scholarly journals MRI analysis of ACL tendon graft Intracanal Incorporation with polypropylene mesh implantation

2021 ◽  
pp. 23-33
Author(s):  
Maxim Golovakha ◽  
Oleksiy Shevelyov ◽  
Stanislav Bondarenko ◽  
Volodymyr Pertsov
Keyword(s):  
Synovial Fluid ◽  
Polypropylene Mesh ◽  
Cruciate Ligament ◽  
Tendon Graft ◽  
Tissue Growth ◽  
Control Group ◽  
General View ◽  
Key Words Knee ◽  
Bone Edema ◽  
Semitendinosus Graft

Hamstring tendon graft remains one of the most popular for ACL reconstruction (ACLR). However, its disadvantage is long term ligamentation process and intracanal incorporation and delayed rehabilitation. One of the methods for stimulation of connective tissue growth is the implantation of polypropylene mesh (PPM), which are widely used in hernioplasty. Objective. To compare the MRI data dynamics of intracanal incorporation of tendon graft with implantation of PPM in bone canals. Methods. For evaluation of graft reconstruction in the femoral and tibial canals we used criteria based on the analysis of MRI images in PD FS and STIR sequences: the nature of the signal from the graft in the center of bone canal; general view of the graft; the nature of the MRI signal from the tissues around the graft on the tendons-bone border; the pre­sence of synovial fluid in the canals and bone edema around them. Results of MRI of 75 patients who underwent «all-inside» ACLR with semitendinosus graft were analyzed. In the study group (40 patients) were compared to control group (35 patients) additionally implanted PPM around the ends of the tendon graft. Results. Intracanal graft incorporation in the group of patients with implantation of PPM occurred faster. The nature of the signal from the center of the bone canal and on the bone-tendon border progressed significantly faster in all observed terms. In the research group there was not presence of synovial fluid in the canals along the graft. Conclusions. Implantation of PPM around the ends of the ACL tendon autograft immersed in bone canals, leads, according to MRI data, to faster intra-canal incorporation. Key words. Knee joint, anterior cruciate ligament, arthroscopy.

The Clinical Application and Evaluation of Artificial Cruciate Ligament Materials for Knee Exercise Injury

2014 ◽  
Vol 1022 ◽  
pp. 64-67
Author(s):  
Zhuo Wang ◽  
Yun Peng Han
Keyword(s):  
Knee Joint ◽  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Tendon Graft ◽  
Ligament Injury ◽  
Artificial Ligament ◽  
Joint Activities ◽  
Tendon Transplant ◽  
Semitendinosus Graft ◽  
Bone Patellar Tendon

Rupture of knee joint cruciate ligament in sports training and competition, need through the surgical method to reconstruction of ligament reconstruction function. Application of biological materials for cruciate ligament, can make patients get less disease waste, and allows the patient knee joint activities immediately after treatment, is beneficial to the rehabilitation of patients. Cruciate ligament graft materials including autograft, allograft ligament ligament and artificial ligament. Autologous tissue reconstruction of knee joint cruciate ligament with bone patellar tendon bone and semitendinosus graft, many complications of bone patellar tendon bone graft, semitendinosus and gracilis tendon transplant will affect the joint function. Allogenic ligament materials mainly include bone patellar tendon bone and four femoral head allograft tendon bone, shortage of material is not completely kill bacteria and viruses. Artificial ligament material divided into permanent ligament, ligament and ligament scaffold material framework material, the effect of LARS artificial ligament transplantation in the treatment of cruciate ligament injury is more ideal, compared with the efficacy of autologous tendon graft, the differences were significant, had no significant differences compared with the long term effect of transplantation of autologous ligament.

