1
|
Estébanez-de-Miguel E, Bueno-Gracia E, González-Rueda V, Pérez-Bellmunt A, Caudevilla-Polo S, López-de-Celis C. Changes Over Time in the Strain on the Inferior Iliofemoral Ligament During a Sustained 5-Minute High-Force Long-Axis Distraction Mobilization: A Cadaveric Study. Arch Phys Med Rehabil 2023; 104:1796-1801. [PMID: 37040862 DOI: 10.1016/j.apmr.2023.03.022] [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: 08/29/2022] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 04/13/2023]
Abstract
OBJECTIVE To analyze the changes over time in the strain on the inferior iliofemoral (IIF) ligament when a constant high-force long-axis distraction mobilization (LADM) was applied over 5 minutes. DESIGN A cross-sectional laboratory cadaveric study. SETTING Anatomy laboratory. PARTICIPANTS Thirteen hip joints from 9 fresh-frozen cadavers (mean age, 75.6±7.8 years; N=13). INTERVENTIONS High-force LADM in open-packed position was sustained for a period of 5 minutes. MAIN OUTCOME MEASURE(S) Strain on IFF ligament was measured over time with a microminiature differential variable reluctance transducer. Strain measurements were taken at every 15 seconds for the first 3 minutes and every 30 seconds for the next 2 minutes. RESULTS Major changes in strain occurred in the first minute of high-force LADM application. The greatest increase in strain on the IFF ligament occurred at the first 15 seconds (7.3±7.2%). At 30 seconds, the increase in strain was 10.1±9.6%, the half of the total increase at the end of the 5-minute high-force LADM (20.2±8.5%). Significant changes in strain measures were shown to occur at 45 seconds of high-force LADM (F=18.11; P<.001). CONCLUSIONS When a 5-minute high-force LADM was applied, the major changes in the strain on IIF ligament occurred in the first minute of the mobilization. A high-force LADM mobilization should be sustained at least 45 seconds to produce a significant change in the strain of capsular-ligament tissue.
Collapse
Affiliation(s)
| | - Elena Bueno-Gracia
- Department of Physiatrist and Nursery, Faculty of Heath Sciences, University of Zaragoza, Zaragoza
| | - Vanessa González-Rueda
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona; Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Albert Pérez-Bellmunt
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona
| | - Santos Caudevilla-Polo
- Department of Physiatrist and Nursery, Faculty of Heath Sciences, University of Zaragoza, Zaragoza
| | - Carlos López-de-Celis
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona; Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| |
Collapse
|
2
|
Burgio V, Casari S, Milizia M, Sanna F, Spezia G, Civera M, Rodriguez Reinoso M, Bertuglia A, Surace C. Mechanical properties of animal ligaments: a review and comparative study for the identification of the most suitable human ligament surrogates. Biomech Model Mechanobiol 2023; 22:1645-1683. [PMID: 37169958 PMCID: PMC10511400 DOI: 10.1007/s10237-023-01718-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 03/29/2023] [Indexed: 05/13/2023]
Abstract
The interest in the properties of animal soft tissues is often related to the desire to find an animal model to replace human counterparts due to the unsteady availability of human tissues for experimental purposes. Once the most appropriate animal model is identified, it is possible to carry out ex-vivo and in-vivo studies for the repair of ligamentous tissues and performance testing of replacement and support healing devices. This work aims to present a systematic review of the mechanical properties of ligaments reported in the scientific literature by considering different anatomical regions in humans and several animal species. This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. Moreover, considering the lack of a standard protocol for preconditioning of tissues, this aspect is also addressed. Ninety-six studies were selected for the systematic review and analysed. The mechanical properties of different animal species are reported and summarised in tables. Only results from studies reporting the strain rate parameter were considered for comparison with human ligaments, as they were deemed more reliable. Elastic modulus, ultimate tensile stress, and ultimate strain properties are graphically reported identifying the range of values for each animal species and to facilitate comparison between values reported in the scientific literature in animal and human ligaments. Useful similarities between the mechanical properties of swine, cow, and rat and human ligaments have been found.
