(s)
- Luca Omini
- Clinica Veterinaria Dr. Omini Luca, Via Maestri del Lavoro, 17, 60033, Chiaravalle, Italy
| | - Stefano Martin
- Veterinary Teaching Hospital, School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione, 93/95, 62024 Matelica, Italy
| | - Adolfo Maria Tambella
- Veterinary Teaching Hospital, School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione, 93/95, 62024 Matelica, Italy
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Lee DW, Lee JW, Kim SB, Park JH, Chung KS, Ha JK, Kim JG, Kim WJ. Comparison of Poly-L-Lactic Acid and Poly-L-Lactic Acid/Hydroxyapatite Bioabsorbable Screws for Tibial Fixation in ACL Reconstruction: Clinical and Magnetic Resonance Imaging Results. Clin Orthop Surg 2017; 9:270-279. [PMID: 28861193 PMCID: PMC5567021 DOI: 10.4055/cios.2017.9.3.270] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 03/23/2017] [Indexed: 11/17/2022] Open
Abstract
Background The purpose of this study was to compare the clinical and radiological results of 2 different tibial fixations performed using bioabsorbable screws with added hydroxyapatite (HA) and pure poly-L-lactic acid (PLLA) screws in anterior cruciate ligament (ACL) reconstruction. Methods A total of 394 patients who underwent arthroscopic ACL reconstruction between March 2009 and June 2012 were retrospectively reviewed. Of those, 172 patients who took the radiological and clinical evaluations at more than 2 years after surgery were enrolled and divided into 2 groups: PLLA group (n = 86) and PLLA-HA group (n = 86). Both groups were assessed by means of the Lysholm score, International Knee Documentation Committee (IKDC) subjective knee score, and Tegner activity score. Stability was evaluated using the KT-2000 arthrometer. Magnetic resonance imaging was performed to evaluate tibial tunnel widening, screw resorption, osteoingeration, and foreign body reactions. Results The PLLA-HA group showed significant reduction in the extent of tibial tunnel widening and foreign body reactions and significant increase in screw resorption compared to the pure PLLA group (p < 0.001 for both). In contrast, postoperative Lysholm score, Tegner activity score, IKDC score, and side-to-side difference on the KT-2000 arthrometer showed no significant differences between groups (p = 0.478, p = 0.906, p = 0.362, and p = 0.078, respectively). The PLLA group showed more significant widening in the proximal tibial tunnel than the PLLA-HA group (p = 0.001). In the correlation analysis, proximal tibial tunnel widening revealed a positive correlation with knee laxity (r = 0.866) and a negative correlation with Lysholm score (r = −0.753) (p < 0.01 for both). Conclusions The HA added PLLA screws would be advantageous for tibial graft fixation by reducing tibial tunnel widening, improving osteointegration, and lowering foreign body reactions. Even though no clinically significant differences were noted between the pure PLLA group and PLLA-HA group, widening of the proximal area of the tibial tunnel showed a tendency to increase knee laxity measured using the KT-2000 arthrometer.
