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.

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 Long-term Outcomes of Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon–Patellar Bone Autograft

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110174
Author(s):  
Do Weon Lee ◽  
Joonhee Lee ◽  
Seonpyo Jang ◽  
Du Hyun Ro ◽  
Myung Chul Lee ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Donor Site ◽  
Quadriceps Tendon ◽  
Donor Site Morbidity ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Background: To date, there have been few studies on the outcomes of anterior cruciate ligament reconstruction (ACLR) using quadriceps tendon–patellar bone (QTPB) autograft. Purpose: To evaluate the long-term clinical outcomes of ACLR using QTPB autograft. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively reviewed 139 patients who underwent primary ACLR with QTPB autografts and had at least 7 years of postoperative follow-up data. Instability, clinical scores, donor-site morbidity, radiographic progression of osteoarthritis, and any associated complications were assessed. Results: The proportion of knees classified as grade >1 on the anterior drawer, Lachman, and pivot-shift tests decreased significantly postsurgically (from 47.4% to 5.0%, 48.9% to 4.3%, and 53.3% to 5.0%, respectively; P < .001 for all). The mean clinical scores at the final follow-up were 89.8, 81.0, and 4.4 for the Lysholm, International Knee Documentation Committee, and Tegner Activity Scale, respectively. The results of the Cybex II dynamometer isokinetic test showed decreases in flexion and extension strength at both 60° and 180° per second, which persisted until the final follow-up visit. About one-fifth (19.4%) of the patients had osteoarthritis (Kellgren-Lawrence grade ≥1) before surgery, which increased to 33.8% at the final follow-up. The overall complication rate was 23.2%, and about one-third of the patients who experienced complications underwent revision surgery as a result of graft rupture and residual instability. Conclusion: In the current study, ACLR using QTPB autograft provided satisfactory long-term clinical results, with acceptable rates of complication and donor-site morbidity.

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.

Return to Play and Long-term Participation in Pivoting Sports After Anterior Cruciate Ligament Reconstruction

2019 ◽  
Vol 47 (14) ◽  
pp. 3339-3346 ◽  
Author(s):  
Line Lindanger ◽  
Torbjørn Strand ◽  
Anders Odd Mølster ◽  
Eirik Solheim ◽  
Eivind Inderhaug
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Replacement ◽  
Revision Surgery ◽  
Cruciate Ligament ◽  
Sports Participation ◽  
Acl Injuries ◽  
Replacement Surgery ◽  
Long Term Consequences ◽  
Anterior Cruciate

Background: Rupture of the anterior cruciate ligament (ACL) is a common and feared injury among athletes because of its potential effect on further sports participation. Reported rates of return to pivoting sports after ACL reconstruction (ACLR) vary in the literature, and the long-term consequences of returning have rarely been studied. Purpose: To examine the rate and level of return to pivoting sports after ACLR, the duration of sports participation, and long-term consequences of returning to pivoting sports. Study Design: Cohort study; Level of evidence, 2. Methods: All primary ACLRs with a bone–patellar tendon–bone autograft between 1987 and 1994 (N = 234) in athletes participating in team handball, basketball, or soccer before injury were selected from a single-center quality database. A long-term evaluation (median, 25 years; range, 22-30 years) was performed using a questionnaire focusing on return to pivoting sports, the duration of sports activity after surgery, later contralateral ACL injuries, revision surgery, and knee replacement surgery. Participants were stratified into 2 groups depending on the time between injury and surgery (early, <24 months; late, ≥24 months). Results: A total of 93% of patients (n = 217) responded to the questionnaire. Although 83% of patients returned to pivoting sports after early ACLR, only 53% returned to preinjury level. Similar return-to-sport rates were observed in males and females ( P > .05), but males had longer sports careers (median, 10 years; range, 1-23 years) than females (median, 4 years; range, 1-25 years; P < .001). The incidence of contralateral ACL injuries was 28% among athletes who returned to sports versus 4% among athletes who did not return ( P = .017) after early ACLR. The pooled reinjury rate after return to preinjury level of sports was 41% (30%, contralateral injuries; 11%, revision surgery). The incidence of contralateral ACL injuries was 32% among females versus 23% among males ( P > .05) and, for revision surgery, was 12% among females versus 7% among males ( P > .05) after returning to sports. Having a late ACLR was associated with an increased risk of knee replacement surgery (9% vs 3%; P = .049) when compared with having an early ACLR. Conclusion: ACLR does not necessarily enable a return to preinjury sports participation. By returning to pivoting sports after ACLR, athletes are also facing a high risk of contralateral ACL injuries. Long-term evaluations in risk assessments after ACLR are important, as a significant number of subsequent ACL injuries occur later than the routine follow-up.

