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Blakeney WG, Hayes A, Kop A, Parry J, Walsh M, Annear P, Pabbruwe M. Biomechanical and Histological Study of Retrieved LARS Synthetic Ligaments. Am J Sports Med 2024; 52:1979-1983. [PMID: 38828652 DOI: 10.1177/03635465241253266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
BACKGROUND Synthetic grafts have been used for a number of years in anterior cruciate ligament (ACL) reconstruction surgery. One of the more recent additions to the stable of synthetic ligaments is the Ligament Augmentation and Reconstruction System (LARS) ligament. PURPOSE To analyze the biomechanics and histology of LARS grafts retrieved due to failure of the device. STUDY DESIGN Descriptive laboratory study. METHODS A total of 22 LARS ligament grafts that were explanted from patients were sent for analysis. Five new, unused samples of the standard LARS ACL graft were also analyzed. Biomechanical testing was performed: ultimate tensile force, force versus displacement, and stress versus strain were recorded. Histopathological examination was performed looking for degree of fibrous tissue ingrowth as well as the presence of a foreign body reaction. RESULTS Of the 22 grafts retrieved, 14 were used for ACL grafts, 1 for a lateral collateral ligament graft, 2 for medial collateral ligament grafts, 4 for gluteal tendon augmentation, and 1 for a supraspinatus augmentation. A severe foreign body reaction was found in 86% of the grafts (18/22) and a mild foreign body reaction in the remaining 14% (4/22). Tissue ingrowth was minimal in the majority of ACL grafts; the other grafts showed moderate tissue ingrowth. Maximal tensile force was significantly higher for the new ACL grafts (mean ± SD, 1667 ± 845 N) compared with the retrieved grafts (897 ± 395 N; P < .05). CONCLUSION This study demonstrated that the vast majority of retrieved LARS artificial ligaments had a florid foreign body reaction. There was minimal tissue ingrowth in ACL grafts and moderate ingrowth in other grafts. Retrieved grafts had a decreased ultimate tensile force, which increased their risk of rupture. CLINICAL RELEVANCE Surgeons should be cautious in choosing to use these grafts in reconstructive surgery for patients.
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Affiliation(s)
- William G Blakeney
- Royal Perth Hospital, Department of Orthopaedic Surgery, Perth, Australia
- University of Western Australia. Department of Surgery, Perth, Australia
| | - Alex Hayes
- Centre for Implant Technology and Retrieval Analysis, Department of Medical Engineering and Physics, Royal Perth Hospital, Perth, Australia
| | - Alan Kop
- Centre for Implant Technology and Retrieval Analysis, Department of Medical Engineering and Physics, Royal Perth Hospital, Perth, Australia
| | | | - Michael Walsh
- Hawkesbury District Health Service, Windsor, New South Wales, Australia
| | - Peter Annear
- Perth Orthopaedic and Sports Medicine Centre, Perth, Australia
| | - Moreica Pabbruwe
- Centre for Implant Technology and Retrieval Analysis, Department of Medical Engineering and Physics, Royal Perth Hospital, Perth, Australia
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Xu F, Li Y, Yu Y, Wang G, Cai G. Evaluation of biomechanical properties and biocompatibility: are partially absorbable cords eligible for anterior cruciate ligament reconstruction? Front Bioeng Biotechnol 2023; 11:1216937. [PMID: 37854884 PMCID: PMC10580803 DOI: 10.3389/fbioe.2023.1216937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/05/2023] [Indexed: 10/20/2023] Open
Abstract
Introduction: Independent augmentation technology based on reinforcing devices has been reported to signifi-cantly reduce the elongation behavior of graft and improve knee stability after anterior cruciate ligament reconstruction (ACLR). Using biodegradable devices could reduce the risk of severe inflammatory reactions due to particle accumulation from foreign bodies. Given the limitations of the mechanical properties of biodegradable materials, partially biodegradable composite devices may offer a compromise strategy. Methods: Three types of partially absorbable core-sheath sutures, including low-absorbable cord (LA-C), medium-absorbable cord (MA-C) and high-absorbable cord (HA-C), were braided using unabsorbable ultra-high molecular weight polyethylene (UHMWPE) yarn and absorbable polydioxanone (PDO) monofil-ament bundle based on the desired configuration. The feasibility of these partially absorbable cords were verified by biomechanical testing, material degradation testing, and cell experiments, all performed in vitro. Results: Reinforcement of an 8 mm graft with the cords decreased dynamic elongation by 24%-76%, was positively related to dynamic stiffness, and increased the failure load by 44%-105%, during which LA-C showed maximum enhancement. Human ligament-derived fibroblasts showed good proliferation and vitality on each cord over 2 weeks and aligned themselves in the direction of the fibers, especially the UHMWPE portion. Discussion: This study supports the potential of partially degradable UHMWPE/PDO cords, particularly LA-C, for graft protection. Nervertheless, a higher proportion of biodegradable material results in lower stiffness, which may impair the protective and lead to mechanical instability during degradation.
