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Adhitya IPGS, Kurniawati I, Sawa R, Wijaya TF, Dewi NPAC. The Risk Factors and Preventive Strategies of Poor Knee Functions and Osteoarthritis after Anterior Cruciate Ligament Reconstruction: A Narrative Review. Phys Ther Res 2023; 26:78-88. [PMID: 38125289 PMCID: PMC10730125 DOI: 10.1298/ptr.r0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/31/2023] [Indexed: 12/23/2023]
Abstract
Anterior cruciate ligament reconstruction (ACLR) is the standard surgical treatment for ACL injury, which typically uses a graft to replace the torn ligament in the knee that uses small incisions with minimally invasive surgery. The optimal knee functions following ACLR depend on rehabilitation processes before and after the surgery. Knee function is the ability of the knee to perform various types of functional movements like walking, squatting, running, jumping, and pivoting where patients expect to achieve maximum knee function or at least more than 80% of its initial condition before the injury to avoid being categorized as poor knee function after ACLR. Patients use patient-reported outcome measures to collect data on their health status and quality of life after ACLR. Post-traumatic osteoarthritis (PTOA) is a type of OA that manifests in local cartilage injury caused by chondrocyte death, and matrix dispersion occurs following a joint injury like ACL injury. Gender, time from injury to surgery, and graft type were considered as risk factors for poor knee function after ACLR, while overweight, meniscus tear, and cartilage defect as risk factors for PTOA. However, age is an internal risk factor for both poor knee function and PTOA following ACLR. This review suggests several strategies to prevent both conditions, including a pre-operative program, comprehensive rehabilitation, body weight control, and return to sport (RTS) consideration based on physical capacity, proper time, and psychological readiness.
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Affiliation(s)
| | - Ida Kurniawati
- Department of Histology, Faculty of Medicine and Health Sciences, Universitas Warmadewa, Indonesia
| | - Ryuichi Sawa
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Japan
| | - Tabita Febyola Wijaya
- Bachelor and Professional Program of Physical Therapy, College of Medicine, Universitas Udayana, Indonesia
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Graft Intra-Articular Remodeling and Bone Incorporation in ACL Reconstruction: The State of the Art and Clinical Implications. J Clin Med 2022; 11:jcm11226704. [PMID: 36431181 PMCID: PMC9693137 DOI: 10.3390/jcm11226704] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/02/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022] Open
Abstract
The knee is one of the most frequently affected joints in sports trauma, and anterior cruciate ligament (ACL) injury and meniscal tears are the most common lesions. ACL reconstruction (ACLR) remains the treatment of choice for patients willing to return to their previous activity. There are different surgical techniques and different possible usable grafts. The graft used for ACLR surgery undergoes a bone incorporation process and an intra-articular remodelling named ligamentization until it reaches characteristics similar to the native ligament. After the first incorporation stage, the remodelling process is divided into an early stage that could last 4 weeks, a proliferative stage that lasts 4 to 12 weeks, and a final stage of ligamentization that could last over 1 year. The period of return to sport (RTS) after ACLR, which is becoming shorter and shorter, can be a high-risk period for athletes due to the risk of graft failure. This systematic review aims to define the phases of the ligamentization process considering graft type and fixation techniques, as well as the graft's anatomopathological and biomechanical characteristics, to evaluate a criterion-based rehab progression and maximize patient outcomes for an RTS respecting graft biology. The rehabilitative program has to promote and optimize the graft remodelling and incorporation processes; moreover, it has to accommodate physiological graft healing and avoid overloading. An early RTS and noncompliance with the biological characteristics of the graft in the various phases are associated with a high incidence of re-injury.
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Szakiel PM, Aksu NE, Kirloskar KM, Gruber MD, Zittel KW, Grieme CV, Geng X, Argintar EH. Rehabilitation and functional outcomes in internally braced and standard ACL reconstructions. J Orthop 2022; 33:95-99. [PMID: 35899098 PMCID: PMC9310076 DOI: 10.1016/j.jor.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/15/2022] [Accepted: 07/05/2022] [Indexed: 10/17/2022] Open
Abstract
Purpose The purpose of this study was to compare surgical outcomes in patients who underwent ACL reconstruction, with and without internal bracing, at 1-3, 4-7, and 8-12 months of postoperative physical therapy. Previous studies show that ACL reconstruction with internal bracing allows earlier and more aggressive rehabilitation. Therefore, it was hypothesized that patients with internal bracing would display superior surgical recovery compared to ACL reconstruction alone after adjusting for length of physical therapy.1, 2, 3. Methods Patients who underwent ACL reconstruction and had a minimum two-year follow-up were included. Demographics including age, gender, use of internal bracing, and pre-operative level of activity were collected. Patient-reported outcomes were assessed using KOOS scores. Results 46 patients underwent ACL reconstruction between January 2013 and December 2015. The mean age was 31.53 ± 8.37 years. Patients who received ACL reconstruction with internal bracing reported similar improvement in KOOS scores (mean = 42.82 ± 15.44; median = 46.39 [34.52-51.80]) compared to ACL reconstruction alone (mean = 38.18 ± 19.91; median = 40.17 [29.49-53.90]) (p = 0.475). Patients who received ACL reconstruction with internal bracing reported comparable improvement to ACL reconstruction alone at 0-3 months (Internal bracing: mean = 35.39 ± 15.26, median = 40.45 [26.49-47.73]; No internal bracing: mean = 42.51 ± 12.33, median = 39.32 [35.69-52.94], p = 0.4113), 4-7 months (Internal bracing: 41.96 ± 14.49, 45.55 [33.94-52.68]; No internal bracing: 30.64 ± 32.29, 41.65 [26.17-46.12], p = 0.7491) and 8+ months groups (Internal bracing: 63.36 ± 13.06, 63.36 [58.74-67.98]; No internal bracing: 47.05 ± 10.14, 47.05 [43.46-50.63]) (p = 0.6985). Conclusion This study demonstrates no statistical difference in functional outcome scores when comparing patients with internally braced ACL reconstruction compared to standard reconstruction. Therefore, the increased structural support provided by use of internal bracing in ACL reconstruction does not afford to quicker improvement in patient-reported recovery.
