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Mann O, Al-Dadah O. Anterior cruciate ligament reconstruction: Effect of graft tunnel position on early to mid-term clinical outcomes. World J Orthop 2024; 15:744-753. [PMID: 39165872 PMCID: PMC11331329 DOI: 10.5312/wjo.v15.i8.744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/30/2024] [Accepted: 07/09/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND Patient reported outcome measures (PROMs) can be used to assess knee function following anterior cruciate ligament (ACL) reconstruction. Intra-operatively, femoral and tibial tunnels are created to accommodate the new ACL graft. It is postulated that there is an optimum position and orientation of these tunnels and that outcomes from this procedure are affected by their position. AIM To evaluate the influence of graft tunnel position on early to mid-term clinical outcomes following ACL reconstruction. METHODS Six PROMs were collected following ACL reconstruction which included the Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee, Lysholm, Tegner, EuroQol-5 Dimension-5 level, and Short Form 12-item Health Survey. A total of 8 radiological parameters were measured from post-operative X-rays relating to graft tunnel positions. This data was analysed to assess for any correlations between graft tunnel position and post-operative PROMs. RESULTS A total of 87 patients were included in the study with a mean post-operative follow-up of 2.3 years (range 1 to 7 years). Posterior position of tibial tunnel was associated with improved KOOS quality of life (rho = 0.43, P = 0.002) and EQ-5D VAS (rho = 0.36, P = 0.010). Anterior position of EndoButton femoral tunnel was associated with an improved EQ-5D index (rho = -0.38, P = 0.028). There were no other significant correlations between any of the other radiological parameters and PROM scores. CONCLUSION Overall, graft tunnel position had very little correlation with clinical outcomes following ACL reconstruction. A few (posterior) tibial tunnel and (anterior) EndoButton femoral tunnel measurements were associated with better PROMs.
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Affiliation(s)
- Oliver Mann
- The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, United Kingdom
| | - Oday Al-Dadah
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, United Kingdom
- Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, Harton Lane, South Tyneside NE34 0PL, United Kingdom
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Dadoo S, Herman ZJ, Hughes JD. Surgical Techniques in Primary ACL Reconstruction: Getting It Right the First Time. Clin Sports Med 2024; 43:399-412. [PMID: 38811118 DOI: 10.1016/j.csm.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
The ideal anterior cruciate ligament reconstruction (ACLR) is an individualized anatomic approach aimed at restoring the native structure and function of the knee. Surgeons are tasked with difficult decisions during operative planning, including the optimal graft choice for the patient and appropriate anatomic tunnel placement. Special considerations should additionally be given for skeletally immature patients and those at high-risk for failure, including younger, active patients participating in pivoting sports. The purpose of this review is to provide an overview of the individualized approach to ACLR, including the necessary preoperative and operative considerations to optimize patient outcomes.
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Affiliation(s)
- Sahil Dadoo
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA.
| | - Zachary J Herman
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Mann O, Al-Dadah O. Anterior cruciate ligament reconstruction: effect of graft type and gender on early to mid-term clinical outcomes. Musculoskelet Surg 2024:10.1007/s12306-024-00824-2. [PMID: 38809336 DOI: 10.1007/s12306-024-00824-2] [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: 10/16/2023] [Accepted: 05/03/2024] [Indexed: 05/30/2024]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) rupture is a debilitating condition and often requires surgery to restore joint stability. Common autografts used for reconstruction include patella tendon and hamstring tendons. The primary aim of this study was to evaluate the early to mid-term clinical outcomes of ACL reconstruction using validated patient-reported outcome measures (PROMs). The secondary aim was to compare clinical outcomes between patella tendon and hamstring tendon autografts. The tertiary aim was to compare clinical outcomes between males and females. METHODS Patients with an ACL rupture were evaluated before and after surgery using PROM scores which included Lysholm, Tegner, International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Short Form-12 Item (SF-12) and EQ-5D-5L. RESULTS A total of 87 patients were included in the study. All PROM scores significantly improved following surgery (p < 0.001) at a mean follow-up time of 28 months (range 12 to 88 months). The patella tendon subgroup (n = 27) had superior post-operative results as compared to the hamstring tendon subgroup (n = 60) for KOOS sport and recreation (p = 0.005), KOOS quality of life (p = 0.025), KOOS overall (p = 0.026), Tegner (p = 0.046) and IKDC (p = 0.021) scores. There was no significant difference of PROM scores between males (n = 60) and females (n = 27) (p > 0.05). CONCLUSIONS ACL reconstruction significantly improves clinical outcomes for patients with symptomatic instability consequent to ACL rupture. Overall, patella tendon autograft resulted in better clinical outcomes as compared to hamstring tendon autograft following surgery. Gender did not influence clinical outcome following ACL reconstruction.
