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.

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

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.

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.

Time-Dependent Effect of Platelet-Rich Plasma in Reducing Donor-Site Pain After Anterior Cruciate Ligament Reconstruction

2020 ◽  
pp. 036354652096828
Author(s):  
André Luís Lugnani de Andrade ◽  
Amanda Veiga Sardeli ◽  
Thiago Alves Garcia ◽  
Bruno Livani ◽  
William Dias Belangero
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Platelet Rich Plasma ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Background: Anterior cruciate ligament reconstruction (ACLR) has a high incidence among sports players, and one important side effect of the surgery is graft donor site morbidity. Although some evidence suggests that application of platelet-rich plasma (PRP) during ACLR reduces pain and improves knee function, it is not a universal finding. Purpose: To perform a meta-analysis of previous studies testing the effects of PRP on donor site morbidity after ACLR. Study Design: Systematic review and meta-analysis. Methods: We reviewed PubMed (Medline), Web of Science, Embase, Scopus, and Cochrane databases to find studies testing the effects of PRP on the donor site of ACLR autograft. After identifying 4 studies, we conducted 2 meta-analyses, 1 for the effects of PRP on pain, assessed by visual analog scale (VAS), and the other for the functional knee scores. We also tested the ability of time after ACLR to predict the PRP-related reduction of pain. Results: In the 4 studies identified, 157 patients were analyzed. Although the VAS score was lower with PRP at 6 months (raw mean difference [RMD], –0.97 [95% CI, −1.59 to −0.36]; P = .001) and 12 months (RMD, −0.61 [95% CI,−1.02 to −0.21]; P = .003), the effects of PRP disappeared at 24 months (RMD, −0.08 [95% CI,−0.38 to 0.22]; P = .586). A univariate regression analysis reinforced the ability of time after ACLR to predict the PRP-related reduction of VAS pain score ( r2 = 0.98). However, knee function after ACLR was not improved by the use of PRP (standardized mean difference, 0.71 [95% CI,−0.17 to 1.60]; P = .114). Conclusion: PRP applied to a bone–patellar tendon–bone donor site could reduce knee pain within a year, and this reduction had a correlation with time, meaning that the effect of PRP decreased with time after surgery. However, pain reduction did not reach clinical relevance and did not lead to better functional knee scores.

Sign in / Sign up

Export Citation Format

Share Document