Advantages of an Attached Semitendinosus Tendon Graft in Anterior Cruciate Ligament Reconstruction in a Rabbit Model

2018 ◽  
Vol 46 (13) ◽  
pp. 3227-3236 ◽  
Author(s):  
Shaohua Liu ◽  
Yaying Sun ◽  
Fang Wan ◽  
Zheci Ding ◽  
Shiyi Chen ◽  
...  
Keyword(s):  
Bone Healing ◽  
Cruciate Ligament ◽  
Tendon Graft ◽  
Semitendinosus Tendon ◽  
Control Group ◽  
Study Group ◽  
Micro Ct ◽  
Tibial Insertion ◽  
Anterior Cruciate ◽  
Biomechanical Strength

Background: The semitendinosus tendon graft with an intact tibial insertion has a sustainable blood supply and might be beneficial for graft maturation after anterior cruciate ligament reconstruction (ACLR); however, its potential advantages for graft tendon-bone healing is still unclear. Hypothesis: Intact tibial insertion of the hamstring tendon can preserve enough blood supply to keep the harvested tendon alive, which can improve tendon-bone healing and the biomechanical strength of the graft. Study Design: Controlled laboratory study. Methods: Sixty-four healthy New Zealand White rabbits underwent unilateral ACLR with a semitendinosus tendon autograft after random enrollment into 2 groups (study group, n = 32 rabbits with semitendinosus tendon–preserved tibial insertions; control group, n = 32 rabbits with free semitendinosus tendons). At weeks 3, 6, 12, and 24, 8 rabbits in each group were sacrificed to evaluate tendon-bone healing by histologic staining, micro–computed tomography (micro-CT) examination, and biomechanical test. Results: The grafts in the study group maintained a similar cell count with no signs of necrosis or hypocellularity across all time points, but the grafts in the control group underwent a characteristic stage of necrosis at weeks 3 and 6. Sharpey-like fibers were observed from postoperative 3 weeks at the tendon-bone interface in the study group, and a normal insertion-like structure was formed at week 12, which became more mature at week 24. In the control group, however, Sharpey-like fibers could not be observed until week 12, and a normal transition through cartilage from bone to tendon was not observed at any time point. Histologic scores of the tendon-bone interface in the study group were significantly higher than those in the control group at week 6 ( P = .04), week 12 ( P < .001), and week 24 ( P = .04). As compared with the control group via micro-CT, the study group had a significantly smaller bone tunnel area at week 6 ( P = .01) and larger bone volume/total volume at week 3 ( P = .0026) and week 6 ( P = .01). Also, the study group had a significantly higher failure load at weeks 12 and 24 (both P = .03) and a significantly higher stiffness at week 24 ( P < .001) versus the control group. Conclusion: The semitendinosus tendon graft with an intact tibial insertion in ACLR would bypass the graft avascular necrosis stage, which improves tendon-bone healing and biomechanical strength. Clinical Relevance: An alive graft in ACLR could improve tendon-bone healing and the biomechanical strength of the graft, which might be beneficial to early and intensive rehabilitation after ACLR.

scholarly journals Effects of ACL Reconstructive Surgery on Temporal Variations of Cytokine Levels in Synovial Fluid

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Marco Bigoni ◽  
Marco Turati ◽  
Marta Gandolla ◽  
Paola Sacerdote ◽  
Massimiliano Piatti ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Temporal Variations ◽  
Control Group ◽  
Knee Stability ◽  
Cytokine Levels ◽  
History Of ◽  
Anterior Cruciate ◽  
Bone Patellar Tendon

Anterior cruciate ligament (ACL) reconstruction restores knee stability but does not reduce the incidence of posttraumatic osteoarthritis induced by inflammatory cytokines. The aim of this research was to longitudinally measure IL-1β, IL-6, IL-8, IL-10, and TNF-αlevels in patients subjected to ACL reconstruction using bone-patellar tendon-bone graft. Synovial fluid was collected within 24–72 hours of ACL rupture (acute), 1 month after injury immediately prior to surgery (presurgery), and 1 month thereafter (postsurgery). For comparison, a “control” group consisted of individuals presenting chronic ACL tears. Our results indicate that levels of IL-6, IL-8, and IL-10 vary significantly over time in reconstruction patients. In theacute phase,the levels of these cytokines in reconstruction patients were significantly greater than those in controls. In thepresurgeryphase, cytokine levels in reconstruction patients were reduced and comparable with those in controls. Finally, cytokine levels increased again with respect to control group in thepostsurgeryphase. The levels of IL-1βand TNF-αshowed no temporal variation. Our data show that the history of an ACL injury, including trauma and reconstruction, has a significant impact on levels of IL-6, IL-8, and IL-10 in synovial fluid but does not affect levels of TNF-αand IL-1β.