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Affiliation(s)
- Dhong Won Lee
- Department of Orthopedic Surgery, Konkuk University Medical Center, Seoul, Korea
| | - Ji Whan Lee
- Department of Orthopedic Surgery, Konkuk University Medical Center, Seoul, Korea
| | - Sang Bum Kim
- Department of Orthopedic Surgery, Konkuk University Medical Center, Seoul, Korea
| | - Jung Ho Park
- Department of Orthopedic Surgery, Konkuk University Medical Center, Seoul, Korea
| | - Kyu Sung Chung
- Department of Orthopedic Surgery, Hanil General Hospital, Seoul, Korea
| | - Jeong Ku Ha
- Department of Orthopedic Surgery, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Jin Goo Kim
- Department of Orthopedic Surgery, Konkuk University Medical Center, Seoul, Korea
| | - Woo Jong Kim
- Department of Orthopedic Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
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Browning WM, Kluczynski MA, Curatolo C, Marzo JM. Suspensory Versus Aperture Fixation of a Quadrupled Hamstring Tendon Autograft in Anterior Cruciate Ligament Reconstruction: A Meta-analysis. Am J Sports Med 2017; 45:2418-2427. [PMID: 28068159 DOI: 10.1177/0363546516680995] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hamstring grafts have become a popular choice for anterior cruciate ligament (ACL) reconstruction; however, the most effective means of fixation of these soft tissue grafts is unknown. PURPOSE To determine whether suspensory or aperture fixation of hamstring tendon autografts provides better stability and clinical outcomes in ACL reconstruction. STUDY DESIGN Meta-analysis. METHODS A literature search of studies reporting single-bundle ACL reconstructions using 4-stranded hamstring tendon autografts with aperture or suspensory fixation with a minimum 24-month follow-up was conducted. Stability and clinical outcomes were compared for aperture versus suspensory fixation. Knee stability was measured with the Lachman or pivot-shift test or KT-1000 arthrometer side-to-side difference (SSD), and outcomes were determined with the International Knee Documentation Committee (IKDC), Tegner, and Lysholm scores as well as graft failures. A random-effects model with a pooled estimate for the between-study variance was used to estimate proportions or means for each outcome and its corresponding 95% CI. RESULTS Forty-one studies were included, of which 20 utilized suspensory fixation techniques and 21 utilized aperture fixation techniques. A >3-mm SSD was seen more often in the aperture group than the suspensory group, which was statistically significant ( P < .0001), but there was no significant difference between groups for a >5-mm SSD ( P = .53). The aperture group demonstrated significantly more graft ruptures than did the suspensory group ( P = .03). There were no statistically significant differences in Lachman grade 0 ( P = .76), grade 1 ( P = .89), and grade 2 ( P = .55) or pivot-shift grade 0 ( P = .72), grade 1 ( P = .97), and grade 2 ( P = .28). There was no statistically significant difference in mean continuous IKDC ( P = .80), Tegner ( P = .34), or Lysholm ( P = .84) scores. CONCLUSION This meta-analysis demonstrated improved overall arthrometric stability and fewer graft ruptures using suspensory fixation compared with aperture fixation of a quadrupled hamstring tendon autograft in ACL reconstruction. There were no differences in IKDC, Lysholm, Lachman, and pivot-shift outcomes between suspensory and aperture fixation.
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Affiliation(s)
| | - Melissa A Kluczynski
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Christian Curatolo
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - John M Marzo
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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Femoral interference screw fixation of hamstring and quadriceps tendons for ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2017; 25:1241-1248. [PMID: 26818555 DOI: 10.1007/s00167-016-4001-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 01/13/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE This cadaveric study compares the biomechanical properties of femoral graft fixation in ACL reconstruction of either quadriceps or hamstring tendon grafts with four different interference screws. The hypothesis was that quadriceps tendon grafts provide at least equal results concerning gap formation during cyclic loading and ultimate failure load compared to hamstring tendon grafts with four different interference screws. METHODS Eighty porcine femora underwent interference screw fixation of human tendon grafts for ACL reconstruction. Either quadriceps (Q) or hamstring (H) tendon grafts and four different bioabsorbable interference (Wolf (W), Storz (S), Mitek (M), Arthrex (A)) screws were used, resulting in 8 groups with 10 specimens per groups (WQ, WH, SQ, SH, MQ, MH, AQ, AH). Biomechanical analysis included pretensioning the constructs with 60 N for 30 s, then cyclic loading of 500 cycles between 60 and 250 N at 1 Hz in a servohydraulic testing machine, with measurement of elongation and stiffness including video measurements. After this, ultimate failure load and failure mode analysis were performed. RESULTS No statistically significant difference could be noted between the groups regarding gap formation during cyclic loading [Cycles 21-500 (mm): WQ 3.6 ± 0.8, WH 3.9 ± 1.4, SQ 3.6 ± 0.8, SH 3.3 ± 1.5, MQ 4.3 ± 0.8, MH 4.6 ± 1.0, AQ 4.8 ± 0.8, AH 4.3 ± 1.5, n.s.], stiffness during cyclic loading [Cycles 21-500 (N/mm): WQ 72.9 ± 16.9, WH 71.6 ± 20.7, SQ 69.5 ± 23.9, SH 77.4 ± 25.1, MQ 59.6 ± 11.2, MH 48.4 ± 15.4, AQ 48.8 ± 12.7, AH 51.9 ± 22.2, n.s.], and ultimate failure load [(N): WQ 474.4 ± 88.0, WH 579.3 ± 124.2, SQ 493.9 ± 105.2, SH 576.0 ± 90.4, MQ 478.6 ± 59.0, MH 543.9 ± 119.7, AQ 480.2 ± 93.8, AH 497.8 ± 74.2, n.s.]. CONCLUSIONS Quadriceps tendon grafts yield comparable biomechanical results for femoral interference screw fixation in ACL reconstruction compared to hamstring tendon grafts. From a clinical perspective, quadriceps tendon grafts should therefore be considered as a good option in ACL reconstruction in the future.
