Collagen-Platelet Composites Improve the Biomechanical Properties of Healing Anterior Cruciate Ligament Grafts in a Porcine Model

Fleming, Braden C.; Spindler, Kurt P.; Palmer, Matthew P.; Magarian, Elise M.; Murray, Martha M.

doi:10.1177/0363546509332257

Cited by 125 publications

(203 citation statements)

References 34 publications

(79 reference statements)

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“…Compared to recent research that focused on suture repair of the ACL in combination with platelet-rich plasma delivery and scaffolds, [36][37][38][39] the results in the current study are not far off in terms of the functional outcomes. The total AP translation of the repaired ACL was 290% to 440% of the intact control under 67N anterior and posterior tibial load (AP load).…”

Section: Discussioncontrasting

confidence: 73%

Healing of the Goat Anterior Cruciate Ligament After a New Suture Repair Technique and Bioscaffold Treatment

Nguyen

Geel

Schulze

et al. 2013

Tissue Engineering Part A

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Primary suture repair of the anterior cruciate ligament (ACL) has been used clinically in an attempt to heal the ruptured ACL. The results, however, were not satisfactory, which in retrospect can be attributed to the used suturing technique and the suboptimal healing conditions. These constraining conditions can be improved by introducing a new suturing technique and by using small intestinal submucosa (SIS) as a bioscaffold. It is hypothesized that the suturing technique keep the torn ends together and that SIS enhance and promote the healing of the ACL. The goat was used as the study model. In the Suture group, the left ACL was transected and suture repaired with a new locking suture repair technique (n = 5) allowing approximation and fixation under tension. The Suture-SIS group underwent the same procedure with the addition of SIS (n = 5). The right ACL served as control. After 12 weeks of healing, anterior-posterior translation and in situ force of the healing ACL were measured, followed by the measurement of the cross-sectional area and structural stiffness. Routine histology was performed on tissue samples. Gross morphology showed that the healing ACL was continuous with collagenous tissue in both groups. The cross-sectional area of the Suture and the Suture-SIS group was 35% and 50% of the intact control, respectively. The anterior-posterior translations at different flexion angles were statistically not different between the Suture group and the Suture-SIS group. Only the in situ force at 30°in the Suture-SIS group was higher than in the Suture group. Tensile tests showed that the stiffness for the Suture group was not different from the Suture-SIS group (31.1 -8.1 N/mm vs. 41.9 -18.0 N/mm [p > 0.05]). Histology showed longitudinally aligned collagen fibers from origo to insertion. More fibroblasts were present in the healing tissue than in the control intact tissue. The study demonstrated the proof of concept of ACL repair in a goat model with a new suture technique and SIS. The mechanical outcome is not worse than previously reported for ACL reconstruction. In conclusion, the approach of using a new suture technique, with or without a bioscaffold to heal the ACL is promising.

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Section: Discussioncontrasting

confidence: 73%

Healing of the Goat Anterior Cruciate Ligament After a New Suture Repair Technique and Bioscaffold Treatment

Nguyen

Geel

Schulze

et al. 2013

Tissue Engineering Part A

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“…Specimens were sectioned at the proximal femur and distal tibia with all soft tissues external to the joint capsule removed. The distal tibia and proximal femur then were potted in polyvinyl chloride tubes with epoxy (SmoothCast 1 300; Smooth-On Inc, Easton, PA, USA) for rigid attachment to the testing frame (MTS 810; Material Testing Systems, Prairie Eden, MN, USA) [22]. The joints were wrapped in towels saturated with physiologic saline to prevent dehydration.…”

Section: Biomechanical Testingmentioning

confidence: 99%

“…The knees were locked at each flexion angle with axial tibial rotation constrained in neutral position, whereas tibial translation and rotation were unconstrained in the coronal plane [22]. The knees were subjected to 12 cycles of ± 40 N AP shear load at each specific flexion angle using the testing frame while the AP displacements were measured.…”

Section: Biomechanical Testingmentioning

confidence: 99%

“…Animal models have been long used to study ACL injuries, treatments, and associated complications [6,7,17,19,20,22,26,44,45]. Animal models provide researchers with the ability to perform invasive procedures and to obtain samples at specific times that are not possible in human trials.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, translational work through animal models typically is required to comply with regulatory requirements before proceeding to human trials. Large animal models including pigs, sheep, goats, dogs, and rabbits have been used as surrogates to study the effects of surgical intervention after ACL injury [7,17,19,20,22,26,44]. Among those, the porcine model has been shown to be the closest to the human based on the size and anatomy of the knee [48], functional dependence on the ACL [10], gait biomechanics [60], and similarity of hematology and wound healing characteristics [15,38,40].…”