Collapse
Affiliation(s)
- V. Burgio
- Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, 10129 Turin, Italy
- Department of Structural, Geotechnical and Building Engineering, Laboratory of Bio-Inspired Nanomechanics, Politecnico di Torino, Corso Duca Degli Abruzzi 24, 10129 Turin, Italy
| | - S. Casari
- Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, 10129 Turin, Italy
- Department of Structural, Geotechnical and Building Engineering, Laboratory of Bio-Inspired Nanomechanics, Politecnico di Torino, Corso Duca Degli Abruzzi 24, 10129 Turin, Italy
| | - M. Milizia
- Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, 10129 Turin, Italy
- Department of Structural, Geotechnical and Building Engineering, Laboratory of Bio-Inspired Nanomechanics, Politecnico di Torino, Corso Duca Degli Abruzzi 24, 10129 Turin, Italy
| | - F. Sanna
- Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, 10129 Turin, Italy
- Department of Structural, Geotechnical and Building Engineering, Laboratory of Bio-Inspired Nanomechanics, Politecnico di Torino, Corso Duca Degli Abruzzi 24, 10129 Turin, Italy
| | - G. Spezia
- Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, 10129 Turin, Italy
- Department of Structural, Geotechnical and Building Engineering, Laboratory of Bio-Inspired Nanomechanics, Politecnico di Torino, Corso Duca Degli Abruzzi 24, 10129 Turin, Italy
| | - M. Civera
- Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, 10129 Turin, Italy
- Department of Structural, Geotechnical and Building Engineering, Laboratory of Bio-Inspired Nanomechanics, Politecnico di Torino, Corso Duca Degli Abruzzi 24, 10129 Turin, Italy
| | - M. Rodriguez Reinoso
- Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, 10129 Turin, Italy
- Department of Structural, Geotechnical and Building Engineering, Laboratory of Bio-Inspired Nanomechanics, Politecnico di Torino, Corso Duca Degli Abruzzi 24, 10129 Turin, Italy
| | - A. Bertuglia
- Department of Veterinary Science, University of Turin, Largo Paolo Braccini 2-5, 10095 Grugliasco, Italy
| | - C. Surace
- Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, 10129 Turin, Italy
- Department of Structural, Geotechnical and Building Engineering, Laboratory of Bio-Inspired Nanomechanics, Politecnico di Torino, Corso Duca Degli Abruzzi 24, 10129 Turin, Italy
| |
Collapse
|
3
|
Rodriguez BL, Novakova SS, Vega-Soto EE, Nutter GP, Macpherson PCD, Larkin LM. Repairing Volumetric Muscle Loss in the Ovine Peroneus Tertius Following a 6-Month Recovery. Tissue Eng Part A 2021; 28:606-620. [PMID: 34937425 DOI: 10.1089/ten.tea.2021.0187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Tissue-engineered skeletal muscle is a promising novel therapy for the treatment of volumetric muscle loss (VML). Our laboratory has developed tissue-engineered skeletal muscle units (SMUs) and engineered neural conduits (ENCs), and modularly scaled them to clinically relevant sizes for the treatment of VML in a large animal (sheep) model. In a previous study, we evaluated the effects of the SMUs and ENCs in treating a 30% VML injury in the ovine peroneus tertius muscle after a 3-month recovery period. The goal of the current study was to expand on our 3-month study and evaluate the SMUs and ENCs in restoring muscle function after a 6-month recovery period. Six months after implantation, we found that the repair groups with the SMU (VML+SMU and VML+SMU+ENC) restored muscle mass to a level that was statistically indistinguishable from the uninjured contralateral muscle. In contrast, the muscle mass in the VML-Only group was significantly less than groups repaired with an SMU. Following the 6-month recovery from VML, the maximum tetanic force was significantly lower for all VML injured groups compared to the uninjured contralateral muscle. However, we did demonstrate the ability of our ENCs to effectively regenerate nerve between the distal stump of the native nerve and the repair site in 93% of the animals.
Collapse
Affiliation(s)
- Brittany Lynn Rodriguez
- University of Michigan, Biomedical Engineering, BSRB 2328, 109 Zina Pitcher Pl, Ann Arbor, Michigan, United States, 48109;
| | | | | | | | | | - Lisa Marie Larkin
- University of Michian, Physiology, 109 Zina Pitcher Place, 2025 BSRB, Ann Arbor, Michigan, United States, 48109;
| |
Collapse
|
4
|
Rodriguez BL, Vega-Soto EE, Kennedy CS, Nguyen MH, Cederna PS, Larkin LM. A tissue engineering approach for repairing craniofacial volumetric muscle loss in a sheep following a 2, 4, and 6-month recovery. PLoS One 2020; 15:e0239152. [PMID: 32956427 PMCID: PMC7505427 DOI: 10.1371/journal.pone.0239152] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/31/2020] [Indexed: 01/02/2023] Open
Abstract
Volumetric muscle loss (VML) is the loss of skeletal muscle that results in significant and persistent impairment of function. The unique characteristics of craniofacial muscle compared trunk and limb skeletal muscle, including differences in gene expression, satellite cell phenotype, and regenerative capacity, suggest that VML injuries may affect craniofacial muscle more severely. However, despite these notable differences, there are currently no animal models of craniofacial VML. In a previous sheep hindlimb VML study, we showed that our lab’s tissue engineered skeletal muscle units (SMUs) were able to restore muscle force production to a level that was statistically indistinguishable from the uninjured contralateral muscle. Thus, the goals of this study were to: 1) develop a model of craniofacial VML in a large animal model and 2) to evaluate the efficacy of our SMUs in repairing a 30% VML in the ovine zygomaticus major muscle. Overall, there was no significant difference in functional recovery between the SMU-treated group and the unrepaired control. Despite the use of the same injury and repair model used in our previous study, results showed differences in pathophysiology between craniofacial and hindlimb VML. Specifically, the craniofacial model was affected by concomitant denervation and ischemia injuries that were not exhibited in the hindlimb model. While clinically realistic, the additional ischemia and denervation likely created an injury that was too severe for our SMUs to repair. This study highlights the importance of balancing the use of a clinically realistic model while also maintaining control over variables related to the severity of the injury. These variables include the volume of muscle removed, the location of the VML injury, and the geometry of the injury, as these affect both the muscle’s ability to self-regenerate as well as the probability of success of the treatment.
