In Vitro and In Vivo Degradation, Mechanical Properties, and Histocompatibility of Weft-Knitted Silk Mesh-Like Grafts

To investigate the degradation, mechanical properties, and histocompatibility of weft-knitted silk mesh-like grafts, we carried out the In Vitro and In Vivo silk grafts degradation assay. The In Vitro degradation experiment was performed by immersing the silk grafts in simulated body fluid for 1 year, and the results showed that the degradation rate of the silk mesh-like grafts was very slow, and there were few changes in the mechanical properties and quality of the silk mesh-like graft. In Vivo degradation assay was taken by implantation of the silk mesh-like grafts into the subcutaneous muscles of rabbits. At 3, 6, and 12 months postoperation, the rate of mass loss was 19.36%, 31.84%, and 58.77%, respectively, and the maximum load was 63.85%, 34.63%, and 10.76%, respectively of that prior to degradation. The results showed that the degradation rate of the silk graft and the loss of mechanical properties In Vivo were faster than the results obtained in the In Vitro experiments. In addition, there were no significant differences in secretion of serum IL-6 and TNF-α between the experimental and normal rabbits (P >0.05), suggesting no obvious inflammatory reaction. The findings suggest that the weft-knitted silk mesh-like grafts have good mechanical properties, histocompatibility, and In Vivo degradation rate, and therefore represent a candidate material for artificial ligament

Combining fascia lata autograft bridging repair with artificial ligament internal brace reinforcement

Aims The aim of this study is to provide a detailed description of cases combining bridging patch repair with artificial ligament “internal brace” reinforcement to treat irreparable massive rotator cuff tears, and report the preliminary results. Methods This is a retrospective review of patients with irreparable massive rotator cuff tears undergoing fascia lata autograft bridging repair with artificial ligament “internal brace” reinforcement technique between January 2017 and May 2018. Inclusion criteria were: patients treated arthroscopically for an incompletely reparable massive rotator cuff tear (dimension > 5 cm or two tendons fully torn), stage 0 to 4 supraspinatus fatty degeneration on MRI according to the Goutallier grading system, and an intact or reparable infraspinatus and/or subscapularis tendon of radiological classification Hamada 0 to 4. The surgical technique comprised two components: first, superior capsular reconstruction using an artificial ligament as an “internal brace” protective device for a fascia lata patch. The second was fascia lata autograft bridging repair for the torn supraspinatus. In all, 26 patients with a mean age 63.4 years (SD 6.2) were included. Results All patients underwent more than two years of follow-up (mean 33.5 months (24 to 45)). All clinical scores were also improved at two-year follow-up (mean visual analogue scale 0.7 (SD 0.5) vs 6.1 (SD 1.2); p < 0.001; mean American Shoulder and Elbow Surgeons score 93.5 (SD 5.3) vs 42.5 (SD 10.8); p < 0.001; mean University of California, Los Angeles score, 31.7 (SD 3.7) vs 12.0 (SD 3.1); p < 0.001; and mean Constant-Murley score 88.7 (SD 3.5) vs 43.3 (SD 10.9); p < 0.001), and 24 of 26 fascia lata grafts were fully healed on MRI (92%). One patient had haematoma formation at the harvesting side of the fascia lata at two days postoperatively. Conclusion The fascia lata autograft bridging repair combined with artificial ligament internal brace reinforcement technique achieved good functional outcomes, with a high rate of graft healing at two-year follow-up. Although the short-term results are promising, further studies with a greater number of patients would provide clearer results. Cite this article: Bone Joint J 2021;103-B(10):1619–1626.

NAL Neck Artificial Ligament Lifting: Neck Rejuvenation with Polytetrafuotoethylene (PTFE) Bands

Background: The current surgical method allows a short recovery and minimally invasive technique with polytetrafluotoethylene (PTFE) bands application, minimal skin excision for a fallen platysma muscle and skin laxity in facelift surgery; the clinical advantage of this method is a short recovery and an anatomic less invasive dissection, ideal for also younger patients who want more and more short healing times. Methods: Retrospective analysis of a 294 cases series of patients seeking platysma and skin laxity increase of neck-face region were included in the study. All of them were primary neck-face lift performed with PTFE bands of dual mesh that are customized for suture to the platysma and anchored to the mastoid, creating a neck artificial ligament (NAL) that is buried into the muscle and tightened, without modifying the superficial musculoaponeurotic system and platysma. Result: Data collection on surgery time, implant dimension selection, and postoperative complications were included. The most frequent complications were rare and include 5 case of superficial epidermolysis (healed within 21 days) and 1 case of mild band infection (treated with antibiotics). The surgical results are still stable over time, like those of a normal facelift after 6 months. Conclusion: minimally invasive NAL application avoids a large dissection and deep modifications of the superficial musculoaponeurotic system and platysma getting a strong upward tension that lasts over time with stable results. Keywords: Cervicoplasty, Neck, Rejuvenation, Aging, Mandible, Platysma Muscle.

