Clinical experience with PDS II augmentation for operative treatment of acute proximal ACL ruptures - 2-year follow-up

Hehl, G.; Strecker, W.; Richter, Markus; Kiefer, H.; Wißmeyer, T.

doi:10.1007/s001670050130

Cited by 7 publications

(10 citation statements)

References 29 publications

(49 reference statements)

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“…Tensile loads can then stretch the weakened graft leading to a permanent elongation and thus to a renewed joint instability. Therefore, resorbable augmentation devices have been developed to temporarily protect healing grafts or sutured ligaments 2–6. However, the stress protection should gradually decrease to enable the healing collagenous tendon or ligament tissue to orientate according to the mechanical stimulus.…”

Section: Introductionmentioning

confidence: 99%

Resorbable polymer fibers for ligament augmentation

Dürselen

Dauner

Hierlemann

et al. 2001

J. Biomed. Mater. Res.

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Resorbable augmentation devices for cruciate ligament surgery have been developed to temporarily protect healing tendon grafts or sutured ligaments against high tensile loads during the postoperative healing period. Materials available at present [e.g., polydioxanone (PDS)] show a half-life tensile strength of only 4-6 weeks, whereas the process of revitalization and recovering of the transplanted tendon graft can take up to 12 months. Therefore, a device that provides gradually decreasing mechanical properties with a half-time strength of at least 6 months would be desirable. In order to obtain a suitable material, we investigated the degradation kinetics of a variety of different resorbable fibers made of poly(L-lactide) and poly(L-lactide-co-glycolide). The fiber materials differed in processing and treatment parameters like thermal posttreatment, irradiation, and fiber diameter. The fibers were degraded in vitro and were tested for mechanical properties and molecular weight at various time points up to 72 weeks. The half-time strength of the materials ranged between 5 and 64 weeks, depending on their treatment parameters. In contrast, the stiffness did not decrease adequately. However, an augmentation stiffness that does not change much versus time could not provide a gradual increase in graft load, which is important to stimulate the orientation of the collagenous tissue. Therefore, design of an augmentation construct braided out of more than one quickly degrading fiber materials is suggested. After the breakdown of the faster-degrading fiber components the stiffness would automatically decrease by the diminution of the load-carrying fiber volume.

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Section: Introductionmentioning

confidence: 99%

Resorbable polymer fibers for ligament augmentation

Dürselen

Dauner

Hierlemann

et al. 2001

J. Biomed. Mater. Res.

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“…Tra¨ger [37] has obtained encouraging results after 5 years of follow-up, while others have reported breakage of augmentation devices, loosening, and high rates of arthrofibrosis [16,17,21]. In our study, only one patient who had undergone reinsertion and PDS-augmentation reported a pivot-shift injury 5 years after surgery.…”

Section: Discussionmentioning

confidence: 51%

Arthroscopic single-stranded semitendinosus tendon- versus PDS-augmentation of reinserted acute femoral anterior cruciate ligament tears: 7 year follow-up study

Schenk

Landsiedl

Enenkel

2005

Knee Surg Sports Traumatol Arthrosc

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This study reviews the long-term results of acute complete femoral tears or combined femoral (2/3 of the ligament diameter) /interstitial tears of the anterior cruciate ligament (ACL) that were reinserted. Out of 27 patients, 11 were treated with reinsertion plus augmentation with single-stranded semitendinosus tendon, 16 patients had a reinsertion and augmentation with a double-stranded PDS-band. Operation was carried out 10 (2-42) days after trauma. A brace was applied for 12 weeks, full weight bearing was allowed after 6 weeks according to our standard rehabilitation protocol. Twenty two patients (81%) could be reevaluated after a mean follow-up time of 7 years 1 month (range 3 years 8 months -11 years 5 months). No statistically significant difference was found between both techniques concerning patient's satisfaction and subjective evaluation of knee function, OAK-scores (semitendinosus-augmentation: 96 point, SD 2.0 PDS-augmentation: 94 points, SD 5.1) and IKDC-scores. Only in the PDS-augmentation group a statistically significant decrease was found in the level of activity in sports (P=0.046). At follow-up, radiological evaluation of the anterior drawer test was performed. In the group of patients who had undergone semitendinosus augmentation (n=9), anterior displacement of the tibia (determined radiologically using the TELOS-device) of 0-2 mm was found in five patients, displacement of 3-5 mm was seen in three cases and displacement of 6-10 mm in one patient (average 2.7 mm). Patients treated with PDS-augmentation (n=13) showed anterior tibial displacement of 0-2 mm in five cases, 3-5 mm in five cases, and 6-10 mm in two knees (average 3.6 mm). One patient of this group underwent ACL-reconstruction 6 years after reinsertion because of recurrent instability. At follow up, flexion was limited to less than 135 degrees in three patients (12.5%). One patient who had undergone semitendinosus augmentation and three patients from the PDS-augmentation group developed a cyclops syndrome and intraarticular adhesions that were treated arthroscopically 6 to 18 month after reinsertion surgery. A tendency towards a higher rate of limitation in range of motion was found for the PDS augmentation group. The reinsertion of a femoral torn ACL plus augmentation with a single strand of semitendinosus tendon or a PDS-band leads to acceptable results, an aggressive rehabilitation protocol may help to decrease the rate of limitation of flexion.