Collapse
Affiliation(s)
- Brittany L. Rodriguez
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Emmanuel E. Vega-Soto
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Christopher S. Kennedy
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Matthew H. Nguyen
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Paul S. Cederna
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Plastic Surgery, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Lisa M. Larkin
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan, United States of America
- * E-mail:
| |
Collapse
|
5
|
Novakova SS, Rodriguez BL, Vega-Soto EE, Nutter GP, Armstrong RE, Macpherson PCD, Larkin LM. Repairing Volumetric Muscle Loss in the Ovine Peroneus Tertius Following a 3-Month Recovery. Tissue Eng Part A 2020; 26:837-851. [PMID: 32013753 DOI: 10.1089/ten.tea.2019.0288] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Much effort has been made to fabricate engineered tissues on a scale that is clinically relevant to humans; however, scale-up remains one of the most significant technological challenges of tissue engineering to date. To address this limitation, our laboratory has developed tissue-engineered skeletal muscle units (SMUs) and engineered neural conduits (ENCs), and modularly scaled them to clinically relevant sizes for the treatment of volumetric muscle loss (VML). The goal of this study was to evaluate the SMUs and ENCs in vitro, and to test the efficacy of our SMUs and ENCs in restoring muscle function in a clinically relevant large animal (sheep) model. The animals received a 30% VML injury to the peroneus tertius muscle and were allowed to recover for 3 months. The animals were divided into three experimental groups: VML injury without a repair (VML only), repair with an SMU (VML+SMU), or repair with an SMU and ENC (VML+SMU+ENC). We evaluated the SMUs before implantation and found that our single scaled-up SMUs were characterized by the presence of contracting myotubes, linearly aligned extracellular matrix proteins, and Pax7+ satellite cells. Three months after implantation, we found that the repair groups (VML+SMU and VML+SMU+ENC) had restored muscle mass and tetanic force production to a level that was statistically indistinguishable from the uninjured contralateral muscle after 3 months in vivo. Furthermore, we demonstrated the ability of our ENCs to effectively bridge the gap between native nerve and the repair site by eliciting a muscle contraction through direct electrical stimulation of the re-routed nerve. Impact statement The fabrication of tissues of clinically relevant sizes is one of the largest obstacles preventing engineered tissues from achieving widespread use in the clinic. This study aimed to combat this limitation by developing a fabrication method to scale-up tissue-engineered skeletal muscle for the treatment of volumetric muscle loss in a large animal (sheep) model and evaluating the efficacy of the tissue-engineered constructs after a 3-month recovery.
Collapse
Affiliation(s)
- Stoyna S Novakova
- Department of Molecular and Integrative Physiology and University of Michigan, Ann Arbor, Michigan, USA
| | - Brittany L Rodriguez
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Emmanuel E Vega-Soto
- Department of Molecular and Integrative Physiology and University of Michigan, Ann Arbor, Michigan, USA
| | - Genevieve P Nutter
- Department of Molecular and Integrative Physiology and University of Michigan, Ann Arbor, Michigan, USA
| | - Rachel E Armstrong
- Department of Molecular and Integrative Physiology and University of Michigan, Ann Arbor, Michigan, USA
| | - Peter C D Macpherson
- Department of Molecular and Integrative Physiology and University of Michigan, Ann Arbor, Michigan, USA
| | - Lisa M Larkin
- Department of Molecular and Integrative Physiology and University of Michigan, Ann Arbor, Michigan, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
6
|
Tam E, McGrath M, Sladkova M, AlManaie A, Alostaad A, de Peppo GM. Hypothermic and cryogenic preservation of tissue-engineered human bone. Ann N Y Acad Sci 2019; 1460:77-87. [PMID: 31667884 PMCID: PMC7027566 DOI: 10.1111/nyas.14264] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/30/2019] [Accepted: 10/07/2019] [Indexed: 02/06/2023]
Abstract
To foster translation and commercialization of tissue-engineered products, preservation methods that do not significantly compromise tissue properties need to be designed and tested. Robust preservation methods will enable the distribution of tissues to third parties for research or transplantation, as well as banking of off-the-shelf products. We recently engineered bone grafts from induced pluripotent stem cells and devised strategies to facilitate a tissue-engineering approach to segmental bone defect therapy. In this study, we tested the effects of two potential preservation methods on the survival, quality, and function of tissue-engineered human bone. Engineered bone grafts were cultured for 5 weeks in an osteogenic environment and then stored in phosphate-buffered saline (PBS) solution at 4 °C or in Synth-a-Freeze™ at -80 °C. After 48 h, samples were warmed up in a water bath at 37 °C, incubated in osteogenic medium, and analyzed 1 and 24 h after revitalization. The results show that while storage in Synth-a-Freeze at -80 °C results in cell death and structural alteration of the extracellular matrix, hypothermic storage in PBS does not significantly affect tissue viability and integrity. This study supports the use of short-term hypothermic storage for preservation and distribution of high-quality tissue-engineered bone grafts for research and future clinical applications.