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Affiliation(s)
- Fei Xu
- Kunming Medical University, Kunming Yunnan, China
- Department of Pain Treatment, The First People’s Hospital of Yunnan Province, Kunming Yunnan, China
| | - Yanlin Li
- Kunming Medical University, Kunming Yunnan, China
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
| | - Yang Yu
- Kunming Medical University, Kunming Yunnan, China
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
| | - Guoliang Wang
- Kunming Medical University, Kunming Yunnan, China
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
| | - Guofeng Cai
- Kunming Medical University, Kunming Yunnan, China
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
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Chen N, Jin W, Gao H, Hong J, Sun L, Yao J, Chen X, Chen J, Chen S, Shao Z. Sequential intervention of anti-inflammatory and osteogenesis with silk fibroin coated polyethylene terephthalate artificial ligaments for anterior cruciate ligament reconstruction. J Mater Chem B 2023; 11:8281-8290. [PMID: 37584321 DOI: 10.1039/d3tb00911d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
Graft-host integration after the anterior cruciate ligament (ACL) reconstruction sequentially follows the prognosis from the inflammation period to the regeneration period. However, due to insufficient bioactivity, polyethylene terephthalate (PET) artificial ligaments often require a long period for graft-host integration. To improve graft-host integration, sequential therapy targeting multifactor is widely advocated. In this study, a multilayer regenerated silk fibroin (RSF) coating loaded with heparin and bone morphogenetic protein binding peptide (BBP) for differentiated release was introduced on the surface of the PET artificial ligament by a stepwise deposition method. The drug release profiles of heparin and BBP on the coated PET artificial ligament indicated the features of differential drug release, i.e., with heparin in the outermost layer releasing a significant amount (more than 60%) during the first 5 days while BBP in the inner layer only releasing a small amount (ca. 30%) within 1 week without burst release. Based on the isometric ACL reconstruction model of rabbits, such drug-loaded RSF coating was verified to be able to modulate the early inflammatory response and promote the maturation of the graft in the articular cavity, meanwhile, it provided a continuous and stable signal of osteogenic induction to improve graft-bone integration. Thus, sequential intervention with heparin and BBP proved to be a reliable combination, and multifunctional RSF-coated PET artificial ligaments hold great potential for improving the clinical efficacy of ACL reconstruction.
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Affiliation(s)
- Ni Chen
- State Key Laboratory of Molecular Engineering of Polymers, Laboratory of Advanced Materials and Department of Macromolecular Science, Fudan University, Shanghai 200433, China.
| | - Wenhe Jin
- Sports Medicine Insititute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China.
| | - Han Gao
- Sports Medicine Insititute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China.
| | - Jiachan Hong
- State Key Laboratory of Molecular Engineering of Polymers, Laboratory of Advanced Materials and Department of Macromolecular Science, Fudan University, Shanghai 200433, China.
| | - Luyi Sun
- Sports Medicine Insititute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China.
| | - Jinrong Yao
- State Key Laboratory of Molecular Engineering of Polymers, Laboratory of Advanced Materials and Department of Macromolecular Science, Fudan University, Shanghai 200433, China.
| | - Xin Chen
- State Key Laboratory of Molecular Engineering of Polymers, Laboratory of Advanced Materials and Department of Macromolecular Science, Fudan University, Shanghai 200433, China.
| | - Jun Chen
- Sports Medicine Insititute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China.
| | - Shiyi Chen
- Sports Medicine Insititute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China.
| | - Zhengzhong Shao
- State Key Laboratory of Molecular Engineering of Polymers, Laboratory of Advanced Materials and Department of Macromolecular Science, Fudan University, Shanghai 200433, China.
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Moretti L, Cassano GD, Caricato A, Caiaffa E, D'Aprile M, Angiulli F, Spinarelli A, Moretti B, Solarino G. Anterior Cruciate Ligament Reconstruction with Quadrupled Semitendinosus Graft or Synthetic Ligament: Knee Stability and Clinical Outcomes at Three Years Follow-Up. Adv Orthop 2023; 2023:4022441. [PMID: 37520887 PMCID: PMC10374376 DOI: 10.1155/2023/4022441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/30/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
The incidence of anterior cruciate ligament reconstruction (ACLR) surgeries is increasing and graft choice is important for a rapid return to activity, especially in patients older than 30 years. The aim of this study is to compare in term of quality of life and knee stability of patients who undergone ACLR using quadrupled semitendinosus (ST4) graft against patients who undergone ACLR with synthetic ligaments. Thirty-nine patients undergoing ACLR were enrolled in the study and were divided into two groups: ACLR with synthetic ligaments-LARS (group A) and ACLR with quadrupled semitendinosus graft ST4 (group B). They underwent surgery at Policlinico di Bari Orthopedic Unit between January 2017 and January 2020. Group A was composed by nineteen patients (36.16 ± 4.41 mean age-years, 22.47 ± 2.63 mean BMI-kg/m2, 39.37 ± 10.05 mean time evaluation after surgery-months) and group B was composed by twenty patients (34.95 ± 3.59 mean age-years, 21.1 ± 2.88 mean BMI-kg/m2, 36.75 ± 8.69 mean time evaluation after surgery-months). For each patient, the following data were recorded: age; side of injury, BMI, date of surgery, anterior knee laxity with the arthrometer, and Lysholm knee scoring scale. Mean value of anterior tibial translation (ATT) in group A was 3.09 mm ± 0.65 and in group B was 2.66 mm ± 1.61 (pvalue of 0.1139). Mann--Whitney U test used to compare the Lysholm means values between groups showed a pvalue of 0.9307. LARS has comparable clinical and functional outcomes compared with hamstring autografts at short-term of 3 years follow-up. Level of Evidence: IV.