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“…Clinically, ACL reconstruction with augmentation allows for early mobilization with continuous passive motion in order to prevent muscle atrophy [14], and the augmentation procedure improves the initial stability of the reconstructed ligament [8,19]. Particularly the clinical results of acute proximal ACL ruptures may benefit from augmentation [19].…”

Section: Discussionmentioning

confidence: 99%

“…Particularly the clinical results of acute proximal ACL ruptures may benefit from augmentation [19]. Stability tests [8] have shown that after a follow-up of two years, 77% of the knees had normal stability if tested with a physiological (89 N anterior-posterior traction) stress. But 57% of the knees failed if tested under maximal anterior-posterior stress.…”

Section: Discussionmentioning

confidence: 99%

Augmentation in anterior cruciate ligament reconstruction—a histological and biomechanical study on goats

Buma¹,

Kok

Blankevoort³

et al. 2003

International Orthopaedics (SICOT)

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We studied reconstruction of the anterior cruciate ligament (ACL) in skeletally mature goats. In one group, the autogenous tissue was augmented with polydioxanone (PDS), the other group had no augmentation. Histological complete incorporation and remodeling of the transplant was found in both groups. The newly formed connective tissues gradually assumed the microscopic properties of the normal ligament. The augmented group showed a delay in remodeling and maturation of the fiber bundles. Mechanically, the PDS-augmented transplants were stronger than the nonaugmented transplants immediately after surgery. During the first 6 weeks, a rapid decrease in strength of the augmented transplants was found, whereas the strength of the nonaugmented group gradually increased. The results of our experiment do not favor augmentation of autografts in reconstruction of the ACL.RØsumØ Nous avons ØtudiØ la reconstruction du ligament croisØ antØrieur chez la chvre à squelette mature. Dans un groupe le tissu autogne a ØtØ renforcØ avec du polydioxanone (PDS), l'autre groupe n'avait aucun renforcement. Une incorporation histologique complte et un remodelage du transplant a ØtØ constatØ. Les tissus conjonctifs rØcemment formØs ont pris progressivement les propriØtØs microscopiques du ligament normal. Le groupe renforcØ a montrØ un dØlai dans le remodelage et la maturation des faisceaux de fibres. MØcaniquement les greffes renforcØes au PDS Øtaient plus fortes que les greffes non renforcØes immØdiatement aprs la chirurgie. Pendant les six premires semaines une baisse rapide de la force des greffes renforcØes a ØtØ constatØe, alors que la force du groupe non-renforcØ a augmentØ progressivement. Les rØsultats de notre expØrience ne sont pas en faveur d'un renforcement des autogreffes dans la reconstruction du ligament croisØ antØrieur.

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Clinical experience with PDS II augmentation for operative treatment of acute proximal ACL ruptures - 2-year follow-up

Cited by 7 publications

References 29 publications

Resorbable polymer fibers for ligament augmentation

Resorbable polymer fibers for ligament augmentation

Arthroscopic single-stranded semitendinosus tendon- versus PDS-augmentation of reinserted acute femoral anterior cruciate ligament tears: 7 year follow-up study

Augmentation in anterior cruciate ligament reconstruction—a histological and biomechanical study on goats

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