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Affiliation(s)
- O Mann
- The Medical School, Newcastle University, Framlington Place, Newcastle-Upon-Tyne, NE2 4HH, UK.
| | - O Al-Dadah
- Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, Harton Lane, South Tyneside, NE34 0PL, UK
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle-Upon-Tyne, NE2 4HH, UK
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Williams AA, Koltsov JCB, Brett A, He J, Chu CR. Using 3D MRI Bone Shape to Predict Pre-Osteoarthritis of the Knee 2 Years After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2023; 51:3677-3686. [PMID: 37936374 DOI: 10.1177/03635465231207615] [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: 11/09/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury increases risks for osteoarthritis (OA), a poorly modifiable and disabling condition. Joint changes of potentially reversible pre-OA have been described just 2 years after ACL reconstruction (ACLR) when early bone shape changes have also been reported. PURPOSE This study evaluates relationships between interlimb differences in tibiofemoral bone shape derived from statistical shape modeling (SSM) of magnetic resonance imaging (MRI) and participant factors on patient-reported outcomes 2 years after unilateral ACLR. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS SSM-derived tibiofemoral bone shape and subchondral bone area were assessed from bilateral knee MRI scans of 72 participants with unilateral ACLR (mean age, 34 ± 11 years; 32 women) and compared with a reference cohort of 398 older individuals without OA (mean age, 50 ± 3 years; 213 women). Multivariable logistic regression models examined relationships between participant and surgical factors with interlimb differences in bone shapes or subchondral bone areas. Relationships between patient-reported outcomes and the interlimb differences in bone shape and subchondral area were examined using similar models. RESULTS Bone shape scores and subchondral bone areas were greater (more OA-like) in ACLR knees than uninjured contralateral knees in every bone metric tested (P≤ .001). Interlimb differences in femur shape scores of participants with ACLR were 65% greater (P < .001) than those of the significantly older reference cohort. Taller height, medial meniscal tears, and decreasing age were associated with larger interlimb differences in shape scores and subchondral areas (P < .05). Bone-patellar tendon-bone (BPTB) autograft recipients demonstrated greater interlimb subchondral area differences compared with allograft recipients (P < .05). Interlimb differences for hamstring autograft recipients did not differ from those with BPTB or allograft. Greater interlimb differences in medial femur subchondral areas were associated with worse patient-reported Knee injury and Osteoarthritis Outcome Score Symptoms (R = 0.27; P = .040). CONCLUSION Even in the absence of radiographic OA, just 2 years after unilateral ACLR patients showed greater bone shape scores and subchondral areas consistent with pre-OA in their ACLR knees. Furthermore, greater medial femur bone areas were weakly associated with worse symptoms. Patients who are younger, are taller, have meniscal tears, or have BPTB grafts may be at increased risk for bony asymmetries 2 years after ACLR.
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Affiliation(s)
- Ashley A Williams
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
- Department of Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Jayme C B Koltsov
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | | | - Jade He
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
- Department of Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Constance R Chu
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
- Department of Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
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Chang MJ, Choi YS, Shin JH, Yoon TH, Kim TW, Chang CB, Kang SB. Comparison of failure rates and functional outcomes between hamstring autografts and hybrid grafts in anterior cruciate ligament reconstruction: A systematic review and meta-analysis. Orthop Traumatol Surg Res 2023; 109:103499. [PMID: 36462633 DOI: 10.1016/j.otsr.2022.103499] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND The viability of augmenting small-diameter hamstring autografts with allografts remains unclear. Recent studies have reported different clinical results after allograft augmentation. Hence, we sought to determine whether hamstring autografts and hybrid grafts differed in terms of failure rates and functional outcomes after anterior cruciate ligament (ACL) reconstruction. We also evaluated whether the results of the comparisons differed based on allograft sterilization methods. PATIENTS AND METHODS This systematic review and meta-analysis were performed by searching the PubMed, Cochrane Library, and EMBASE databases to identify prospective or retrospective studies (evidence levels 1, 2, or 3) that compared the failure rates and functional outcomes of ACL reconstruction using autografts and hybrid grafts. RESULTS We identified 15 relevant studies, including 1,521 patients, with 798 and 723 treated using autografts and hybrid grafts, respectively. Fourteen studies were retrospective comparative studies, and one was a prospective randomized controlled trial. Of these, three studies used non-irradiated allografts. In the analysis of all participants, no significant differences in failure rates and subjective International Knee Documentation Committee (IKDC) scores were observed between the autograft and hybrid graft groups. Comparing the autograft and hybrid graft groups that used non-irradiated allografts, no differences in the failure rates and subjective IKDC scores were also noted. Meanwhile, in the groups that used irradiated allograft, the autograft group demonstrated higher Lysholm knee scores and reduced anterior laxity than the hybrid graft group. DISCUSSION Overall, ACL reconstruction using hybrid grafts may not reduce failure rates compared to reconstructions using hamstring autografts, although hybrid grafts with irradiation may decrease functional outcomes. LEVEL OF EVIDENCE III; systematic review of level II and III studies.