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Affiliation(s)
- Lorenzo Moretti
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, 70124 Bari, Italy
| | - Giuseppe D. Cassano
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, 70124 Bari, Italy
| | - Alessandro Caricato
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, 70124 Bari, Italy
| | - Elio Caiaffa
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, 70124 Bari, Italy
| | - Matteo D'Aprile
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, 70124 Bari, Italy
| | - Francesco Angiulli
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, 70124 Bari, Italy
| | - Antonio Spinarelli
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, 70124 Bari, Italy
| | - Biagio Moretti
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, 70124 Bari, Italy
| | - Giuseppe Solarino
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, 70124 Bari, Italy
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Gomez-Cerezo MN, Perevoshchikova N, Ruan R, Moerman KM, Bindra R, Lloyd DG, Zheng MH, Saxby DJ, Vaquette C. Additively manufactured polyethylene terephthalate scaffolds for scapholunate interosseous ligament reconstruction. BIOMATERIALS ADVANCES 2023; 149:213397. [PMID: 37023566 DOI: 10.1016/j.bioadv.2023.213397] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 03/29/2023]
Abstract
The regeneration of the ruptured scapholunate interosseous ligament (SLIL) represents a clinical challenge. Here, we propose the use of a Bone-Ligament-Bone (BLB) 3D-printed polyethylene terephthalate (PET) scaffold for achieving mechanical stabilisation of the scaphoid and lunate following SLIL rupture. The BLB scaffold featured two bone compartments bridged by aligned fibres (ligament compartment) mimicking the architecture of the native tissue. The scaffold presented tensile stiffness in the range of 260 ± 38 N/mm and ultimate load of 113 ± 13 N, which would support physiological loading. A finite element analysis (FEA), using inverse finite element analysis (iFEA) for material property identification, showed an adequate fit between simulation and experimental data. The scaffold was then biofunctionalized using two different methods: injected with a Gelatin Methacryloyl solution containing human mesenchymal stem cell spheroids (hMSC) or seeded with tendon-derived stem cells (TDSC) and placed in a bioreactor to undergo cyclic deformation. The first approach demonstrated high cell viability, as cells migrated out of the spheroid and colonised the interstitial space of the scaffold. These cells adopted an elongated morphology suggesting the internal architecture of the scaffold exerted topographical guidance. The second method demonstrated the high resilience of the scaffold to cyclic deformation and the secretion of a fibroblastic related protein was enhanced by the mechanical stimulation. This process promoted the expression of relevant proteins, such as Tenomodulin (TNMD), indicating mechanical stimulation may enhance cell differentiation and be useful prior to surgical implantation. In conclusion, the PET scaffold presented several promising characteristics for the immediate mechanical stabilisation of disassociated scaphoid and lunate and, in the longer-term, the regeneration of the ruptured SLIL.
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Cai Y, Zhu W, Zhong M. Letter to the editor on "Clinical outcomes of medial patellofemoral ligament reconstruction using FiberTape and knotless SwiveLock anchors". Knee 2023:S0968-0160(23)00032-7. [PMID: 36801120 DOI: 10.1016/j.knee.2023.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 01/30/2023] [Indexed: 02/23/2023]
Affiliation(s)
- Yuyin Cai
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen 518000, Guangdong Province, China
| | - Weimin Zhu
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen 518000, Guangdong Province, China
| | - Mingjin Zhong
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen 518000, Guangdong Province, China.
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Reply to Letter to the editor on "Clinical outcomes of medial patellofemoral ligament reconstruction using FiberTape and knotless SwiveLock anchors". Knee 2023:S0968-0160(23)00033-9. [PMID: 36781342 DOI: 10.1016/j.knee.2023.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/15/2023]
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Ambrosio L, Vadalà G, Castaldo R, Gentile G, Nibid L, Rabitti C, Ambrosio L, Franceschetti E, Samuelsson K, Senorski EH, Papalia R, Denaro V. Massive foreign body reaction and osteolysis following primary anterior cruciate ligament reconstruction with the ligament augmentation and reconstruction system (LARS): a case report with histopathological and physicochemical analysis. BMC Musculoskelet Disord 2022; 23:1140. [PMID: 36581922 PMCID: PMC9801556 DOI: 10.1186/s12891-022-05984-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 11/14/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Autologous hamstrings and patellar tendon have historically been considered the gold standard grafts for anterior cruciate ligament reconstruction (ACLR). In the last decades, the utilization of synthetic grafts has re-emerged due to advantageous lack of donor site morbidity and more rapid return to sport. The Ligament Augmentation and Reconstruction System (LARS) has demonstrated to be a valid and safe option for ACLR in the short term. However, recent studies have pointed out the notable frequency of associated complications, including synovitis, mechanical failure, and even chondrolysis requiring joint replacement. CASE PRESENTATION We report the case of a 23-year-old male who developed a serious foreign body reaction with wide osteolysis of both femoral and tibial tunnels following ACLR with LARS. During first-stage arthroscopy, we performed a debridement of the pseudocystic mass incorporating the anterior cruciate ligament (ACL) and extending towards the tunnels, which were filled with autologous anterior iliac crest bone graft chips. Histological analysis revealed the presence of chronic inflammation, fibrosis, and foreign body giant cells with synthetic fiber inclusions. Furthermore, physicochemical analysis showed signs of fiber depolymerization, increased crystallinity and formation of lipid peroxidation-derived aldehydes, which indicate mechanical aging and instability of the graft. After 8 months, revision surgery was performed and ACL revision surgery with autologous hamstrings was successfully carried out. CONCLUSIONS The use of the LARS grafts for ACLR should be cautiously contemplated considering the high risk of complications and early failure.