Collapse
Affiliation(s)
- Edmund Tam
- The New York Stem Cell Foundation Research Institute, New York, New York
| | - Madison McGrath
- The New York Stem Cell Foundation Research Institute, New York, New York
| | - Martina Sladkova
- The New York Stem Cell Foundation Research Institute, New York, New York
| | - Athbah AlManaie
- The New York Stem Cell Foundation Research Institute, New York, New York
| | - Anaam Alostaad
- The New York Stem Cell Foundation Research Institute, New York, New York
| | | |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Singh A, Scholze M, Hammer N. On the influence of surface coating on tissue biomechanics - effects on rat bones under routine conditions with implications for image-based deformation detection. BMC Musculoskelet Disord 2018; 19:387. [PMID: 30368235 PMCID: PMC6204271 DOI: 10.1186/s12891-018-2308-z] [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: 04/27/2018] [Accepted: 10/17/2018] [Indexed: 11/10/2022] Open
Abstract
Background Biomechanical testing using image-based deformation detection techniques such as digital image correlation (DIC) offer optical contactless methods for strain and displacement measurements of biological tissues. However, given the need of most samples to be speckled for image correlation using sprays, chemical alterations with impact on tissue mechanicals may result. The aim of this study was to assess the impact of such surface coating on the mechanical properties of rat bones, under routine laboratory conditions including multiple freeze-thaw cycles. Methods Two groups of rat bones, highly-uniform and mixed-effects, were assigned to six subgroups consisting of three types of surface coating (uncoated, commercially-available water- and solvent-based sprays) and two types of bone conditions (periosteum attached and removed). The mixed-effects group had undergone an additional freeze-thaw cycle at − 20 degrees. All bones underwent a three-point bending test ranging until material failure. Results Coating resulted in similar and non-significantly different mechanical properties of rat bones, indicated by elastic moduli, maximum force and bending stress. Scanning electron microscopy showed more pronounced mechanical alterations related to the additional freeze-thaw cycle, with fewer cracks being present in a bone from the highly-uniform group. Conclusions This study has concluded that surface coating with water- or solvent-based sprays for enhancing image correlation for DIC and having an additional freeze-thaw cycle do not significantly alter mechanical properties of rat bones. Therefore, this method may be recommended as an effective way of obtaining a speckled pattern.
Collapse
Affiliation(s)
- Aqeeda Singh
- Department of Anatomy, University of Otago, Lindo Ferguson Building, 270 Great King St, Dunedin, 9016, New Zealand
| | - Mario Scholze
- Department of Anatomy, University of Otago, Lindo Ferguson Building, 270 Great King St, Dunedin, 9016, New Zealand.,Institute of Materials Science and Engineering, Chemnitz University of Technology, Chemnitz, Germany
| | - Niels Hammer
- Department of Anatomy, University of Otago, Lindo Ferguson Building, 270 Great King St, Dunedin, 9016, New Zealand. .,Department of Orthopedic and Trauma Surgery, University Clinics of Leipzig, Leipzig, Germany. .,Fraunhofer IWU, Dresden, Germany.
| |
Collapse
|
9
|
The Maturation of Tissue-Engineered Skeletal Muscle Units following 28-Day Ectopic Implantation in a Rat. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2018; 5:86-94. [PMID: 31218247 DOI: 10.1007/s40883-018-0078-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Volumetric muscle loss (VML) is a loss of skeletal muscle that results in a sustained impairment of function and is often accompanied by physical deformity. To address the need for more innovative repair options, our laboratory has developed scaffold-free, multiphasic tissue-engineered skeletal muscle units (SMUs) to treat VML injuries. In our previous work, using the concept of the "body as a bioreactor", we have shown that implantation promotes the maturation of our SMUs beyond what is possible in vitro. Thus, in this study we sought to better understand the effect of implantation on the maturation of our SMUs, including the effects of implantation on SMU force production and cellular remodeling. We used an ectopic implantation so that we could more easily dissect the implanted tissues post-recovery and measure the force contribution of the SMU alone and compare it to pre-implantation values. This study also aimed to scale up the size of our SMUs to enable the replacement of larger volumes of muscle in our future VML studies. Overall, implantation resulted in extensive maturation of the SMUs, as characterized by an increase in force production, substantial integration with native tissue, innervation, vascularization, and the development of structural organization similar to native tissue.
