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 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 The Effects of Stromal Vascular Fraction Administration in Stimulating Graft Healing Process after Anterior Cruciate Ligament Reconstruction Surgery in Rattus norvegicus

2021 ◽  
Vol 9 (A) ◽  
pp. 941-945
Author(s):  
Agung Riyanto Budi Santoso ◽  
Edi Mustamsir ◽  
Muhammad Luqman Fadli ◽  
Krisna Yuarno Phatama ◽  
Anindita E. P. Wijaya ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Treatment Group ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Healing Process ◽  
Stromal Vascular Fraction ◽  
Control Group ◽  
Reconstruction Surgery ◽  
Graft Healing ◽  
Anterior Cruciate

Introduction: Ligament injuries commonly occur in the knee region, and the anterior cruciate ligament (ACL) being the most usually injured. Currently, autograft or allograft is the most common material used for ACL reconstruction surgery. The result of the ACL reconstruction depends on the healing process of the graft or ligamentization between graft and bone tunnel. This study aims to evaluate the effect of Stromal Vascular Fraction (SVF) intratunnel injection to stimulates graft healing following ACL reconstruction surgery, as measured by histology examination. Method: This study was an experimental laboratory study with a post-test-only control group design using male Rattus novergicus. A random sampling procedure was used to choose the sample, which was then divided into two groups. The two groups consist of the control group that only had ACL reconstruction surgery and the treatment group that had reconstruction surgery with SVF administration. Result: This study used Advanced Ligament Maturity Index (LMI) score and showed a significant improvement of graft healing in the treatment group compared to the control group. The measurement is based on the cellular, collagen, and vascular aspect testing with P < 0,05 for each subscore. Conclusion: SVF intratunnel injection stimulates graft healing after ACL reconstruction surgery and causes a significant increase in cellular, collagen, and vascular aspects in the graft.

Comparison of the Position-Matching and Position-Reproducing Tasks to Detect Deficits in Knee Position Sense After Reconstruction of the Anterior Cruciate Ligament

2020 ◽  
Vol 29 (1) ◽  
pp. 87-92
Author(s):  
Takuma Hoshiba ◽  
Hiroki Nakata ◽  
Yasuaki Saho ◽  
Kazuyuki Kanosue ◽  
Toru Fukubayashi
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Sport Participation ◽  
Cruciate Ligament ◽  
Knee Extension ◽  
Position Sense ◽  
Matching Task ◽  
Control Group ◽  
Knee Position ◽  
Anterior Cruciate

Context: Deficits in knee position sense following reconstruction of the anterior cruciate ligament (ACL) can delay an athlete’s return to sport participation and increase the risk of reinjury. Deficits in position sense postreconstruction have been evaluated using either a position-reproducing or position-matching task. Objective: The aim of our study was to combine both to determine which assessment would be more effective to identify deficits in knee position sense. Design: Longitudinal laboratory-based study. Participants: Eleven athletes (6 men and 5 women; mean age, 20.5 [1.2] y), who had undergone ACL reconstruction with an ipsilateral hamstring autograft, and 12 age-matched controls. Interventions: Position sense was evaluated at 6 and 12 months postreconstruction and once for the control group. In addition, peak isokinetic knee extension and flexion strength, at 60°/s and 180°/s, was assessed for the ACL reconstruction group to evaluate possible influences of muscle strength on knee joint position sense. Main Outcome Measures: The variables include the angular differences between the reference limb and indicator limb, and peak torque values of isokinetic knee extension and flexion. Results: Significant matching differences were identified at 6 months postsurgery on the position-matching task, but not at 12 months postsurgery. No significant between-group and within-subject differences were identified on the position-reproducing task. No significant matching errors were identified for the control group. There was no correlation between errors in position sense and maximum isokinetic strength. Conclusion: The position-matching task is more sensitive than the position-reproducing task to identify deficits in knee position sense over the first year following ACL reconstruction surgery.

