Graft Laceration and Pullout Strength of Soft-Tissue Anterior Cruciate Ligament Reconstruction: In Vitro Study Comparing Titanium, Poly-D,L-Lactide, and Poly-D,L-Lactide–Tricalcium Phosphate Screws

Zantop, Thore; Weimann, André; Schmidtko, Romana; Herbort, Mirco; Raschke, Michael J.; Petersen, Wolf

doi:10.1016/j.arthro.2006.06.015

Cited by 116 publications

(80 citation statements)

References 28 publications

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“…Although there are a large number of publications exploring differences in biomechanical properties between different fixation devices at time 0 [10,14,43,45,57,58,122,130], comparative studies exploring differences in biological incorporation of soft-tissue grafts between different fixation methods are lacking [96,131].…”

Section: Graft Fixationmentioning

confidence: 99%

Graft healing in anterior cruciate ligament reconstruction

Ekdahl

Wang

Ronga

et al. 2008

Knee Surg Sports Traumatol Arthr

200

146

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Graft healing within the bone tunnel after anterior cruciate ligament (ACL) reconstruction is still a complex, poorly understood biological process that is influenced by multiple surgical and postoperative variables. However, remarkable advances in knowledge of this process have been made based primarly on animal models. According to the findings of this review, some surgical and postoperative variables are known to directly affect time-course and quality of graft-tunnel healing. The type of graft, graft motion, and fixation methods have shown to directly affect time-course and quality of graft-tunnel healing. Therefore, the application of early and aggressive rehabilitation protocols should be cautious when using soft-tissue graft, allografts, and direct or aperture type of fixation for ACL reconstruction. With regard to graft placement, several cadaveric models showed biomechanical advantages of a more anatomical graft location; however, there are no studies that explore the relationship between graft placement and healing process. The precise effect of graft tensioning, graft/tunnel diameter disparity, and graft length within the bone tunnel in the graft healing process remains unclear and requires more research. To enhance graft-tunnel healing, tissue-engineering approaches, including the use of growth factors, mesenchymal stem cells, and periosteum graft augmentation, have been tested on animal models. These have shown promising results in terms of enhancement of bone-graft healing rate.

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Section: Graft Fixationmentioning

confidence: 99%

Graft healing in anterior cruciate ligament reconstruction

Ekdahl

Wang

Ronga

et al. 2008

Knee Surg Sports Traumatol Arthr

200

146

View full text Add to dashboard Cite

show abstract

“…However, they have a number of well-documented limitations and difficulties that include stress shielding [1], interference with MRI and CT imaging [2,3], graft laceration [4] and permanence.…”

Section: Introductionmentioning

confidence: 99%

Polymer-hydroxyapatite composite versus polymer interference screws in anterior cruciate ligament reconstruction in a large animal model

Hunt

Callaghan

2008

Knee Surg Sports Traumatol Arthr

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The aim of the study was to assess the hard tissue response of a composite hydroxyapatite/poly L-lactic acid (HA/PLLA) interference screw for anterior cruciate ligament (ACL) reconstruction compared to a standard PLLA screw. Twelve skeletally mature rams underwent unilateral ACL reconstruction using an autologous bone-patellar tendon graft. Each animal received either two test HA/PLLA interference screws or two control PLLA interference screws. Animals were sacrificed at 6 and 12 months post-implantation and the operated knees excised. Undecalcified sections of the screw and surrounding tissues were cut from resin embedded samples and stained; sections were approximately parallel to the longitudinal axis of the screws. A quantitative assessment of bone formation between each screw type (PLLA vs. HA/PLLA) and adjacent tissue in both the tibia and femur was undertaken using automated image analysis (KS400, Zeiss, UK). The inflammatory response of each screw type was assessed by histological evaluation. New bone formation along the perimeter of the screw threads was statistically significantly higher with the HA/PLLA than the PLLA alone. The inflammatory response as assessed semi-quantitatively by histologically determining the number of inflammatory cells present in the tissue adjacent to the implant, was higher for PLLA than HA/PLLA. Significantly increased new bone formation and decreased inflammatory cells were observed in vivo with the composite screw in comparison with the standard polymer. A novel HA/PLLA composite biomaterial in the form of an interference screw demonstrated an improved hard-tissue response compared to PLLA in a large animal ACL reconstruction. This study determined the differences in the tissue response between PLLA and a composite material of HA/PLLA. The improved tissue related outcomes observed in vivo, may be of benefit clinically in ACL reconstruction.

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“…Revision surgery may be complicated by the need of hardware extraction [18]. Some implants are known to cause graft lacerations [26]. Post-operative MRI diagnostic may be compromised by artifacts caused by the implants.…”

Section: Introductionmentioning

confidence: 99%