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Affiliation(s)
- Moon Jong Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Yun Seong Choi
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, South Korea
| | | | - Tae Hyuck Yoon
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, South Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnamsi, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
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Dadoo S, Engler ID, Kaarre J, Chang AY, Shannon MF, Smith CN, Keeling LE, Musahl V. Low-Volume Surgeons Use Allograft in Younger Patients and Show Greater Rates of Revision Following Primary Allograft Anterior Cruciate Ligament Reconstruction Compared With High-Volume Surgeons. Arthrosc Sports Med Rehabil 2023; 5:100746. [PMID: 37645389 PMCID: PMC10461138 DOI: 10.1016/j.asmr.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/09/2023] [Indexed: 08/31/2023] Open
Abstract
Purpose To determine whether surgeon volume affects revision rate following primary anterior cruciate ligament reconstruction (ACLR) with allograft and to determine whether surgeon volume impacts allograft tissue type used. Methods All patients aged 14 years or older who underwent primary allograft ACLR at a large hospital system between January 2015 to December 2019 with minimum 2-year follow-up were included. Patients with double-bundle ACLR, multiligament reconstruction, and absent allograft type data were excluded. Surgeon volume was categorized as 35 or more ACLR/year for high-volume surgeons and less than 35 ACLR/year for low-volume surgeons. Revision was defined as subsequent ipsilateral ACLR. Patient characteristics, operative details, allograft type, and revision ACLR rates were retrospectively collected. Revision rate and allograft type were analyzed based on surgeon volume. Results A total of 457 primary allograft ACLR cases (mean age: 38.8 ± 12.3 years) were included. Low-volume surgeons experienced greater revision rates (10% vs 5%, P = .04) and used allograft in a younger population (37.6 vs 40.0 years old, P = .03) than high-volume surgeons. Subgroup analysis of the total cohort identified a significantly increased failure rate in patients <25 years old compared with ≥25 years old (30% vs 4%, P < .001). Allograft type selection varied significantly between surgeon volume groups, with low-volume surgeons using more bone-patellar tendon-bone (P < .001) and less semitendinosus allograft (P = .01) than high-volume surgeons. No differences in revision rate were observed based on allograft type (P = .71). Conclusions There was a greater revision rate following primary allograft ACLR among low-volume surgeons compared with high-volume surgeons. Low-volume surgeons also used allograft in a younger population than did high-volume surgeons. Level of Evidence Level III, retrospective comparative prognostic trial.
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Affiliation(s)
- Sahil Dadoo
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Ian D. Engler
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
- Central Maine Healthcare Orthopedics, Central Maine Medical Center, Auburn, Maine, U.S.A
| | - Janina Kaarre
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Audrey Y. Chang
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Michael F. Shannon
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Clair N. Smith
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Laura E. Keeling
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Volker Musahl
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Solis-Cordova J, Edwards JH, Fermor HL, Riches P, Brockett CL, Herbert A. Characterisation of native and decellularised porcine tendon under tension and compression: A closer look at glycosaminoglycan contribution to tendon mechanics. J Mech Behav Biomed Mater 2023; 139:105671. [PMID: 36682172 DOI: 10.1016/j.jmbbm.2023.105671] [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: 09/29/2022] [Revised: 11/17/2022] [Accepted: 01/07/2023] [Indexed: 01/13/2023]
Abstract
Decellularised porcine superflexor tendon (pSFT) has been characterised as a suitable scaffold for anterior cruciate ligament replacement, with dimensions similar to hamstring tendon autograft. However, decellularisation of tissues may reduce or damage extracellular matrix components, leading to undesirable biomechanical changes at a whole tissue scale. Although the role of collagen in tendons is well established, the mechanical contribution of glycosaminoglycans (GAGs) is less evident and could be altered by the decellularisation process. In this study, the contribution of GAGs to the tensile and compressive mechanical properties of pSFT was determined and whether decellularisation affected these properties by reducing GAG content or functionality. PSFTs were either enzymatically treated using chondroitinase ABC to remove GAGs or decellularised using previously established methods. Native, GAG-depleted and decellularised pSFT groups were then subjected to quantitative assays and biomechanical characterisation. In tension, specimens underwent stress relaxation and strength testing. In compression, specimens underwent confined compression testing. The GAG-depleted group was found to have circa 86% reduction of GAG content compared to native and decellularised groups. There was no significant difference in GAG content between native (3.75 ± 0.58 μg/mg) and decellularised (3.40 ± 0.37 μg/mg) groups. Stress relaxation testing discovered the time-independent and time-dependent relaxation moduli of the decellularised group were reduced ≥50% compared to native and GAG-depleted groups. However, viscoelastic behaviour of native and GAG-depleted groups resulted similar. Strength testing discovered no differences between native and GAG-depleted group's properties, albeit a reduction ∼20% for decellularised specimens' linear modulus and tensile strength compared to native tissue. In compression testing, the aggregate modulus was found to be circa 74% lower in the GAG-depleted group than the native and decellularised groups, while the zero-strain permeability was significantly higher in the GAG-depleted group (0.86 ± 0.65 mm4/N) than the decellularised group (0.03 ± 0.04 mm4/N). The results indicate that GAGs may significantly contribute to the mechanical properties of pSFT in compression, but not in tension. Furthermore, the content and function of GAGs in pSFTs are unaffected by decellularisation and the mechanical properties of the tissue remain comparable to native tissue.