The Effect of Remnant Preservation on Tibial Tunnel Enlargement in Anterior Cruciate Ligament Reconstruction with Polyethylene Terephthalate Artificial Ligament in a Large Animal Model

2018 ◽  
Vol 32 (11) ◽  
pp. 1094-1101
Author(s):  
Jiangyu Cai ◽  
Fang Wan ◽  
Chengchong Ai ◽  
Wenhe Jin ◽  
Dandan Sheng ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Bone Tunnel ◽  
Control Group ◽  
Micro Ct ◽  
Tunnel Enlargement ◽  
Artificial Ligament ◽  
Remnant Preservation ◽  
Anterior Cruciate

AbstractAn enlarged bone tunnel may affect the graft–bone integration and pose a problem for revision anterior cruciate ligament (ACL) surgery. The purpose of this study was to evaluate the effect of remnant preservation on tibial tunnel enlargement in ACL reconstruction with polyethylene terephthalate (PET) artificial ligament. Twenty-four skeletally mature male beagles underwent ACL reconstruction with PET artificial ligament for both knees. One knee was reconstructed with remnant preservation using sleeve technique (remnant group), while the contralateral was reconstructed without remnant preservation (control group). The animals were sacrificed at 1 day, 6 weeks, and 12 weeks after surgery for further evaluation including macroscopic observation, microcomputed tomography (micro-CT), histological assessment, and biomechanical testing. The remnant group had better synovial coverage than the control group at 6 and 12 weeks after surgery. The micro-CT analysis showed the tibial tunnel area (TTA) of the remnant group was significantly smaller and the bone volume/total volume fraction (BV/TV) value was higher than those of the control group at 6 and 12 weeks. Moreover, TTA and BV/TV at each time point were divided into three groups according to the different grade of synovial coverage. Significant association was observed between the synovial coverage degree and the TTA and BV/TV values. The histological assessment revealed that the interface width between the graft and host bone in the remnant group was smaller than that in the control group in the tibial tunnels at 6 and 12 weeks. Moreover, the remnant group had better failure load and stiffness than the control group at 12 weeks. The remnant preservation using sleeve technique could effectively promote the synovial coverage of the graft, decrease the risk of tibial tunnel enlargement by sealing the bone tunnel entrance, and enhance the biological environment for graft–bone healing after ACL reconstruction using PET artificial ligament. This technique provides a potential solution for bone tunnel enlargement following artificial ligament surgery for the acute ACL rupture in the clinical practice.

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 The effect of femoral bone tunnel configuration on tendon-bone healing in an anterior cruciate ligament reconstruction

2018 ◽  
Vol 7 (5) ◽  
pp. 327-335 ◽  
Author(s):  
Y. Sato ◽  
R. Akagi ◽  
Y. Akatsu ◽  
Y. Matsuura ◽  
S. Takahashi ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Acl Reconstruction ◽  
Bone Healing ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Bone Tunnel ◽  
Femoral Bone ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Objectives To compare the effect of femoral bone tunnel configuration on tendon-bone healing in an anterior cruciate ligament (ACL) reconstruction animal model. Methods Anterior cruciate ligament reconstruction using the plantaris tendon as graft material was performed on both knees of 24 rabbits (48 knees) to mimic ACL reconstruction by two different suspensory fixation devices for graft fixation. For the adjustable fixation device model (Socket group; group S), a 5 mm deep socket was created in the lateral femoral condyle (LFC) of the right knee. For the fixed-loop model (Tunnel group; group T), a femoral tunnel penetrating the LFC was created in the left knee. Animals were sacrificed at four and eight weeks after surgery for histological evaluation and biomechanical testing. Results Histologically, both groups showed a mixture of direct and indirect healing patterns at four weeks, whereas only indirect healing patterns were observed in both groups at eight weeks. No significant histological differences were seen between the two groups at four and eight weeks in the roof zone (four weeks, S: mean 4.8 sd 1.7, T: mean 4.5 sd 0.5, p = 0.14; eight weeks, S: mean 5.8 sd 0.8, T: mean 4.8 sd 1.8, p = 0.88, Mann-Whitney U test) or side zone (four weeks, S: mean 5.0 sd 1.2, T: mean 4.8 sd 0.4, p = 0.43; eight weeks, S: mean 5.3 sd 0.8,T: mean 5.5 sd 0.8, p = 0.61, Mann-Whitney U test) . Similarly, no significant difference was seen in the maximum failure load between group S and group T at four (15.6 sd 9.0N and 13.1 sd 5.6N) or eight weeks (12.6 sd 3.6N and 17.1 sd 6.4N, respectively). Conclusion Regardless of bone tunnel configuration, tendon-bone healing after ACL reconstruction primarily occurred through indirect healing. No significant histological or mechanical differences were observed between adjustable and fixed-loop femoral cortical suspension methods. Cite this article: Y. Sato, R. Akagi, Y. Akatsu, Y. Matsuura, S. Takahashi, S. Yamaguchi, T. Enomoto, R. Nakagawa, H. Hoshi, T. Sasaki, S. Kimura, Y. Ogawa, A. Sadamasu, S. Ohtori, T. Sasho. The effect of femoral bone tunnel configuration on tendon-bone healing in an anterior cruciate ligament reconstruction: An animal study. Bone Joint Res 2018;7:327–335. DOI: 10.1302/2046-3758.75.BJR-2017-0238.R2.

