scholarly journals Second Generation of Tissue-Engineered Ligament Substitutes for Torn ACL Replacement: Adaptations for Clinical Applications

2021 ◽  
Vol 8 (12) ◽  
pp. 206
Author(s):  
Franck Simon ◽  
Jadson Moreira-Pereira ◽  
Jean Lamontagne ◽  
Rejean Cloutier ◽  
Francine Goulet ◽  
...  
Keyword(s):  
Second Generation ◽  
Cruciate Ligament ◽  
Donor Site ◽  
Collagen Scaffold ◽  
Collagen Matrix ◽  
Donor Site Morbidity ◽  
The Body ◽  
Anterior Cruciate ◽  
Acl Replacement

The anterior cruciate ligament (ACL) of the knee joint is one of the strongest ligaments of the body and is often the target of traumatic injuries. Unfortunately, its healing potential is limited, and the surgical options for its replacement are frequently associated with clinical issues. A bioengineered ACL (bACL) was developed using a collagen matrix, seeded with autologous cells and successfully grafted and integrated into goat knee joints. We hypothesize that, in order to reduce the cost and simplify the model, an acellular bACL can be used as a substitute for a torn ACL, and bone plugs can be replaced by endobuttons to fix the bACL in situ. First, acellular bACLs were successfully grafted in the goat model with 18% recovery of ultimate tensile strength 6 months after implantation (94 N/mm2 vs. 520). Second, a bACL with endobuttons was produced and tested in an exvivo bovine knee model. The natural collagen scaffold of the bACL contributes to supporting host cell migration, growth and differentiation in situ post-implantation. Bone plugs were replaced by endobuttons to design a second generation of bACLs that offer more versatility as biocompatible grafts for torn ACL replacement in humans. A robust collagen bACL will allow solving therapeutic issues currently encountered by orthopedic surgeons such as donor-site morbidity, graft failure and post-traumatic osteoarthritis.

scholarly journals Most British Surgeons Would Consider Using a Tissue-Engineered Anterior Cruciate Ligament: A Questionnaire Study

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Sarah Rathbone ◽  
Nicola Maffulli ◽  
Sarah H. Cartmell
Keyword(s):  
Anterior Cruciate Ligament ◽  
Mechanical Performance ◽  
Tissue Injury ◽  
Cruciate Ligament ◽  
Donor Site ◽  
Soft Tissue Injury ◽  
Donor Site Morbidity ◽  
Online Questionnaire ◽  
Common Problems ◽  
Anterior Cruciate

Donor site morbidity, poor graft site integration, and incorrect mechanical performance are all common problems associated with autografts for anterior cruciate ligament (ACL) reconstructions. A tissue-engineered (TE) ligament has the potential to overcome these problems. We produced an online questionnaire relating to tissue engineering of the ACL to obtain input from practising clinicians who currently manage these injuries. 300 British orthopaedic surgeons specialising in knee surgery and soft tissue injury were invited to participate. 86% of surgeons would consider using a TE ACL if it were an option, provided that it showed biological and mechanical success, if it significantly improved the patient satisfaction (63%) or shortened surgical time (62%). 76% felt that using a TE ACL would be more appropriate than a patellar tendon, hamstring, or quadriceps autograft. Overall, most surgeons would be prepared to use a TE ACL if it were an improvement over the current techniques.

Effects of Sterilization Techniques and Culture Time on the Creep of Collagenous Ligament Analogues

2002 ◽  
Author(s):  
Darryl A. Dickerson ◽  
Kay C. Dee ◽  
Glen A. Livesay
Keyword(s):  
Cruciate Ligament ◽  
Donor Site ◽  
Critical Role ◽  
The United States ◽  
Donor Site Morbidity ◽  
Joint Stability ◽  
Acl Injuries ◽  
Anterior Cruciate ◽  
Active Patients

Every year, approximately 200,000 anterior cruciate ligament (ACL) injuries occur in the United States; of these cases, 60,000–75,000 patients undergo ACL reconstruction [1]. The ACL plays a critical role in knee stability; however, it possesses little inherent capacity for healing. Although reconstruction is often used in active patients, issues such as donor site morbidity and long term joint stability have motivated interest in tissue-engineered ligament analogues.

scholarly journals Graft choice in combined anterior cruciate ligament and medial collateral ligament reconstruction

