Loss of anterior cruciate ligament integrity and the risk of secondary meniscal injury and bone marrow lesions: data from the osteoarthritis initiative

ABSTRACTFollowing anterior cruciate ligament (ACL) injury, the ligament is often reconstructed with a tendon graft passed through bone marrow tunnels. This procedure results in a staged repair response where cell death occurs in the tendon graft, the graft is repopulated by host cells outside the graft, and tendon-to-bone attachments form at the graft/bone interface. While this healing process is well appreciated, the biological mechanisms that regulate it including the cellular origin of the repair response is poorly understood. Embryonic progenitor cells expressing growth and differentiation factor 5 (GDF5) give rise to several mesenchymal tissues in the joint and epiphyses. Therefore, we hypothesized that cells from a GDF5 origin, even in the adult tissue, would give rise to cells that contribute to the stages of repair following ACL reconstruction. ACLs were reconstructed in Gdf5Cre;R26R-tdTomato lineage tracing mice to monitor the contribution of Gdf5Cre;tdTom+ cells to graft revitalization and examine the extent to which these cells are capable of creating mineralized attachments within the bone tunnels. Anterior-posterior drawer tests were used to establish the stability of the knee following the procedure and demonstrated 58% restoration in anterior-posterior stability. Following reconstruction, Gdf5Cre;tdTom+ cells within the bone marrow expanded by 135-fold compared to intact controls in response to the injury. These cells migrated to the tendon graft interface, repopulated regions of the graft, and initiated tendon-to-bone attachments. These cells continued to organize and mature the attachments yielding a zonal insertion site at 4 weeks with collagen fibers spanning across unmineralized and mineralized fibrocartilage and anchored to adjacent bone. The zonal attachment possessed organized tidemarks with concentrated alkaline phosphatase activity similar to normal tendon or ligament entheses. This study established that mesenchymal cells from a GDF5 origin contribute to the creation of zonal tendon-to-bone attachments within bone tunnels following ACL reconstruction. Future studies will target this cell population to modulate the repair response in order to better understand key biological mechanisms that regulate tendon-to-bone repair.

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Diagnostic values of clinical tests for the meniscals tear in patients with anterior cruciate ligament injury

Vietnam Journal of Endolaparoscopic Surgery ◽

10.51199/vjsel.2020.1.1 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Đình Toàn Dương ◽

Tiến Thành Vũ

Keyword(s):

