Biomechanical Properties and Vascularity of an Anterior Cruciate Ligament Graft can be Predicted by Contrast-Enhanced Magnetic Resonance Imaging

Weiler, Andreas; Peters, Gunnar; Mäurer, J.; Unterhauser, Frank N.; Südkamp, Norbert P.

doi:10.1177/03635465010290061401

Cited by 236 publications

(354 citation statements)

References 52 publications

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“…This led to impaired functional knee stability and reduced structural properties of PAA grafts during subsequent healing up to 3 months. Our finding of inhibited graft remodeling due to PAA sterilization confirms findings of several other authors' [1,12,35] and our own report [22] of nonsterilized allo-and autograft ACL reconstructions in vivo. Both graft types undergo a maturation process, which is characterized by overall hypocellularity and hypervascularity as early as 6 weeks postoperatively, and a significant recellularization and revascularization that occurs from the periphery towards the center of the grafts [22].…”

Section: Discussionsupporting

confidence: 92%

“…Both graft types undergo a maturation process, which is characterized by overall hypocellularity and hypervascularity as early as 6 weeks postoperatively, and a significant recellularization and revascularization that occurs from the periphery towards the center of the grafts [22]. By 12 weeks, the cellularity of the intact ACL was restored in autografts [1,12,35] and allografts [1,12,35] and that hypervascularity remained. This graft maturation has been defined as the ligamentization process [1,12,35].…”

Section: Discussionmentioning

confidence: 99%

“…By 12 weeks, the cellularity of the intact ACL was restored in autografts [1,12,35] and allografts [1,12,35] and that hypervascularity remained. This graft maturation has been defined as the ligamentization process [1,12,35]. In contrast, PAA graft cellularity only slightly increased during early healing and did not recover to values of the intact ACL, while graft vascularity never exceeded the values for the intact ACL and substantially lagged behind nonsterilized ACL alloand autografts [1,12,35].…”

Section: Discussionmentioning

confidence: 99%

“…This graft maturation has been defined as the ligamentization process [1,12,35]. In contrast, PAA graft cellularity only slightly increased during early healing and did not recover to values of the intact ACL, while graft vascularity never exceeded the values for the intact ACL and substantially lagged behind nonsterilized ACL alloand autografts [1,12,35]. The longer crimp of ACL autoand allografts than in the intact ACL, appears characteristic for the time of simultaneous degradation and reorganization of the extracellular matrix [7].…”

Section: Discussionmentioning

confidence: 99%

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Remodeling of ACL Allografts is Inhibited by Peracetic Acid Sterilization

Scheffler

Gonnermann

Kamp

et al. 2008

Clin Orthop Relat Res

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Sterilization of allografts for anterior cruciate ligament (ACL) reconstruction has become an important prerequisite to prevent disease transmission. However, current sterilization techniques impair the biological or mechanical properties of such treated grafts. Peracetic acid (PAA) has been successfully used to sterilize bone allografts without these disadvantages and does not impair the mechanical properties of soft tissue grafts in vitro. We asked whether PAA sterilization would influence recellularization, restoration of crimp length and pattern, and revascularization of ACL grafts during early healing. We used an in vivo sheep model for open ACL reconstruction. We also correlated the histologic findings with the restoration of anteroposterior stability and structural properties during load-to-failure testing. PAA slowed remodeling activity at 6 and 12 weeks compared to nonsterilized allografts and autografts. The mechanical properties of PAA grafts were also reduced compared to these control groups at both time points. We conclude PAA sterilization currently should not be used to sterilize soft tissue grafts typically used in ACL reconstruction.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Remodeling of ACL Allografts is Inhibited by Peracetic Acid Sterilization

Scheffler

Gonnermann

Kamp

et al. 2008

Clin Orthop Relat Res

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“…This mechanism could be causative for the limited mechanical strength of autologous tendon grafts used for anterior cruciate ligament (ACL) reconstruction or for the pathogenesis of tendon degeneration. The rapid deprivation in ultimate strength of ACL grafts is accompanied by a strong upregulation of VEGF and angiogenesis [37,51]. In degenerative tendons, tissue neovascularization was accompanied by high VEGF levels [38].…”

Section: Introductionmentioning

confidence: 99%

Cyclic strain influences the expression of the vascular endothelial growth factor (VEGF) and the hypoxia inducible factor 1 alpha (HIF‐1α) in tendon fibroblasts