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Affiliation(s)
- Jacqueline Solis-Cordova
- Institute of Medical and Biological Engineering, School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom; Institute of Medical and Biological Engineering, School of Mechanical Engineering, Faculty of Engineering and Physical Sciences, University of Leeds, Leeds, United Kingdom.
| | - Jennifer H Edwards
- Institute of Medical and Biological Engineering, School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
| | - Hazel L Fermor
- Institute of Medical and Biological Engineering, School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
| | - Philip Riches
- Department of Biomedical Engineering, Faculty of Engineering, University of Strathclyde, Wolfson Centre, Glasgow, United Kingdom
| | - Claire L Brockett
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, Faculty of Engineering and Physical Sciences, University of Leeds, Leeds, United Kingdom
| | - Anthony Herbert
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, Faculty of Engineering and Physical Sciences, University of Leeds, Leeds, United Kingdom
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Return to sport soccer after anterior cruciate ligament reconstruction: ISAKOS consensus. J ISAKOS 2022; 7:150-161. [PMID: 35998884 DOI: 10.1016/j.jisako.2022.08.004] [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: 07/09/2022] [Accepted: 08/07/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Many factors can affect the return to pivoting sports, after an Anterior Cruciate Ligament Reconstruction. Prehabilitation, rehabilitation, surgical and psychological aspects play an essential role in the decision to return to sports. The purpose of this study is to reach an international consensus about the best conditions for returning to sports in soccer-one of the most demanding level I pivoting sports after anterior cruciate ligament (ACL) reconstruction. METHODS 34 International experts in the management of ACL injuries, representing all the Continents were convened and participated in a process based on the Delphi method to achieve a consensus. 37 statements related to ACL reconstruction were reviewed by the experts in three rounds of surveys in complete anonymity. The statements were prepared by the working group based on previous literature or systematic reviews. Rating agreement through a Likert Scale: strongly agree, agree, neither agree or disagree, disagree and strongly disagree was used. To define consensus, it was established that the assertions should achieve a 75% of agreement or disagreement. RESULTS Of the 37 statements, 10 achieved unanimous consensus, 18 non-unanimous consensus and 9 did not achieve consensus. In the preoperative, the correction of the range of motion deficit, the previous high level of participation in sports and a better knowledge of the injury by the patient and compliance to participate in Rehabilitation were the statements that reached unanimous consensus. During the surgery, the treatment of associated injuries, as well as the use of autografts, and the addition of a lateral extra-articular tenodesis in some particular cases (active young athletes, <25 years old, hyperlaxity, high rotatory laxity and revision cases) obtained also 100% consensus. In the postoperative period, psychological readiness and its validation with scales, adequate physical preparation, as well as not basing the RTSS purely on the time of evolution after surgery, were the factors that reached unanimous Consensus. CONCLUSIONS The consensus statements derived from this international ISAKOS leaders, may assist clinicians in deciding when to return to sports soccer in patients after an ACL reconstruction. Those statements that reached 100% consensus have to be strongly considered in the final decision to RTS soccer.
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Abstract
In the last decade, there have been significant advances in our understanding of anterior cruciate ligament (ACL) reconstruction. Recent prospective cohort studies have identified risk factors for ACL reconstruction graft failure such as younger patient age, increased activity level, nonanatomic tunnel placement, and the use of allograft. Among these, the most easily modifiable risk factor is graft choice. Given that the surgeon's recommendation has been shown to be one of the most important factors behind patients' graft choice, it is critical that the operating surgeon have a thorough understanding of all the ACL graft options available to choose the graft that would be most suitable for the patient's personalized reconstruction (i.e., patient's anatomy, sport, level of competition, age, risk factors for failure, and graft used in previous ACL surgery). The purpose of this review is to provide an up-to-date understanding of the current ACL graft reconstruction options. The indications, advantages, and disadvantages of the different ACL reconstruction graft options available will be discussed.
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Buerba RA, Zaffagnini S, Kuroda R, Musahl V. ACL reconstruction in the professional or elite athlete: state of the art. J ISAKOS 2021; 6:226-236. [PMID: 34272299 DOI: 10.1136/jisakos-2020-000456] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 10/27/2020] [Accepted: 11/07/2020] [Indexed: 01/26/2023]
Abstract
Anterior cruciate ligament (ACL) injuries are on the rise at all levels of sport, including elite athletics. ACL injury can have implications on the athlete's sport longevity, as well as other long-term consequences, such as the development of future knee osteoarthritis. In the elite athlete, ACL injury can also have ramifications in terms of contract/scholastic obligations, sponsorships and revenue-generating potential. Although the goal of anterior cruciate ligament reconstruction (ACLR) is to return any athlete to the same preinjury level of sport, management of ACL injuries in the elite athlete come with the additional challenge of returning him or her to an extremely high level of physical performance. Despite outcome studies after ACLR in elite athletes showing a high return-to-sport rate, these studies also show that very few athletes are able to return to sport at the same level of performance. They also show that those athletes who undergo ACLR have careers that are more short-lived in comparison to those without injury. Thus, returning an elite athlete to 'near peak' performance may not be good enough for the athletic demands of elite-level sports. A possible explanation for the variability in outcomes is the great diversity seen in the management of ACL injuries in the elite athlete in terms of rehabilitation, graft choices, portal drilling and reconstruction techniques. Recently, the advent of anatomical, individualised ACLR has shown improved results in ACLR outcomes. However, larger-scale studies with long-term follow-ups are needed to better understand the outcomes of modern ACLR techniques-particularly with the rise of quadriceps tendon as an autograft choice and the addition of lateral extra-articular tenodesis procedures. The purpose of this article was thus to provide an up-to-date state-of-the-art review in the management of ACL injuries in the elite athlete.
