OBJECTIVE: To observe the strength of thigh muscles after reconstruction of anterior cruciate ligament by autogenous bone-patellar tendon-bone graft. METHODS: Twenty-three patients, 9 males and 14 females, were followed up one year after reconstruction of the anterior cruciate ligament with autogenous bone-patellar tendon-bone graft. Through arthroscope, no intra-articular derangement was found. The strengths of isometric and isotonic contractions of the quadri ceps and the hamstrings muscles of the affected and contralateral thighs were recorded. RESULTS: The donor side for autogenous bone-patellar tendon-bone graft showed significant decrease (P lt; 0.01), but no effect on that of the hamstrings muscle(P gt; 0.05). CONCLUSION: To reconstruct the anterior cruciate ligament, harvest of the bone-patellar tendon-bone graft as a reparative material may markedly lower the strength of the quadriceps femoris muscle.
ObjectiveTo observe the effect of preserving tibial residual fibers on the expressions of ligament remodeling related genes in rabbit anterior cruciate ligament (ACL) reconstruction model. MethodsSixty healthy adult New Zealand white rabbits were randomly divided into 4 groups:normal control group (group A, n=6) , sham-operation group (group B, n=18) , non tibial remnant preserved group (group C, n=18) , and tibial remnant preserved group (group D, n=18) . At 2, 6, and 12 weeks after operation, the ligament tissue was harvested to detect the mRNA expressions of collagen type 1A1(COL1A1) , collagen type 3A1(COL3A1) , transforming growth factor β1(TGF-β1), vascular endothelial growth factor (VEGF), growth-associated protein 43(GAP-43) , and neurotrophin 3(NT-3) by real-time fluorescent quantitative PCR. ResultsAt each time point, there was no significant difference in the mRNA expressions of COL1A1, COL3A1, VEGF, and NT-3 between group A and group B (P>0.05) . In group D, the mRNA expressions of COL1A1, COL3A1, TGF-β1, and GAP-43 significantly increased when compared with those of group C at 6 weeks after operation (P＜0.05) ; an increased level of VEGF mRNA was also detected in the group D at 12 weeks after operation (P＜0.05) ; and an increased level of NT-3 mRNA was also observed in group D at 2 and 12 weeks after operation (P＜0.05) . ConclusionThere is a time-dependent manner of angiogenesis-promoting, repair-related, and nerve-related gene expressions after ACL reconstruction with preserving tibial residual fibers during the process of ligamentization. Furthermore, the remnant preservation in ACL reconstruction can promote the expressions of related genes in some time points.
Objective The tendon-bone heal ing is the key point to ensure the success of the anterior cruciate l igament (ACL) reconstruction. To observe the histological change in the tendon-bone heal ing after ACL reconstruction by different concentrations of platelet-rich plasma (PRP) combined with deproteinized bone (DPB) of calf as bone tunnel infill ing and to investigate the active effect of the complex on tendon-bone heal ing and to define the optimal concentration of PRP. Methods Eight mL blood was drawn from central artery of New Zealand rabbit ears; PRP was prepared by Landesbergmethod, and l iquid supernatant was used as thinner to prepare different concentrations of PRP (30%, 60%, and 100%). Fresh osteoepiphysis spongy bone was harvested from lower end of femur of newborn calf to prepare DPB by way of 30% H2O2 and ether alternating soaking for 24 hours continuous 6 times. DPB was soaked in different concentrations of PRP and mixed with activator to prepare the PRP/DPB complex. A total of 54 New Zealand white rabbits, aging 8-12 months, weighing (2.5 ± 0.4) kg, were divided randomly into 3 groups: group A (30%PRP/DPB complex, n=18), group B (60%PRP/DPB complex, n=18), and group C (100%PRP/DPB complex, n=18). The legs of the rabbits were randomly divided into experimental side and the control side; ACL was reconstructed by semitendinosus and PRP/DPB complex in bone tunnel in the experimental side, and only by semitendinosus in the control side. The general conditions of the rabbits were observed postoperatively and HE staining was used to observe the tendon-bone heal ing, then I-IV levels of semi-quantitative analysis of the tendon-bone heal ing were evaluated according to Demirag standard at 3, 6, and 12 weeks. Results General observation: Synovial fluid sl ightly increased in the specimens and no bony tissue was found in inner of femoral tunnel at 3 weeks; there was no synovial fluid in all the specimens and scar tissue was discovered in inner of femoral tunnel at 6 weeks; and there was no synovial fluid and the tendons became tighter with fibrous tissue at 12 weeks. Histological observation: New granulation tissue formed in the tendon-bone interface of group A experimental sides at 3 weeks; there was various widths of Sharpey type textile fiber in the tendon-bone interface at 6 weeks; Sharpey type textile fiber arranged regularly, which formed an irregular and blur “tidal l ine” at 12 weeks. Group B experimental sides were better than any other group at 3, 6, and 12 weeks; chondrocyte-l ike arranged regularly in the tendonboneinterface at 3 weeks; the number of chondrocyte-l ike per unit area was more than that of the other groups at 6 weeks;and chondrocyte-l ike prol iferated and matured in the tendon-bone interface, Sharpey type textile fiber became tighter andordered. Group C experimental sides were similar to both sides of group A at 3 weeks, however, the prol iferation of relatively mature dense connective tissue was worse than that of other groups at 6 and 12 weeks. According to Demirag grading, there were significant differences in tendon-bone heal ing between the experimental sides and the control sides of group B at 3 and 6 weeks, and between group B experimental sides and group C experimental sides at 12 weeks (P lt; 0.05). Conclusion The mixture of PRP/PRP has good biocompatibil ity and bone induction, so it can enhance tendon-bone heal ing after ACL reconstruction when the concentration of PRP is 60%.