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Affiliation(s)
- Luca Ambrosio
- grid.488514.40000000417684285Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy ,grid.9657.d0000 0004 1757 5329Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Gianluca Vadalà
- grid.488514.40000000417684285Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy ,grid.9657.d0000 0004 1757 5329Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Rachele Castaldo
- grid.5326.20000 0001 1940 4177Institute of Polymers, Composites and Biomaterials, National Research Council, Naples, Italy
| | - Gennaro Gentile
- grid.5326.20000 0001 1940 4177Institute of Polymers, Composites and Biomaterials, National Research Council, Naples, Italy
| | - Lorenzo Nibid
- grid.488514.40000000417684285Department of Human Pathology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Carla Rabitti
- grid.488514.40000000417684285Department of Human Pathology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Luigi Ambrosio
- grid.5326.20000 0001 1940 4177Institute of Polymers, Composites and Biomaterials, National Research Council, Naples, Italy
| | - Edoardo Franceschetti
- grid.488514.40000000417684285Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy ,grid.9657.d0000 0004 1757 5329Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Kristian Samuelsson
- grid.8761.80000 0000 9919 9582Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden ,Sahlgrenska Sports Medicine Center, Gothenburg, Sweden ,grid.1649.a000000009445082XDepartment of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Eric Hamrin Senorski
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden ,grid.8761.80000 0000 9919 9582Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rocco Papalia
- grid.488514.40000000417684285Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy ,grid.9657.d0000 0004 1757 5329Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Vincenzo Denaro
- grid.488514.40000000417684285Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
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Saraglis G, Prinja A, To K, Khan W, Singh J. Surgical treatments for acute unstable acromioclavicular joint dislocations. SICOT J 2022; 8:38. [PMID: 36069502 PMCID: PMC9450493 DOI: 10.1051/sicotj/2022038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/21/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Surgical treatment is usually recommended for acute, high-grade acromioclavicular joint (ACJ) injuries. A wide variety of surgical techniques exist, and the literature does not strongly support one over the other. In this literature review, we describe and compare the results of different surgical treatments for the management of acute unstable ACJ dislocation and aim to guide surgeons on optimal treatment. MATERIALS AND METHODS A literature review was performed by searching PubMed, Medline, Cochrane, and Embase databases. Seventeen studies met the inclusion criteria and were analyzed. Only studies with comparative data were included. The clinical and radiological outcomes of these studies were reviewed. RESULTS Seventeen studies were included in this literature review. We found no difference in outcomes between open and arthroscopic procedures. Coracoclavicular ligament (CCL) reconstruction techniques provide better results than the more rigid hook plate fixation. There is no evidence that biologic repair with tendon graft is superior to synthetic grafts. Furthermore, an autograft is not shown to be better than an allograft. Rigid fixation between the clavicle and coracoid and the non-anatomic Weaver-Dunn technique appears less popular in recent literature. The hook plate is associated with subacromial osteolysis, acromial erosion, and the morbidity of a secondary procedure. DISCUSSION There is a recent increase in publications on the reconstruction of the ACJ after injury, with new techniques focusing on the anatomic reconstruction of the CCLs aiming to restore both vertical and horizontal plane stability of the ACJ using synthetic/biological grafts. Despite the plethora of new techniques introduced, meaningful comparisons are difficult to draw due to the heterogeneity of the treatments used and the outcome measure used to assess the results.
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Affiliation(s)
- Georgios Saraglis
- Department of Trauma and Orthopaedics, Lewisham and Greenwich NHS Trust, London SE13 6LH, UK
| | - Aditya Prinja
- Upper Limb Unit, Wrightington Hospital, Lancashire, UK
| | - Kendrick To
- Division of Trauma and Orthopaedic Surgery, Department of Surgery, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Wasim Khan
- Division of Trauma and Orthopaedic Surgery, Department of Surgery, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Jagwant Singh
- Department of Trauma and Orthopaedics, Lewisham and Greenwich NHS Trust, London SE13 6LH, UK
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Bruschi A, Cevolani L, Spazzoli B, Focaccia M, Pasini S, Frisoni T, Donati DM. Periacetabular Tumour Resection under Anterosuperior Iliac Spine Allows Better Alloprosthetic Reconstruction than Above: Bone Contact Matters. J Clin Med 2022; 11:jcm11154499. [PMID: 35956114 PMCID: PMC9369579 DOI: 10.3390/jcm11154499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/26/2022] [Accepted: 07/30/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Periacetabular resections are more affected by late complications than other pelvic resections. Reconstruction using bone allograft is considered a suitable solution. However, it is still not clear how the bone-allograft contact surface impacts on mechanical and functional outcome. Materials and methods: This paper presents the results of a retrospective analysis of 33 patients with resection of the entire acetabulum and reconstruction with an allograft-prosthetic composite for the period 1999 to 2010. Patients were divided in two groups, based on type of resection. In Group 1. patients had resections under anterosuperior iliac spine allowing the highest bone-allograft surface contact in reconstruction, while in Group 2 patients had resections over it. Results: Mechanical survival of the implant and Musculoskeletal Tumor Society functional score were calculated. Impact of age and artificial ligament were investigated as well. Patients in Group 1 had 38% mechanical failure rate of the implant while patients in Group 2 had 88%. Average functional score was higher in Group 1 compared with patients in Group 2. An artificial ligament was shown to have non-significant impact on survival of the reconstruction in Group 1, while significantly improving survival of reconstruction in Group 2. Conclusion: Bone-allograft contact matters: resection under anterosuperior iliac spine allows better mechanical survival and offers better reconstruction functional scores.
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Philpott A, Epstein D, Lording T. No evidence of reduced autograft ACL rupture rates with synthetic reinforcement: A systematic review. J ISAKOS 2022. [DOI: 10.1016/j.jisako.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tsutsumi H, Kurimoto R, Nakamichi R, Chiba T, Matsushima T, Fujii Y, Sanada R, Kato T, Shishido K, Sakamaki Y, Kimura T, Kishida A, Asahara H. Generation of a tendon-like tissue from human iPS cells. J Tissue Eng 2022; 13:20417314221074018. [PMID: 35083031 PMCID: PMC8785341 DOI: 10.1177/20417314221074018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/01/2022] [Indexed: 12/29/2022] Open
Abstract
Tendons and ligaments are essential connective tissues that connect the muscle and bone. Their recovery from injuries is known to be poor, highlighting the crucial need for an effective therapy. A few reports have described the development of artificial ligaments with sufficient strength from human cells. In this study, we successfully generated a tendon-like tissue (bio-tendon) using human induced pluripotent stem cells (iPSCs). We first differentiated human iPSCs into mesenchymal stem cells (iPSC-MSCs) and transfected them with Mohawk (Mkx) to obtain Mkx-iPSC-MSCs, which were applied to a newly designed chamber with a mechanical stretch incubation system. The embedded Mkx-iPSC-MSCs created bio-tendons and exhibited an aligned extracellular matrix structure. Transplantation of the bio-tendons into a mouse Achilles tendon rupture model showed host-derived cell infiltration with improved histological score and biomechanical properties. Taken together, the bio-tendon generated in this study has potential clinical applications for tendon/ligament-related injuries and diseases.