scholarly journals Evaluation of Adjustable Loop Suspensory Anterior Cruciate Ligament Fixation Devices

2019 ◽  
Vol 5 (1) ◽  
pp. 505-507
Author(s):  
Mira Dreier ◽  
Samuel Bachmayer ◽  
Christian Baumgartner ◽  
Jörg Schröttner
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Healing Process ◽  
Bone Tunnel ◽  
Test Series ◽  
Fixation Device ◽  
Test Protocol ◽  
Graft Tension ◽  
Fixation Devices ◽  
Anterior Cruciate

AbstractAlong with increasing enthusiasm for sports comes an increase of sport related injuries. One of the most common injuries in the human knee is the tear of the anterior cruciate ligament (ACL). The selection of a graft fixation device is an important factor that determines the outcome of an anterior cruciate ligament reconstruction. Before the healing process is completed, the graft is dependent on tibial and femoral fixation devices to maintain normal ACL graft tension. Among various devices, the use of an adjustable loop suspensory fixation device (ALD) in soft-tissue graft reconstruction attracts current interest. An advantage of the ALD is the ability to draw the graft to the depth of the bone tunnel to achieve adequate graft tension while minimizing the empty space in the tunnel. In this study a comprehensive controlled laboratory investigation is performed to examine the biomechanical properties of commonly used cortical fixation devices, with the aim of implementing a standard testing procedure for adjustable loop devices. The procedure consists of three test series, a loop shortening test and two different stability test series (singe device and tendon device test). Those test series are used to compare the performance of a new ALD from Arthrex (Naples, USA) with five competitor devices already on the market. In order to obtain representative results eight samples of each device are tested. In comparison to the previously performed studies, a complete unloading is applied in the stability tests, which allows for a detailed examination of the ALDs locking mechanisms in dynamically loaded test situations. Furthermore, the performed loop shortening tests reveal important aspects, such as the shortening accuracy and settling effects of the loops, that are not found in previous studies. Therefore, the used test protocol can be recommended for further testing.

scholarly journals Gait Analysis and Knee Kinematics in Patients with Anterior Cruciate Ligament Rupture: Before and After Reconstruction

2020 ◽  
Vol 10 (10) ◽  
pp. 3378
Author(s):  
Dmitry Skvortsov ◽  
Sergey Kaurkin ◽  
Alexander Akhpashev ◽  
Aljona Altukhova ◽  
Alexander Troitskiy ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Gait Analysis ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Surgical Reconstruction ◽  
Control Group ◽  
Cycle Duration ◽  
Post Surgery ◽  
Before And After ◽  
Anterior Cruciate