Collapse
|
10
|
Novakova SS, Mahalingam VD, Florida SE, Mendias CL, Allen A, Arruda EM, Bedi A, Larkin LM. Tissue-engineered tendon constructs for rotator cuff repair in sheep. J Orthop Res 2018; 36:289-299. [PMID: 28657154 DOI: 10.1002/jor.23642] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 06/25/2017] [Indexed: 02/04/2023]
Abstract
Current rotator cuff repair commonly involves the use of single or double row suture techniques, and despite successful outcomes, failure rates continue to range from 20 to 95%. Failure to regenerate native biomechanical properties at the enthesis is thought to contribute to failure rates. Thus, the need for technologies that improve structural healing of the enthesis after rotator cuff repair is imperative. To address this issue, our lab has previously demonstrated enthesis regeneration using a tissue-engineered graft approach in a sheep anterior cruciate ligament (ACL) repair model. We hypothesized that our tissue-engineered graft designed for ACL repair also will be effective in rotator cuff repair. The goal of this study was to test the efficacy of our Engineered Tissue Graft for Rotator Cuff (ETG-RC) in a rotator cuff tear model in sheep and compare this novel graft technology to the commonly used double row suture repair technique. Following a 6-month recovery, the grafted and contralateral shoulders were removed, imaged using X-ray, and tested biomechanically. Additionally, the infraspinatus muscle, myotendinous junction, enthesis, and humeral head were preserved for histological analysis of muscle, tendon, and enthesis structure. Our results showed that our ETC-RCs reached 31% of the native tendon tangent modulus, which was a modest, non-significant, 11% increase over that of the suture-only repairs. However, the histological analysis showed the regeneration of a native-like enthesis in the ETG-RC-repaired animals. This advanced structural healing may improve over longer times and may diminish recurrence rates of rotator cuff tears and lead to better clinical outcomes. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:289-299, 2018.
Collapse
Affiliation(s)
- Stoyna S Novakova
- Departments of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan 48109-2200Michigan 48109-2200
| | - Vasudevan D Mahalingam
- Departments of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan 48109-2200Michigan 48109-2200
| | - Shelby E Florida
- Departments of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan 48109-2200Michigan 48109-2200
| | - Christopher L Mendias
- Departments of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan 48109-2200Michigan 48109-2200.,Departments of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan 48109-2200
| | | | - Ellen M Arruda
- Departments of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan 48109-2200.,Departments of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109-2200.,Departments of Macromolecular Science and Engineering, University of Michigan, Ann Arbor, Michigan 48109-2200
| | - Asheesh Bedi
- Departments of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan 48109-2200
| | - Lisa M Larkin
- Departments of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan 48109-2200Michigan 48109-2200.,Departments of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109-2200
| |
Collapse
|
11
|
Development of Multilayered Chlorogenate-Peptide Based Biocomposite Scaffolds for Potential Applications in Ligament Tissue Engineering - An <i>In Vitro</i> Study. JOURNAL OF BIOMIMETICS BIOMATERIALS AND BIOMEDICAL ENGINEERING 2017. [DOI: 10.4028/www.scientific.net/jbbbe.34.37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In this work, for the first time, chlorogenic acid, a natural phytochemical, was conjugated to a lactoferrin derived antimicrobial peptide sequence RRWQWRMKKLG to develop a self-assembled template. To mimic the components of extracellular matrix, we then incorporated Type I Collagen, followed by a sequence of aggrecan peptide (ATEGQVRVNSIYQDKVSL) onto the self-assembled templates for potential applications in ligament tissue regeneration. Mechanical properties and surface roughness were studied and the scaffolds displayed a Young’s Modulus of 169 MP and an average roughness of 72 nm respectively. Thermal phase changes were studied by DSC analysis. Results showed short endothermic peaks due to water loss and an exothermic peak due to crystallization of the scaffold caused by rearrangement of the components. Biodegradability studies indicated a percent weight loss of 27.5 % over a period of 37 days. Furthermore, the scaffolds were found to adhere to fibroblasts, the main cellular component of ligament tissue. The scaffolds promoted cell proliferation and displayed actin stress fibers indicative of cell motility and attachment. Collagen and proteoglycan synthesis were also promoted, demonstrating increased expression and deposition of collagen and proteoglycans. Additionally, the scaffolds exhibited antimicrobial activity against Staphylococcus epidermis bacteria, which is beneficial for minimizing biofilm formation if potentially used as implants. Thus, we have developed a novel biocomposite that may open new avenues to enhance ligament tissue regeneration.