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Clinical Signs ◽

Meniscus Tear ◽

Ligament Injury ◽

Meniscal Injury ◽

Clinical Tests ◽

Arthroscopic Reconstruction ◽

Anterior Cruciate ◽

Sensitivity Specificity

Tóm tắt Đặt vấn đề: Từ tháng 4/2017 - 6/2018 chúng tôi đã tiến hành nghiên cứu trên 50 người bệnh tổn thương dây chằng chéo trước (DCCT) và rách sụn chêm (SC) khớp gối, được phẫu thuật nội soi tại Bệnh viện Hữu nghị Việt Đức với mục tiêu: Đánh giá độ nhạy, độ đặc hiệu và độ chính xác của các nghiệm pháp lâm sàng trong chẩn đoán tổn thương SC khớp gối. Phương pháp nghiên cứu: 50 người bệnh tổn thương DCCT và rách SC khớp gối, được phẫu thuật nội soi. Tổn thương SC (hình thái, phân loại) được quan sát trong mổ, được đối chiếu với triệu chứng lâm sàng, từ đó xác định độ nhạy, độ đặc hiệu và độ chính xác của các nghiệm pháp lâm sàng. Kết quả: Độ nhạy, độ đặc hiệu và độ chính xác của các dấu hiệu và nghiệm pháp lâm sàng lần lượt của rách sụn chêm trong: đau khe khớp (70%; 53%; 60%); McMuray (80%; 73,3%: 76%); Apley (65%; 70%; 68%); Thessaly (70%; 76,7%;74%); rách sụn chêm ngoài: đau khe khớp (73%; 66,7%; 70%); McMurray (69,2%; 75%: 72%); Apley (69,2%; 70,8%; 70%); Thessaly (73,1%; 75%; 74%). Kết luận: Khi thăm khám đánh giá tổn thương SC, nếu phát hiện có ít nhất 2 nghiệm pháp dương tính thì giá trị của chẩn đoán lâm sàng được nâng cao. Abstract Introduction: From 4 / 2017-6 / 2018, we conducted a study on 50 patients with anterior cruciate ligament (ACL) injury and meniscal injury, which had ACL arthroscopic reconstruction at Viet Duc University Hospital. Objectives: To evaluate the sensitivity, specificity and accuracy of clinical tests for meniscal injury. Materials and Methods: 50 patients with ACL injury and meniscal torn, had ACL arthroscopic reconstruction. Meniscal injury (morphology, classification) observed during surgery, collated with clinical tests, determining sensitivity, specificity and accuracy of clinical signs and clinical tests. Results: The sensitivity, specificity and accuracy of the clinical signs and clinical tests of medial meniscus tear: joint pain (70%; 53%; 60%); McMurraytest (80%; 73.3%: 76%); Apleytest (65%; 70%; 68%); Thessalytest (70%; 76.7%; 74%); for lateral meniscus tear: joint pain (73%; 66.7%; 70%); McMurraytest (69.2%; 75%: 72%); Apleytest (69.2%; 70.8%; 70%); Thessalytest (73.1%; 75%; 74%). Conclusion: When examining and assessing meniscus lesions, if the examination finds at least two positive results, the value of the clinical diagnosis is greatly improved. Keywords: Meniscal injury, knee injury, anterior cruciate ligament injury, arthroscopy.

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Image Guided Injection of Anterior Cruciate Ligament Tears with Autologous Bone Marrow Concentrate and Platelets: Midterm Analysis from A Randomized Controlled Trial

Biologic Orthopedics Journal ◽

10.22374/boj.v3isp2.24 ◽

2022 ◽

Vol 3 (SP2) ◽

pp. e7-e20

Author(s):

Christopher Centeno ◽

Matthew Lucas ◽

Ian Stemper ◽

Ehren Dodson

Keyword(s):

Bone Marrow ◽

Anterior Cruciate Ligament ◽

Exercise Therapy ◽

Cruciate Ligament ◽

Post Treatment ◽

Percutaneous Injection ◽

Bone Marrow Concentrate ◽

Recent Emergence ◽

Ligament Healing ◽

Anterior Cruciate

Background: There has been a recent emergence in the use of orthobiologics, including platelet-rich plasma (PRP) and bone marrow concentrate (BMC), in the treatment of various musculoskeletal conditions. The goal of this study was to determine if injection of BMC and platelet products into partial and full-thickness anterior cruciate ligament (ACL) tears can facilitate primary ligament healing in patients failing conservative care, resulting in improved outcomes compared to exercise therapy.Methods: Patients were randomized to either exercise therapy or percutaneous injection of autologous BMC with PRP and platelet lysate into the ACL under fluoroscopic guidance. Pain and function were assessed at baseline and at 1, 3, 6, 12, and 24 months. Baseline and 6-month post-treatment magnetic resonance imaging (MRI) were obtained to evaluate interval healing. Laxity was assessed using the Telos device.Results: There was significant improvement in functional outcomes in the BMC group, compared to base-line for LEFS at time points 3 up to 24 months s = 0.000000005), and significant improvement in pain in the BMC group at 6 (p = 0.00054), 12 (p = 0.00127), and 24 months (p = 0.002). There was no significant improvement in pain or function at any time point in the exercise therapy group. There was significant improvement in ACL MRI ImageJ quantitative assessment in the BMC group (p = 0.001) and no difference in the exercise group (p > 0.05). No serious adverse events were reported.Conclusion: Autologous BMC and platelet product injection into ACL tears improved patient function compared to exercise, observed through 24 months. Patients treated with BMC demonstrated quantitative improvements in post-treatment MRI scans suggestive of interval ligament healing.

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