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Affiliation(s)
| | - Stefano Zaffagnini
- 2nd Orthopaedic Surgery and Traumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Ryosuke Kuroda
- Orthopaedic, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Volker Musahl
- Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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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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Comparison of the outcomes of anterior cruciate ligament reconstruction by using patellar tendon or hamstring tendon autografts that have been fixed with cross-pin system at femoral side. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2020. [DOI: 10.21673/anadoluklin.735533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Oliveira AS, Seidi O, Ribeiro N, Colaço R, Serro AP. Tribomechanical Comparison between PVA Hydrogels Obtained Using Different Processing Conditions and Human Cartilage. MATERIALS (BASEL, SWITZERLAND) 2019; 12:E3413. [PMID: 31635284 PMCID: PMC6829290 DOI: 10.3390/ma12203413] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 10/11/2019] [Accepted: 10/15/2019] [Indexed: 02/07/2023]
Abstract
Designing materials for cartilage replacement raises several challenges due to the complexity of the natural tissue and its unique tribomechanical properties. Poly(vinyl alcohol) (PVA) hydrogels have been explored for such purpose since they are biocompatible, present high chemical stability, and their properties may be tailored through different strategies. In this work, the influence of preparation conditions of PVA hydrogels on its morphology, water absorption capacity, thermotropic behavior, mechanical properties, and tribological performance was evaluated and compared with those of human cartilage (HC). The hydrogels were obtained by cast-drying (CD) and freeze-thawing (FT), in various conditions. It was found that the method of preparation of the PVA hydrogels critically affects their microstructure and performance. CD gels presented a denser structure, absorbed less water, were stiffer, dissipated less energy, and withstood higher loads than FT gels. Moreover, they led to friction coefficients against stainless steel comparable with those of HC. Overall, CD hydrogels had a closer performance to natural HC, when compared to FT ones.
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Affiliation(s)
- Andreia Sofia Oliveira
- Centro de Química Estrutural (CQE), Instituto Superior Técnico-Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa, Portugal.
- Instituto de Engenharia Mecânica Instituto Superior Técnico (IDMEC)-Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa, Portugal.
| | - Oumar Seidi
- Institut Supérieur des BioSciences (ISBS), École Supérieure d'Ingénieurs de Paris-Est Créteil, 71 Rue Saint-Simon, 94000 Créteil, France.
| | - Nuno Ribeiro
- Centro de Química Estrutural (CQE), Instituto Superior Técnico-Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa, Portugal.
- Instituto de Engenharia Mecânica Instituto Superior Técnico (IDMEC)-Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa, Portugal.
- Departamento de Ortopedia, Hospital Lusíadas Lisboa, R. Abílio Mendes 12, 1500-458 Lisboa, Portugal.
| | - Rogério Colaço
- Instituto de Engenharia Mecânica Instituto Superior Técnico (IDMEC)-Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa, Portugal.
| | - Ana Paula Serro
- Centro de Química Estrutural (CQE), Instituto Superior Técnico-Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa, Portugal.
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz, Quinta da Granja, Monte de Caparica, 2829-511 Caparica, Portugal.
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Hulet C, Sonnery-Cottet B, Stevenson C, Samuelsson K, Laver L, Zdanowicz U, Stufkens S, Curado J, Verdonk P, Spalding T. The use of allograft tendons in primary ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2019; 27:1754-1770. [PMID: 30830297 DOI: 10.1007/s00167-019-05440-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 02/22/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Graft choice in primary anterior cruciate ligament (ACL) reconstruction remains controversial. The use of allograft has risen exponentially in recent years with the attraction of absent donor site morbidity, reduced surgical time and reliable graft size. However, the published evidence examining their clinical effectiveness over autograft tendons has been unclear. The aim of this paper is to provide a current review of the clinical evidence available to help guide surgeons through the decision-making process for the use of allografts in primary ACL reconstruction. METHODS The literature in relation to allograft healing, storage, sterilisation, differences in surgical technique and rehabilitation have been reviewed in addition to recent comparative studies and all clinical systematic reviews and meta-analyses. RESULTS Early reviews have indicated a higher risk of failure with allografts due to association with irradiation for sterilisation and where rehabilitation programs and post-operative loading may ignore the slower incorporation of allografts. More recent analysis indicates a similar low failure rate for allograft and autograft methods of reconstruction when using non-irradiated allografts that have not undergone chemically processing and where rehabilitation has been slower. However, inferior outcomes with allografts have been reported in young (< 25 years) highly active patients, and also when irradiated or chemically processed grafts are used. CONCLUSION When considering use of allografts in primary ACL reconstruction, use of irradiation, chemical processing and rehabilitation programs suited to autograft are important negative factors. Allografts, when used for primary ACL reconstruction, should be fresh frozen and non-irradiated. Quantification of the risk of use of allograft in the young requires further evaluation. LEVELS OF EVIDENCE III.