Collapse
|
12
|
Mallett KF, Arruda EM. Digital image correlation-aided mechanical characterization of the anteromedial and posterolateral bundles of the anterior cruciate ligament. Acta Biomater 2017; 56:44-57. [PMID: 28366841 DOI: 10.1016/j.actbio.2017.03.045] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 03/10/2017] [Accepted: 03/27/2017] [Indexed: 01/12/2023]
Abstract
The anterior cruciate ligament (ACL) is one of the most commonly injured soft tissue structures in the articular knee joint, often requiring invasive surgery for patients to restore pre-injury knee kinematics. There is a pressing need to understand the role of the ACL in knee function, in order to select proper replacements. Digital image correlation (DIC), a non-contact full field displacement measurement technique, is an established tool for evaluating non-biological materials. The application of DIC to soft tissues has been in the nascent stages, largely due to patterning challenges of such materials. The ACL is notoriously difficult to mechanically characterize, due to the complex geometry of its two bundles and their insertions. This paper examines the use of DIC to determine the tensile mechanical properties of the AM and PL bundles of ovine ACLs in a well-known loading state. Homogenous loading in the mid-substance of the bundles provides for accurate development of stress/strain curves using DIC. Animal to animal variability is reduced, and the bundles are stiffer than previously thought when tissue-level strains are accurately measured. STATEMENT OF SIGNIFICANCE The anterior cruciate ligament (ACL), a major stabilizing ligament of the articular knee joint, is one of the most commonly injured soft tissue structures in the knee. Often, invasive surgery is required to restore pre-injury knee kinematics, and there are several long-term consequences of ACL reconstructions, including early-onset osteoarthritis. The role of the ACL in knee stability and motion has received much attention in the biomechanics community. This paper examines the use of a non-contact full-field displacement measurement technique, digital image correlation, to determine the tensile mechanical properties of the ACL. The focus of this work is to investigate the intrinsic mechanical properties of the ACL, as new knowledge in these areas will aid clinicians in selecting ACL replacements.
Collapse
Affiliation(s)
- Kaitlyn F Mallett
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, United States.
| | - Ellen M Arruda
- Department of Mechanical Engineering, Department of Biomedical Engineering, Program in Macromolecular Science and Engineering, University of Michigan, Ann Arbor, MI 48109, United States.
| |
Collapse
|
13
|
McCorry MC, Mansfield MM, Sha X, Coppola DJ, Lee JW, Bonassar LJ. A model system for developing a tissue engineered meniscal enthesis. Acta Biomater 2017; 56:110-117. [PMID: 27989921 PMCID: PMC7326006 DOI: 10.1016/j.actbio.2016.10.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 10/26/2016] [Accepted: 10/26/2016] [Indexed: 02/07/2023]
Abstract
The meniscus acts as a stabilizer, lubricator, and load distributer in the knee joint. The mechanical stability of the meniscus depends on its connection to the underlying bone by a fibrocartilage to bone transition zone called the meniscal enthesis. Tissue engineered menisci hold great promise as a treatment alternative however lack a means of integrated fixation to the underlying bone needed in order for a tissue engineered meniscal replacement to be successful. Tissue engineering the meniscal enthesis is a difficult task given the complex gradients of cell type, mineral, and extracellular matrix molecules. Therefore, there is a need for a simplified and high throughput enthesis model to test experimental parameters. The goal of this study was to develop a simplified enthesis model to test collagen integration with decellularized bone. We found that injection molding collagen into tubing loaded with decellularized bone plugs resulted in a scaffold with three regions: bone, bone-collagen, and collagen. Furthermore, collagen formation was directed in the axial direction by using mechanical fixation at the bony ends. The results of this study showed that this technique can be used to mimic the native enthesis morphology and serves as ideal test platform to generate a model tissue engineered enthesis. STATEMENT OF SIGNIFICANCE The meniscal enthesis is a complex structure that is essential to mechanical stability of the meniscus and the knee joint. Several studies document the development of anatomically shaped tissue engineered meniscus constructs, but none have focused on how to integrate such tissues with underlying bone. This study establishes a simplified construct to model the meniscal enthesis composed of a collagen gel seeded with meniscal fibrochondrocytes integrated with decellularized cancellous bone. Mechanical fixation at the bony ends induced tissue integration of fibers into the bony tissue, which is critical for mechanical performance and has yet to be shown in enthesis literature. Our test platform is amenable to targeted experiments investigating mineralization gradients, collagen fiber alignment, cell population phenotype, and media conditioning with experimental impact on enthesis studies for meniscus, tendon, and ligament.
Collapse
Affiliation(s)
- Mary Clare McCorry
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, United States.
| | - Melissa M Mansfield
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, United States.
| | - Xiaozhou Sha
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, United States.
| | - Daniel J Coppola
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, United States.
| | - Jonathan W Lee
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, United States.
| | - Lawrence J Bonassar
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, United States; Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, United States.