Petersen

Varoga

Zantop

et al. 2004

Journal Orthopaedic Research

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Neovascularization is involved in beneficial and detrimental processes of tendon pathology. We investigated the influence of repetitive motion on the expression of the most important angiogenic factor, the vascular endothelial growth factor (VEGF) in the 3T3 NIH fibroblast cell line and in cultures of rat Achilles tendon fibroblasts. Monolayers of subconfluently grown cells were stretched in rectangular silicone dishes with cyclic uniaxial movement. Strain was applied over 24 h varying the frequency (0.5–1 Hz). Fibroblasts (3T3 fibroblasts and rat Achilles tendon cultures) cultivated without the application of cyclic strain released measurable VEGF amounts into their culture supernatants. Cyclic stretching of the cells with a frequency of 1 Hz resulted in an increased expression of VEGF. A low frequency (0.5 Hz) reduced VEGF expression to control levels. RT PCR revealed VEGF 121 and VEGF 165 as the only splice forms that were induced by cyclic stretching. Western blot experiments could further show that cyclic stretching induced activation of the transcription factor HIF‐1α. These results demonstrate that mechanical factors are involved in the regulation of VEGF expression in tendon tissue. © 2003 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved.

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Intra-Articular Platelet-Rich Plasma Injection After Anterior Cruciate Ligament Reconstruction

Ye,

Chen,

Qiao

et al. 2024

JAMA Netw Open

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ImportancePlatelet-rich plasma (PRP) has been considered a promising treatment for musculoskeletal disorders. The effects of PRP on clinical outcomes of anterior cruciate ligament reconstruction (ACLR) are controversial.ObjectiveTo compare subjective outcomes and graft maturity in patients undergoing ACLR with and without postoperative intra-articular PRP injection.Design, Setting, and ParticipantsThis surgeon- and investigator-masked randomized clinical trial included patients treated at a national medical center in China who were aged 16 to 45 years and scheduled to undergo ACLR. Participants were enrolled between March 21, 2021, and August 18, 2022, and followed up for 12 months, with the last participant completing follow-up on August 28, 2023.InterventionsParticipants were randomized 1:1 to the PRP group (n = 60), which received 3 doses of postoperative intra-articular PRP injection at monthly intervals, or to the control group (n = 60), which did not receive postoperative PRP injection. Both groups had the same follow-up schedule.Main Outcomes and MeasuresThe primary outcome was the mean score for 4 subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS4) (range, 0-100, with higher scores indicating better knee function and fewer symptoms) at 12 months postoperatively. Secondary outcomes were patient-reported outcomes, graft maturity (on magnetic resonance imaging), and physical examinations at 3, 6, and 12 months.ResultsAmong the 120 randomized participants (mean [SD] age, 29.0 [8.0] years; 84 males [70%]), 114 (95%) were available for the primary outcome analysis. The mean KOOS4 scores at 12 months were 78.3 (SD, 12.0; 95% CI, 75.2-81.4) in the PRP group and 76.8 (SD, 11.9; 95% CI, 73.7-79.9) in the control group (adjusted mean between-group difference, 2.0; 95% CI, −2.3 to 6.3; P = .36). Secondary outcomes were not statistically significantly different between the 2 groups except for sports and recreation level and graft maturity at 6 months. Intervention-related adverse events included pain at the injection site and knee swelling after injection.Conclusions and RelevanceIn this randomized clinical trial among patients undergoing ACLR, the addition of postoperative intra-articular PRP injection did not result in superior improvement of knee symptoms and function at 12 months compared with no postoperative injection. Further studies are required to determine appropriate indications for PRP in musculoskeletal disorders.Trial RegistrationChinese Clinical Trial Registry Identifier: ChiCTR2000040262

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Biomechanical Properties and Vascularity of an Anterior Cruciate Ligament Graft can be Predicted by Contrast-Enhanced Magnetic Resonance Imaging

Cited by 236 publications

References 52 publications

Remodeling of ACL Allografts is Inhibited by Peracetic Acid Sterilization

Remodeling of ACL Allografts is Inhibited by Peracetic Acid Sterilization

Cyclic strain influences the expression of the vascular endothelial growth factor (VEGF) and the hypoxia inducible factor 1 alpha (HIF‐1α) in tendon fibroblasts

Intra-Articular Platelet-Rich Plasma Injection After Anterior Cruciate Ligament Reconstruction

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