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Affiliation(s)
| | | | | | | | - Kyle W. Zittel
- Georgetown University Hospital, Department of Orthopedics, Washington, D.C, USA
| | - Caleb V. Grieme
- Georgetown University School of Medicine, Washington, D.C, USA
| | - Xue Geng
- Georgetown University Department of Biostatistics, Bioinformatics and Biomathematics, Washington, D.C, USA
| | - Evan H. Argintar
- MedStar Washington Hospital Center, Department of Orthopedics and Sports Medicine, Washington, D.C, USA
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BMSC-derived exosomes promote tendon-bone healing after anterior cruciate ligament reconstruction by regulating M1/M2 macrophage polarization in rats. Stem Cell Res Ther 2022; 13:295. [PMID: 35841008 PMCID: PMC9284827 DOI: 10.1186/s13287-022-02975-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/06/2022] [Indexed: 11/22/2022] Open
Abstract
Background Recent studies have shown that bone marrow stromal cell-derived exosomes (BMSC-Exos) can be used for tissue repair. However, whether the BMSC-Exos can promote tendon-bone healing after anterior cruciate ligament reconstruction (ACLR) is still unclear. In this study, we observed in vivo and in vitro the effect of rat BMSC-Exos on tendon-bone healing after ACLR and its possible mechanism. Methods Highly expressed miRNAs in rat BMSC-Exos were selected by bioinformatics and verified in vitro. The effect of overexpressed miRNA in BMSC-Exos on M2 macrophage polarization was observed. A rat model of ACLR was established. The experimental components were divided into three groups: the control group, the BMSC-Exos group, and the BMSC-Exos with miR-23a-3p overexpression (BMSC-Exos mimic) group. Biomechanical tests, micro-CT, and histological staining were performed for analysis. Results Bioinformatics analysis showed that miR-23a-3p was highly expressed in rat BMSC-Exos and could target interferon regulatory factor 1 (IRF1, a crucial regulator in M1 macrophage polarization). In vitro, compared with the control group or the BMSC-Exos group, the BMSC-Exos mimic more significantly promoted the polarization of macrophages from M1 to M2. In vivo, at 2 weeks, the number of M2 macrophages in the early local stage of ACLR was significantly increased in the BMSC-Exos mimic group; at 4 and 8 weeks, compared with the control group or the BMSC-Exos group, the bone tunnels of the tibia and femur sides of the rats in the BMSC-Exos mimic group were significantly smaller, the interface between the graft and the bone was narrowed, the bone volume/total volume ratio (BV/TV) increased, the collagen type II alpha 1 level increased, and the mechanical strength increased. Conclusions BMSC-Exos promoted M1 macrophage to M2 macrophage polarization via miR-23a-3p, reduced the early inflammatory reaction at the tendon-bone interface, and promoted early healing after ACLR. Supplementary Information The online version contains supplementary material available at 10.1186/s13287-022-02975-0.
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The novel epiligament theory: differences in healing failure between the medial collateral and anterior cruciate ligaments. J Exp Orthop 2022; 9:10. [PMID: 35028759 PMCID: PMC8758860 DOI: 10.1186/s40634-021-00440-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/06/2021] [Indexed: 12/21/2022] Open
Abstract
According to current literature, 90% of knee ligament injuries involve the medial collateral ligament or the anterior cruciate ligament. In contrast to the medial collateral ligament, which regenerates relatively well, the anterior cruciate ligament demonstrates compromised healing. In the past, there were numerous studies in animal models that examined the healing process of these ligaments, and different explanations were established. Although the healing of these ligaments has been largely investigated and different theories exist, unanswered questions persist. Therefore, the aim of this article is 1) to review the different historical aspects of healing of the medial collateral ligament and present the theories for healing failure of the anterior cruciate ligament; 2) to examine the novel epiligament theory explaining the medial collateral ligament healing process and failure of anterior cruciate ligament healing; and 3) to discuss why the enveloping tissue microstructure of the aforementioned ligaments needs to be examined in future studies. We believe that knowledge of the novel epiligament theory will lead to a better understanding of the normal healing process for implementing optimal treatments, as well as a more holistic explanation for anterior cruciate ligament healing failure.
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Kyriakopoulos G, Manthas S, Vlachou M, Oikonomou L, Papadakis SA, Kateros K. Anterior Cruciate Ligament Reconstruction With the All-Inside Technique: Equivalent Outcomes and Failure Rate at Three-Year Follow-Up Compared to a Doubled Semitendinosus-Gracilis Graft. Cureus 2021; 13:e20508. [PMID: 35070545 PMCID: PMC8764460 DOI: 10.7759/cureus.20508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose: To compare in terms of failure rates, clinical and functional outcomes the all-inside anterior cruciate ligament (ACL) reconstruction with double suspensory fixation and quadrupled semitendinosus autograft with anteromedial portal doubled semitendinosus-gracilis autograft with suspensory femoral and tibial interference screw fixation. Methods: Forty-four patients were sequentially allocated into two groups and followed up prospectively for a 3-year period. The first group was the all-inside group and the second was the “classic” AM portal with S-G graft. Each group comprised 22 patients. All patients underwent KT-1000 testing preoperatively and at a minimum of six months postoperatively. Visual pain analog was recorded preoperatively and during both the immediate postoperative period and throughout the follow-up. The Lysholm knee score was used comparing the preoperative and 24-month timepoints. Results: The visual analog scale (VAS) pain scores showed a significant difference at two weeks (2.4 vs 1.8, p < 0.01 ) in favor of the all-inside group, but that difference disappeared in the later follow-up visits. Similarly, there was no significant difference with Lysholm knee scores at two years and the side-to-side anterior translation measured with the KT-1000. At the three-year mark, there were no failures in either of the groups. Conclusion: The all-inside technique appears to be equivalent in terms of outcomes to the classic S-G technique, and given the less-invasive nature and versatility in graft choices is a safe and effective technique for primary ACL reconstruction.
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Affiliation(s)
- George Kyriakopoulos
- A' Orthopaedic Department, General Hospital G. Gennimatas, Athens, GRC.,Department of Trauma and Orthopaedics, General Hospital of Livadeia, Livadeia, GRC
| | - Spyros Manthas
- A' Orthopaedic Department, General Hospital G.Gennimatas, Athens, GRC
| | - Maria Vlachou
- A' Orthopaedic Department, General Hospital G.Gennimatas, Athens, GRC
| | - Leon Oikonomou
- A' Orthopaedic Department, General Hospital G.Gennimatas, Athens, GRC
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Gupta R, Singh S, Kapoor A, Soni A, Kaur R, Kaur N. Graft tunnel integration occurs early in the tibial tunnel compared with the femoral tunnel after anterior cruciate ligament reconstruction with preserved insertion hamstring tendon graft. Knee Surg Relat Res 2021; 33:37. [PMID: 34627401 PMCID: PMC8501577 DOI: 10.1186/s43019-021-00119-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background Preservation of hamstring tendon insertion at the time of anterior cruciate ligament (ACL) reconstruction is a well-known technique; however, its effect on graft integration is not well studied. The present study was conducted to study the graft integration inside the tibial and femoral tunnels, respectively, after ACL reconstruction using hamstring tendon graft with preserved insertion. Methods Twenty-five professional athletes who underwent ACL reconstruction using hamstring tendon graft with preserved tibia insertion were enrolled in the study. Functional outcomes were checked at final follow-up using Lysholm score and Tegner activity scale. Magnetic resonance imaging (MRI) was done at 8 months and 14 months follow-up to study the graft tunnel integration of the ACL graft at both tibial and femoral tunnels. Results The mean Fibrous interzone (FI) score (tibial tunnel) decreased from 2.61 (1–5) at 8 months to 2.04 (1–4) at 14 months follow-up (p = 0.02). The mean FI score (femoral side) decreased from 3.04 (2–5) at 8 months to 2.57 (2–4) at 14 months (p = 0.02). Conclusions Graft integration occurs early in the tibial tunnel as compared with the femur tunnel with preserved insertion hamstring tendon autograft. Trial registration CTRI/2019/07/020320 [registered on 22/07/2019]; http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=33884&EncHid=&modid=&compid=%27,%2733884det%27
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Affiliation(s)
- Ravi Gupta
- Unit II, Orthopaedics Cum Project Director Sports Injury Centre and Medical Superintendent, Government Medical College Hospital, Chandigarh, India
| | - Sandeep Singh
- Department of Orthopaedics, Government Medical College Hospital, Chandigarh, India
| | - Anil Kapoor
- Department of Orthopaedics, Government Medical College Hospital, Chandigarh, India.