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Moewis P, Duda GN, Jung T, Heller MO, Boeth H, Kaptein B, Taylor WR. The Restoration of Passive Rotational Tibio-Femoral Laxity after Anterior Cruciate Ligament Reconstruction. PLoS One 2016; 11:e0159600. [PMID: 27467744 PMCID: PMC4965218 DOI: 10.1371/journal.pone.0159600] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 06/01/2016] [Indexed: 01/15/2023] Open
Abstract
While the anterior cruciate ligament (ACL) is considered one of the most important ligaments for providing knee joint stability, its influence on rotational laxity is not fully understood and its role in resisting rotation at different flexion angles in vivo remains unknown. In this prospective study, we investigated the relationship between in vivo passive axial rotational laxity and knee flexion angle, as well as how they were altered with ACL injury and reconstruction. A rotometer device was developed to assess knee joint rotational laxity under controlled passive testing. An axial torque of ±2.5Nm was applied to the knee while synchronised fluoroscopic images of the tibia and femur allowed axial rotation of the bones to be accurately determined. Passive rotational laxity tests were completed in 9 patients with an untreated ACL injury and compared to measurements at 3 and 12 months after anatomical single bundle ACL reconstruction, as well as to the contralateral controls. Significant differences in rotational laxity were found between the injured and the healthy contralateral knees with internal rotation values of 8.7°±4.0° and 3.7°±1.4° (p = 0.003) at 30° of flexion and 9.3°±2.6° and 4.0°±2.0° (p = 0.001) at 90° respectively. After 3 months, the rotational laxity remained similar to the injured condition, and significantly different to the healthy knees. However, after 12 months, a considerable reduction of rotational laxity was observed towards the levels of the contralateral controls. The significantly greater laxity observed at both knee flexion angles after 3 months (but not at 12 months), suggests an initial lack of post-operative rotational stability, possibly due to reduced mechanical properties or fixation stability of the graft tissue. After 12 months, reduced levels of rotational laxity compared with the injured and 3 month conditions, both internally and externally, suggests progressive rotational stability of the reconstruction with time.
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Affiliation(s)
- Philippe Moewis
- Julius Wolff Institute, Charité-Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
| | - Georg N. Duda
- Julius Wolff Institute, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Jung
- Knee Surgery and Sports Traumatology, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Markus O. Heller
- Bioengineering Research Group, University of Southhampton, Southhampton, United Kingdom
| | - Heide Boeth
- Julius Wolff Institute, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Bart Kaptein
- Department of Orthopaedic Surgery, Biomechanics and Imaging Group, Leiden University Medical Center, Leiden, Netherlands
| | - William R. Taylor
- Department of Health Sciences and Technology, Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
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Teuschl A, Heimel P, Nürnberger S, van Griensven M, Redl H, Nau T. A Novel Silk Fiber-Based Scaffold for Regeneration of the Anterior Cruciate Ligament: Histological Results From a Study in Sheep. Am J Sports Med 2016; 44:1547-57. [PMID: 26957219 DOI: 10.1177/0363546516631954] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Because of ongoing problems with anterior cruciate ligament (ACL) reconstruction, new approaches in the treatment of ACL injuries, particularly strategies based on tissue engineering, have gained increasing research interest. To allow for ACL regeneration, a structured scaffold that provides a mechanical basis, has cells from different sources, and comprises mechanical as well as biological factors is needed. Biological materials, biodegradable polymers, and composite materials are being used and tested as scaffolds. The optimal scaffold for ACL regeneration should be biocompatible and biodegradable to allow tissue ingrowth but also needs to have the right mechanical properties to provide immediate mechanical stability. HYPOTHESES The study hypotheses were that (1) a novel degradable silk fiber-based scaffold with mechanical properties similar to the native ACL will be able to initiate ligament regeneration after ACL resection and reconstruction under in vivo conditions and (2) additional cell seeding of the scaffold with autologous stromal vascular fraction-containing adipose-derived stem cells will increase regenerative activity. STUDY DESIGN Controlled laboratory