Tendon healing in a bone tunnel. Part I

Weiler, Andreas; Peine, Ricarda; Pashmineh-Azar, Alireza; Abel, Clemens; Südkamp, Norbert P.; Hoffmann, Reinhard

doi:10.1053/jars.2002.30656

Cited by 210 publications

(26 citation statements)

References 56 publications

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“…5,24–28 Sheep were selected for this study because their bone density and weight are similar to humans. 29 Pena et al 6 reported that bone density had an influence on determining peak loads at failure in human cadaveric specimens, so the use of sheep specimens can help to minimize specimen-related bias.…”

Section: Discussionmentioning

confidence: 99%

Influence of Hydroxyapatite-Coated and Growth Factor–Releasing Interference Screws on Tendon-Bone Healing in an Ovine Model

Markel

Nemke

et al. 2009

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Purpose Our purpose was to determine whether a bioresorbable interference screw coated with a hydroxyapatite-based mineral layer designed to release an engineered peptide growth factor (linkBMP-2 [where “BMP-2” indicates bone morphogenetic protein 2]) improved tendon-bone healing compared with a screw without coating. Methods Tagged linkBMP-2 peptides were used to quantify binding efficiency and release kinetics on 9 mineral-coated BIORCI screws (Smith & Nephew, Andover, MA). Fourteen mature female sheep were used in this study. In each of the 14 sheep, each stifle was randomized to either receive a linkBMP-2–coated or uncoated interference screw (n ± 14 per treatment). The sheep were euthanized at 6 weeks after surgery. Eight sheep were subjected to biomechanical testing for peak load at failure and stiffness, and six sheep were used for histologic analysis according to a semiquantitative scoring scale. Results The linkBMP-2 molecule bound efficiently to the surface of mineral-coated interference screws. Over 80% of the initially bound linkBMP-2 was released during a 6-week time frame in vitro. Peak load at failure in the linkBMP-2–coated interference screw group (mean ± SD, 449.3 ± 84.7 N) was not significantly different from that in the uncoated group (421.0 ± 61.8 N) (P = .22). Stiffness in the linkBMP-2–coated interference screw group (157.3 ± 39.6 N/mm) was not significantly different from that in the uncoated group (140.6 ± 20.3 N/mm) (P = .12). Histologic analysis showed that the tendons in the linkBMP-2–coated interference screw group had higher scores (better) than the uncoated group. In the linkBMP-2–coated interference screw group, mesenchymal cells were present at the interface between screw and tendon, whereas these cells were not present in the uncoated group. Conclusions We found that linkBMP-2 can be bound onto a mineral-coated BIORCI interference screw surface and subsequently released from the screw surface in a sustained manner. The histologic result of this study showed that the linkBMP-2–coated interference screw significantly improved the histologic scores of early tendon-bone healing in this sheep model. Clinical Relevance This linkBMP-2 coating material may improve early tendon/ligament fixation.

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Section: Discussionmentioning

confidence: 99%

Influence of Hydroxyapatite-Coated and Growth Factor–Releasing Interference Screws on Tendon-Bone Healing in an Ovine Model

Markel

Nemke

et al. 2009

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…Three factors contribute to the decline in the grafts’ mechanical properties: (a) increased revascularization and extra-cellular infiltration, (b) loss of regular collagen orientation and crimp pattern and (c) decrease in collagen fibril density, followed by increased collagen synthesis with a shift from large-diameter collagen fibrils to small-diameter fibrils [6, 9, 16, 20, 21, 27, 46, 51, 52, 54, 58, 60, 61]. Furthermore, increased collagen III synthesis (with lower mechanical strength than type I collagen) may further explain why a full restoration of the mechanical strength of the intact ACL has not been observed in any in vivo model even after 2 years of healing [32, 42, 46, 52].…”

Section: Phases Of Remodellingmentioning

confidence: 99%

“…Even though substantial research efforts have been published on various aspects of ACL reconstruction, there is limited knowledge on the biology of the human ACL graft [10, 12, 13, 15, 18, 24, 30, 33, 44–46, 48, 57, 61, 63, 65, 66]. Graft healing after ACL reconstruction occurs at two different sites: intra-tunnel graft incorporation [59, 60] and intra-articular graft remodelling, often referred to as “ligamentization” [4, 10, 24, 30, 33, 34, 44, 46, 53]. This article presents the current knowledge on intra-articular remodelling of ACL grafts with special focus on human hamstring autografts.…”

