Anterior crucial ligament rupture: self-healing through dynamic intraligamentary stabilization technique

Abstract

Purpose Surgery involving arthroscopic reconstruction of the injured ligament is the gold standard treatment for torn anterior cruciate ligament (ACL). Recent studies support the hypothesis of biological self-healing of ruptured ACL. The aim of the study is to evaluate, in an animal model, the efficacy of a new technique, dynamic intraligamentary stabilization that utilizes biological self-healing for repair of acute ACL ruptures. Methods The ACL in 11 adult female white alpine sheep was transected and in 8 sheep reconstructed by dynamic intraligamentary stabilization. To enhance the healing potential, microfracturing and collagen were used in all animals. The contralateral, non-operated knees served as controls. At 3 months postkilling, all animals were submitted to magnetic resonance imaging and biomechanical and histological evaluation. Results No surgery-related complications were observed. Postoperatively, all animals regularly used the operated leg with full weight bearing and no lameness. At the time of killing, all animals exhibited radiological and histological healing of the transacted ACL. Biomechanical tests confirmed successful restoration of anteroposterior translation in the dynamic intraligamentary stabilization knees. Histological examination revealed dense scar tissue at the ends of the transected ligaments exhibiting hypercellularity and hypervascularization. Conclusion The dynamic intraligamentary stabilization technique successfully induced self-healing of ruptured ACL in a sheep model. Knee joints remained stable during the healing period allowing free range of motion and full weight bearing, and no signs of osteoarthritis or other intraarticular damage in the follow up were observed.

Dynamic intraligamentary stabilization and primary repair: A new concept for the treatment of knee dislocation

“…In previous studies, the authors have already demonstrated the efficacy of the DIS procedure for the surgical repair of acute ACL ruptures; an approach based on self-healing of the ligament [23][24][25]. Since having the DIS method introduced for repair of acute ACL ruptures, a ''novel biological concept'' was introduced for the treatment protocol of knee dislocations in our centre, based on the acute repair of all ligament lesions (Figs.…”

“…The DIS technique was used to repair the ACL back to its anatomic position based on the site of injury [23][24][25]. For proximal ACL ruptures, sutures (PDS 3.0 Ethicon, Somerville, NJ, USA) were initially placed in both the anteromedial and posterolateral bundles.…”

“…A new technique, dynamic intraligamentary stabilization (DIS), was recently developed at the authors' Institution (University Hospital, Level A Trauma Center) for the treatment of acute ACL ruptures, providing adequate AP knee stability for potential ACL healing [23][24][25]. It consists of a threaded sleeve (10 mm  30 mm) housing a preloaded spring and a mechanism for securing the spring in the tibia.…”

The Use of Autologous Fibroblasts for the Reconstruction of the Anterior Cruciate Ligament Tears

“…This result indicates that the ACL has a self-healing potential without cells. In fact, there are some recent studies that points-out to the idea of the self-healing of the ACL breakage, although this capacity is probably limited (Fujimoto, Sumen, Ochi, & Ikuta, 2002;Kohl et al, 2013) and may be influenced by acute phase inflammatory mediators such as the tumor necrosis factor alpha (TNF-α) (Xie et al, 2014). The healing efficiency is mediated by the fibroblastic lysyl oxidase enzyme, which function is to catalyze the cross-linking between the collagen and the elastin and whose activity increases with the levels of TNF-α (Xie et al, 2014).…”

Dynamische intraligamentäre Stabilisierung frischer Rupturen des vorderen Kreuzbandes (Ligamys)

“…In einer ersten Grundlagenarbeit am Schafmodell konnte bereits gezeigt werden, dass eine Heilung des rupturierten VKB nach DIS möglich ist [10]. Auch hinsichtlich der biomechanischen Eigenschaften scheinen die Voraussetzungen für eine Wiederherstellung der Kniegelenkkinematik gegeben.…”