Objective To investigate the clinical outcomes of autologous platelet rich plasma (PRP) for anterior cruciate ligament (ACL) reconstruction. Methods Between August 2014 and August 2016, 42 patients with ACL ruptures who underwent arthroscopic ACL reconstruction were randomly divided into 2 groups: 21 patients received graft soaked with PRP (trial group) and 21 patients received routine graft in ACL reconstruction (control group). Because 6 patients failed to be followed up, 17 patients of trial group and 19 of control group were enrolled in the study. There was no significant difference in gender, age, body mass index, side, injury reason, disease duration, Kellgren-Lawrence grade, and preoperative visual analogue scale (VAS), Lysholm score, and International Knee Documentation Committee (IKDC) activity scores between 2 groups (P>0.05). VAS score, Lysholm score, and IKDC activity scores were used to evaluate pain and function at 3 and 12 months postoperatively. Further, second arthroscopy and MRI examination were performed at 12 months postoperatively. Results The patients in both groups were followed up 3 to 12 months with an average of 9.83 months. The VAS score, Lysholm score, and IKDC activity scores were significantly improved at 3 and 12 months after operation in 2 groups (P<0.05), and the scores of trial group were significantly better than those of control group at 3 months (P<0.05), but no significant difference was found between 2 groups at 12 months (P>0.05). No complications of effusion, infection, and allergy were observed in 2 groups during follow-up. MRI showed good position of ACL grafts and good signal quality of the graft in the majority of the cases. However, mixed hyperintense and presence of synovial fluid at the femoral bone-tendon graft interface were found in 3 patients of trial group and 4 patients of control group, indicating poor remodeling ligamentation. MRI score was 3.53±1.13 in trial group and was 3.21±0.92 in control group, showing no significant difference (t=0.936,P=0.356). The second arthroscopy examination showed ligament remodeling score was higher in trial group than control group (t=3.248,P=0.014), but no significant difference was found in synovial coverage score and the incidence of cartilage repair (t=2.190,P=0.064;χ2=0.090,P=0.764). Conclusion PRP application in allograft ACL reconstruction can improve knee function and relieve pain after operation, which may also accelerate graft remodeling.
ObjectiveTo investigate the histological characteristics of autogenous hamstring grafts after anterior cruciate ligament (ACL) reconstruction.MethodsThe patients who underwent arthroscopic single-bundle ACL reconstruction with autogenous hamstring tendons and were followed up at least 4 years and also underwent second-look arthroscopy between March 2017 and December 2017 and met the selection criteria were considered for enrollment. Graft quality under arthroscopy was evaluated as good remodeling group (GRG, the total scores were 4-6) and poor remodeling group (PRG, the total scores were 1-3) according to synovial and vascular coverage, the apparent tension of the grafts, the thickness and retear of the grafts. During the second-look arthroscopic procedures, ACL graft biopsies were performed. Normal ACL tissues harvested from the patients under 60 years old who underwent total knee arthroplasty were designated as normal controls. Graft vascularity, cellular morphology, cellular metabolism, and collagen fibril distribution were analyzed.ResultsThe 18 specimens (11 cases of GRG group and 7 cases of PRG group) and 9 native ACL biopsied tissue sample were enrolled into the study. Arthroscopy scores were 2-6 (mean, 4.7). The biology under light microscopy of GRG group was similar to that of native ACL in control group. There was no significant difference in the scores of graft vascularity and cellular morphology between GRG group and control group (P>0.05), while PRG group was significantly lower than the other two groups (P<0.05). Transmission electron microscope evaluation showed that GRG group and control group had better collagen fibril distribution and lower levels of cellular metabolism than PRG group (P<0.05). There was no significant difference in cellular metabolism between GRG and control groups (P>0.05), while collagen fibril distribution score of GRG group was significantly lower than that of control group (P<0.05).ConclusionWhile good remodeling grafts under arthroscopy in histological maturation period was proved to be more similar to normal ACL on ultrastructure properties under light and electron microscope, ultra structural differences regarding collagen fibril distribution still persist.