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Affiliation(s)
- Christophe Hulet
- Department of Orthopedics and Traumatology, Caen University Hospital, Avenue Cote de Nacre, 14000, Caen, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Ciara Stevenson
- University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, UK
| | - Kristian Samuelsson
- Sahlgrenska University Hospital, Mölndal, Sweden
- Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lior Laver
- University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, UK
| | - Urszula Zdanowicz
- Carolina Medical Center, Pory 78, 02-757, Warsaw, Poland
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA, 15219-3110, USA
| | - Sjoerd Stufkens
- Academic Medical Center Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jonathan Curado
- Department of Orthopedics and Traumatology, Caen University Hospital, Avenue Cote de Nacre, 14000, Caen, France
| | - Peter Verdonk
- Antwerp Orthopedic Center, Monica Hospitals, Antwerp, Belgium
| | - Tim Spalding
- University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, UK.
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15
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Zheng X, Xu W, Gu J, Hu Y, Cui M, Feng YE, Gao S. Effects of graft preconditioning on γ-irradiated deep frozen tendon allografts used in anterior cruciate ligament reconstruction. Exp Ther Med 2018; 16:1338-1342. [PMID: 30116383 PMCID: PMC6090265 DOI: 10.3892/etm.2018.6338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 05/25/2018] [Indexed: 11/14/2022] Open
Abstract
Preconditioning of the grafts prior to implantation into the knee is considered to reduce the loss of tension caused by graft viscoelasticity after anterior cruciate ligament reconstruction. The present study analyzed the impacts of different preconditioning forces on the biomechanical properties of the γ-irradiated deep frozen tendon allografts. A total of 36 tendon grafts were randomly divided into three groups and were preconditioned at 80 N (group 1), 160 N (group 2) and 320 N (group 3) for 10 min. Subsequently, the grafts were gradually completely relaxed for 1 min and subsequently received 25 cyclic loads of 0–80 N. Afterwards, the grafts were loaded to 80 N, which was maintained for 30 min. Finally, load was gradually increased until ultimate failure at maximum load (UFML) was obtained. There were significant differences in the stiffness and UFML values between the 3 groups (all P<0.05). The graft stiffness in group 3 significantly increased compared with the other 2 groups, and the stiffness of group 2 grafts increased compared with group 1. The UFML in group 3 was significantly lower compared with groups 1 and 2, while there was no significant difference between groups 1 and 2. In the present study, the results suggested that increasing the initial tension could effectively reduce the loss of stiffness due to viscoelasticity for the γ-irradiated deep frozen allogeneic tendon grafts. However, overloaded initial tension decreased the tensile strength.
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Affiliation(s)
- Xiaozuo Zheng
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China.,Orthopaedic Biomechanics Laboratory of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
| | - Wei Xu
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China.,Emergency Department, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Juyuan Gu
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China.,Orthopaedic Biomechanics Laboratory of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
| | - Yang Hu
- The Second Department of Intensive Care Unit, Children's Hospital of Hebei Province, Shijiazhuang, Hebei 050000, P.R. China
| | - Meijuan Cui
- Department of Medical Records, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
| | - Yu-E Feng
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
| | - Shijun Gao
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China.,Orthopaedic Biomechanics Laboratory of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
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16
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Li J, Wang J, Li Y, Shao D, You X, Shen Y. A Prospective Randomized Study of Anterior Cruciate Ligament Reconstruction With Autograft, γ-Irradiated Allograft, and Hybrid Graft. Arthroscopy 2015; 31:1296-302. [PMID: 25891223 DOI: 10.1016/j.arthro.2015.02.033] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 02/01/2015] [Accepted: 02/17/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the results of patients who underwent anterior cruciate ligament (ACL) reconstruction with autograft, γ-irradiated allograft, or hybrid graft in a prospective randomized study with a minimum clinical follow-up period of 5 years. METHODS In this prospective, randomized, comparative study, 102 patients with ACL tears underwent ACL reconstruction with autograft (gracilis and semitendinosus tendons), γ-irradiated allograft (tibialis anterior tendons), or hybrid graft (γ-irradiated tibialis anterior tendon allograft and semitendinosus tendon autograft). Laboratory testing of the erythrocyte sedimentation rate and C-reaction protein level were performed; clinical results were evaluated with the KT-1000 arthrometer (MEDmetric, San Diego, CA), Lachman test, Lysholm score, Tegner activity score, and International Knee Documentation Committee evaluation (both objective and subjective). RESULTS There were 32 patients in the autograft group, 31 in the hybrid graft group, and 32 in the γ-irradiated allograft group at last follow-up. No differences were found among the 3 groups regarding patient demographic data and the duration from injury to operation (P > .05). The C-reaction protein and erythrocyte sedimentation rate values were statistically higher in the