scholarly journals Tackling the Challenges of Graft Healing After Anterior Cruciate Ligament Reconstruction—Thinking From the Endpoint

2021 ◽  
Vol 9 ◽  
Author(s):  
Shiyi Yao ◽  
Patrick Shu Hang Yung ◽  
Pauline Po Yee Lui
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
Tendon Graft ◽  
Bone Tunnel ◽  
Biological Graft ◽  
Graft Healing ◽  
Clinical Literature ◽  
Posterior Translation ◽  
Anterior Cruciate

Anterior cruciate ligament (ACL) tear is common in sports and accidents, and accounts for over 50% of all knee injuries. ACL reconstruction (ACLR) is commonly indicated to restore the knee stability, prevent anterior–posterior translation, and reduce the risk of developing post-traumatic osteoarthritis. However, the outcome of biological graft healing is not satisfactory with graft failure after ACLR. Tendon graft-to-bone tunnel healing and graft mid-substance remodeling are two key challenges of biological graft healing after ACLR. Mounting evidence supports excessive inflammation due to ACL injury and ACLR, and tendon graft-to-bone tunnel motion negatively influences these two key processes. To tackle the problem of biological graft healing, we believe that an inductive approach should be adopted, starting from the endpoint that we expected after ACLR, even though the results may not be achievable at present, followed by developing clinically practical strategies to achieve this ultimate goal. We believe that mineralization of tunnel graft and ligamentization of graft mid-substance to restore the ultrastructure and anatomy of the original ACL are the ultimate targets of ACLR. Hence, strategies that are osteoinductive, angiogenic, or anti-inflammatory should drive graft healing toward the targets. This paper reviews pre-clinical and clinical literature supporting this claim and the role of inflammation in negatively influencing graft healing. The practical considerations when developing a biological therapy to promote ACLR for future clinical translation are also discussed.

How Four Weeks of Implantation Affect the Strength and Stiffness of a Tendon Graft in a Bone Tunnel

2002 ◽  
Vol 30 (4) ◽  
pp. 506-513 ◽  
Author(s):  
Wamis Singhatat ◽  
Keith W. Lawhorn ◽  
Stephen M. Howell ◽  
Maury L. Hull
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Tendon Graft ◽  
Interference Screw ◽  
Bone Tunnel ◽  
Fixation Device ◽  
Fixation Devices ◽  
Soft Tissue Graft ◽  
Anterior Cruciate ◽  
Strength And Stiffness

Background For a tendon graft to function as an anterior cruciate ligament, the tendon must heal to the bone tunnel. We studied the effect of 4 weeks of implantation on the strength and stiffness of a tendon in a bone tunnel using two different fixation devices in an ovine model. Hypothesis The type of fixation device in anterior cruciate ligament reconstruction may affect early healing, which can be measured as the strength and stiffness of a tendon in a bone tunnel. Study Design Controlled laboratory study. Methods An extraarticular tendon graft reconstruction was performed in ovine tibias. The graft was fixed with either a bioresorbable interference screw or a WasherLoc. After 4 weeks of implantation the strength and stiffness of the complex and the tendon graft-bone tunnel interface were determined by incrementally loading specimens to failure. Results For the interference screw, the strength deteriorated 63% and the stiffness deteriorated 40%. For the WasherLoc, the strength was similar and the stiffness improved 136%. Conclusions The type of fixation device determines whether the strength and stiffness of a tendon in a bone tunnel increases or decreases after implantation. Clinical Relevance The pace of rehabilitation may need to be adjusted based on the type of fixation device used to secure a soft tissue graft.

scholarly journals Tendon Healing in Bone Tunnel after Human Anterior Cruciate Ligament Reconstruction: A Systematic Review of Histological Results

2018 ◽  
Vol 32 (05) ◽  
pp. 454-462 ◽  
Author(s):  
Hongbin Lu ◽  
Can Chen ◽  
Shanshan Xie ◽  
Yifu Tang ◽  
Jin Qu
Keyword(s):  
Systematic Review ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Healing Process ◽  
Tendon Healing ◽  
Tendon Graft ◽  
Bone Tunnel ◽  
Bone Interface ◽  
Graft Healing ◽  
Anterior Cruciate

AbstractMost studies concerning to tendon healing and incorporation into bone are mainly based on animal studies due to the invasive nature of the biopsy procedure. The evidence considering tendon graft healing to bone in humans is limited in several case series or case reports, and therefore, it is difficult to understand the healing process. A computerized search using relevant search terms was performed in the PubMed, EMBASE, Scopus, and Cochrane Library databases, as well as a manual search of reference lists. Searches were limited to studies that investigated tendon graft healing to bone by histologic examination after anterior cruciate ligament (ACL) reconstruction with hamstring. Ten studies were determined to be eligible for this systematic review. Thirty-seven cases were extracted from the included studies. Most studies showed that a fibrovascular interface would form at the tendon–bone interface at the early stage and a fibrous indirect interface with Sharpey-like fibers would be expected at the later stage. Cartilage-like tissue at tendon graft–bone interface was reported in three studies. Tendon graft failed to integrate with the surrounding bone in 10 of the 37 cases. Unexpectedly, suspensory type of fixation was used for the above failure cases. An indirect type of insertion with Sharpey-like fibers at tendon–bone interface could be expected after ACL reconstruction with hamstring. Regional cartilage-like tissue may form at tendon–bone interface occasionally. The underlying tendon-to-bone healing process is far from understood in the human hamstring ACL reconstruction. Further human studies are highly needed to understand tendon graft healing in bone tunnel after hamstring ACL reconstruction.

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.

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