Massive Chondrolysis and Joint Destruction after Artificial Anterior Cruciate Ligament Repair

The Ligament Augmentation Reconstruction System (LARS) is an artificial ligament made of polyethylene terephthalate (PET) used for anterior cruciate ligament (ACL) reconstruction in Australia. Poor results with previous generations of synthetic grafts causing synovitis, graft failure, and premature osteoarthritis have encouraged the production of the newer LARS ligament with good results. We present a case of massive chondrolysis and joint destruction after LARS implantation requiring total knee replacement in a 23-year-old male. This case documents a rare and severe complication to the LARS ligament as caution for the implementation of this device in young athlete.

Preparation and Properties of Antibacterial Polydopamine and Nano-Hydroxyapatite Modified Polyethylene Terephthalate Artificial Ligament

Due to its great biomechanical property, the polyethylene terephthalate (PET) artificial ligament has become one of the most promising allografts for anterior cruciate ligament (ACL) reconstruction. However, because of its chemical and biological inertness, PET is not a favored scaffold material for osteoblast growth, which promotes the ligament-bone healing. Meanwhile, in consideration of prevention of potential infection, the prophylactic injection of antibiotic was used as a post-operative standard procedure but also has the increasing risk of bacterial resistance. To face these two contradictions, in this article we coated a polydopamine (PDA) nano-layer on the PET ligament and used the coating as the adhesion interlayer to introduce nano-hydroxyapatite (nHA) and silver atoms to the surface of PET ligament. Because of the mild self-polymerization reaction of dopamine, the thermogravity analysis (TGA), Raman spectrum, and tensile test results show that the modification procedure have no negative effects on the chemical stability and mechanical properties of the PET. The results of NIH3T3 cell culture show that the PDA and nHA could effectively improve the biocompatibility of PET artificial ligament for fibroblast growth, and staphylococcus aureus antibacterial test results show that the Ag atom provided an antibacterial effect for PET ligament. As shown in this paper, the nano-PDA coating modification procedure could not only preserve the advantages of PET but also introduce new performance characteristics to PET, which opens the door for further functionalization of PET artificial ligament for its advanced development and application.

Structural Characterization of a Biogenic Secretion Extracted from the Tendon or Ligament in Rabbits for Artificial Ligament Formation

Thus far, our research group has conducted a basic investigation for the development of an artificial ligament, which was performed by utilizing a biogenic secretion that was derived from the Achilles tendon in mice; this was achieved using the film model method. In this study, an attempt has been made to derive a biogenic secretion from the Achilles tendon (tendon gel) and the medial collateral ligament (ligament gel) in rabbits. Subsequently, a discussion was carried out on the possibility of forming a ligament-like structure that was based on the structural, mechanical, and spectroscopic investigations. The tendon gel was successfully formed from a parent tendon that was preserved in vivo for 3, 5, 10, and 15 d. Further, an aligned collagen fiber emerged in the tendon gel, which was subjected to tension on every preservation date. Further, the mechanical behavior of the tendon gel specimens was classified in two groups. The values of the Young's modulus of the specimens preserved for 10 and 15 d were higher than those of the specimens preserved for 3 and 5 d. Within the range of this experimental condition, the aligned collagen fiber structure was formed by applying a tension of approximately greater than 0.05 N. Conversely, only a 10-d preservation period yielded a sufficient amount of ligament gel for the experiment. Notably, the volume of ligament gel was less than that of the tendon gel. In the ligament gel specimen without the synovial membrane, the collagen fiber structure was formed by applying a tension, which was similar to that experienced by the tendon gel specimen. However, the cross-linking and growth of collagen fibers in the ligament gel samples were insignificant as compared with those of the tendon gel samples.