γ-irradiated allograft group than in the other 2 groups on the third, seventh, and fourteenth days (P < .05). No significant differences were found between the autograft and hybrid graft groups (P > .05). The KT-1000 examination showed more anterior laxity in the γ-irradiated allograft group than in the other 2 groups (P < .05). No significant differences in the Lachman test and pivot-shift test findings were found among the 3 groups (P > .05). The Lysholm score, Tegner activity score, and International Knee Documentation Committee evaluation (subjective and objective) showed no differences among the 3 groups (P > .05). CONCLUSIONS Patients undergoing primary ACL reconstruction with hybrid graft or autograft had satisfactory and similar objective and subjective clinical results. On KT-1000 measurement of anteroposterior knee laxity, both the autograft and hybrid graft groups showed statistically significant differences compared with the γ-irradiated allograft group. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Jia Li
- Department of Orthopaedic Surgery and The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jianzhao Wang
- Department of Orthopaedic Surgery and The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yongqian Li
- Department of Orthopaedic Surgery and The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Decheng Shao
- Department of Orthopaedic Surgery and The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaona You
- Department of Orthopaedic Surgery and The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yong Shen
- Department of Orthopaedic Surgery and The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
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17
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Ghebes CA, Kelder C, Schot T, Renard AJ, Pakvis DFM, Fernandes H, Saris DB. Anterior cruciate ligament- and hamstring tendon-derived cells: in vitro differential properties of cells involved in ACL reconstruction. J Tissue Eng Regen Med 2015; 11:1077-1088. [PMID: 25758215 DOI: 10.1002/term.2009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 12/08/2014] [Accepted: 01/12/2015] [Indexed: 01/13/2023]
Abstract
Anterior cruciate ligament (ACL) reconstruction involves the replacement of the torn ligament with a new graft, often a hamstring tendon (HT). Described as similar, the ACL and HT have intrinsic differences related to their distinct anatomical locations. From a cellular perspective, identifying these differences represents a step forward in the search for new cues that enhance recovery after the reconstruction. The purpose of this study was to characterize the phenotype and multilineage potential of ACL- and HT-derived cells. ACL- and HT-derived cells were isolated from tissue harvest from patients undergoing total knee arthroplasty (TKA) or ACL reconstruction. In total, three ACL and three HT donors were investigated. Cell morphology, self-renewal potential (CFU-F), surface marker profiling, expression of tendon/ligament-related markers (PCR) and multilineage potential were analysed for both cell types; both had fibroblast-like morphology and low self-renewal potential. No differences in the expression of tendon/ligament-related genes or a selected set of surface markers were observed between the two cell types. However, differences in their multilineage potential were observed: while ACL-derived cells showed a high potential to differentiate into chondrocytes and adipocytes, but not osteoblasts, HT-derived cells showed poor potential to form adipocytes, chondrocytes and osteoblasts. Our results demonstrated that HT-derived cells have low multilineage potential compared to ACL-derived cells, further highlighting the need for extrinsic signals to fully restore the function of the ACL upon reconstruction. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Corina Adriana Ghebes
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Cindy Kelder
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Thomas Schot
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Auke J Renard
- Department of Orthopaedic Surgery, Medisch Spectrum Twente Hospital, Enschede, The Netherland
| | - Dean F M Pakvis
- Department of Orthopaedics and Traumatology, Orthopaedic Centre OCON, Hengelo, The Netherlands
| | - Hugo Fernandes
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.,Center for Neuroscience and Cell Biology (CNC), Stem Cells and Drug Screening group, University of Coimbra, Coimbra, Portugal
| | - Daniel B Saris
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.,Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
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18
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Barber FA, Cowden CH, Sanders EJ. Revision rates after anterior cruciate ligament reconstruction using bone-patellar tendon-bone allograft or autograft in a population 25 years old and younger. Arthroscopy 2014; 30:483-91. [PMID: 24680308 DOI: 10.1016/j.arthro.2013.12.