| | - Ashwani Soni
- Department of Orthopaedics, Government Medical College Hospital, Chandigarh, India
| | - Ravinder Kaur
- Department of Radio-Diagnosis, Government Medical College Hospital, Chandigarh, India
| | - Narinder Kaur
- Department of Radio-Diagnosis, Government Medical College Hospital, Chandigarh, India
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Yao S, Fu BSC, Yung PSH. Graft healing after anterior cruciate ligament reconstruction (ACLR). ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2021; 25:8-15. [PMID: 34094881 PMCID: PMC8134949 DOI: 10.1016/j.asmart.2021.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/05/2021] [Accepted: 03/21/2021] [Indexed: 01/11/2023]
Abstract
Anterior cruciate ligament reconstruction (ACLR) is a commonly performed procedure in Orthopaedic sports medicine. With advances in surgical techniques providing better positioning and fixation of the graft, subsequent graft failure to certain extent should be accounted by poor graft healing. Although different biological modulations for enhancement of graft healing have been tried in different clinical and animal studies, complete graft incorporation into bone tunnels and the “ligamentization” of the intra-articular part have not been fully achieved yet. Based on the understanding of graft healing process and its failure mechanism, the purpose of this review is to combine both the known basic science & clinical evidence, to provide a much clearer picture of the obstacle encountered in graft healing, so as to facilitate researchers on subsequent work on the enhancement of ACL graft healing.
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Affiliation(s)
- Shiyi Yao
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Bruma Sai-Chuen Fu
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
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Radiographic assessment of bone tunnels after anterior cruciate ligament reconstruction: A comparison of hamstring tendon and bone-patellar tendon-bone autografting technique. Jt Dis Relat Surg 2021; 32:122-128. [PMID: 33463427 PMCID: PMC8073458 DOI: 10.5606/ehc.2021.75694] [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: 04/28/2020] [Accepted: 09/04/2020] [Indexed: 12/02/2022] Open
Abstract
Objectives
This study aims to compare the postoperative change of femoral and tibial tunnel widths after hamstring tendon (HT) and bone-patellar tendon-bone (BPTB) autografting in primary anterior cruciate ligament (ACL) reconstruction surgery with the anteromedial portal technique. Patients and methods
This case-control and retrospective study included 39 patients (36 males, 3 females; mean age 30.1±7.9; range, 17 to 44 years) who underwent primary ACL reconstruction surgery with either BPTB autografting method (BPTB group, n=18) or HT autografting method (HT group, n=21) between March 2014 and December 2016. Femoral fixation was achieved with bioabsorbable screw in BPTB group and endobutton in HT group. Tibial fixation was achieved with bioabsorbable interference screw in both groups. Femoral and tibial tunnel widths of groups were compared on digital radiographs. Results
When we compared the baseline values with the second-year results, the mean of femoral tunnel widths were significantly lower on radiographs at the second-year evaluation in both groups (p<0.001 for all). However, the means of tibial tunnel widths were significantly lower only in the BPTB group (p<0.001 for BPTB group and p=0.616 for HT group). Change levels of anteroposterior and lateral widths were more prominent in BPTB group than HT group (p<0.001 for all). Conclusion
Changes in tunnel widths show us superior ossification in BPTB grafting. This can be explained by superior bone-to-bone healing. As a result of radiological evaluation, we think that BPTB grafting can be more strong and durable.
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Gürpınar T, Polat B, Eren M, Çarkçı E, Özyalvaç ON, Erdoğan S. The effect of soft tissue interposition of the Endobutton on clinical results and on its postoperative migration after single-bundle anterior cruciate ligament reconstruction. Knee 2020; 27:1980-1987. [PMID: 33248352 DOI: 10.1016/j.knee.2020.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 08/29/2020] [Accepted: 10/17/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study aimed to investigate the possible consequences of soft tissue interposition of Endobutton on clinical outcomes and reoperation rates after anterior cruciate ligament reconstruction. METHODS We measured the distance between the centre of the Endobutton and the lateral femoral cortex on the postoperative first day anteroposterior X-rays of the 156 knees that underwent anterior cruciate ligament reconstruction. Those with a distance less than 1 mm were regarded as Group 1 (118 patients), the ones between 1 mm and 2 mm were regarded as Group 2 (30 patients) and the ones more than 2 mm were regarded as Group 3 (8 patients). The movement of the Endobutton of more than 1 mm along the femoral tunnel axis on anteroposterior X-rays or its rotation by more than 5° on lateral X-rays during follow-up were considered migration. Clinical assessment scores (Lysholm, Tegner Activity Scale), clinical examination tests, and rates of Endobutton migration in the groups were analysed. RESULTS Eleven Endobuttons (9.3%) in Group 1, 26 Endobuttons (86.7%) in Group 2 and all of the 8 Endobuttons (100%) in Group 3 were observed to have migrated. Clinical results and examination tests showed no significant difference between Groups 1 and 2, whereas a significant difference was detected in Group 3 compared to Groups 1 and 2 (p < 0.05). CONCLUSION Soft tissue interposition is a major cause of Endobutton migration, and an interposition over 2 mm between the Endobutton and the lateral femoral cortex can negatively affect the outcomes after an anterior cruciate ligament surgery.