study. METHODS A total of 33 mountain sheep underwent ACL resection and randomization to 2 experimental groups: (1) ACL reconstruction with a scaffold alone and (2) ACL reconstruction with a cell-seeded scaffold. Histological evaluation of the intra-articular portion of the reconstructed/regenerated ligament was performed after 6 and 12 months. RESULTS After 6 months, connective tissue surrounded the silk scaffold with ingrowth in some areas. The cell-seeded scaffolds had a significant lower silk content compared with the unseeded scaffolds and demonstrated a higher content of newly formed tissue. After 12 months, the density of the silk fibers decreased significantly, and the ingrowth of newly formed tissue increased in both groups. No differences between the 2 groups regarding silk fiber degradation and regenerated tissue were detected at 12 months. CONCLUSION The novel silk fiber-based scaffold was able to stimulate ACL regeneration under in vivo conditions. Additional cell seeding led to increased tissue regeneration and decreased silk fiber content at 6 months, whereas these differences were not present at 12 months. CLINICAL RELEVANCE ACL regeneration using a silk fiber-based scaffold with and without additional cell seeding may provide a new treatment option after joint injuries.
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Affiliation(s)
- Andreas Teuschl
- Department of Biochemical Engineering, University of Applied Sciences Technikum Wien, Vienna, Austria Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Center, Vienna, Austria Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Patrick Heimel
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Center, Vienna, Austria Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Medical University of Vienna, Vienna, Austria
| | - Silvia Nürnberger
- Austrian Cluster for Tissue Regeneration, Vienna, Austria Department of Traumatology, Medical University of Vienna, Vienna, Austria
| | - Martijn van Griensven
- Department of Experimental Trauma Surgery, Technical University of Munich, Munich, Germany
| | - Heinz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Center, Vienna, Austria Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Thomas Nau
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Center, Vienna, Austria Austrian Cluster for Tissue Regeneration, Vienna, Austria
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Suspensory Versus Interference Screw Fixation for Arthroscopic Anterior Cruciate Ligament Reconstruction in a Translational Large-Animal Model. Arthroscopy 2016; 32:1086-97. [PMID: 26853947 DOI: 10.1016/j.arthro.2015.11.026] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 08/17/2015] [Accepted: 11/05/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare all-inside cortical-button suspensory fixation in sockets versus interference screw fixation in tunnels with respect to clinical, histologic, and biomechanical assessments of all-soft tissue (AST) tendon autografts used for anterior cruciate ligament (ACL) reconstruction in a canine model. METHODS By use of a validated "hybrid" double-bundle ACL reconstruction technique (reconstruction of the anteromedial bundle with preservation of the native posterolateral bundle), dogs were randomly assigned to undergo either suspensory fixation in sockets (n = 6) or interference screw fixation in tunnels (n = 6). Contralateral knees were used as nonoperated controls (n = 12). Quadrupled extensor tendon autografts were used for both ACL reconstruction groups. Dogs were assessed radiographically and functionally and humanely euthanized at 12 weeks after surgery for arthroscopic, gross, biomechanical, and histologic assessments. RESULTS Histologic assessments showed significantly (P = .018) better graft incorporation with 4-zone direct healing to bone for the grafts using suspensory fixation in sockets (16.3 ± 1.5) compared with the grafts using interference screw fixation in tunnels (14.2 ± 2.1). Furthermore, graft healing to bone was significantly better at the aperture (P = .05) and mid-socket (P = .01) location for the group that underwent suspensory fixation in sockets (16.1 ± 1.8 and 16.4 ± 1.9, respectively). CONCLUSIONS Suspensory fixation of AST grafts in sockets was associated with superior tendon-to-bone healing compared with interference screw fixation in tunnels, with 4-zone direct graft healing to bone seen for femoral and tibial sockets only in the suspensory-fixation group. Biomechanical properties were similar between groups. CLINICAL RELEVANCE These data provide evidence suggesting that an all-inside ACL reconstruction technique using adjustable-loop cortical-button suspensory fixation in bone sockets has potential clinical advantages for ACL reconstruction using AST grafts.