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Affiliation(s)
- Hiroki Tsutsumi
- Department of Systems BioMedicine, Tokyo Medical and Dental University, Bunkyo City, Japan
| | - Ryota Kurimoto
- Department of Systems BioMedicine, Tokyo Medical and Dental University, Bunkyo City, Japan
| | - Ryo Nakamichi
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - Tomoki Chiba
- Department of Systems BioMedicine, Tokyo Medical and Dental University, Bunkyo City, Japan
| | - Takahide Matsushima
- Department of Systems BioMedicine, Tokyo Medical and Dental University, Bunkyo City, Japan
| | - Yuta Fujii
- Department of Systems BioMedicine, Tokyo Medical and Dental University, Bunkyo City, Japan
| | - Risa Sanada
- Department of Systems BioMedicine, Tokyo Medical and Dental University, Bunkyo City, Japan
| | - Tomomi Kato
- Department of Systems BioMedicine, Tokyo Medical and Dental University, Bunkyo City, Japan
| | - Kana Shishido
- Department of Systems BioMedicine, Tokyo Medical and Dental University, Bunkyo City, Japan
| | - Yuriko Sakamaki
- Research Core, Tokyo Medical and Dental University, Bunkyo City, Japan
| | - Tsuyoshi Kimura
- Department of Material-Based Medical Engineering, Tokyo Medical and Dental University, Bunkyo City, Japan
| | - Akio Kishida
- Department of Material-Based Medical Engineering, Tokyo Medical and Dental University, Bunkyo City, Japan
| | - Hiroshi Asahara
- Department of Systems BioMedicine, Tokyo Medical and Dental University, Bunkyo City, Japan
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, USA
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13
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Li H, Jiang F, Ge Y, Wan F, Li H, Chen S. Differences in artificial ligament graft osseointegration of the anterior cruciate ligament in a sheep model: a comparison between interference screw and cortical suspensory fixation. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1370. [PMID: 34733922 PMCID: PMC8506542 DOI: 10.21037/atm-21-1076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 07/14/2021] [Indexed: 11/28/2022]
Abstract
Background Interference screws are the most common femoral fixation for anterior cruciate ligament (ACL) reconstruction with polyethylene terephthalate (PET) artificial ligaments. However, interference screws have several disadvantages, such as the risk of one tunnel blowout and damage to the graft. Suspensory fixations have the advantages of high tensile strength and promotion of graft bone contact. The purpose of this study was to compare PET artificial ligament graft osseointegration between interference screw fixation (ISF) and cortical suspensory fixation (CSF) for ACL reconstruction. Methods Forty sheep underwent ACL reconstruction of the right knee with PET artificial ligament. The graft was fixed with ISF or CSF for femoral fixation. Animals were randomly assigned to the ISF (n=20) or the CSF (n=20) groups. The sheep were sacrificed at 3 or 12 months postoperatively for biomechanical tests, micro computed tomography (micro-CT) scans, and histological assessments. Results The mean load-to-failure between the CSF group (836±355 N) appeared higher than that of the ISF group (604±277 N) at 3 months, but no significant difference was detected between the groups (P=0.24). At 12 months, there was also no significant difference in load-to-failure between the CSF and ISF groups (1,194±350 vs. 1,097±764 N; P=0.78). According to the micro-CT scan results, the femoral bone tunnel diameter of the ISF group appeared larger than that of the CSF group at 3 months (12±1 vs. 10±1 mm; P=0.02) and similar to that of the CSF group at 12 months (12±1 vs. 11±2 mm; P=0.38). Furthermore, histological results showed that at the graft-tunnel interface of the femoral tunnel aperture, disoriented fibers formed in the ISF group while oriented and dense fibers formed in the CSF group. Conclusions ACLR with synthetic ligament by cortical suspension devices with adjustable loops demonstrated a better graft-bone healing capacity at the femoral tunnel aperture compared with that from titanium interference screws over 12 months postoperatively. No significant difference was found in biomechanical strength between the two fixation methods during the early healing stage.
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Affiliation(s)
- Hong Li
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Fangyi Jiang
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Yunsheng Ge
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Fang Wan
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Hongyun Li
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
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14
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Baawa-Ameyaw J, Plastow R, Begum FA, Kayani B, Jeddy H, Haddad F. Current concepts in graft selection for anterior cruciate ligament reconstruction. EFORT Open Rev 2021; 6:808-815. [PMID: 34667652 PMCID: PMC8489469 DOI: 10.1302/2058-5241.6.210023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Graft selection for anterior cruciate ligament reconstruction (ACLR) is important for optimizing post-operative rehabilitation, facilitating return to full sporting function and reducing the risk of complications.The most commonly used grafts for ACLR include hamstring tendon autografts, bone-patellar tendon-bone autografts, quadriceps tendon autografts, allografts and synthetic grafts.This instructional review explores the existing literature on clinical outcomes with these different graft types for ACLR and provides an evidence-based approach for graft selection in ACLR.The existing evidence on the use of extra-articular tenodesis to provide additional rotational stability during ACLR is also revisited. Cite this article: EFORT Open Rev 2021;6:808-815. DOI: 10.1302/2058-5241.6.210023.