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 12/21/2013] [Accepted: 12/31/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare clinical outcomes and revision rates for anterior cruciate ligament (ACL) reconstructions using bone-patellar tendon-bone (BPTB) allografts versus BPTB autografts in a population of patients aged 25 years and younger. METHODS A consecutive series of patients 25 years or younger undergoing ACL reconstruction with either a patient-selected BPTB allograft or BPTB autograft fixed with biocomposite interference screws was retrospectively reviewed. Multiligamentous and posterior cruciate ligament tears were excluded. All allografts were from a single source and not chemically processed or irradiated. Two graft-specific rehabilitation programs were used. The primary outcome measure was graft failure. Failure was defined as a subsequent ACL revision surgery, 2+ Lachman test, positive pivot-shift, or side-to-side KT difference of greater than 5 mm. Secondary outcome measures included Cincinnati, Lysholm, and International Knee Documentation Committee (IKDC) activity scores. RESULTS In 81 patients at least 24 months after surgery (28 allografts; 53 autografts), 7 failures were identified: 2 of 28 (7.1%) allografts and 5 of 53 (9.4%) autografts. Mean Cincinnati scores improved from 54.6 and 39.5 (allografts and autografts, respectively) to 86.2 and 85.1. Mean Lysholm scores improved from 60.3 and 44.8 (allografts and autografts, respectively) to 89.9 and 87.0. Average KT differences were 0.59 mm (allograft) and 0.34 mm (autograft group) (P = .58). IKDC activity scores were 2.9 (allografts) and 3.1 (autografts) postoperatively (P = .32). CONCLUSIONS Using a patient-choice ACL graft selection program after appropriate counseling and using graft-specific rehabilitation programs, not chemically processed or irradiated BPTB allograft reconstructions have no greater failure rate than autografts in patients aged 25 years and younger at a minimum 2-year follow-up. No significant differences in Cincinnati, Lysholm, and IKDC activity scores were found between these 2 groups. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- F Alan Barber
- Plano Orthopedic Sports Medicine and Spine Center, Plano, Texas, U.S.A
| | - Courtney H Cowden
- Plano Orthopedic Sports Medicine and Spine Center, Plano, Texas, U.S.A
| | - Eric J Sanders
- Plano Orthopedic Sports Medicine and Spine Center, Plano, Texas, U.S.A
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19
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Deluiz D, Oliveira LS, Pires FR, Tinoco EMB. Time-dependent changes in fresh-frozen bone block grafts: tomographic, histologic, and histomorphometric findings. Clin Implant Dent Relat Res 2013; 17:296-306. [PMID: 23837530 DOI: 10.1111/cid.12108] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bone allografts have shown satisfactory clinical results in alveolar ridge reconstructions. However, the process of incorporation and the resorption rates of these grafts are not yet fully understood. PURPOSE The aim of this study was to use computed tomography (CT), histology, and histomorphometry to assess the time-dependent rates of resorption and incorporation of fresh-frozen bone allografts. MATERIALS AND METHODS Twenty-four patients underwent alveolar ridge reconstruction with bone block allografts and were randomly allocated to three groups with different graft healing periods (4, 6, or 8 months) before implant placement. To assess the resorption rates, CT scans were acquired within 7 days after bone graft surgery and at the end of the period. Graft samples were collected and sent for histological and histomorphometric analyses. RESULTS The graft resorption mean rates were 50.78% ± 10.43, 32.77% ± 7.84, and 13.02% ± 3.86 for the 4-, 6-, and 8-month groups, respectively, and were significantly different among the three groups. Newly formed bone with osteocytes near the grafted bone was observed in all three groups. The number of osteocytes was significantly lower at 4 months. Grafted bone remains were significantly higher in the shortest period of time. All of the grafts showed large amounts of calcified tissue. CONCLUSIONS All three groups showed new bone formation and different bone resorption rates. Graft healing periods of 4 months showed less graft resorption and seemed to be the most favorable for implant placement. Healing periods of 8 months showed the largest rate of graft resorption, which could render the grafts unfavorable for implant placement.
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Affiliation(s)
- Daniel Deluiz
- Department of Periodontology, UERJ - Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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20
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Duncan IC, Kane PW, Lawson KA, Cohen SB, Ciccotti MG, Dodson CC. Evaluation of information available on the Internet regarding anterior cruciate ligament reconstruction. Arthroscopy 2013; 29:1101-7. [PMID: 23591383 DOI: 10.1016/j.arthro.2013.02.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 02/01/2013] [Accepted: 02/08/2013] [Indexed: 02/02/2023]
Abstract
Searching the Internet is one of the most popular methods for acquiring information related to health. The Internet offers physicians and patients easy access to a wide range of medical material from anywhere in the world. For many patients, this information helps formulate decisions related to their health and health care. An important caveat is that virtually anything can be published on the Internet. Although academic publications require rigorous peer review, Internet websites have no regulatory body monitoring quality and content. With a lack of external regulation, the information retrieved may be incorrect or outdated. The Internet can be a valuable asset for educating patients, but because of significant variability physicians should be familiar with the quality of information available. This article discusses both the strengths and weaknesses of information available on the Internet regarding anterior cruciate ligament repair.
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Affiliation(s)
- Ian C Duncan
- The Rothman Institute, Thomas Jefferson Sports Medicine Division, Philadelphia, PA 19010, USA
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21
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Mehran N, Skendzel JG, Lesniak BP, Bedi A. Contemporary Graft Options in Anterior Cruciate Ligament Reconstruction. OPER TECHN SPORT MED 2013. [DOI: 10.1053/j.otsm.2012.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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