Bleeding from the bone marrow enhances remodeling of the in situ frozen-thawed anterior cruciate ligament

Yasuda, Kazunori; Sakai, Toshihiko; Kondo, Eiji; Onodera, Shin

doi:10.1016/j.clinbiomech.2007.05.007

Cited by 11 publications

(8 citation statements)

References 19 publications

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“…Other authors have also noted the high healing potential of small tears and particularly lateral tears left untreated at the time of ACLR. 36,43 In animal models, blood clot from ACLR bone tunnels influences graft healing, 44 and Bab and Einhorn 3 reported that multiple growth factors are present within bone marrow-derived clot-including platelet-derived growth factor. Galliera et al 13 demonstrated elevated postoperative levels of vascular endothelial growth factor (VEGF) and VEGF receptor 2 after ACLR compared with arthroscopic partial meniscectomy.…”

Section: Discussionmentioning

confidence: 99%

Platelet-Rich Plasma Reduces Failure Risk for Isolated Meniscal Repairs but Provides No Benefit for Meniscal Repairs With Anterior Cruciate Ligament Reconstruction

et al. 2019

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Background: The effect of platelet-rich plasma (PRP) on the risk of meniscal repair failure is unclear. Current evidence is limited to small studies without comparison between isolated repairs and meniscal repairs with concomitant anterior cruciate ligament (ACL) reconstruction. It is also unclear whether the efficacy of PRP differs between preparation systems in the setting of meniscal repair. Purpose: (1) To determine whether intraoperative PRP affects the risk of meniscal repair failure. (2) To determine whether the effect of PRP on meniscal failure risk is influenced by ACL reconstruction status or by PRP preparation system. Study Design: Cohort study; Level of evidence, 3. Methods: The study entailed 550 patients (mean ± SD age, 28.8 ± 11.2 years) who underwent meniscal repair surgery with PRP (n = 203 total; n = 148 prepared with GPS III system, n = 55 prepared with Angel system) or without PRP (n = 347) and with (n = 399) or without (n = 151) concurrent ACL reconstruction. The patients were assessed for meniscal repair failure within 3 years. The independent effect of PRP on the risk of meniscal repair failure was determined by multivariate Cox proportional hazards modeling with adjustment for age, sex, body mass index, ACL status, tear pattern, tear vascularity, repair technique, side (medial or lateral), and number of sutures or implants used. Results: Failures within 3 years occurred in 17.0% of patients without PRP and 14.6% of patients with PRP ( P = .60) (Angel PRP, 15.9%; GPS III PRP, 14.2%; P = .58). Increased patient age was protective against meniscal failure regardless of ACL or PRP status (per 5-year increase in age: adjusted hazard ratio [aHR], 0.90; 95% CI, 0.81-1.0; P = .047). The effect of PRP on meniscal failure risk was dependent on concomitant ACL injury status. Among isolated meniscal repairs (20.3% failures at 3 years), PRP was independently associated with lower risk of failure (aHR, 0.18; 95% CI, 0.03-0.59; P = .002) with no difference between PRP preparation systems ( P = .84). Among meniscal repairs with concomitant ACL reconstruction (14.1% failures at 3 years), PRP was not independently associated with risk of failure (aHR, 1.39; 95% CI, 0.81-2.36; P = .23) with no difference between PRP preparation systems ( P = .78). Conclusion: Both PRP preparations used in the current study had a substantial protective effect in terms of the risk of isolated meniscal repair failure over 3 years. In the setting of concomitant ACL reconstruction, PRP does not reduce the risk of meniscal repair failure.

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Section: Discussionmentioning

confidence: 99%

Platelet-Rich Plasma Reduces Failure Risk for Isolated Meniscal Repairs but Provides No Benefit for Meniscal Repairs With Anterior Cruciate Ligament Reconstruction

et al. 2019

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“…Basing our study on this observation, we suggest that the occurrence of hematoma and bleeding from the bone marrow even during ACL reconstruction enhances the healing of the lateral meniscus tear. Yasuda et al 39 demonstrated that bleeding from the bone marrow after creating bone tunnels plays an important role in graft remodeling. The blood clot from a bone tunnel contains various types of cells and various growth factors.…”

Section: Discussionmentioning

confidence: 99%

Clinical, Radiological, and Morphological Evaluations of Posterior Horn Tears of the Lateral Meniscus Left In Situ During Anterior Cruciate Ligament Reconstruction

Lee

Jang

Lee³

et al. 2013

Am J Sports Med

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Stable posterior horn tears of the lateral meniscus left in situ at the time of ACL reconstruction revealed successful clinical outcomes compared with isolated ACL injuries and showed considerable healing and functional restoration of tears with repeat MRI and second-look arthroscopic surgery. Therefore, leaving stable posterior horn tears of the lateral meniscus in situ during ACL reconstruction should be considered.