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

ACL reconstruction in the professional or elite athlete: state of the art

2021 ◽  
pp. jisakos-2020-000456
Author(s):  
Rafael A Buerba ◽  
Stefano Zaffagnini ◽  
Ryosuke Kuroda ◽  
Volker Musahl
Keyword(s):  
Anterior Cruciate Ligament ◽  
Elite Athlete ◽  
State Of The Art ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Acl Injury ◽  
Peak Performance ◽  
Acl Injuries ◽  
Anterior Cruciate

Anterior cruciate ligament (ACL) injuries are on the rise at all levels of sport, including elite athletics. ACL injury can have implications on the athlete’s sport longevity, as well as other long-term consequences, such as the development of future knee osteoarthritis. In the elite athlete, ACL injury can also have ramifications in terms of contract/scholastic obligations, sponsorships and revenue-generating potential. Although the goal of anterior cruciate ligament reconstruction (ACLR) is to return any athlete to the same preinjury level of sport, management of ACL injuries in the elite athlete come with the additional challenge of returning him or her to an extremely high level of physical performance. Despite outcome studies after ACLR in elite athletes showing a high return-to-sport rate, these studies also show that very few athletes are able to return to sport at the same level of performance. They also show that those athletes who undergo ACLR have careers that are more short-lived in comparison to those without injury. Thus, returning an elite athlete to ‘near peak’ performance may not be good enough for the athletic demands of elite-level sports. A possible explanation for the variability in outcomes is the great diversity seen in the management of ACL injuries in the elite athlete in terms of rehabilitation, graft choices, portal drilling and reconstruction techniques. Recently, the advent of anatomical, individualised ACLR has shown improved results in ACLR outcomes. However, larger-scale studies with long-term follow-ups are needed to better understand the outcomes of modern ACLR techniques—particularly with the rise of quadriceps tendon as an autograft choice and the addition of lateral extra-articular tenodesis procedures. The purpose of this article was thus to provide an up-to-date state-of-the-art review in the management of ACL injuries in the elite athlete.

Mechanical Testing of a New Prosthetic Anterior Cruciate Ligament Using Biocompatible Fibrous Hydrogel Constructs

2011 ◽  
Author(s):  
Jason S. Bach ◽  
Fabrice Detrez ◽  
Frances R. Baxter ◽  
Sabine Cantournet ◽  
Mohammed Cherkaoui ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Donor Site ◽  
The United States ◽  
Long Term Results ◽  
Anterior Tibial Translation ◽  
Wide Range ◽  
Anterior Cruciate ◽  
Tibial Translation

The anterior cruciate ligament (ACL) is an important intra-articular structure in the knee joint that prevents excessive anterior tibial translation and resists internal rotational loads. Its rupture is one of the most common injuries of the knee and about 100,000 ACL reconstructions are performed each year in the United States. The current techniques for reconstruction involve replacing the ACL with autografts, most commonly from the hamstrings or patellar tendons, though use of these grafts is associated with various drawbacks, the most prominent of which is donor site morbidity. Over the past 30 years, numerous prosthetic devices for ACL replacement have been made with a wide range of materials. However none of them have demonstrated positive long term results in vivo, and no such devices are currently approved by the FDA for clinical use. Failures of previous devices mostly originate from a lack of biocompatibility due to immunogenic particulation or from mechanical failures causing prosthetic laxity and knee instability as the result of creep or rupture by wear and fatigue.

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>

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