scholarly journals Bone marrow stromal cells from a GDF5 origin produce zonal tendon-to-bone attachments following anterior cruciate ligament reconstruction

2019 ◽  
Author(s):  
Yusuke Hagiwara ◽  
Felix Dyrna ◽  
Andrew F Kuntz ◽  
Douglas J Adams ◽  
Nathaniel A Dyment
Keyword(s):  
Bone Marrow ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tendon Graft ◽  
Host Cells ◽  
Biological Mechanisms ◽  
Anterior Cruciate ◽  
Bone Tunnels ◽  
Anterior Posterior

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.

scholarly journals Arthroscopic anterior cruciate ligament reconstruction with semitendinosus graft versus peroneus longus tendon graft

2020 ◽  
Vol 6 (2) ◽  
pp. 386
Author(s):  
Pudari Manoj Kumar ◽  
Ishan Shevte ◽  
Mukesh Phalak ◽  
Abhishek Nair ◽  
Parth .
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tendon Graft ◽  
Collateral Ligament ◽  
Peroneus Longus Tendon ◽  
Longus Tendon ◽  
Peroneus Longus ◽  
Anterior Cruciate ◽  
Tendon Autograft

<p class="abstract"><strong>Background:</strong> Arthroscopic anterior cruciate ligament (ACL) reconstruction can be performed using autograft from various sources namely, bone patellar tendon graft, hamstring tendons (semitendinosus, gracilis) or peroneus longus tendon.</p><p class="abstract"><strong>Methods:</strong> A prospective study of 30 patients who underwent arthroscopic ACL reconstruction using quadrupled semitendinosus tendon autograft and peroneus longus tendon autograft during the study period.<strong></strong></p><p class="abstract"><strong>Results:</strong> Statistically, there is very little comparable difference between semitendinosus and peroneus longus when used for arthroscopic ACL reconstruction. However, peroneus longus tendon shows superior results when used in patients with grade 3 medial collateral ligament (MCL) injury combined with ACL injury.</p><p class="abstract"><strong>Conclusions:</strong> Our study brings forth the superior efficacy and quality of the double stranded peroneus longus tendon especially in cases associated with complicated injuries involving the medial collateral ligament with a follow up date of about 2 years and as a healthy supplement to other choices of autografts and revision cases.</p>

scholarly journals Outcomes and Complications After All-Epiphyseal Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients

2017 ◽  
Vol 5 (3) ◽  
pp. 232596711769360 ◽  
Author(s):  
Eric J. Wall ◽  
Paul J. Ghattas ◽  
Emily A. Eismann ◽  
Gregory D. Myer ◽  
Preston Carr
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Case Series ◽  
Reconstruction Technique ◽  
Skeletally Immature ◽  
Patient Reported ◽  
Ikdc Score ◽  
Anterior Cruciate ◽  
Bone Tunnels

Background: The safest and most effective technique for anterior cruciate ligament (ACL) reconstruction in skeletally immature patients is currently unknown. Purpose: To evaluate the functional and patient-reported outcomes of a specific all-epiphyseal ACL reconstruction technique in which the graft, bone tunnels, and fixation do not cross the knee growth plates. Study Design: Case series; Level of evidence, 4. Methods: Twenty-seven patients (23 boys, 4 girls; mean age, 11 years; range, 8-15 years) underwent an all-epiphyseal ACL reconstruction with a single femoral transverse epiphyseal tunnel and primarily split tibial epiphyseal tunnels. Outcomes were evaluated in terms of the manual Lachman test, range of motion, pain, return to activity, angular or leg-length deformity on imaging, and International Knee Documentation Committee (IKDC) or Pedi-IKDC score an average of 3.8 years postoperatively, with a minimum 2-year follow-up. Results: The mean IKDC score was 94 ± 11. There were no growth arrests, but 3 patients had knee overgrowth, and 2 required a subsequent guided growth procedure. The ACL graft failed in 4 patients (15%), and 2 patients had contralateral ACL tears (7%). There were 5 subsequent ipsilateral meniscal tears, 4 of which were retears of a repaired meniscus. Ipsilateral knee reinjury significantly correlated with the number of associated injuries at the time of index surgery ( P = .040) and the number of sports played ( P = .029). Conclusion: All-epiphyseal ACL reconstruction resulted in excellent long-term functional outcomes, despite a high rate of complications (48%) and secondary procedures (37%) in this highly active cohort. The incidence of graft failure was similar to other standard ACL reconstruction techniques for patients younger than 20 years.