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Affiliation(s)
- Joanna Baawa-Ameyaw
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Ricci Plastow
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Fahima Aarah Begum
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Hyder Jeddy
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Fares Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
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15
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Savić L, Augustyniak EM, Kastensson A, Snelling S, Abhari RE, Baldwin M, Price A, Jackson W, Carr A, Mouthuy PA. Early development of a polycaprolactone electrospun augment for anterior cruciate ligament reconstruction. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 129:112414. [PMID: 34579923 DOI: 10.1016/j.msec.2021.112414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/23/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022]
Abstract
Despite the clinical success of Anterior Cruciate Ligament reconstruction (ACLR) in some patients, unsatisfactory clinical outcomes secondary to graft failure are seen, indicating the need to develop new regeneration strategies. The use of degradable and bioactive textiles has the potential to improve the biological repair of soft tissue. Electrospun (ES) filaments are particularly promising as they have the ability to mimic the structure of natural tissues and influence endogenous cell behaviour. In this study, we produced continuous polycaprolactone (PCL) ES filaments using a previously described electrospinning collection method. These filaments were stretched, twisted, and assembled into woven structures. The morphological, tensile, and biological properties of the woven fabric were then assessed. Scanning electron microscopy (SEM) images highlighted the aligned and ACL-like microfibre structure found in the stretched filaments. The tensile properties indicated that the ES fabric reached suitable strengths for a use as an ACLR augmentation device. Human ACL-derived cell cultured on the fabric showed approximately a 3-fold increase in cell number over 2 weeks and this was equivalent to a collagen coated synthetic suture commonly used in ACLR. Cells generally adopted a more elongated cell morphology on the ES fabric compared to the control suture, aligning themselves in the direction of the microfibres. A NRU assay confirmed that the ES fabric was non-cytotoxic according to regulatory standards. Overall, this study supports the development of ES textiles as augmentation devices for ACLR.
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Affiliation(s)
- Luka Savić
- Botnar Institute of Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Edyta M Augustyniak
- Botnar Institute of Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Adele Kastensson
- Botnar Institute of Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sarah Snelling
- Botnar Institute of Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Roxanna E Abhari
- Botnar Institute of Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Mathew Baldwin
- Botnar Institute of Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Andrew Price
- Botnar Institute of Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - William Jackson
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Andrew Carr
- Botnar Institute of Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Pierre-Alexis Mouthuy
- Botnar Institute of Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
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16
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Shiroud Heidari B, Ruan R, De-Juan-Pardo EM, Zheng M, Doyle B. Biofabrication and Signaling Strategies for Tendon/Ligament Interfacial Tissue Engineering. ACS Biomater Sci Eng 2021; 7:383-399. [PMID: 33492125 DOI: 10.1021/acsbiomaterials.0c00731] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Tendons and ligaments (TL) have poor healing capability, and for serious injuries like tears or ruptures, surgical intervention employing autografts or allografts is usually required. Current tissue replacements are nonideal and can lead to future problems such as high retear rates, poor tissue integration, or heterotopic ossification. Alternatively, tissue engineering strategies are being pursued using biodegradable scaffolds. As tendons connect muscle and bone and ligaments attach bones, the interface of TL with other tissues represent complex structures, and this intricacy must be considered in tissue engineered approaches. In this paper, we review recent biofabrication and signaling strategies for biodegradable polymeric scaffolds for TL interfacial tissue engineering. First, we discuss biodegradable polymeric scaffolds based on the fabrication techniques as well as the target tissue application. Next, we consider the effect of signaling factors, including cell culture, growth factors, and biophysical stimulation. Then, we discuss human clinical studies on TL tissue healing using commercial synthetic scaffolds that have occurred over the past decade. Finally, we highlight the challenges and future directions for biodegradable scaffolds in the field of TL and interface tissue engineering.
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Affiliation(s)
- Behzad Shiroud Heidari
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre and the UWA Centre for Medical Research, The University of Western Australia, Nedlands, Western Australia 6009, Australia.,School of Engineering, The University of Western Australia, Perth, Western Australia 6009, Australia.,Australian Research Council Centre for Personalised Therapeutics Technologies, Australia
| | - Rui Ruan
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia 6009, Australia
| | - Elena M De-Juan-Pardo
- School of Engineering, The University of Western Australia, Perth, Western Australia 6009, Australia.,T3mPLATE, Harry Perkins Institute of Medical Research, QEII Medical Centre and the UWA Centre for Medical Research, The University of Western Australia, Nedlands, Western Australia 6009, Australia.,Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, 4000, Australia
| | - Minghao Zheng
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia 6009, Australia.,Perron Institute for Neurological and Translational Science, Nedlands, Western Australia 6009, Australia
| | - Barry Doyle
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre and the UWA Centre for Medical Research, The University of Western Australia, Nedlands, Western Australia 6009, Australia.,School of Engineering, The University of Western Australia, Perth, Western Australia 6009, Australia.,Australian Research Council Centre for Personalised Therapeutics Technologies, Australia.,BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh EH9 3FD, United Kingdom
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17
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A triple-coated ligament graft to facilitate ligament-bone healing by inhibiting fibrogenesis and promoting osteogenesis. Acta Biomater 2020; 115:160-175. [PMID: 32791348 DOI: 10.1016/j.actbio.2020.07.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/26/2020] [Accepted: 07/30/2020] [Indexed: 02/07/2023]
Abstract
Absence of ligament-bone healing due to poor bioactivity and hyperplasia of fibrous tissue caused by immune response severely impairs ligament grafts' functional duration in anterior cruciate ligament (ACL) reconstruction. While osteogenic modification is a popular technique for promoting ligament-bone integration, inadequate osseointegration remains a common experience, due to occupying fibrous hyperplasia and impaired osteogenesis potential. In the present study, a triple-nano-coating polyethylene terephthalate (PET) graft was developed by polydopamine self-assembly, chondroitin sulfate (CS) chemical-grafting and BMP-2 physical-immobilization to facilitate robust ligament-bone healing, The CS/polydopamine-modified PET (C-pPET) graft was demonstrated to inhibit fibrogenesis by regulating polarization of macrophages and promoting the secretion of anti-inflammatory factors. Moreover, the immunoregulatory function of CS cooperated with BMP-2 to facilitate osteogenic differentiation of stem cells, promoting the expression of ALP, Runx2, OCN and COL I. Bone regeneration was significantly enhanced at early-middle stage in the BMP-loaded pPET (B/pPET) group, while occurring at middle-late stage in the C-pPET group. Continuous new bone formation and optimal ligament-bone healing were observed in the B/C-pPET group via sequential and synergistic immune osteogenesis by CS and cytokine osteogenesis by BMP-2. Thus, the present study revealed a practical avenue for the promotion of ligament-bone healing through the development of a triple-nano-coating engineered ligament combining immunoregulatory anti-fibrogenesis and sequential-synergistic osteogenesis, which holds a great potential for improving the clinical efficacy of ligament graft in ACL reconstruction. STATEMENT OF SIGNIFICANCE: A triple-nano-coating polyethylene terephthalate (PET) graft was developed by polydopamine self-assembly, chondroitin sulfate (CS) chemical-grafting and BMP-2 physical-immobilization to facilitate robust ligament-bone healing. This study demonstrated that the multifunctional ligament grafts could reshape the local immune microenvironment by regulating macrophage phenotype and immune cytokine secretion to inhibit the fibrous hyperplasia and regulate stem cell towards osteogenic differentiation to promote bone regeneration. The present study demonstrates that efficient ligament-bone healing is achieved via the combination of immunoregulatory anti-fibrogenesis and dual osteogenesis of immunoregulation and cytokine induction.