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Affiliation(s)
- Tahsin Gürpınar
- Department of Orthopaedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey.
| | - Barış Polat
- Department of Orthopaedics and Traumatology, Faculty of Medicine, University of Kyrenia, Kyrenia, Cyprus.
| | - Murat Eren
- Department of Orthopaedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey.
| | - Engin Çarkçı
- Department of Orthopaedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey.
| | - Osman Nuri Özyalvaç
- Department of Orthopaedics and Traumatology, Baltalimanı Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey.
| | - Sinan Erdoğan
- Department of Orthopaedics and Traumatology, Baltalimanı Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey.
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Zhang J, Liu Z, Li Y, You Q, Yang J, Jin Y, Zou G, Tang J, Ge Z, Liu Y. FGF2: a key regulator augmenting tendon-to-bone healing and cartilage repair. Regen Med 2020; 15:2129-2142. [PMID: 33201773 DOI: 10.2217/rme-2019-0080] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Ligament/tendon and cartilage injuries are clinically common diseases that perplex most clinicians. Because of the lack of blood vessels and nerves, their self-repairing abilities are rather poor. Therefore, surgeries are necessary and also widely used to treat ligament/tendon or cartilage injuries. However, after surgery, there are still many problems that affect healing. In recent years, it has been found that exogenous FGF2 plays an important role in the repair of ligament/tendon and cartilage injuries and exerts a synergistic effect with endogenous FGF2. Therefore, FGF2 can be used as a new type of biomolecule to accelerate tendon-to-bone healing and cartilage repair after injury.
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Affiliation(s)
- Jun Zhang
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Guizhou 563000, China
| | - Ziming Liu
- Peking University Institute of Sports Medicine, Beijing 100083, China
| | - Yuwan Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Qi You
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Guizhou 563000, China
| | - Jibin Yang
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Guizhou 563000, China
| | - Ying Jin
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Guizhou 563000, China
| | - Gang Zou
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Guizhou 563000, China
| | - Jingfeng Tang
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Guizhou 563000, China
| | - Zhen Ge
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Guizhou 563000, China
| | - Yi Liu
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Guizhou 563000, China
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Biomechanical, histologic, and molecular characteristics of graft-tunnel healing in a murine modified ACL reconstruction model. J Orthop Translat 2020; 24:103-111. [PMID: 32775202 PMCID: PMC7390781 DOI: 10.1016/j.jot.2020.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 05/15/2020] [Accepted: 05/20/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose The purpose of our study was to introduce and validate a metal-free, reproducible and reliable mouse model of anterior cruciate ligament (ACL) reconstruction (ACLR) surgery as an effective tool for a better understanding of molecular mechanisms of graft-tunnel healing after ACLR. Methods A total of 150 C57BL/6 mice were randomly allocated into five Groups: Group 1 (mice with intact ACL), Group 2–4 (mice underwent modified ACLR surgery and sacrificed 1-, 2-, and 4-weeks after surgery), and Group 5 (mice underwent unmodified ACLR surgery and sacrificed 4 weeks after surgery). Micro-computed tomography (CT), biomechanical histological as well as immunohistochemical (IHC) analyses were performed to characterize the modified ACLR. Results Micro-CT analysis demonstrated there is a non-significant increase in BV/TV and BMD of the bone tunnel during the tendon-to-bone healing following ACLR. Biomechanical tests showed that the mean load-to-failure forces of Group 3 and 4 are equal to 31.7% and 46.0% of that in Group 1, while the stiffness was 33.1% and 57.2% of that of Group 1, respectively. And no obvious difference in biomechanical parameters was found between Group 4 and 5. Histological analysis demonstrated that formation of fibrovascular tissue in the tibial tunnel and aperture in Groups 4 and 5 and direct junction appeared between tendon graft and tunnel both in Groups 4 and 5. IHC results showed that there are gradually enhanced expression of Patched1, Smoothened and Gli2 concomitant with decreased Gli3 protein in the tendon-bone interface during the tendon-bone healing process. Conclusion We introduced a metal-free, reproducible and reliable mouse model of ACLR compared to the unmodified ACLR procedure, and characterized the expression pattern of key molecules in Ihh signaling during the graft healing process. The translational potential of this article In the present study we introduced and validated, for the first time, a metal-free, reproducible and reliable ACLR mouse model, which could be used to investigate the detailed molecular mechanisms of graft-tunnel healing after ACLR. We also explored new strategies to promote the healing of tendon-to-bone integration.
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Key Words
- ACL, Anterior cruciate ligament
- ACLR, ACL reconstruction
- Anterior cruciate ligament
- BMD, Bone mineral density
- BV/TV, Bone volume/total volume
- CI, Confidence interval
- CT, Computed tomography
- Gli1, Glioma-associated oncogene homologue 1
- Gli2, Glioma-associated oncogene homologue 2
- Gli3, Glioma-associated oncogene homologue 3
- H&E, Haematoxylin-eosin
- Hedgehog signaling
- Ihh, Indian hedgehog
- Mouse model
- NS, Non-significant
- Ptch1, Patched1
- Smo, Smoothened
- Tendon-bone healing
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Sun Y, Lovric V, Wang T, Oliver RA, Walsh WR. Effects of SCCO 2, Gamma Irradiation, and Sodium Dodecyl Sulfate Treatments on the Initial Properties of Tendon Allografts. Int J Mol Sci 2020; 21:ijms21051565. [PMID: 32106592 PMCID: PMC7084268 DOI: 10.3390/ijms21051565] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/07/2020] [Accepted: 02/15/2020] [Indexed: 01/05/2023] Open
Abstract
Sterile and decellularized allograft tendons are viable biomaterials used in reconstructive surgeries for dense connective tissue injuries. Established allograft processing techniques including gamma irradiation and sodium dodecyl sulfate (SDS) can affect tissue integrity. Supercritical carbon dioxide (SCCO2) represents a novel alternative that has the potential to decellularize and sterilize tendons with minimized exposure to denaturants, shortened treatment time, lack of toxic residues, and superior tissue penetration, and thus efficacy. This study attempted to develop a single-step hybrid decellularization and sterilization protocol for tendons that involved SCCO2 treatment with various chemical additives. The processed tendons were evaluated with mechanical testing, histology, scanning electron microscopy (SEM), and Fourier-transform infrared (FTIR) spectroscopy. Uniaxial mechanical testing showed that tendons treated with SCCO2 and additive NovaKillTM Gen2 and 0.1% SDS had significantly higher (p < 0.05) ultimate tensile stress (UTS) and Young's modulus compared to gamma-irradiated and standard-SDS-treated tendons. This was corroborated by the ultrastructural intactness of SCCO2-treated tendons as examined by SEM and FTIR spectroscopy, which was not preserved in gamma-irradiated and standard SDS-treated tendons. However, complete decellularization was not achieved by the experimented SCCO2-SDS protocols used in this study. The present study therefore serves as a concrete starting point for development of an SCCO2-based combined sterilization and decellularization protocol for allograft tendons, where additive choice is to be optimized.