scholarly journals The Use of a Corrugated Suture for Cortical Fixation of a Semitendinosus Tendon Autograft in Anterior Cruciate Ligament Reconstruction: Clinical Results

2020 ◽  
Vol 26 (2) ◽  
pp. 128-138
Author(s):  
V. V. Slastinin ◽  
N. V. Yarygin ◽  
M. V. Parshikov ◽  
A. M. Fain ◽  
M. V. Sychevskiy ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Clinical Results ◽  
Tendon Graft ◽  
Semitendinosus Tendon ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate ◽  
Bone Tunnels

The study purpose — to evaluate the clinical results and the condition of bone tunnels after anterior cruciate ligament reconstruction with a semitendinosus tendon graft using cortical fixation and corrugated sutures.Materials and Methods. The results anterior cruciate ligament reconstruction with a semitendinosus tendon autograft were analyzed in 57 patients aged 18 to 53 years. The patients of the first group (n = 27) underwent anterior cruciate ligament reconstruction with a semitendinosus tendon graft using cortical fixation on the femur and tibia in combination with corrugated sutures at the proximal and distal ends of the graft. The patients of the second group (n = 30) underwent anterior cruciate ligament reconstruction in a similar way, but without the use of corrugated sutures. Clinical results were assessed using the Lysholm and IKDC scales. The degree of bone tunnels widening was evaluated by CT data in 6 months after the surgery.Results. In the first group, the degree of postoperative bone tunnels widening was significantly lower (for the femoral tunnel by 18% and tibial — by 17%) compared with the second group (for the femoral tunnel by 30% and tibial — by 31%). Scores by the IKDC 2000 and Lysholm scales were higher in the corrugated sutured group. Although, the treatment outcome was interpreted as equally good for both groups. The time for graft preparation was on average 6 minutes longer in the first group. This slightly increased the duration of the surgery.Conclusion. The anterior cruciate ligament reconstruction with a semitendinosus tendon graft using cortical fixation on the femur and tibia in combination with corrugated sutures ensured the tight contact of the tendon inside the bone tunnels without additional implants and reduced the degree of tunnels widening. This is important for a possible re-grafting. The proposed method does not significantly affect the clinical outcomes.

Tendon graft revitalization using adult anterior cruciate ligament (ACL)-derived CD34+ cell sheets for ACL reconstruction

Biomaterials ◽  
2013 ◽  
Vol 34 (22) ◽  
pp. 5476-5487 ◽  
Author(s):  
Yutaka Mifune ◽  
Tomoyuki Matsumoto ◽  
Koji Takayama ◽  
Satoshi Terada ◽  
Naosumi Sekiya ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tendon Graft ◽  
Cell Sheets ◽  
Anterior Cruciate

scholarly journals Simultaneous Double-boundle “All Inside” Posterior Cruciate Ligament and Anterior Cruciate Ligament Reconstruction: 2 Years Follow Up

2018 ◽  
Vol 6 (12_suppl5) ◽  
pp. 2325967118S0018
Author(s):  
Franco Farina ◽  
Matías Orlando ◽  
Ma. Florencia Weisburd ◽  
Francisco Vega ◽  
Emilio Morales ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Posterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Anatomical Reconstruction ◽  
Pcl Reconstruction ◽  
Kt 1000 ◽  
Anterior Cruciate ◽  
Anterior Posterior