The objective of the study was to evaluate the clinical, functional, and biomechanical symptoms in patients with anterior cruciate ligament (ACL) rupture before and after ACL reconstruction. The study enrolled 20 patients and 20 healthy subjects as controls. Walking biomechanics was assessed at three time points: before surgery and three months and a year or more after surgical reconstruction. Impact loads on both sides differed significantly from the respective values before surgery (p<0.05). Walking cycle duration decreased with time after surgery. On both sides (affected and unaffected), hip movement amplitudes were significantly smaller than in control (p<0.05). They remained so in the follow-up periods after the reconstruction. Before ACL reconstruction, the amplitude of the main flexion of the knee was significantly reduced both on the affected and unaffected sides. The amplitude gradually increased after the reconstruction, and a year post-surgery, it reached, on the operated side, the same values as in the control group. Complete functional recovery of the knee joint was not achieved within a year after the ACL surgical reconstruction. The remaining changes, however, were not clinically pronounced and could only be detected by instrumental gait analysis. The compensatory processes developed bilaterally, in both the hip and knee joints.

scholarly journals Mesenchymal stromal cells and platelet-rich plasma promote tendon allograft healing in ovine anterior cruciate ligament reconstruction

2020 ◽  
Author(s):  
Adam T. Hexter ◽  
Anita Sanghani-Kerai ◽  
Nima Heidari ◽  
Deepak M. Kalaskar ◽  
Ashleigh Boyd ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Stromal Cells ◽  
Femoral Tunnel ◽  
Platelet Rich Plasma ◽  
Cruciate Ligament ◽  
Control Group ◽  
Tendon Allograft ◽  
Tunnel Diameter ◽  
Anterior Cruciate

Abstract Purpose The effect of bone marrow mesenchymal stromal cells (BMSCs) and platelet-rich plasma (PRP) on tendon allograft maturation in a large animal anterior cruciate ligament (ACL) reconstruction model was reported for the first time. It was hypothesised that compared with non-augmented ACL reconstruction, BMSCs and PRP would enhance graft maturation after 12 weeks and this would be detected using magnetic resonance imaging (MRI). Methods Fifteen sheep underwent unilateral tendon allograft ACL reconstruction using aperture fixation and were randomised into three groups (n = 5). Group 1 received 10 million allogeneic BMSCs in 2 ml fibrin sealant; Group 2 received 12 ml PRP in a plasma clot injected into the graft and bone tunnels; and Group 3 (control) received no adjunctive treatment. At autopsy at 12 weeks, a graft maturation score was determined by the sum for graft integrity, synovial coverage and vascularisation, graft thickness and apparent tension, and synovial sealing at tunnel apertures. MRI analysis (n = 2 animals per group) of the signal–noise quotient (SNQ) and fibrous interzone (FIZ) was used to evaluate intra-articular graft maturation and tendon–bone healing, respectively. Spearman’s rank correlation coefficient (r) of SNQ, autopsy graft maturation score and bone tunnel diameter were analysed. Results The BMSC group (p = 0.01) and PRP group (p = 0.03) had a significantly higher graft maturation score compared with the control group. The BMSC group scored significantly higher for synovial sealing at tunnel apertures (p = 0.03) compared with the control group. The graft maturation score at autopsy significantly correlated with the SNQ (r = − 0.83, p < 0.01). The tunnel diameter of the femoral tunnel at the aperture (r = 0.883, p = 0.03) and mid-portion (r = 0.941, p = 0.02) positively correlated with the SNQ. Conclusions BMSCs and PRP significantly enhanced graft maturation, which indicates that orthobiologics can accelerate the biologic events in tendon allograft incorporation. Femoral tunnel expansion significantly correlated with inferior maturation of the intra-articular graft. The clinical relevance of this study is that BMSCs and PRP enhance allograft healing in a translational model, and biological modulation of graft healing can be evaluated non-invasively using MRI.

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