2020 ◽  
Vol 5 (4) ◽  
pp. 221-225
Author(s):  
Francisco Figueroa ◽  
David Figueroa ◽  
Rafael Calvo ◽  
Alex Vaisman ◽  
João Espregueira-Mendes
Keyword(s):  
Anterior Cruciate Ligament ◽  
Medial Collateral Ligament ◽  
Cruciate Ligament ◽  
Donor Site ◽  
Hamstring Tendon ◽  
Donor Site Morbidity ◽  
Collateral Ligament ◽  
Expert Opinions ◽  
Medial Collateral Ligament Reconstruction ◽  
Anterior Cruciate

There is a concern regarding which grafts should be used in combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) reconstructions, with a paucity of recommendations focused on this specific topic. Expert opinions suggest the use of allograft-only reconstructions to limit donor-site morbidity or using at least one allograft and one autograft. When a hamstring tendon autograft is harvested, techniques that maintain both the integrity of the sartorius fascia and the gracilis are recommended because of the role that the ST-G-S (semitendinosus-gracilis-sartorius) complex plays in valgus stability in the setting of an MCL-deficient knee. Cite this article: EFORT Open Rev 2020;5:221-225. DOI: 10.1302/2058-5241.5.190049

Use of Extracellular Matrix Bioscaffolds to Enhance ACL Healing: A Multidisciplinary Approach in a Goat Model

2010 ◽  
Author(s):  
Matthew B. Fisher ◽  
Ho-Joong Jung ◽  
Rui Liang ◽  
Kwang Kim ◽  
Patrick J. McMahon ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Healing Process ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Surgical Reconstruction ◽  
Suture Repair ◽  
Joint Stability ◽  
Tissue Replacement ◽  
Anterior Cruciate ◽  
And Function

Due to the poor healing potential of the anterior cruciate ligament (ACL) of the knee, surgical reconstruction using soft tissue replacement grafts is performed to restore knee stability and function. However, the surgery has serious complications including a high incidence of donor site morbidity and the development of osteoarthritis in the long-term. Recently, functional tissue engineering approaches to heal an injured ACL using biological stimulation via growth factors and bioscaffolds have yielded some positive clinical and laboratory results. As the healing process for the ACL is slow, additional suture repair of the ACL has been needed to provide initial joint stability and to reduce the risk of injury to neighboring tissues.

scholarly journals All-Inside Anterior Cruciate Ligament Reconstruction Using an Anterior Half of the Peroneus Longus Tendon Autograft

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712199122
Author(s):  
Mingguang Bi ◽  
Chen Zhao ◽  
Qiong Zhang ◽  
Li Cao ◽  
Xinji Chen ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Donor Site ◽  
International Knee Documentation Committee ◽  
Donor Site Morbidity ◽  
Peroneus Longus Tendon ◽  
Ankle Eversion ◽  
Anterior Cruciate ◽  
American Orthopaedic

Background: The peroneus longus tendon (PLT) has been used as a graft in many orthopaedic surgical procedures because of its comparable biomechanical strength with the native anterior cruciate ligament (ACL). Despite its potential, few studies have been performed to investigate the clinical reliability of ACL reconstruction using a PLT autograft. Purpose: To assess the clinical outcomes and donor-site morbidity of ACL reconstruction using an anterior half of the PLT (AHPLT) autograft in patients with an isolated ACL injury. Study Design: Case series; Level of evidence, 4. Methods: Between January 2016 and January 2017, a total of 21 patients with an isolated ACL injury underwent all-inside single-bundle ACL reconstruction using an AHPLT autograft. Knee stability was assessed using the Lachman test, pivot-shift test, and KT-2000 arthrometer (side-to-side difference) with 134-N anterior force and at 30° of knee flexion. Knee function was evaluated using the International Knee Documentation Committee score, Lysholm score, and Tegner score. Donor-site morbidity was assessed using ankle eversion and plantarflexion strength as well as the American Orthopaedic Foot & Ankle Society scoring system and the Foot and Ankle Disability Index. Results: At a mean final follow-up of 40.1 months (range, 36-48 months), the KT-2000 arthrometer side-to-side difference was significantly lower compared with preoperatively (1.1 ± 0.62 vs 7.0 ± 2.18 mm, respectively; P < .001). The mean preoperative International Knee Documentation Committee, Lysholm, and Tegner scores were 52.0 ± 8.27, 50.9 ± 8.50, and 1.8 ± 0.87, respectively, increasing significantly to 94.2 ± 2.61, 95.2 ± 2.64, and 6.8 ± 1.50, respectively, at final follow-up ( P < .001 for all). All patients had grade 5 muscle strength in ankle eversion and plantarflexion at the donor site, with mean American Orthopaedic Foot & Ankle Society and Foot and Ankle Disability Index scores of 96.8 and 97.6, respectively. No complications or reoperations occurred. Conclusion: All-inside ACL reconstruction using an AHPLT autograft produced good functional scores and stability without obvious ankle-site morbidity.