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Return to sport after ACL reconstruction: a survey between the Italian Society of Knee, Arthroscopy, Sport, Cartilage and Orthopaedic Technologies (SIGASCOT) members. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:509-16. [DOI: 10.1007/s00590-016-1756-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 02/17/2016] [Indexed: 12/18/2022]
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Chen G, Zhang H, Ma Q, Zhao J, Zhang Y, Fan Q, Ma B. Fresh-frozen Complete Extensor Mechanism Allograft versus Autograft Reconstruction in Rabbits. Sci Rep 2016; 6:22106. [PMID: 26911538 PMCID: PMC4766497 DOI: 10.1038/srep22106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/08/2016] [Indexed: 11/30/2022] Open
Abstract
Different clinical results have been reported in the repair of extensor mechanism disruption using fresh-frozen complete extensor mechanism (CEM) allograft, creating a need for a better understanding of fresh-frozen CME allograft reconstruction. Here, we perform histological and biomechanical analyses of fresh-frozen CEM allograft or autograft reconstruction in an in vivo rabbit model. Our histological results show complete incorporation of the quadriceps tendon into the host tissues, patellar survival and total integration of the allograft tibia, with relatively fewer osteocytes, into the host tibia. Vascularity and cellularity are reduced and delayed in the allograft but exhibit similar distributions to those in the autograft. The infrapatellar fat pad provides the main blood supply, and the lowest cellularity is observed in the patellar tendon close to the tibia in both the allograft and autograft. The biomechanical properties of the junction of quadriceps tendon and host tissues and those of the allograft patellar tendon are completely and considerably restored, respectively. Therefore, fresh-frozen CEM allograft reconstruction is viable, but the distal patellar tendon and the tibial block may be the weak links of the reconstruction. These findings provide new insight into the use of allograft in repairing disruption of the extensor mechanism.
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Affiliation(s)
- Guanyin Chen
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, Xi'an 710038, China
| | - Hongtao Zhang
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, Xi'an 710038, China
| | - Qiong Ma
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, Xi'an 710038, China
| | - Jian Zhao
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, Xi'an 710038, China
| | - Yinglong Zhang
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, Xi'an 710038, China
| | - Qingyu Fan
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, Xi'an 710038, China
| | - Baoan Ma
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, Xi'an 710038, China
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Mathis DT, Rasch H, Hirschmann MT. In vivo bone tunnel remodeling in symptomatic patients after ACL reconstruction: a retrospective comparison of articular and extra-articular fixation. Muscles Ligaments Tendons J 2016; 5:316-24. [PMID: 26958543 DOI: 10.11138/mltj/2015.5.4.316] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND there is only a paucity of studies dealing with bone remodeling within the tunnels after anterior cruciate ligament (ACL) reconstruction. The objective of this study was to evaluate the influence of tendon graft type and surgical fixation technique on bone tunnel remodeling in patients with symptomatic knees after ACL reconstruction. METHODS in a retrospective study 99mTc-HDP bone tracer uptake (BTU) in SPECT/CT of 57 knees with symptoms of pain and/or instability after ACL reconstruction was investigated. All 57 knees were subdivided according their anatomy (femur and tibia), fixation (articular versus extra-articular fixation) and graft types into eight groups: femoral-articular versus extra-articular fixation using bone-patellar tendon-bone (BPTB) and hamstring autografts; tibial-articular versus extra-articular fixation using patellar tendon and hamstring autografts; BTU grading for each area of the localisation scheme were recorded. Tunnel diameter and length was measured in the CT scans. RESULTS BTU was higher for the articular fixation in the femur and for the extra-articular fixation in the tibial tunnel. Patellar tendon graft fixation showed a significantly higher BTU in the superior-lateral and posterior-central area of the tibia, meaning the areas of the tibial tunnel near the entrance into the joint. Tunnel enlargement correlated significantly with increased BTU (p<0.05). CONCLUSION assessment of in vivo bone tunnel remodelling in symptomatic patients after ACL reconstruction revealed different patterns of BTU with regards to graft and fixation method.