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18
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The Infinity-Lock System for Chronic Grade III AC Joint Dislocation: A Novel Technique, Rehabilitation Protocol and Short Term Results. J Clin Med 2020; 9:jcm9082519. [PMID: 32764304 PMCID: PMC7464969 DOI: 10.3390/jcm9082519] [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] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/27/2020] [Indexed: 12/17/2022] Open
Abstract
Background: the choice of treatment of chronic grade III acromioclavicular (AC) joint dislocation is controversial. Several surgical techniques have been described in the literature, responding differently to nonoperative treatment. The aim of this study is to describe a modified technique of stabilizing an AC joint dislocation with the new Infinity-Lock Button System, in order to demonstrate that it is effective in optimizing outcomes and decreasing complications. Methods: this is a retrospective study of 15 patients who underwent surgical stabilization of the AC joint dislocation between 2018 and 2019, through modified surgical technique using the Infinity-Lock Button System. Active range of motion (ROM), Specific Acromio Clavicular Score (SACS) and Constant Score (CS) were evaluated preoperatively and postoperatively at last 18 months follow up. Patients rated their outcomes as very good, good, satisfactory, or unsatisfactory. Results: a total of twelve patients rated their outcome as very good and three as good; no patients were dissatisfied with surgery. The mean Constant Score increased from 38 points preoperatively to 95 postoperatively, the average SACS score decreased from 52 points preoperatively to 10 postoperatively, both significantly. No complications were detected. Conclusion: the described technique is effective for treatment of chronic grade III AC joint dislocation, resulting in elevated satisfaction ratings and predictable outcomes. Nevertheless, further longer term follow-up studies are required.
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19
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Cowling P, Hackney R, Dube B, Grainger AJ, Biglands JD, Stanley M, Song D, Conaghan PG, Kingsbury SR. The use of a synthetic shoulder patch for large and massive rotator cuff tears - a feasibility study. BMC Musculoskelet Disord 2020; 21:213. [PMID: 32264949 PMCID: PMC7140555 DOI: 10.1186/s12891-020-03227-z] [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: 09/09/2019] [Accepted: 03/20/2020] [Indexed: 01/26/2023] Open
Abstract
Background The aim of this study was to explore the feasibility of using a non-absorbable biocompatible polyester patch to augment open repair of massive rotator cuff tears (Patch group) and compare outcomes with other treatment options (Non-patch group). Methods Participants referred to orthopaedic clinics for rotator cuff surgery were recruited. Choice of intervention (Patch or Non-patch) was based on patient preference and intra-operative findings. Oxford Shoulder Score (OSS), Shoulder Pain and Disability Index (SPADI), and Constant score were completed at baseline and 6 months. Shoulder MRI was performed at baseline and 6 months to assess fat fraction and Goutallier classification pre- and post- treatment. Feasibility outcomes (including retention, consent and missing data) were assessed. Results Sixty-eight participants (29 in the Patch group, 39 in Non-patch group) were included (mean age 65.3 years). Conversion to consent (92.6%), missing data (0% at baseline), and attrition rate (16%) were deemed successful feasibility endpoints. There was significant improvement in the Patch group compared to Non-patch at 6 months in OSS (difference in medians 9.76 (95% CI 2.25, 17.29) and SPADI: 22.97 (95% CI 3.02, 42.92), with no substantive differences in Constant score. The patch group had a higher proportion of participants improving greater than MCID for OSS (78% vs 62%) and SPADI (63% vs 50%) respectively. Analysis of the 48 paired MRIs demonstrated a slight increase in the fat fraction for supraspinatus (53 to 55%), and infraspinatus (26 to 29%) at 6 months. These differences were similar and in the same direction when the participants were analysed by treatment group. The Goutallier score remained the same or worsened one grade in both groups equally. Conclusions This study indicates that a definitive clinical trial investigating the use of a non-absorbable patch to augment repair of massive rotator cuff tears is feasible. In such patients, the patch has the potential to improve shoulder symptoms at 6 months. Trial registration ISRCTN, ISRCTN79844053, Registered 15th October 2014 (retrospectively registered).
