Granuloma formation associated with patellar tendon necrosis in response to Ethibond confirmed by histopathological examination

Blasco, Alejandro; Baixauli, Emilio J.

doi:10.1136/bcr-2017-222854

Cited by 4 publications

(3 citation statements)

References 13 publications

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“…These are histologically characterized by the presence of multinucleated giant cells (MNGC) and fibrous capsule surrounding the implanted material. Foreign body reactions have been observed around clinically used medical implants comprising non-bioactive materials such as the FDA-approved UHMWPE-based sutures , and PVA-based implants, , which form the major components of our FRH-PG and FRH-PGS scaffolds. The presence of MNGC as an indicator of a foreign body reaction to our composite implant material is thus unsurprising.…”

Section: Discussionmentioning

confidence: 99%

High-Strength Fiber-Reinforced Composite Hydrogel Scaffolds as Biosynthetic Tendon Graft Material

Tarafder

Reischl

et al. 2020

ACS Biomater. Sci. Eng.

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The development of suitable synthetic scaffolds for use as human tendon grafts to repair tendon ruptures remains a significant engineering challenge. Previous synthetic tendon grafts have demonstrated suboptimal tissue ingrowth and synovitis due to wear particles from fiber-to-fiber abrasion. In this study, we present a novel fiber-reinforced hydrogel (FRH) that mimics the hierarchical structure of the native human tendon for synthetic tendon graft material. Ultrahigh molecular weight polyethylene (UHMWPE) fibers were impregnated with either biosynthetic polyvinyl alcohol/gelatin hydrogel (FRH-PG) or with polyvinyl alcohol/gelatin + strontium-hardystonite (Sr-Ca2ZnSi2O7, Sr-HT) composite hydrogel (FRH-PGS). The scaffolds were fabricated and assessed to evaluate their suitability for tendon graft applications. The microstructure of both FRH-PG and FRH-PGS showed successful impregnation of the hydrogel component, and the tendon scaffolds exhibited equilibrium water content of ∼70 wt %, similar to the values reported for native human tendon, compared to ∼50 wt % water content retained in unmodified UHMWPE fibers. The tensile strength of FRH-PG and FRH-PGS (77.0–81.8 MPa) matched the range of human Achilles’ tendon tensile strengths reported in the literature. In vitro culture of rat tendon stem cells showed cell and tissue infiltration into both FRH-PG and FRH-PGS after 2 weeks, and the presence of Sr-HT ceramic particles influenced the expression of tenogenic markers. On the other hand, FRH-PG supported the proliferation of murine C2C12 myoblasts, whereas FRH-PGS seemingly did not support it under static culture conditions. In vivo implantation of FRH-PG and FRH-PGS scaffolds into full-thickness rat patellar tendon defects showed good collagenous tissue ingrowth into these scaffolds after 6 weeks. This study demonstrates the potential viability for our FRH-PG and FRH-PGS scaffolds to be used for off-the-shelf biosynthetic tendon graft material.

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Section: Discussionmentioning

confidence: 99%

High-Strength Fiber-Reinforced Composite Hydrogel Scaffolds as Biosynthetic Tendon Graft Material

Tarafder

Reischl

et al. 2020

ACS Biomater. Sci. Eng.

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“…Nonetheless, there are several case reports in the literature reporting on the delayed formation of suture granulomas after Ethibond use, ranging from 4 months and up to 7 years postoperatively. 3 , 19 , 31 A retrospective case series (n = 672) investigating the rate of Ethibond-related suture granuloma formation after Achilles tendon repair in adults, found an incidence rate of 1.6% at a mean of 6 ± 3.2 months after surgery. 10 In our cohort, suture granulomas appeared on average at 1.67 ± 0.7 years postoperatively (range, 6-28 months).…”

Section: Discussionmentioning

confidence: 99%

Association of Quadriceps Tendon Harvest for ACL Reconstruction With Development of Osteochondritis Dissecans of the Patella in Pediatric Patients