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Affiliation(s)
- Dominic T Mathis
- Department of Orthopaedic Surgery and Trauma-tology, Kantonsspital Baselland, Bruderholz, Switzerland
| | - Helmut Rasch
- Institute of Radiology and Nuclear Medicine, Kan-tonsspital Baselland, Bruderholz, Switzerland
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Trauma-tology, Kantonsspital Baselland, Bruderholz, Switzerland
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Cook JL, Smith PA, Stannard JP, Pfeiffer FM, Kuroki K, Bozynski CC, Cook CR. A canine hybrid double-bundle model for study of arthroscopic ACL reconstruction. J Orthop Res 2015; 33:1171-9. [PMID: 25763560 DOI: 10.1002/jor.22870] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 02/13/2015] [Indexed: 02/04/2023]
Abstract
Development and validation of a large animal model for pre-clinical studies of intra-articular anterior cruciate ligament (ACL) reconstruction that addresses current limitations is highly desirable. The objective of the present study was to investigate a translational canine model for ACL reconstruction. With institutional approval, adult research hounds underwent arthroscopic debridement of the anteromedial bundle (AMB) of the ACL, and then either received a tendon autograft for "hybrid double-bundle" ACL reconstruction (n = 12) or no graft to remain ACL/AMB-deficient (n = 6). Contralateral knees were used as non-operated controls (n = 18) and matched canine cadaveric knees were used as biomechanical controls (n = 6). Dogs were assessed using functional, diagnostic imaging, gross, biomechanical, and histologic outcome measures required for pre-clinical animal models. The data suggest that this canine model was able to overcome the major limitations of large animal models used for translational research in ACL reconstruction and closely follow clinical aspects of human ACL reconstruction. The "hybrid double-bundle" ACL reconstruction allowed for sustained knee function without the development of osteoarthritis and for significantly improved functional, diagnostic imaging, gross, biomechanical, and histologic outcomes in grafted knees compared to ACL/AMB-deficient knees.
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Affiliation(s)
- James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,Comparative Orthopaedic Laboratory, University of Missouri, Columbia, Missouri
| | - Patrick A Smith
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,Columbia Orthopaedic Group, Columbia, Missouri
| | - James P Stannard
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,Comparative Orthopaedic Laboratory, University of Missouri, Columbia, Missouri
| | - Ferris M Pfeiffer
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,Comparative Orthopaedic Laboratory, University of Missouri, Columbia, Missouri
| | - Keiichi Kuroki
- Comparative Orthopaedic Laboratory, University of Missouri, Columbia, Missouri
| | | | - Cristi R Cook
- Comparative Orthopaedic Laboratory, University of Missouri, Columbia, Missouri
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Song Y, Zheng J, Yan M, Ding W, Xu K, Fan Q, Li Z. The Effects of Irreversible Electroporation on the Achilles Tendon: An Experimental Study in a Rabbit Model. PLoS One 2015; 10:e0131404. [PMID: 26114962 PMCID: PMC4482699 DOI: 10.1371/journal.pone.0131404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 06/02/2015] [Indexed: 11/18/2022] Open
Abstract
Background To evaluate the potential effects of irreversible electroporation ablation on the Achilles tendon in a rabbit model and to compare the histopathological and biomechanical changes between specimens following electroporation ablation and radiofrequency ablation. Methods A total of 140 six-month-old male New Zealand rabbits were used. The animals were randomly divided into two groups, 70 in the radiofrequency ablation group and 70 in the electroporation group. In situ ablations were applied directly to the Achilles tendons of rabbits using typical electroporation (1800 V/cm, 90 pulses) and radiofrequency ablation (power control mode) protocols. Histopathological and biomechanical evaluations were performed to examine the effects of electroporation ablation and radiofrequency ablation over time. Results Both electroporation and radiofrequency ablation produced complete cell ablation in the target region. Thermal damage resulted in tendon rupture 3 days post radiofrequency ablation. In contrast, electroporation-ablated Achilles tendons preserved their biomechanical properties and showed no detectable rupture at this time point. The electroporation-ablated tendons exhibited signs of recovery, including tenoblast regeneration and angiogenesis within 2 weeks, and the restoration of their integral structure was evident within 12 weeks. Conclusions When applying electroporation to ablate solid tumors, major advantage could be that collateral damage to adjacent tendons or ligaments is minimized due to the unique ability of electroporation ablation to target the cell membrane. This advantage could have a significant impact on the field of tumor ablation near vital tendons or ligaments.