scholarly journals Evaluation of results of anterior cruciate ligament reconstruction using peroneus longus graft

2021 ◽  
Vol 7 (3) ◽  
pp. 594
Author(s):  
Kautilyakumar V. Mahida ◽  
Jyotish G. Patel ◽  
Hiren K. Shah ◽  
Ankit R. Patel
Keyword(s):  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Knee Score ◽  
Cruciate Ligament Reconstruction ◽  
Peroneus Longus ◽  
Lysholm Knee Score ◽  
Anterior Cruciate ◽  
Graft Diameter

<p class="abstract"><strong>Background: </strong>The objective of the study was to assess clinical outcome and donor site morbidity of ACL reconstruction with peroneus longus tendon autografts in patients with ACL injury.</p><p class="abstract"><strong>Methods:</strong> 60 Patients who underwent ACL reconstruction using peroneus longus autograft after fulfilling inclusion criteria and obtaining informed consent were assessed preoperatively and postoperatively and followed up for 1 year. Graft diameter was measured intraoperatively. Functional score of knee (Tegner and Lysholm Knee score) and American Orthopedic Foot and Ankle Score (AOFAS) for donor site morbidity were recorded preoperatively and 1 year after surgery.</p><p class="abstract"><strong>Results: </strong>93.3% Patients (56 out of 60) had good to excellent Lysholm knee score 1 year postoperatively and the mean AOFAS score was 96.7. The average peroneus longus graft diameter 8 .7mm.</p><p class="abstract"><strong>Conclusions: </strong>Anterior cruciate ligament reconstruction with peroneus longus autografts produces a good functional outcome at 1  year follow-up, with the advantages of large graft diameter and excellent ankle function based on AOFAS score.res.</p>

An Analysis of Soft Tissue Allograft Anterior Cruciate Ligament Reconstruction in a Rabbit Model

2007 ◽  
Vol 35 (6) ◽  
pp. 962-971 ◽  
Author(s):  
Michael Y. H. Soon ◽  
Afizah Hassan ◽  
James H. P. Hui ◽  
James C. H. Goh ◽  
E.H. Lee
Keyword(s):  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Anterior Cruciate Ligament ◽  
Soft Tissue ◽  
Cruciate Ligament ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Bone Interface ◽  
Tissue Allograft ◽  
Anterior Cruciate

Background Soft tissue allografts are essential for revision and multiple ligament surgeries in the knee, where donor-site morbidity is an issue. However, the use of allografts is associated with a higher failure rate of osteointegration. Mesenchymal stem cells (MSCs) are investigated as potential agents to enhance bone tunnel and tendon healing. Purpose This study was conducted to analyze the effect of coating allografts with MSCs on the quality and rate of osteointegration at the allograft tendon and bone interface, and the biomechanical properties of these enhanced anterior cruciate ligament (ACL) grafts compared with controls. Study Design Descriptive laboratory study. Methods Bilateral ACL reconstructions using Achilles tendon allografts were performed in 36 rabbits. On 1 limb, the graft was coated with autogenous MSCs in a fibrin glue carrier, while the contralateral limb served as a control with no MSCs. The reconstructions were assessed histologically and biomechanically at 2, 4, and 8 weeks. Results At 8 weeks, histologic analysis of the controls revealed the development of mature scar tissue resembling Sharpey fibers spanning the tendon-bone interface. In contrast, the MSC-enhanced reconstructions showed a mature zone of fibrocartilage blending from bone to the allograft, strongly resembling a normal ACL insertion. On biomechanical testing, the MSC-enhanced grafts had significantly higher load-to-failure rates than controls. However, the stiffness and Young's modulus were lower in the treatment group. Conclusions The application of MSCs at the allograft tendon-bone interface during ACL reconstruction results in the development of an intervening zone of fibrocartilage. The use of MSCs to enhance allograft osteointegration is a novel method offering the potential of more physiologic and earlier healing, although further investigation must be conducted to improve the biomechanical strength. Clinical Relevance Mesenchymal stem cells can improve the biologic properties of soft tissue allograft healing. Combined with the decrease in donor-site morbidity, allografts are a viable choice for the sports medicine surgeon.

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