The purpose of this study was to evaluate the clinical results of simultaneuos Double-boundle “All Inside” posterior Cruciate Ligament (PCL) and Anterior Cruciate Ligament (ACL) Reconstruction. Methods: this study population included 31 men and 2 women with 26 acute and 7 chronic knee injuries. Ligament injuries included 21 ACL / PCL / Posterolateral instability, 9 ACL / PCL / Medial Cruciate Ligament (MCL), 3 ACL / PCL instability. Artroscopically assited combined ACL/PCL. Reconstruction were performed using the All Inside PCL reconstruction and ACL anatomical Reconstruction. The patients were followed up for a minimum of 2 years and evaluated according to the International Knee Documentation Committee (IKDC) and Lysholm Rating scale. The anterior-posterior knee laxity was assessed by KT-1000 examination. Results: At the last Follow Up, all patients showed normal knee extension. Two patients had 10 grades flexion limitation, and five had a 5 grades flexion limitation. The Lysholm scores was 90,4 +/- 4,6. According to the last IKDC evaluation, the results were graded as normal in 21 patients (63,6%), nearly normal in 11 patients (33,3%), and abnormal in 1 patient (3,1%). The KT-1000 examination showed that de side to side difference in overall anterior-posterior laxity at 70 grades flexion was 0 to 2 mm in 24 patients, 3 to 5 mm in 8 patients, and 6 to 10 mm in 1 patient; the side to side difference in overall anterior-posterior laxity at 20 grades flexion was 0 to 2 mm in 23 patients, 3 to 5 mm in 9 patients and 6 to 10 mm in 1 patient. Conclusion: simultaneuos Double-Boundle “All Inside” PCL and ACL reconstruction can effectively and safely restore knee stability, and can yield normal results in 62,5% of patients and nearly normal in 33,3% at minimum 2 years.

scholarly journals Complications of anterior cruciate ligament reconstructions

2017 ◽  
Vol 70 (11-12) ◽  
pp. 449-458
Author(s):  
Vladimir Ristic ◽  
Miodrag Vranjes ◽  
Mirko Obradovic ◽  
Mile Bjelobrk ◽  
Vladimir Harhaji ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Tendon Graft ◽  
Complication Rates ◽  
X Rays ◽  
Hamstring Tendons ◽  
Patellar Tendon Graft ◽  
Anterior Cruciate ◽  
Bone Tunnels

Introduction. The aim of study was to analyze the results and complications of anterior cruciate ligament reconstructions, treatment and prevention possibilities. Material and Methods. We performed 210 operations: 175 with patellar tendon graft and 35 with hamstring tendons. Men were 7 times more present in our survey. The average age being 27.1 years. The average follow up was 3.2 years. The participants answered a modified Knee Ostedoarthritis Outcome Scale questionnaire set. We used clinical examination tests (Range of motion, Lachman and pivot shift) and postoperative X-rays. Results. The complication?s rate was 9% (19 patients). In patellar tendon group we registered one patellar fracture and pulmonary tromboembolism and two cases of cyclops lesions. Septic arthritis was more common among professional athletes and in hamstring tendons group. Reoperations had to be performed: in 5 cases of infections (continous irrigation and drainage), two arthrofibrosis and one osteosynthesis of patella. Graft had to be removed in 2.5% of cases and revisions happened mostly because of impropriate position of bone tunnels and new trauma. One algodystrophic syndrome happened in hamstring tendons group. Complications were successfully treated in 12 cases but 5 patients had knee contractures, so average Knee Ostedoarthritis Outcome Scale score was 88.2 points in comparison to 93.8 points in patients without complications. Seventy-three percent of patients returned to nonrestricted (sport) activities. Complications can compromise the final results of anterios cruciate ligament reconstructions. We registered similar complication rates between different grafts. Some of complications had almost every eleventh patient that resulted with reoperation at every eighteenth of them. Conclusion. The most of complications can be prevented and treated successfuly althought many questions are still left opened.

scholarly journals 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

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Ravi Gupta ◽  
Sandeep Singh ◽  
Anil Kapoor ◽  
Ashwani soni ◽  
Ravinder Kaur ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Hamstring Tendon ◽  
Tendon Graft ◽  
Hamstring Tendon Graft ◽  
The Mean ◽  
Anterior Cruciate

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

Sign in / Sign up

Export Citation Format

Share Document