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“…Considering the observed increased incidence of LMRA in chronic cases, one may question whether the avulsion occurred at the time of the ACL injury and did not heal or whether it occurred later, as a result of laxity associated with ACL insufficiency. Untreated radial or longitudinal tears of the posterior horn of the lateral meniscus appear to have a higher chance of healing than medial meniscus tears [ 10 – 15 ] for several reasons: there is better blood supply to the posterior horn of the lateral meniscus in comparison to the pars intermedia [ 16 ]; concomitant ACL reconstruction also promotes healing as a result of intraarticular blood clotting [ 17 , 18 ]; and increased joint stability may reduce forces on the lesion, enhancing the chances of spontaneous healing. Shelbourne and Heinrich [ 13 ] reported that stable radial flap tears and peripheral posterior horn tears that did not extend more than 1 cm anterior to the popliteus tendon could be treated successfully by leaving them in situ.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic incidence of lateral meniscal root avulsion in patients with anterior cruciate ligament injury

Ciatti¹,

Gabrielli²,

Iannella³

et al. 2021

J Orthop Traumatol

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Background To arthroscopically evaluate the incidence of lateral meniscal root avulsion (LMRA) and associated intra-articular injuries in patients undergoing anterior cruciate ligament (ACL) reconstruction. Materials and Methods From April 2014 to March 2017, 532 consecutive patients were diagnosed as having an ACL injury and underwent arthroscopic ACL reconstruction. The diagnosis of LMRA was made arthroscopically. The effects of gender, activity, grade of laxity, time from injury, and concomitant meniscal lesions were analyzed. Results Among 532 patients, 497 (93.4%) underwent primary ACL reconstruction and 35 (6.5%) underwent revision procedures. 383 were acute or subacute injuries (less than 6 months from injury to surgery) and 149 chronic (more than 6 months). Average age was 30.4 years (DS: ± 11.04); there were 422 (79.3%) males and 110 (20.6%) females. A LMRA associated with the ACL injury was detected in 72 cases (13.5%), with a significant prevalence observed in males ($${\chi ^2}$$ χ 2 = 4.65; P = 0.031, statistically significant). In the 149 patients with a chronic injury, 27 patients had LMRA (18.1%), while 45 of the 383 patients with an acute or subacute injury had LMRA (11.7%). There was a tendency, albeit not significant ($${\chi ^2}$$ χ 2 = 3.721; P = 0.054), for the prevalence to increase with time since the initial ACL injury. LMRA was significantly associated ($${\chi ^2}$$ χ 2 = 7.81; P = 0.006) with a meniscocapsular tear of the posterior horn of the medial meniscus (ramp lesion). No other significant associations, such as with severity of A-P translation (as measured by KT-2000) or activity level, were detected. Conclusion LMRA is a relatively common injury associated with both acute and chronic ACL tears. A relatively high incidence in cases of chronic ACL insufficiency suggests that LMRAs do not heal spontaneously or that they may appear with time, even when absent at the time of the initial injury. Level of evidence Level III, cross-sectional study.

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Bleeding from the bone marrow enhances remodeling of the in situ frozen-thawed anterior cruciate ligament

Cited by 11 publications

References 19 publications

Platelet-Rich Plasma Reduces Failure Risk for Isolated Meniscal Repairs but Provides No Benefit for Meniscal Repairs With Anterior Cruciate Ligament Reconstruction

Platelet-Rich Plasma Reduces Failure Risk for Isolated Meniscal Repairs but Provides No Benefit for Meniscal Repairs With Anterior Cruciate Ligament Reconstruction

Clinical, Radiological, and Morphological Evaluations of Posterior Horn Tears of the Lateral Meniscus Left In Situ During Anterior Cruciate Ligament Reconstruction

Arthroscopic incidence of lateral meniscal root avulsion in patients with anterior cruciate ligament injury

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