scholarly journals INTRATUNNEL THE EFFECT OF ADMINISTRATION OF BONE MARROW MESENCHYMAL STEM CELLS (BM-MSCs) AND VASCULAR ENDOTHELIAL GROWTH FACTOR (VEGF) TENDON-BONE TO INTERFACE HISTOLOGICAL GRAFT ANTERIOR CRUCIATE LIGAMENT APPEARANCE AFTER RECONSTRUCTION IN RABBITS

2018 ◽  
Vol 2 (1) ◽  
Author(s):  
Atria Abirama
Keyword(s):  
Stem Cells ◽  
Bone Marrow ◽  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Cruciate Ligament ◽  
Tendon Graft ◽  
Bone Tunnel ◽  
Control Group ◽  
Vascular Endothelial ◽  
Endothelial Growth Factor

The success of the Anterior Cruciate Ligament (ACL) reconstruction using a tendon graft is determined by integration in the bone tendon-graft interface on the bone tunnel. The use of stem cells and growth factors proved to accelerate the healing of the bone tendon-graft interface. The aim of this study was to inveestigate the difference of histology picture in the tendon-bone tunnel model after ACL reconstruction with intratunnel intravenous allogenic bone marrow mesenchymalstemcells (BM-MSCs) and intratunnel vascular endothelial growth factor (VEGF). This research used Post-Test Only Control Group design with 20 rabbits divided into treatment group and control group. Each group performed histologic image evaluation (thickness of collagen fiber or sharpey fiber) at week 3 and 6. Evaluation of histology overview at week 3 and week 6 showed a significantly thicker thickness of collagen fiber or sharpey fiber in treatment group compared with control group (p <0.05). Intravenous administration of BM-SCs and VEGF after ACL reconstruction can speed healing of the bone tunnel significantly from week 3 and 6. The study by Faridyan et al has concluded that intravenous BM-SCs + VEGF increased ultimate tension strength in the bone-tendon interface significantly. In this study, intravenous administration of BM-SCs and VEGF gave histologic images showing acceleration of bone tunnel healing.Keywords:Anterior cruciate ligament reconstruction, allogenic bone marrow mesenchymal stem cells, vascular endothelial growth factor, graft tunnel healing, and Sharpey fiber.

scholarly journals Influence of Synovial Fluid on Human Osteoblasts: An In Vitro Study

2007 ◽  
Vol 7 ◽  
pp. 2012-2020 ◽  
Author(s):  
Thomas F. Fuchs ◽  
Wolf Petersen ◽  
Thomas Vordemvenne ◽  
Richard Stange ◽  
Michael Raschke ◽  
...  
Keyword(s):  
Gene Expression ◽  
Alkaline Phosphatase ◽  
Synovial Fluid ◽  
Cruciate Ligament ◽  
Calf Serum ◽  
Collagen I ◽  
Control Group ◽  
Marker Genes ◽  
Human Osteoblasts