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Crispim JF, Fu SC, Lee YW, Fernandes HAM, Jonkheijm P, Yung PSH, Saris DBF. Bioactive Tape With BMP-2 Binding Peptides Captures Endogenous Growth Factors and Accelerates Healing After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2018; 46:2905-2914. [PMID: 30074814 DOI: 10.1177/0363546518787507] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The anterior cruciate ligament (ACL) has poor regenerative capacity, and an injury leads to loss of function, limiting quality of life and increasing the incidence of osteoarthritis. Surgical interventions can stabilize the joint and improve functional recovery. The delivery of growth factors (GFs) enhances the healing process; however, this is complex in its regulation, is high in costs, has side effects, and can only be accomplished with supraphysiological concentrations and thus is currently not clinically feasible. However, the immobilization of a patient's endogenous GFs in biomaterials can overcome these problems. PURPOSE To develop a method to capture endogenous bone morphogenetic protein-2 (BMP-2) and ultimately show enhanced ACL healing in vivo using this novel methodology. STUDY DESIGN Controlled laboratory study. METHODS BMP-2 binding peptides were synthetized, purified, and immobilized on polycaprolactone (PCL) films. The affinity between the peptide and human BMP-2 (hBMP-2) was confirmed with immunofluorescence and enzyme-linked immunosorbent assay. The C2C12 Luc reporter cell line was used to confirm the bioactivity of immobilized BMP-2. For in vivo experiments, the same functionalization technology was applied to the commercially available Polytape, and the functionalized tape was sutured together with the graft used for ACL reconstruction in rats. Each animal underwent reconstruction with either native Polytape (n = 3) or Polytape with BMP-2 binding peptides (n = 3). At 2 and 6 weeks after surgery, the graft was assessed by histology and micro-computed tomography. RESULTS The covalent immobilization of the peptide in PCL was successful, allowing the peptide to capture hBMP-2, which remained bioactive and led to the osteogenic differentiation of C2C12. In vivo experiments confirmed the potential of the Polytape functionalized with the BMP-2 binding peptide to capture endogenous BMP-2, leading to enhanced bone formation inside the femoral and tibial tunnels and ultimately improving the graft's quality. CONCLUSION The incorporation of BMP-2 binding peptides into materials used for ACL reconstruction can capture endogenous hBMP-2, which enhances the healing process inside the bone tunnels. CLINICAL RELEVANCE These results demonstrate the potential of using synthetic peptides to endow biomaterials with novel biological functions, namely to capture and immobilize endogenous GFs.
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Affiliation(s)
- João F Crispim
- Department of Developmental Bioengineering, TechMed Centre, University of Twente, Enschede, the Netherlands.,Bioinspired Molecular Engineering Laboratory, TechMed Centre, University of Twente, Enschede, the Netherlands
| | - Sai C Fu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yuk W Lee
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Pascal Jonkheijm
- Bioinspired Molecular Engineering Laboratory, TechMed Centre, University of Twente, Enschede, the Netherlands.,Molecular Nanofabrication Group, MESA+ Institute for Nanotechnology, University of Twente, Enschede, the Netherlands
| | - Patrick S H Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Daniël B F Saris
- Department of Developmental Bioengineering, TechMed Centre, University of Twente, Enschede, the Netherlands.,Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands
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15
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Ahn JH, Ko TS, Lee YS, Jeong HJ, Park JK. Magnetic Resonance Imaging and Clinical Results of Outside-in Anterior Cruciate Ligament Reconstruction: A Comparison of Fixed- and Adjustable-Length Loop Cortical Fixation. Clin Orthop Surg 2018; 10:157-166. [PMID: 29854338 PMCID: PMC5964263 DOI: 10.4055/cios.2018.10.2.157] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 02/27/2018] [Indexed: 12/31/2022] Open
Abstract
Background Cortical suspensory femoral fixation is commonly performed for graft fixation to the femur in anterior cruciate ligament (ACL) reconstruction using hamstring tendons. The purpose of this study was to compare graft healing in the femoral tunnel, implant-related failure, and clinical results between fixed- and adjustable-length loop devices in outside-in ACL reconstruction. Methods A total of 109 patients who underwent ACL reconstruction using the outside-in technique from December 2010 to July 2014 were included. For femoral graft fixation, a fixed-length loop device was used in 48 patients (fixed-loop group) and an adjustable-length loop device was used in 61 patients (adjustable-loop group). For evaluation of graft healing in the femoral tunnel, magnetic resonance imaging was performed at postoperative 6 months and the signal-to-noise ratios (SNRs) of the tendon graft and tendon-bone interface in the femoral bone tunnel were evaluated. The presence of synovial fluid was evaluated to determine loop lengthening at the femoral tunnel exit. Clinical results assessed using International Knee Documentation Committee score, Tegner-Lysholm Knee Scoring scale, and knee instability tests were compared between groups. Results The SNRs of the tendon graft and tendon-bone interface were not statistically different between groups. The presence of synovial fluid at the femoral exit showed no statistical difference between groups. Clinical results were not significantly different between groups. Conclusions The adjustable-length loop device provided comparable graft healing, implant-related failure, and clinical results with the fixed-length loop device, allowing adaptation of the graft to the different tunnel lengths. Therefore, it could be effectively used with an adjustment according to the femoral tunnel length.
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Affiliation(s)
- Jin Hwan Ahn
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taeg Su Ko
- Department of Orthopedic Surgery, Barunbone Hospital, Seoul, Korea
| | - Yong Seuk Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hwa Jae Jeong
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Kuen Park
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Song F, Jiang D, Wang T, Wang Y, Chen F, Xu G, Kang Y, Zhang Y. Mechanical Loading Improves Tendon-Bone Healing in a Rabbit Anterior Cruciate Ligament Reconstruction Model by Promoting Proliferation and Matrix Formation of Mesenchymal Stem Cells and Tendon Cells. Cell Physiol Biochem 2017; 41:875-889. [DOI: 10.1159/000460005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 12/21/2016] [Indexed: 12/17/2022] Open
Abstract
Background/Aims: This study investigated the effect of mechanical stress on tendon-bone healing in a rabbit anterior cruciate ligament (ACL) reconstruction model as well as cell proliferation and matrix formation in co-culture of bone-marrow mesenchymal stem cells (BMSCs) and tendon cells (TCs). Methods: The effect of continuous passive motion (CPM) therapy on tendon-bone healing in a rabbit ACL reconstruction model was evaluated by histological analysis, biomechanical testing and gene expressions at the tendon-bone interface. Furthermore, the effect of mechanical stretch on cell proliferation and matrix synthesis in BMSC/TC co-culture was also examined. Results: Postoperative CPM therapy significantly enhanced tendon-bone healing, as evidenced by increased amount of fibrocartilage, elevated ultimate load to failure levels, and up-regulated gene expressions of Collagen I, alkaline phosphatase, osteopontin, Tenascin C and tenomodulin at the tendon-bone junction. In addition, BMSC/TC co-culture treated with mechanical stretch showed a higher rate of cell proliferation and enhanced expressions of Collagen I, Collagen III, alkaline phosphatase, osteopontin, Tenascin C and tenomodulin than that of controls. Conclusion: These results demonstrated that proliferation and differentiation of local precursor cells could be enhanced by mechanical stimulation, which results in enhanced regenerative potential of BMSCs and TCs in tendon-bone healing.