| |
Collapse
|
14
|
Adams AM, VanDusen KW, Kostrominova TY, Mertens JP, Larkin LM. Scaffoldless tissue-engineered nerve conduit promotes peripheral nerve regeneration and functional recovery after tibial nerve injury in rats. Neural Regen Res 2017; 12:1529-1537. [PMID: 29090000 PMCID: PMC5649475 DOI: 10.4103/1673-5374.215265] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Damage to peripheral nerve tissue may cause loss of function in both the nerve and the targeted muscles it innervates. This study compared the repair capability of engineered nerve conduit (ENC), engineered fibroblast conduit (EFC), and autograft in a 10-mm tibial nerve gap. ENCs were fabricated utilizing primary fibroblasts and the nerve cells of rats on embryonic day 15 (E15). EFCs were fabricated utilizing primary fibroblasts only. Following a 12-week recovery, nerve repair was assessed by measuring contractile properties in the medial gastrocnemius muscle, distal motor nerve conduction velocity in the lateral gastrocnemius, and histology of muscle and nerve. The autografts, ENCs and EFCs reestablished 96%, 87% and 84% of native distal motor nerve conduction velocity in the lateral gastrocnemius, 100%, 44% and 44% of native specific force of medical gastrocnemius, and 63%, 61% and 67% of native medial gastrocnemius mass, respectively. Histology of the repaired nerve revealed large axons in the autograft, larger but fewer axons in the ENC repair, and many smaller axons in the EFC repair. Muscle histology revealed similar muscle fiber cross-sectional areas among autograft, ENC and EFC repairs. In conclusion, both ENCs and EFCs promoted nerve regeneration in a 10-mm tibial nerve gap repair, suggesting that the E15 rat nerve cells may not be necessary for nerve regeneration, and EFC alone can suffice for peripheral nerve injury repair.
Collapse
Affiliation(s)
- Aaron M Adams
- Department of Molecular and Integrated Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Keith W VanDusen
- Department of Molecular and Integrated Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Tatiana Y Kostrominova
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Northwest, Gary, IN, USA
| | - Jacob P Mertens
- Department of Molecular and Integrated Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Lisa M Larkin
- Department of Molecular and Integrated Physiology, University of Michigan, Ann Arbor, MI, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
15
|
Florida SE, VanDusen KW, Mahalingam VD, Schlientz AJ, Wojtys EM, Wellik DM, Larkin LM. In vivo structural and cellular remodeling of engineered bone-ligament-bone constructs used for anterior cruciate ligament reconstruction in sheep. Connect Tissue Res 2016; 57:526-538. [PMID: 27184487 PMCID: PMC5167374 DOI: 10.1080/03008207.2016.1187141] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Anterior cruciate ligament (ACL) ruptures rank among the most prevalent and costly sports-related injuries. Current tendon grafts used for ACL reconstruction are limited by suboptimal biomechanical properties. We have addressed these issues by engineering multiphasic bone-ligament-bone (BLB) constructs that develop structural and mechanical properties similar to native ACL. The purpose of this study was to examine the acute remodeling process that occurs as the BLB grafts advance toward the adult ligament phenotype in vivo. Thus, we implanted BLB constructs fabricated from male cells into female host sheep and allowed 3, 7, 14, or 28 days (n = 4 at each time point) for recovery. To address whether or not graft-derived cells were even necessary, a subset of BLB constructs (n = 3) were acellularized, implanted, and allowed 28 days for recovery. At each recovery time point, the following histological analyses were performed: picrosirius red staining to assess collagen alignment and immunohistochemistry to assess both graft development and host immune response. Polymerase chain reaction (PCR) analysis, performed on every explanted BLB, was used to detect the presence of graft-derived male cells remaining in the constructs and/or migration into surrounding host tissue. The analysis of the PCR and histology samples revealed a rapid migration of host-derived macrophages and neutrophils into the graft at 3 days, followed by increased collagen density and alignment, vascularization, innervation, and near complete repopulation of the graft with host cells within 28 days. This study provides a greater understanding of the processes of ligament regeneration in our BLB constructs as they remodel toward the adult ligament phenotype.
Collapse
Affiliation(s)
- Shelby E. Florida
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Keith W. VanDusen
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Vasudevan D. Mahalingam
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Aleesa J. Schlientz
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Edward M. Wojtys
- Medsport Sports Medicine Program, Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Deneen M. Wellik
- Department of Cell & Developmental Biology University of Michigan, Ann Arbor, Michigan, USA,Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Lisa M. Larkin
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, Michigan, USA,Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
16
|
Mahalingam V, Wojtys EM, Wellik DM, Arruda EM, Larkin LM. Fresh and Frozen Tissue-Engineered Three-Dimensional Bone-Ligament-Bone Constructs for Sheep Anterior Cruciate Ligament Repair Following a 2-Year Implantation. Biores Open Access 2016; 5:289-298. [PMID: 27843707 PMCID: PMC5107674 DOI: 10.1089/biores.2016.0032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Injuries to the anterior cruciate ligament (ACL) often require surgical reconstruction utilizing tendon grafts to restore knee function and stability. Some current graft options for ACL repair are associated with poor long-term outcomes. Our laboratory has fabricated tissue-engineered bone–ligament–bone (BLB) constructs that demonstrate native ligament regeneration and advancement toward native ACL mechanical properties in a sheep ACL reconstruction model. Prior work has shown that freezing BLBs as a method of preservation resulted in similar outcomes compared with fresh BLBs after 6-month implantation. The purpose of this study was to evaluate the long-term efficacy of fresh and frozen BLBs. We hypothesized that both fresh and frozen BLBs would show continued regeneration of structural and functional properties toward those of native ACL after a 2-year implantation. Following removal of the native ACL, fresh (n = 2) and frozen (n = 2) BLBs were implanted arthroscopically. After 2 years of recovery, sheep were euthanized and both the experimental and contralateral hindlimbs were removed and radiographs were performed. Explanted knees were initially evaluated for joint laxity and were then further dissected for uniaxial tensile testing of the isolated ACL or BLB. Following mechanical testing, explanted contralateral ACL (C-ACL) and BLBs were harvested for histology. Two years post-ACL reconstruction, fresh and frozen BLBs exhibited similar morphological and biomechanical properties as well as more advanced regeneration compared with our 6-month recovery study. These data indicate that an additional 1.5-year regeneration period allows the BLB to continue ligament regeneration in vivo. In addition, freezing the BLBs is a viable option for the preservation of the graft after fabrication.