Osseous graft healing at the tendon bone interface after anterior cruciate ligament (ACL) reconstruction is unsatisfactory in 10—25%, depending on the evaluation criteria or the kind of graft used for reconstruction. Mechanical as well as biological aspects are currently discussed. Since osteoblasts play an important role in the osseous integration of an ACL graft, we hypothesize that synovial fluid (SF), when entering the bone tunnel, has an inhibitory effect on osteoblasts. In order to verify this hypothesis, human osteoblasts (p3) were incubated in the presence of SF or partially purified SF. Proliferation was assayed using MTT or BrdU assay. Gene expression of osteoblast markers (alkaline phosphatase, collagen I, and osteocalcin) were determined by TaqMan analysis. In the control group, SF was exchanged by fetal calf serum (FCS). The results showed osteoblast proliferation in the presence of SF as well as in partially purified heat-pretreated synovial fluid. Native SF induced alkaline phosphatase and collagen I gene expression. No induction of the osteocalcin gene was observed in the experiment. These results were comparable to that obtained with FCS. These findings suggest that SF stimulated proliferation of osteoblasts in vitro. This effect is mediated, in part, by heat-stable components of SF. In addition, the expression of osteoblast marker genes alkaline phosphatase and collagen I, but not osteocalcin, was induced by SF. Therefore, problems associated with cruciate ligament reconstruction might be due to the inhibition of osteoblast differentiation. If so, this is not a specific attribute of SF, but also applies to serum.

scholarly journals Failed Meniscal Repairs After Anterior Cruciate Ligament Reconstruction Increases Risk of Revision Surgery

2020 ◽  
Vol 8 (10) ◽  
pp. 232596712096053
Author(s):  
Søren Vindfeld ◽  
Torbjørn Strand ◽  
Eirik Solheim ◽  
Eivind Inderhaug
Keyword(s):  
Revision Surgery ◽  
Cruciate Ligament ◽  
Meniscal Repair ◽  
Hamstring Tendon ◽  
Tendon Graft ◽  
Control Group ◽  
Hamstring Tendon Graft ◽  
Acl Surgery ◽  
Anterior Cruciate ◽  
Time From Injury

Background: Failed anterior cruciate ligament (ACL) reconstruction (ACLR) can lead to reduced quality of life because of recurrent episodes of instability, restrictions in level of activity, and development of osteoarthritis. A profound knowledge of the causes of a failed surgery can ultimately help improve graft survival rates. Purpose: To investigate the patient-related risks of inferior outcomes leading to revision surgery after ACLR. Study Design: Case-control study; Level of evidence, 3. Methods: From a prospective cohort of primary ACLRs performed at a single center, patients who required later revision surgery were matched with a control group of uneventful primary ACLRs. Patient characteristics, data from the preoperative examinations, KT-1000 arthrometer laxity testing, Tegner activity scale, International Knee Documentation Committee subjective score, Knee injury and Osteoarthritis Outcome Score, and perioperative data from the initial surgery were included. Results: A total of 100 revision cases and 100 matched controls, with a median follow-up time of 11 years, were included in the study. Those who had undergone revision surgery were younger at the time of reconstruction and had a shorter time from injury to surgery than their matched controls ( P = .006). The control group—of uneventful ACLRs—had a higher incidence of meniscal repair at reconstruction ( P = .024). Also, the revision group more frequently experienced later failure of the previous meniscal repair ( P = .004). Surgeon experience was not found to affect the risk of revision ACL surgery. Those who had undergone ACL revision surgery had more frequently received a hamstring tendon graft size of <8 mm ( P = .018) compared with the controls. Conclusion: The current study demonstrated that failed meniscal repair and a hamstring tendon graft size of <8 mm were associated with primary ACLR failure. Also, younger age at the time of surgery and shorter time from injury to surgery were found to affect the risk of undergoing revision ACL surgery.

scholarly journals Bioresorbable Stent in Anterior Cruciate Ligament Reconstruction

Polymers ◽  
2019 ◽  
Vol 11 (12) ◽  
pp. 1961
Author(s):  
Krzysztof Ficek ◽  
Jolanta Rajca ◽  
Mateusz Stolarz ◽  
Ewa Stodolak-Zych ◽  
Jarosław Wieczorek ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Healing Process ◽  
Tendon Graft ◽  
Bone Tunnel ◽  
Control Group ◽  
Microstructural Parameters ◽  
Beneficial Effects ◽  
Anterior Cruciate