Section: Introductionmentioning

confidence: 99%

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Validation of Porcine Knee as a Sex-specific Model to Study Human Anterior Cruciate Ligament Disorders

Kiapour

Shalvoy

Murray

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Animal models have long been considered an important modality for studying ACL injuries. However, to our knowledge, the value of these preclinical models to study sex-related phenomena associated with ACL injury and recovery has not been evaluated. Questions/purposesWe asked whether (1) prominent anatomic and (2) biomechanical factors differ between female and male porcine knees, particularly those known to increase the risk of ACL injury. Methods Eighteen intact minipig knees (nine males, nine females) underwent MRI to determine the femoral bicondylar width, intercondylar notch size (width, area and index), medial and lateral tibial slope, ACL size (length, cross-sectional area, and volume), and medial compartment tibiofemoral cartilage thickness. AP knee laxity at 30°, 60°, and 90°flexion and ACL tensile structural properties were measured using custom-designed loading fixtures in a universal tensile testing apparatus. Comparisons between males and females were performed for all anatomic and biomechanical measures. The findings then were compared with published data from human knees. Results Female pigs had smaller bicondylar widths (2.9 mm, ratio = 0.93, effect size = À1.5) and intercondylar notches (width: 2.0 mm, ratio = 0.79, effect size = À2.8; area: 30.8 mm 2 , ratio = 0.76, effect size = 2.1; index: 0.4, ratio = 0.84, effect size = À2.0), steeper lateral tibial slope (4.3°, ratio = 1.13, effect size = 1.1), smaller ACL (length: 2.7 mm, ratio = 0.91, effect size = 1.1; area: 6.8 mm 2 , ratio = 0.74, effect size = À1.5; volume: 266.2 mm 3 , ratio = 0.68, effect size = À1.5), thinner medial femoral cartilage (0.4 mm, ratio = 0.8, effect size = À1.1), lower ACL yield load (275 N, ratio = 0.81, effect size = À1.1), and greater AP knee laxity at 30°( 0.7 mm, ratio = 1.32, effect size = 1.1) and 90°(0.5 mm, ratio = 1.24, effect size = 1

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TRITON‐X is most effective among three decellularization agents for ACL tissue engineering

Vavken

Joshi

Murray

2009

Journal Orthopaedic Research

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Ruptures of the anterior cruciate ligament (ACL) are still associated with high rates of long-term complications, even in patients undergoing modern, state-of-the-art replacement. Tissue-engineering approaches have been shown to be of value in improving treatment of ACL ruptures. However, the success of tissue-engineering procedures depends on the choice of an appropriate biomaterial. Decellularized ACL tissue potentially combines the structural composition of the targeted tissue with a reduced risk of graft rejection or disease transmission. In this study, we tested the effectiveness of currently available decellularization methods based on TRITON-X, sodium dodecyl sulfate (SDS), and trypsin. After identifying the most effective decellularization method, the capacity for reseeding with ACL fibroblasts was studied. All decellularization protocols reduced DNA content, with TRITON-X treatment having the greatest effect. Concurrently, decellularization did not affect tissue collagen or total protein content, but did decrease glycosaminoglycan content. TRITON-X also resulted the least glycosaminoglycan depletion. Porcine ACL tissue after decellularization with TRITON-X could be successfully reseeded with human ACL fibroblasts as demonstrated by steady DNA content and increasing pro-collagen expression.

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Collagen-Platelet Composites Improve the Biomechanical Properties of Healing Anterior Cruciate Ligament Grafts in a Porcine Model

Abstract: Background-The outcome of ACL reconstruction is variable and many patients have increased joint laxity postoperatively.

Cited by 125 publications

References 34 publications

Healing of the Goat Anterior Cruciate Ligament After a New Suture Repair Technique and Bioscaffold Treatment

Healing of the Goat Anterior Cruciate Ligament After a New Suture Repair Technique and Bioscaffold Treatment

Validation of Porcine Knee as a Sex-specific Model to Study Human Anterior Cruciate Ligament Disorders

TRITON‐X is most effective among three decellularization agents for ACL tissue engineering

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