Section: Introductionmentioning

confidence: 99%

Intra-articular remodelling of hamstring tendon grafts after anterior cruciate ligament reconstruction

Janssen

Scheffler

2013

Knee Surg Sports Traumatol Arthrosc

185

200

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Purpose A summary is provided on the existing knowledge about the specific healing phases of the intra-articular hamstring tendon graft used for ACL reconstruction. Differences between human and animal in vivo studies are explained, and implications for the postoperative time period are laid out.MethodsA systematic review of the existing literature was performed on the topic of tendon remodelling of hamstring grafts in ACL reconstruction using Medline database. Publications between 1982 and 2012 were included. Special focus was directed on in vivo human and animal studies analysing intra-articular free tendon graft remodelling.ResultsAnimal and human in vitro and vivo researches have demonstrated three characteristic stages of graft healing after ACL reconstruction: an early graft healing phase with central graft necrosis and hypocellularity and no detectable revascularization of the graft tissue, followed by a phase of proliferation, the time of most intensive remodelling and revascularization and finally, a ligamentization phase with characteristic restructuring of the graft towards the properties of the intact ACL. However, a full restoration of either the biological or biomechanical properties of the intact ACL is not achieved.ConclusionSignificant knowledge on human cruciate ligament remodelling has been added in the understanding of the processes during the course of graft healing. Most importantly, the remodelling process in humans is prolonged compared to animal studies. While today´s rehabilitation protocols are often extrapolated from findings of animal in vivo healing studies, current findings of human in vivo healing studies might require new post-operative regimens following hamstring ACL reconstruction.

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“…Animals underwent replacement of the anterior cruciate ligament in an open fashion using an Achilles tendon split graft to study the tendon-to-bone healing using a soft tissue graft [38,39]. All animals were screened to ensure good physical condition.…”

Section: Animal Modelmentioning

confidence: 99%

α‐Smooth muscle actin is expressed by fibroblastic cells of the ovine anterior cruciate ligament and its free tendon graft during remodeling

Weiler

Unterhauser

Bail

et al. 2002

Journal Orthopaedic Research

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Contractile fibroblastic cells expressing the a-smooth muscle actin isoform, so-called myofibroblasts, have been identified to play a possible role during the healing of the medial collateral ligament by means of restoring the tissues in situ strain via extracellular matrix contraction. Recently, these cells have also been identified to be a normal part of the human anterior cruciate ligament. It has been hypothesized that myofibroblasts play a role in the wrinkling of the extracellular matrix. The goal of the present study was to identify myofibroblasts in the intact ovine anterior cruciate ligament and a free autologous tendon graft during remodeling after anterior cruciate ligament reconstruction. In 36 mature merino sheep the anterior cruciate ligament was replaced with an ipsilateral Achilles tendon split graft. Midsubstance tissue samples were immunostained for a-smooth muscle actin at 6,9, 12,24, 52, and 104 weeks. Myofibroblasts were identified in the intact ovine anterior cruciate ligament as well as in the Achilles tendon graft prior to implantation. During remodeling the first myofibroblasts were found at six weeks within newly formed fiber bundles. At 24, 52, and 104 weeks myofibroblast distribution and cell density were similar to those of the intact ovine anterior cruciate ligament. These findings indicate that a-smooth muscle actin containing fibroblastic cells are a regular part of the intact as well as the remodeled anterior cruciate ligament. There is evidence that myofibroblasts may be involved in maintaining tissue homeostasis in the mature ligament e.g., by means of crimp formation. The presence of these cells during the early remodeling may further indicate that asmooth muscle actin containing fibroblastic cells are involved in the earliest stages of fiber bundle formation. The role and function of this special cell type for the anterior cruciate ligament needs to be further clarified.

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Tendon healing in a bone tunnel. Part I

Cited by 210 publications

References 56 publications

Influence of Hydroxyapatite-Coated and Growth Factor–Releasing Interference Screws on Tendon-Bone Healing in an Ovine Model

Influence of Hydroxyapatite-Coated and Growth Factor–Releasing Interference Screws on Tendon-Bone Healing in an Ovine Model

Intra-articular remodelling of hamstring tendon grafts after anterior cruciate ligament reconstruction

α‐Smooth muscle actin is expressed by fibroblastic cells of the ovine anterior cruciate ligament and its free tendon graft during remodeling

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