The exact causes of failure of anterior cruciate ligament (ACL) reconstruction are still unknown. A key to successful ACL reconstruction is the prevention of bone tunnel enlargement (BTE). In this study, a new strategy to improve the outcome of ACL reconstruction was analyzed using a bioresorbable polylactide (PLA) stent as a catalyst for the healing process. The study included 24 sheep with 12 months of age. The animals were randomized to the PLA group (n = 16) and control group (n = 8), subjected to the ACL reconstruction with and without the implantation of the PLA tube, respectively. The sheep were sacrificed 6 or 12 weeks post-procedure, and their knee joints were evaluated by X-ray microcomputed tomography with a 50 μm resolution. While the analysis of tibial and femoral tunnel diameters and volumes demonstrated the presence of BTE in both groups, the enlargement was less evident in the PLA group. Also, the microstructural parameters of the bone adjacent to the tunnels tended to be better in the PLA group. This suggested that the implantation of a bioresorbable PLA tube might facilitate osteointegration of the tendon graft after the ACL reconstruction. The beneficial effects of the stent were likely associated with osteogenic and osteoconductive properties of polylactide.

scholarly journals Effects of adenovirus-mediated knockdown of IRAK4 on synovitis in the osteoarthritis rabbit model

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Muzhe Li ◽  
Huiyun Li ◽  
Xun Ran ◽  
Han Yin ◽  
Xuling Luo ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Cruciate Ligament ◽  
Interleukin 1 ◽  
Cartilage Damage ◽  
Rabbit Model ◽  
Joint Disease ◽  
Control Group ◽  
Model Group ◽  
Tnf Α ◽  
And Cartilage

Abstract Background The use of interleukin-1 receptor-associated kinase 4 (IRAK4) inhibitor as a treatment for the inflammatory joint disease is a promising method. However, its underlying mechanism in osteoarthritis (OA) remains unclear. The purpose of this study is to look into the effects of adenovirus-mediated knockdown of IRAK4 on synovitis in the OA rabbit model. Methods Ad-shIRAK4 was injected two weeks after anterior cruciate ligament resection. Six weeks later, the rabbits were killed. The expression of IRAK4, TNFR-associated factor 6(TRAF6), TGF-activated kinase 1(TAK1), p-IKB kinase (p-IKK), p-nuclear factor kappa-B (p-NFκB), p38, and p-p38 in the synovial membrane was detected by western blot, qRT-PCR, and immunohistochemistry analysis. Immunohistochemistry was to detect the expression of IRAK4 proteins in articular cartilage. H&E staining was to assess the pathological changes of synovium and cartilage. The levels of interleukin (IL)-1β, tumor necrosis factor-α(TNF-α), and MMP-13 in the synovial fluid were measured by ELISA. X-ray and micro-computerized tomography (μCT) scans were used to assess knee joint conditions and microstructure of subchondral bone. Results IRAK4 expression levels in synovial tissues of the OA model group exhibited a significant upward trend. Ad-shIRAK4 significantly reduced IRAK4 mRNA expression in synovium tissues. Notably, Ad-shIRAK4 suppressed the Toll-like receptor/interleukin-1 receptor (TLR/IL-1R) signaling. In addition, in the Ad-shIRAK4 treatment group, we can see less inflammatory cell infiltration and reduced hyperplasia and angiogenesis. The levels of IL-1β, TNF-α, and MMP-13 in the synovial fluid in the OA model group were significantly higher than that in the control group, which were reduced by Ad-shIRAK4 treatment. Finally, Results of HE stains, immunohistochemistry, and μCT showed that Ad-shIRAK4 treatment has a protective effect on cartilage damage. Conclusions IRAK4 is significantly upregulated in the synovium from the osteoarthritis rabbit model. In addition, Ad-shIRAK4 reduced the expression of IRAK4 and suppressed TLR/IL-1R signaling in the synovium from the osteoarthritis rabbit model. Ad-shIRAK4 could alleviate synovitis and cartilage degradation in the osteoarthritis rabbit model, and thus alleviate the symptoms of OA and prevent the progression of OA. Graphical abstract

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