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17
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Neo PY, Teh TKH, Tay ASR, Asuncion MCT, Png SN, Toh SL, Goh JCH. Stem cell-derived cell-sheets for connective tissue engineering. Connect Tissue Res 2016; 57:428-442. [PMID: 27050427 DOI: 10.3109/03008207.2016.1173035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Cell-sheet technology involves the recovery of cells with its secreted ECM and cell-cell junctions intact, and thereby harvesting them in a single contiguous layer. Temperature changes coupled with a thermoresponsive polymer grafted culture plate surface are typically used to induce detachment of this cell-matrix layer by controlling the hydrophobicity and hydrophilicity properties of the culture surface. This review article details the genesis and development of this technique as a critical tissue-engineering tool, with a comprehensive discussion on connective tissue applications. This includes applications in the myocardial, vascular, cartilage, bone, tendon/ligament, and periodontal areas among others discussed. In particular, further focus will be given to the use of stem cells-derived cell-sheets, such as those involving bone marrow-derived and adipose tissue-derived mesenchymal stem cells. In addition, some of the associated challenges faced by approaches using stem cells-derived cell-sheets will also be discussed. Finally, recent advances pertaining to technologies forming, detaching, and manipulating cell-sheets will be covered in view of the potential impact they will have on shaping the way cell-sheet technology will be utilized in the future as a tissue-engineering technique.
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Affiliation(s)
- Puay Yong Neo
- a Department of Biomedical Engineering, Faculty of Engineering , National University of Singapore , Singapore.,b NUS Tissue Engineering Programme, Life Sciences Institute, National University of Singapore , Singapore
| | - Thomas Kok Hiong Teh
- a Department of Biomedical Engineering, Faculty of Engineering , National University of Singapore , Singapore.,b NUS Tissue Engineering Programme, Life Sciences Institute, National University of Singapore , Singapore
| | - Alex Sheng Ru Tay
- a Department of Biomedical Engineering, Faculty of Engineering , National University of Singapore , Singapore
| | | | - Si Ning Png
- a Department of Biomedical Engineering, Faculty of Engineering , National University of Singapore , Singapore.,b NUS Tissue Engineering Programme, Life Sciences Institute, National University of Singapore , Singapore
| | - Siew Lok Toh
- a Department of Biomedical Engineering, Faculty of Engineering , National University of Singapore , Singapore.,c Department of Mechanical Engineering, Faculty of Engineering , National University of Singapore , Singapore
| | - James Cho-Hong Goh
- a Department of Biomedical Engineering, Faculty of Engineering , National University of Singapore , Singapore.,b NUS Tissue Engineering Programme, Life Sciences Institute, National University of Singapore , Singapore.,d Department of Orthopaedic Surgery , Yong Loo Lin School of Medicine, National University of Singapore , Singapore
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18
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Chahla J, Dean CS, Cram TR, Civitarese D, O'Brien L, Moulton SG, LaPrade RF. Two-Stage Revision Anterior Cruciate Ligament Reconstruction: Bone Grafting Technique Using an Allograft Bone Matrix. Arthrosc Tech 2016; 5:e189-95. [PMID: 27274452 PMCID: PMC4886209 DOI: 10.1016/j.eats.2015.10.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 10/30/2015] [Indexed: 02/03/2023] Open
Abstract
Outcomes of primary anterior cruciate ligament (ACL) reconstruction have been reported to be far superior to those of revision reconstruction. However, as the incidence of ACL reconstruction is rapidly increasing, so is the number of failures. The subsequent need for revision ACL reconstruction is estimated to occur in up to 13,000 patients each year in the United States. Revision ACL reconstruction can be performed in one or two stages. A two-stage approach is recommended in cases of improper placement of the original tunnels or in cases of unacceptable tunnel enlargement. The aim of this study was to describe the technique for allograft ACL tunnel bone grafting in patients requiring a two-stage revision ACL reconstruction.
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Affiliation(s)
- Jorge Chahla
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Chase S. Dean
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | | | | | - Luke O'Brien
- Howard Head Sports Medicine, Vail, Colorado, U.S.A
| | | | - Robert F. LaPrade
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.,The Steadman Clinic, Vail, Colorado, U.S.A.,Address correspondence to Robert F. LaPrade, M.D., Ph.D., The Steadman Clinic, 181 W Meadow Dr, Ste 400, Vail, CO 81657, U.S.A.The Steadman Clinic181 W Meadow DrSte 400VailCO81657U.S.A.
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19
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Fu W, Li Q, Tang X, Chen G, Zhang C, Li J. Mesenchymal stem cells reside in anterior cruciate ligament remnants in situ. INTERNATIONAL ORTHOPAEDICS 2015; 40:1523-30. [PMID: 26227919 DOI: 10.1007/s00264-015-2925-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 04/08/2015] [Indexed: 02/05/2023]
Abstract
PURPOSE It has been reported that the anterior cruciate ligament (ACL) has certain self-healing ability after acute injury or with primary suture repair. Many studies have confirmed that a remnant preservation technique with ACL reconstruction contributes to biological augmentation for ACL healing. However, it remains unclear whether mesenchymal stem cells (MSC) reside in ACL remnants in situ. The aim of this study was to investigate the methods of culture and identification of MSC derived from the remnants of ACL rupture patients and to analyse these MSC's properties. METHODS The cells of ACL remnants from the ACL rupture patients were isolated by the methods of enzymatic digestion and cultured in vitro to the third passage under the microscope to observe their morphology and growth status. The third passage of isolated cells was analysed for the identification of immunophenotype, osteogenic, adipogenic and chondrogenic differentiation. RESULTS On the third to fifth days of in vitro culture, a few cells of long fusiform shape appeared and were adherent to the plastic walls. On the sixth to ninth days, cells clustered and colonies were observed. The third passage cells showed uniform cell morphology and good proliferation, with appearance of the typical surface markers of MSC, CD29, CD44, CD90 and CD105. The surface markers of CD34 and CD45 of haematopoietic stem cells were not expressed. Under appropriate conditions of in vitro culture, isolated cells could be differentiated into osteoblasts that deposit mineralised matrix and express early osteogenic markers, adipocytes that accumulate lipid droplets in cytoplasm and chondrocytes that secrete chondrogenic-specific matrix aggrecan and collagen II. Real-time polymerase chain reaction (PCR) analysis demonstrated that the specific mRNA expression of osteogenesis, adipogenesis and chondrogenesis increased significantly compared with the control groups at day zero. CONCLUSIONS Stem cells derived in situ from the human ACL stump were successfully isolated and characterised. Those isolated cells were identified as MSC according to their adherent ability, morphology, surface markers and multilineage differentiation potential. MSC derived from ACL remnants could be a potential source of seeding cells for ligament regeneration.