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Affiliation(s)
- P Cowling
- Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.
| | - R Hackney
- Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - B Dube
- NIHR Leeds Biomedical Research Centre, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - A J Grainger
- Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - J D Biglands
- Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - M Stanley
- Leeds Medical School, University of Leeds, Leeds, UK
| | - D Song
- Leeds Medical School, University of Leeds, Leeds, UK
| | - P G Conaghan
- NIHR Leeds Biomedical Research Centre, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - S R Kingsbury
- NIHR Leeds Biomedical Research Centre, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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20
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Nolte PC, Lacheta L, Dekker TJ, Elrick BP, Millett PJ. Optimal Management of Acromioclavicular Dislocation: Current Perspectives. Orthop Res Rev 2020; 12:27-44. [PMID: 32184680 PMCID: PMC7062404 DOI: 10.2147/orr.s218991] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/19/2020] [Indexed: 12/14/2022] Open
Abstract
Injuries to the acromioclavicular (AC) joint are common and mostly involve younger, male individuals. Whereas the majority of AC joint dislocations can be treated nonoperatively with a trial of immobilization, pain medication, cryotherapy, and physiotherapy, there are patients that do not respond well to conservative management and may require surgical treatment. Identifying and treating these patients according to the type and chronicity of AC joint dislocation is paramount. To date, a myriad of surgical techniques have been proposed to address unstable AC joint dislocations and are indicative of the uncertainty that exists in optimal management of these injuries. Historically research has focused on the restoration of the coracoclavicular ligament complex. However, recently the importance of the acromioclavicular capsule and ligaments has been emphasized. This review aims to provide the reader with an overview of current treatment strategies and research, as well as future perspectives.
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Affiliation(s)
- Philip C Nolte
- Steadman Philippon Research Institute, Vail, CO, USA.,Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
| | - Lucca Lacheta
- Steadman Philippon Research Institute, Vail, CO, USA.,Center for Musculoskeletal Surgery, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Travis J Dekker
- Steadman Philippon Research Institute, Vail, CO, USA.,Eglin Air Force Base, 96th Medical Group, United States Air Force, Eglin, FL, USA
| | | | - Peter J Millett
- Steadman Philippon Research Institute, Vail, CO, USA.,The Steadman Clinic, Vail, CO, USA
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21
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Chiang LY, Lee CH, Tong KM, Wang SP, Lee KT, Tsai WC, Chen CP. Posterior cruciate ligament reconstruction implemented by the Ligament Advanced Reinforcement System over a minimum follow-up of 10 years. Knee 2020; 27:165-172. [PMID: 31813699 DOI: 10.1016/j.knee.2019.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 09/08/2019] [Accepted: 11/10/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE This study evaluated the long-term clinical follow-up results of patients who underwent double-bundle posterior cruciate ligament (PCL) reconstruction using the Ligament Advanced Reinforcement System (LARS). METHODS Patients were assessed using clinical scores that included the Tegner activity level scale, the Lysholm score, and the International Knee Documentation Committee (IKDC) score. KT-1000 was adopted to assess stability. Radiographs and magnetic resonance imaging (MRI) were used to evaluate osteoarthritis and LARS condition. RESULTS This study examined 38 patients, of which follow-up procedures were completed for 33 patients, resulting in a follow-up rate of 86.8%. The average follow-up period was 11.9 ± 1.2 years (range: 10.3-14.2 years). The median scores of the clinical scales were as follows: Tegner activity score, 6 (range: five to seven); Lysholm score, 90 (range: 67-100); and IKDC score, 89.7 (range: 46-100). The median of the side-to-side difference (SSD) was four millimeters (range: 0-10 mm). In radiographs, the moderate OA rate was 6.9%. MRI results revealed that 26 patients exhibited ingrowth and 11 patients exhibited partial rupture of the LARS. With SSD ≤ 3 mm set as the standard for successful knee stabilization, the optimal cutoff point of LARS midsubstance thickness in the receiver operating characteristic (ROC) curve analysis was 14.3 mm. CONCLUSIONS Long-term follow-up of the studied patients demonstrated the durability of LARS. However, clinical outcomes showed no enhancement using LARS, so it is not recommended for routine use in PCL reconstruction. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Liang-Yu Chiang
- Department of Orthopaedic Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Section 4, Taichung City 40705, Taiwan, ROC; Department of Orthopaedic Surgery, Taichung Armed Forces General Hospital, No.348, Sec.2, Chungshan Rd., Taiping Dist., Taichung City 41152, Taiwan, ROC; School of Medicine, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei City 11490, Taiwan, ROC
| | - Cheng-Hung Lee
- Department of Orthopaedic Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Section 4, Taichung City 40705, Taiwan, ROC; Department of Biotechnology, HungKuang University, No. 1018, Sec. 6, Taiwan Boulevard, Shalu District, Taichung City 43302, Taiwan, ROC
| | - Kwok-Man Tong
- Department of Orthopedics, Asia University Hospital, No.222, Fuxin Rd., Wufeng Dist., Taichung City 413, Taiwan, ROC
| | - Shun-Ping Wang
- Department of Orthopaedic Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Section 4, Taichung City 40705, Taiwan, ROC
| | - Kun-Tsan Lee
- Department of Orthopaedic Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Section 4, Taichung City 40705, Taiwan, ROC
| | - Wen-Chen Tsai
- Department of Public Health, China Medical University, No. 91, Hsueh-Shih Road, Taichung 40402, Taiwan, ROC
| | - Chao-Ping Chen
- Department of Orthopaedic Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Section 4, Taichung City 40705, Taiwan, ROC; Department of Public Health, China Medical University, No. 91, Hsueh-Shih Road, Taichung 40402, Taiwan, ROC; Jen-Teh Junior College of Medicine, Nursing and Management, No.79-9, Shalunhu, Houlong Township, Miaoli County 356, Taiwan, ROC.
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