Hidalgo Perea,

Chipman,

Cordasco

et al. 2024

Orthopaedic Journal of Sports Medicine

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Background: There are various reported complications after primary anterior cruciate ligament reconstruction (ACLR) necessitating additional surgery in skeletally immature patients, regardless of technique and autograft type. Purpose: To analyze the rate and type of complications encountered with soft tissue quadriceps tendon autograft (QTA) for ACLR in patients ≤18 years as well as the overall rate of second surgery, unrelated to the use of the QTA. Study Design: Case series; Level of evidence, 4. Methods: A total of 141 patients ≤18 years who underwent ACLR with a QTA and had minimum 6-month follow-up were included. All patients underwent ACLR by utilizing a full-thickness soft tissue QTA. Complications associated with the QTA harvest site and use of QTA were reported. Results: The mean age of the included cohort (84 men, 57 women) was 14.8 ± 1.6 years. The average follow-up was of 2.0 ± 1.2 years. A total of 30 (21%) patients had a subsequent complication that required surgical intervention; in 11 (8%) patients, the complication was specifically associated with the use of a QTA, whereas in 19 (13%) patients, the complication was related to the ACLR. In addition, 13 (9%) patients underwent a contralateral ACLR procedure. Of the QTA-related complications, 2 patients developed osteochondritis dissecans (OCD)-like lesions in the superior aspect of the patella, 2 patients had injured their quadriceps extensor mechanism and required surgical repair, and 8 patients had a subsequent procedure to remove nonabsorbable sutures used for donor site quadriceps tendon closure. One of the patients who underwent the removal of nonabsorbable sutures also had an arthroscopic debridement of patellar chondral damage. Conclusion: We reported complications encountered with soft tissue QTA for ACLR. The complication rate for QTA harvest was 8%. However, given that the removal of nonabsorbable sutures from the donor site was caused by the surgical technique used, the revised nonsuture-related complication rate for QTA graft harvest was 2%. Although the use of a QTA has recently gained popularity due to its high return-to-sport and low graft-failure rates, surgeons should be aware of the complications associated with using this graft type.

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“…In tendons and ligaments, this combination is achieved through the hierarchical structure of type I collagen microfibrils within a highly hydrated extracellular ground substance [ 11 , 12 ]. It is extensively documented that dry, highly aligned synthetic fibre constructs made from bioinert high-strength polymers such as ultra-high molecular weight polyethylene, polyethylene terephthalate, and polytetrafluoroethylene are subject to foreign body responses characterised by the presence of multinucleated giant cells that eventually act to degrade the fibrous constructs, rendering them mechanically weaker and substantially increasing the risk of rupture around the ~5–15 years post-implantation period [ 13 , 14 , 15 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Theta-Gel-Reinforced Hydrogel Composites for Potential Tensile Load-Bearing Soft Tissue Repair Applications

Virdi,

Lu,

Zreiqat

et al. 2023

JFB

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Engineering synthetic hydrogels for the repair and augmentation of load-bearing soft tissues with simultaneously high-water content and mechanical strength is a long-standing challenge. Prior formulations to enhance the strength have involved using chemical crosslinkers where residues remain a risk for implantation or complex processes such as freeze-casting and self-assembly, requiring specialised equipment and technical expertise to manufacture reliably. In this study, we report for the first time that the tensile strength of high-water content (>60 wt.%), biocompatible polyvinyl alcohol hydrogels can exceed 1.0 MPa through a combination of facile manufacturing strategies via physical crosslinking, mechanical drawing, post-fabrication freeze drying, and deliberate hierarchical design. It is anticipated that the findings in this paper can also be used in conjunction with other strategies to enhance the mechanical properties of hydrogel platforms in the design and construction of synthetic grafts for load-bearing soft tissues.

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Granuloma formation associated with patellar tendon necrosis in response to Ethibond confirmed by histopathological examination

Cited by 4 publications

References 13 publications

High-Strength Fiber-Reinforced Composite Hydrogel Scaffolds as Biosynthetic Tendon Graft Material

High-Strength Fiber-Reinforced Composite Hydrogel Scaffolds as Biosynthetic Tendon Graft Material

Association of Quadriceps Tendon Harvest for ACL Reconstruction With Development of Osteochondritis Dissecans of the Patella in Pediatric Patients

Theta-Gel-Reinforced Hydrogel Composites for Potential Tensile Load-Bearing Soft Tissue Repair Applications

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