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Affiliation(s)
- Weili Fu
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Qi Li
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Tang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Gang Chen
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Chenghao Zhang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Li
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China.
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20
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Królikowska A, Czamara A, Kentel M. Does Gracilis Tendon Harvest During ACL Reconstruction with a Hamstring Autograft Affect Torque of Muscles Responsible for Shin Rotation? Med Sci Monit 2015; 21:2084-93. [PMID: 26190033 PMCID: PMC4514330 DOI: 10.12659/msm.893930] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background A growing body of evidence indicates that in patients after anterior cruciate ligament reconstruction (ACLR) with a combined semitendinosus and gracilis (STGR) graft there are large deficits in the internal rotation strength, which has led some authors to recommend harvest of only ST tendon whenever possible. The purpose of this study was to assess the isometric (IT) and peak torque (PT) of the muscles responsible for shin rotation in patients after ACLR with an ST or with an STGR graft. Material/Methods Twenty patients with an ST graft and 20 patients with a combined STGR graft underwent a 6-month postoperative rehabilitation program after ACLR. At the end of the rehabilitation program, the IT and PT of the muscles responsible for internal (IR) and external rotation (ER) of the shin were measured. The results were compared to the results of a control group. Additionally, to determine the reliability of the dynamometer for clinical research, a test-retest assessment was performed. Results There were no statistically significant differences between the 3 groups of participants. Nevertheless, in the STGR group there was a statistically significant difference between the IT of muscles internally rotating the shin in the involved knee and uninvolved knee at 25° of the internal shin rotation. Conclusions Comparison of IT and PT measurements performed after 24 weeks of postoperative rehabilitation generally showed no differences between patients after ACLR with the use of ST graft and patients who received a combination graft consisting of STGR. Nevertheless, there was an influence of GR harvest on internal shin rotation torque at a deep internal rotation angle.
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Affiliation(s)
| | - Andrzej Czamara
- Department of Physiotherapy, The College of Physiotherapy in Wrocław, Wrocław, Poland
| | - Maciej Kentel
- Department of Physiotherapy, The College of Physiotherapy in Wrocław, Wrocław, Poland
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21
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Ge Y, Li H, Tao H, Hua Y, Chen J, Chen S. Comparison of tendon-bone healing between autografts and allografts after anterior cruciate ligament reconstruction using magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc 2015; 23:954-60. [PMID: 24196576 DOI: 10.1007/s00167-013-2755-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 10/28/2013] [Indexed: 01/11/2023]
Abstract
PURPOSE The purpose of the study is to compare tendon-bone healing between autograft tendons and allograft tendons after anterior cruciate ligament (ACL) reconstruction using 3.0T magnetic resonance imaging. METHODS A total of 36 participants (18 with autograft and 18 with allograft reconstruction) underwent MRI scans at least 2 years after the ACL reconstruction operation. Oblique axial images were obtained on three-dimensional dual-echo steady-state images and imported into solid modelling software for three-dimensional model reconstruction of the bone tunnel. The graft signal intensity in the tunnel, tendon-bone interface, tunnel morphology, and tunnel area was analysed using the Siemens software packages to determine the tendon-bone healing between the groups. RESULTS For the tunnel morphology, both groups exhibited bone tunnel enlargement either at the femoral or tibial tunnel aperture. For the tendon-bone interface, one patient in the autograft group and two patients in the allograft group exhibited a significant fibrous scar tissue bands at the tendon-bone interface. The graft signal/noise quotient values of the allograft group were higher than the autograft group. However, there was no significant difference in the tunnel area between the allograft group and the autograft group. CONCLUSIONS Although the autograft tendons exhibited a better remodelling effect than did the allograft tendons in the bone tunnel, there was no significant difference in the tendon-bone healing between the autograft tendons and the allograft tendons postoperatively. These findings indicate that the biomechanical effect of graft motion may play a significant role in the tunnel aperture. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yunshen Ge
- Department of Sports Medicine, Huashan Hospital, No 12, Wulumuqi Zhong Road, Shanghai, 200040, People's Republic of China
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Ho WP, Lee CH, Huang CH, Chen CH, Chuang TY. Clinical results of hamstring autografts in anterior cruciate ligament reconstruction: a comparison of femoral knot/press-fit fixation and interference screw fixation. Arthroscopy 2014; 30:823-32. [PMID: 24768467 DOI: 10.1016/j.arthro.2014.02.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 02/27/2014] [Accepted: 02/27/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the clinical outcomes of femoral knot/press-fit anterior cruciate ligament (ACL) reconstruction with conventional techniques using femoral interference screws. METHODS Among patients who underwent arthroscopic ACL reconstruction with hamstring autografts, 73 were treated with either a femoral knot/press-fit technique (40 patients, group A) or femoral interference screw fixation (33 patients, group B). The clinical results of the 2 groups were retrospectively compared. The inclusion criteria were primary ACL reconstruction in active patients. The exclusion criteria were fractures, multiligamentous injuries, patients undergoing revision, or patients with contralateral ACL-deficient knees. In the femoral knot/press-fit technique, semitendinosus and gracilis tendons were prepared as 2 loops with knots. After passage through a bottleneck femoral tunnel, the grafts were fixed with a press-fit method (grafts' knots were stuck in the bottleneck of the femoral tunnel). A tie with Mersilene tape (Ethicon, Somerville, NJ) over a bone bridge for each tendon loop and an additional bioabsorbable interference screw were used for tibial fixation. RESULTS The mean follow-up period was 38 months (range, 24 to 61 months). A significant improvement in knee function and symptoms was reported in most patients, as shown by improved Tegner scores, Lysholm knee scores, and International Knee Documentation Committee assessments (P < .01). The results of instrumented laxity testing, thigh muscle assessment, and radiologic assessment were clearly improved when compared with the preoperative status (P < .01). No statistically significant difference in outcomes could be observed between group A and group B (P = not significant). CONCLUSIONS In this nonrandomized study, femoral knot/press-fit ACL reconstruction did not appear to provide increased anterior instability compared with that of conventional femoral interference screw ACL reconstruction. Favorable outcomes with regard to knee stability and patient satisfaction were achieved in most of our ACL-reconstructed patients using femoral knot/press-fit fixation with hamstring tendon autograft. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Wei-Pin Ho
- Department of Orthopedic Surgery, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan
| | - Chian-Her Lee
- Department of Orthopedic Surgery, Taipei Medical University, Taipei, Taiwan
| | - Chang-Hung Huang
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chih-Hwa Chen
- Department of Orthopedic Surgery, Taipei Medical University, Taipei, Taiwan
| | - Tai-Yuan Chuang
- Department of Orthopedic Surgery, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan.