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Affiliation(s)
- Yue Song
- Orthopedics Oncology Institute of Chinese PLA and Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi, P.R. China
- Department of General Surgery, NO. 202 Hospital of PLA, Shenyang, Liaoning, P.R. China
| | - Jingjing Zheng
- Department of Neurobiology, Fourth Military Medical University, Xi’an, Shaanxi, P.R. China
| | - Mingwei Yan
- Department of Electrical Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Weidong Ding
- Department of Electrical Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Kui Xu
- Orthopedics Oncology Institute of Chinese PLA and Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi, P.R. China
| | - Qingyu Fan
- Orthopedics Oncology Institute of Chinese PLA and Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi, P.R. China
- * E-mail: (QYF); (ZL)
| | - Zhao Li
- Orthopedics Oncology Institute of Chinese PLA and Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi, P.R. China
- * E-mail: (QYF); (ZL)
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The effect of graft strength on knee laxity and graft in-situ forces after posterior cruciate ligament reconstruction. PLoS One 2015; 10:e0127293. [PMID: 26001045 PMCID: PMC4441446 DOI: 10.1371/journal.pone.0127293] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 04/13/2015] [Indexed: 11/19/2022] Open
Abstract
Surgical reconstruction is generally recommended for posterior cruciate ligament (PCL) injuries; however, the use of grafts is still a controversial problem. In this study, a three-dimensional finite element model of the human tibiofemoral joint with articular cartilage layers, menisci, and four main ligaments was constructed to investigate the effects of graft strengths on knee kinematics and in-situ forces of PCL grafts. Nine different graft strengths with stiffness ranging from 0% (PCL rupture) to 200%, in increments of 25%, of an intact PCL's strength were used to simulate the PCL reconstruction. A 100 N posterior tibial drawer load was applied to the knee joint at full extension. Results revealed that the maximum posterior translation of the PCL rupture model (0% stiffness) was 6.77 mm in the medial compartment, which resulted in tibial internal rotation of about 3.01°. After PCL reconstruction with any graft strength, the laxity of the medial tibial compartment was noticeably improved. Tibial translation and rotation were similar to the intact knee after PCL reconstruction with graft strengths ranging from 75% to 125% of an intact PCL. When the graft's strength surpassed 150%, the medial tibia moved forward and external tibial rotation greatly increased. The in-situ forces generated in the PCL grafts ranged from 13.15 N to 75.82 N, depending on the stiffness. In conclusion, the strength of PCL grafts have has a noticeable effect on anterior-posterior translation of the medial tibial compartment and its in-situ force. Similar kinematic response may happen in the models when the PCL graft's strength lies between 75% and 125% of an intact PCL.