Collapse
Affiliation(s)
- Vasudevan Mahalingam
- Department of Molecular and Integrative Physiology, University of Michigan , Ann Arbor, Michigan
| | - Edward M Wojtys
- Medsport Sports Medicine Program, Department of Orthopaedic Surgery, University of Michigan , Ann Arbor, Michigan
| | - Deneen M Wellik
- Department of Internal Medicine, Division of Molecular Medicine and Genetics, University of Michigan , Ann Arbor, Michigan
| | - Ellen M Arruda
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan.; Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan.; Program in Macromolecular Science and Engineering, University of Michigan, Ann Arbor, Michigan
| | - Lisa M Larkin
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan.; Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
17
|
Nyland J, Mattocks A, Kibbe S, Kalloub A, Greene JW, Caborn DNM. Anterior cruciate ligament reconstruction, rehabilitation, and return to play: 2015 update. Open Access J Sports Med 2016; 7:21-32. [PMID: 26955296 PMCID: PMC4772947 DOI: 10.2147/oajsm.s72332] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Anatomical discoveries and a growing appreciation of the knee as a complex organ are driving innovations in patient care decision-making following anterior cruciate ligament (ACL) injury. Surgeons are increasing their efforts to restore combined mechanical-neurosensory ACL function and placing more consideration on when to reconstruct versus repair native anatomical structures. Surgical options now include primary repair with or without reinforcing the injured ACL with suture-based internal bracing, and growing evidence supports biological augmentation using platelet-rich plasma and mesenchymal stem cells to enhance tissue healing. Physical therapists and athletic trainers are increasing their efforts to facilitate greater athlete cognitive engagement during therapeutic exercise performance to better restore nonimpaired neuromuscular control activation amplitude and timing. Knee brace design and use needs to evolve to better match these innovations and their influence on the rehabilitation plan timetable. There is a growing appreciation for the multifaceted characteristics of the rehabilitation process and how they influence neuromuscular, educational, and psychobehavioral treatment goal achievement. Multiple sources may influence the athlete during the return to sports process and clinical outcome measures need to be refined to better evaluate these influences. This update summarizes contemporary ACL surgical, medical, and rehabilitation interventions and future trends.
Collapse
Affiliation(s)
- John Nyland
- Athletic Training Program, Kosair Charities College of Health and Natural Sciences, Spalding University, Louisville, KY, USA; Department of Orthopedic Surgery, University of Louisville, Louisville, KY, USA
| | - Alma Mattocks
- Athletic Training Program, Kosair Charities College of Health and Natural Sciences, Spalding University, Louisville, KY, USA
| | - Shane Kibbe
- Department of Orthopedic Surgery, University of Louisville, Louisville, KY, USA
| | - Alaa Kalloub
- Department of Orthopedic Surgery, University of Louisville, Louisville, KY, USA; Shea Orthopedic Group, Louisville, KY, USA
| | - Joe W Greene
- Norton Orthopedic and Sports, Louisville, KY, USA
| | - David N M Caborn
- Department of Orthopedic Surgery, University of Louisville, Louisville, KY, USA; Shea Orthopedic Group, Louisville, KY, USA
| |
Collapse
|
18
|
Walter SG, Thomas TS, Tafuro L, Thomas W. Enhanced Bone-Tendon-Bone Approach for Open Anterior Cruciate Ligament Replacement With Conservation of the Joint Capsule. Arthrosc Tech 2015; 4:e609-13. [PMID: 26900562 PMCID: PMC4722702 DOI: 10.1016/j.eats.2015.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/15/2015] [Indexed: 02/03/2023] Open
Abstract
Arthroscopic procedures for ruptured anterior cruciate ligament (ACL) tears are a common standard. However, there are strong alternatives to this standard. The purpose of this study is to present a precise, fast, and minimally invasive but open procedure for reconstruction of the ruptured ACL. The torn ACL is substituted by a widely used bone-patellar tendon-bone (BPTB) autograft. After the BPTB graft has been harvested, the Hoffa body is exposed and mobilized ventrally. The surgeon then has a free view of the remnants of the torn ACL, which are to be removed completely. Through the tibial and femoral footprints of the ACL, a tunnel is drilled under a direct view, thus ensuring optimal anatomic positioning of the BPTB graft. The described approach is simple in handling and advantageous because all steps are performed under a direct view, which improves overall precision and intraoperative functional control.
Collapse
|