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Preoperative assessments completed for anterior cruciate ligament reconstructions with remnant preservation. J Orthop 2014; 12:S75-8. [PMID: 26719613 DOI: 10.1016/j.jor.2014.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 04/15/2014] [Indexed: 11/24/2022] Open
Abstract
The purpose of this study was to investigate the preoperative characteristics that are necessary to be able to perform reconstructions of the anterior cruciate ligament (ACL) with remnant preservation. The preoperative period was significantly shorter for patients in patients who received a reconstruction with remnant preservation than for those without remnant (3.9 months vs 16.0 months, p < 0.01). The cut-off time to be able to reconstruct an ACL with remnant preservation were 2.5 months. The preoperative period is important to perform an ACL reconstruction with remnant preservation.
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Cho S, Li H, Chen C, Jiang J, Tao H, Chen S. Cationised gelatin and hyaluronic acid coating enhances polyethylene terephthalate artificial ligament graft osseointegration in porcine bone tunnels. INTERNATIONAL ORTHOPAEDICS 2012; 37:507-13. [PMID: 23132501 DOI: 10.1007/s00264-012-1694-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 10/16/2012] [Indexed: 01/13/2023]
Abstract
PURPOSE The aim of this study was to investigate whether cationised gelatin and hyaluronic acid (CH) coating could induce polyethylene terephthalate (PET) artificial ligament graft osseointegration in the bone tunnel. METHODS Surface modification of PET artificial ligament graft was performed by layer-by-layer (LBL) self-assembly CH coating. Six pigs underwent anterior cruciate ligament (ACL) reconstruction on the right knees, with three pigs receiving the CH-coated PET grafts and the other three pigs non-CH-coated PET grafts as controls. They were sacrificed at three months after surgery and the graft-bone complexes were acquired for computed tomography (CT) scan and histological examination. RESULTS CT scans showed a significant difference at the distal femoral site (p = 0.031) or at the distal tibial site (p = 0.0078), but no significant difference in the bone tunnel areas' enlargement at other sites (p > 0.05) between the CH group and the control group. Histologically, application of CH coating induced new bone formation between graft and bone at three months compared with the controls at the distal site. The interface width of the CH group was significantly lower than that of the control group at the distal femoral site (p = 0.0327) and at the distal tibial site (p = 0.0047). CONCLUSIONS The study has shown that CH coating on the PET artificial ligament surface has a positive biological effect in the induction of artificial ligament osseointegration within the bone tunnel at the distal site of the bone tunnel.
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Affiliation(s)
- Samson Cho
- Department of Sports Medicine, Huashan Hospital, No 12, Wulumuqi Zhong Road, Shanghai, 200040, People's Republic of China
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Ochi M, Abouheif MM, Kongcharoensombat W, Nakamae A, Adachi N, Deie M. Double bundle arthroscopic Anterior Cruciate Ligament reconstruction with remnant preserving technique using a hamstring autograft. Sports Med Arthrosc Rehabil Ther Technol 2011; 3:30. [PMID: 22141394 PMCID: PMC3284875 DOI: 10.1186/1758-2555-3-30] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 12/05/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Preservation of the Anterior Cruciate Ligament (ACL) remnant is important from the biological point of view as it enhances revascularization, and preserves the proprioceptive function of the graft construct. Additionally, it may have a useful biomechanical function. Double bundle ACL reconstruction has been shown to better replicate the native ACL anatomy and results in better restoration of the rotational stability than single bundle reconstruction. METHODS We used the far anteromedial (FAM) portal for creation of the femoral tunnels, with a special technique for its preoperative localization using three dimensional (3D) CT. The central anteromedial (AM) portal was used to make a longitudinal slit in the ACL remnant to allow visualization of the tips of the guide pins during anatomical creation of the tibial tunnels within the native ACL tibial foot print. The use of curved hemostat allow retrieval of the wire loop from the apertures of the femoral tunnels through the longitudinal slit in the ACL remnant thereby, guarding against impingement of the reconstruction graft against the ACL remnant as well as the roof of the intercondylar notch. CONCLUSION Our technique allows for anatomical double bundle reconstruction of the ACL while maximally preserving the ACL remnant without the use of intra-operative image intensifier.
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Affiliation(s)
- Mitsuo Ochi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
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Li H, Jiang J, Wu Y, Chen S. Potential mechanisms of a periosteum patch as an effective and favourable approach to enhance tendon-bone healing in the human body. INTERNATIONAL ORTHOPAEDICS 2011; 36:665-9. [PMID: 22009448 DOI: 10.1007/s00264-011-1346-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 08/17/2011] [Indexed: 01/14/2023]
Abstract
Tendon-bone healing is a progressive and complex pathophysiological process after tendon graft transplantation into a bone tunnel. A fibrous scar tissue layer forms at the graft-bone interface, which means a weak bonding of the graft in the bone tunnel. Periosteum, a favourable autologous tissue, was confirmed to be effective in promoting tendon-bone healing in the human body. The advantages of a periosteum patch for tendon-bone repair include the fact that this tissue meets the three primary requirements for tissue engineering: a source of progenitor cells, a scaffold for recruiting cells and growth factors, and a source of local growth factors. Furthermore, the periosteum can prevent graft micromotion, alleviate inflammation and deter bone resorption. In this review, we highlight the role of progenitor cells in the periosteum, which contribute to the regeneration of new bone and/or fibrocartilage at the tendon-bone interface. In summary, the periosteum has shown significant potential for use in the enhancement of graft-bone healing. Our investigations may provoke further studies on the management of allograft-bone healing and artificial ligament graft healing using a periosteum patch in future.
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Affiliation(s)
- Hong Li
- Department of Sports Medicine, Huashan Hospital, No 12, Wulumuqi Zhong Road, Shanghai, 200040, People's Republic of China
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Chen CH, Whu SW, Chang CH, Su CI. Gene and protein expressions of bone marrow mesenchymal stem cells in a bone tunnel for tendon-bone healing. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.fjmd.2011.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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