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Moon DK, Yoon CH, Park JS, Kang BJ, Cho SH, Jo HS, Hwang SC. Effect of anteromedial portal entrance drilling angle during anterior cruciate ligament reconstruction: a three-dimensional computer simulation. Yonsei Med J 2014; 55:1584-91. [PMID: 25323895 PMCID: PMC4205698 DOI: 10.3349/ymj.2014.55.6.1584] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE The object of this study was to evaluate entrance angle effects on femoral tunnel length and cartilage damage during anteromedial portal drilling using three-dimensional computer simulation. MATERIALS AND METHODS Data was obtained from an anatomic study performed using 16 cadaveric knees. The anterior cruciate ligament femoral insertion was dissected and the knees were scanned by computer tomography. Tunnels with different of three-dimensional entrance angles were identified using a computer simulation. The effects of different entrance angles on the femoral tunnel length and medial femoral cartilage damage were evaluated. Specifically, tunnel length and distance from the medial femoral condyle to a virtual cylinder of the femoral tunnel were measured. RESULTS In tunnels drilled at a coronal angle of 45°, an axial angle of 45°, and a sagittal angle of 45°, the mean femoral tunnel length was 39.5±3.7 mm and the distance between the virtual cylinder of the femoral tunnel and the medial femoral condyle was 9.4±2.6 mm. The tunnel length at a coronal angle of 30°, an axial angle of 60°, and a sagittal angle of 45°, was 34.0±2.9 mm and the distance between the virtual cylinder of the tunnel and the medial femoral condyle was 0.7±1.3 mm, which was significantly shorter than the standard angle (p<0.001). CONCLUSION Extremely low and high entrance angles in both of axial plane and coronal plane produced inappropriate tunnel angles, lengths and higher incidence of cartilage damage. We recommend that angles in proximity to standard angles be chosen during femoral tunnel drilling through the anteromedial portal.
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Affiliation(s)
- Dong Kyu Moon
- Department of Orthopaedic Surgery, Military Hospital, Hongcheon, Korea
| | - Chul Ho Yoon
- Department of Rehabilitation Medicine and Institute of Health Sciences, School of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea
| | - Jin Seung Park
- Department of Orthopaedic Surgery and Institute of Health Sciences, School of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea
| | - Bun Jung Kang
- Department of Orthopaedic Surgery and Institute of Health Sciences, School of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea
| | - Seong Hee Cho
- Department of Orthopaedic Surgery and Institute of Health Sciences, School of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea
| | - Ho Seung Jo
- Department of Orthopaedic Surgery and Institute of Health Sciences, School of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea
| | - Sun Chul Hwang
- Department of Orthopaedic Surgery and Institute of Health Sciences, School of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea.
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Lenschow S, Schliemann B, Schulze M, Raschke M, Kösters C. Comparison of outside-in and inside-out technique for tibial fixation of a soft-tissue graft in ACL reconstruction using the Shim technique. Arch Orthop Trauma Surg 2014; 134:1293-9. [PMID: 24935662 DOI: 10.1007/s00402-014-2029-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The aim of this study was to compare the biomechanical properties of tibial fixation of a free tendon graft in ACL reconstruction using the Shim, a new wedge-shaped implant, in an outside-in technique to fixation by the Shim used in an inside-out technique and fixation by interference screw in a porcine model. MATERIALS AND METHODS Porcine tibia and flexor tendons were used. In Group 1, the Shim was applied outside-in. In Group 2, the Shim was inserted inside-out. In the Group 3, an 8-mm interference screw was used. Ten specimens were tested in each group. Load-to-failure, elongation, stiffness and failure mode were recorded. Cyclic loading was performed between 5 and 250 N for 1,000 cycles, followed by a load to failure testing. RESULTS Mean maximum load-to-failure was 629.53 N in Group 1,648.54 N in Group 2 and 749.53 N in Group 3. There was no significant difference between the groups. Stiffness varied between 127.34 N/mm in Group 1, 151.27 N/mm in Group 2 and 182.25 N/mm in Group 3. No significant differences were found between outside-in Shim and interference screw fixation. No significant difference was found for elongation among the three groups. The main failure mode was a rupture of the tendon in the IFS group and a slippage of either the implant or the tendon in both groups using the Shim. CONCLUSIONS As no statistically significant difference could be seen concerning load to failure, stiffness and elongation between the inside-out and the outside-in techniques, the Shim can be used for tibial fixation in an outside-in or inside-out technique depending on the preference of the surgeon. To prevent slippage of the graft a hybrid fixation should be considered.
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Affiliation(s)
- S Lenschow
- Department of Trauma, Hand and, Reconstructive Surgery, Wilhelms University Muenster, Waldeyerstraße 1, 48149, Münster, Germany,
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