ObjectiveTo study the effectiveness of internal tension-relieving technique for arthroscopic assisted anterior cruciate ligament (ACL) reconstruction. MethodsBetween March 2011 and September 2014, 51 cases of complete ACL rupture were randomly divided into 2 groups. Arthroscopic assisted single-bundle ACL reconstruction combined with internal tension-relieving technique was performed in 26 cases (group A), arthroscopic assisted single-bundle ACL reconstruction in 25 cases (group B). There was no significant difference in gender, age, cause of injury, injured side, body mass index, Outerbridge classification of articular cartilage injury, disease duration, and the preoperative International Knee Documentation Committee (IKDC) score, Lysholm score, and KT-1000 test value between 2 groups (P>0.05). At 3, 6, and 12 months after operation, the KT-1000 was used to measure the anterior stability, and IKDC and Lysholm scores to evaluate the function of knee joint. ResultsHealing of incision by first intention was obtained in all patients of 2 groups, without complications of infection, deep vein thrombosis of lower extremity, and blood vessels and nerves injury. The patients were followed up 12 months after operation. All patients received second microscopic examination. The reconstructed ACL had good continuity and good coverage of synovial tissue. There was no re-rupture in any cases. The range of motion of the knee joint was close to normal. The MRI showed good healing of the ligament and the bone tunnel at 12 months after operation. KT-1000 test value, IKDC score, and Lysholm score at 3, 6, and 12 months after operation were significantly improved when compared with preoperative ones (P<0.05), but no significant difference was found among different time points after operation (P>0.05). There was no significant difference in IKDC score and Lysholm score between 2 groups at 3 and 12 months (P>0.05); but IKDC score and Lysholm score of group A were significantly higher than those of group B (P<0.05) at 6 months. At diffenent time points after operation, the KT-1000 test values of group A were significantly lower than those of group B (P<0.05) except the value at 3 months (P>0.05). ConclusionFor patients with ACL rupture, using internal tension-relieving technique can effectively alleviate tension force of reconstructed ligament, which is beneficial to the healing of reconstructed ligament and early rehabilitation of the knee joint.
Objective To investigate the effect of Kartogenin (KGN) combined with adipose-derived stem cells (ADSCs) on tendon-bone healing after anterior cruciate ligament (ACL) reconstruction in rabbits. Methods After the primary ADSCs were cultured by passaging, the 3rd generation cells were cultured with 10 μmol/L KGN solution for 72 hours. The supernatant of KGN-ADSCs was harvested and mixed with fibrin glue at a ratio of 1∶1; the 3rd generation ADSCs were mixed with fibrin glue as a control. Eighty adult New Zealand white rabbits were taken and randomly divided into 4 groups: saline group (group A), ADSCs group (group B), KGN-ADSCs group (group C), and sham-operated group (group D). After the ACL reconstruction model was prepared in groups A-C, the saline, the mixture of ADSCs and fibrin glue, and the mixture of supernatant of KGN-ADSCs and fibrin glue were injected into the tendon-bone interface and tendon gap, respectively. ACL was only exposed without other treatment in group D. The general conditions of the animals were observed after operation. At 6 and 12 weeks, the tendon-bone interface tissues and ACL specimens were taken and the tendon-bone healing was observed by HE staining, c-Jun N-terminal kinase (JNK) immunohistochemical staining, and TUNEL apoptosis assay. The fibroblasts were counted, and the positive expression rate of JNK protein and apoptosis index (AI) were measured. At the same time point, the tensile strength test was performed to measure the maximum load and the maximum tensile distance to observe the biomechanical properties. Results Twenty-eight rabbits were excluded from the study due to incision infection or death, and finally 12, 12, 12, and 16 rabbits in groups A-D were included in the study, respectively. After operation, the tendon-bone interface of groups A and B healed poorly, while group C healed well. At 6 and 12 weeks, the number of fibroblasts and positive expression rate of JNK protein in group C were significantly higher than those of groups A, B, and D (P<0.05). Compared with 6 weeks, the number of fibroblasts gradually decreased and the positive expression rate of JNK protein and AI decreased in group C at 12 weeks after operation, with significant differences (P<0.05). Biomechanical tests showed that the maximum loads at 6 and 12 weeks after operation in group C were higher than in groups A and B, but lower than those in group D, while the maximum tensile distance results were opposite, but the differences between groups were significant (P<0.05). Conclusion After ACL reconstruction, local injection of a mixture of KGN-ADSCs and fibrin glue can promote the tendon-bone healing and enhance the mechanical strength and tensile resistance of the tendon-bone interface.