Integración tendinosa de plastias autólogas en túneles de diferente calibre. Estudio experimental en ovejas

Hidalgo, R. Sánchez; Forriol, Francisco

doi:10.1016/j.recot.2011.10.005

Cited by 3 publications

(3 citation statements)

References 138 publications

(221 reference statements)

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“…This hypothesis also applies to the slower bone formation and reduction of defects in the animals treated with noncellularized grafts. Recent studies complement this hypothesis [19] by demonstrating that TGF, BMP, FGF, IGF and PDGF are the main growth factors able to influence the proliferation and differentiation of mesenchymal cells into osteoprogenitors and osteoblasts [20]. …”

Section: Discussionmentioning

confidence: 99%

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The effect of bone allografts combined with bone marrow stromal cells on the healing of segmental bone defects in a sheep model

et al. 2014

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BackgroundThe repair of large bone defects is a major orthopedic challenge because autologous bone grafts are not available in large amounts and because harvesting is often associated with donor-site morbidity. Considering that bone marrow stromal cells (BMSC) are responsible for the maintenance of bone turnover throughout life, we investigated bone repair at a site of a critically sized segmental defect in sheep tibia treated with BMSCs loaded onto allografts. The defect was created in the mid-portion of the tibial diaphysis of eight adult sheep, and the sheep were treated with ex-vivo expanded autologous BMSCs isolated from marrow aspirates and loaded onto cortical allografts (n = 4). The treated sheep were compared with control sheep that had been treated with cell-free allografts (n = 4) obtained from donors of the same breed as the receptor sheep.ResultsThe healing response was monitored by radiographs monthly and by computed tomography and histology at six, ten, fourteen, and eighteen weeks after surgery. For the cell-loaded allografts, union was established more rapidly at the interface between the host bone and the allograft, and the healing process was more conspicuous. Remodeling of the allograft was complete at 18 weeks in the cell-treated animals. Histologically, the marrow cavity was reestablished, with intertrabecular spaces being filled with adipose marrow and with evidence of focal hematopoiesis.ConclusionsAllografts cellularized with AOCs (allografts of osteoprogenitor cells) can generate great clinical outcomes to noncellularized allografts to consolidate, reshape, structurally and morphologically reconstruct bone and bone marrow in a relatively short period of time. These features make this strategy very attractive for clinical use in orthopedic bioengineering.

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Section: Discussionmentioning

confidence: 99%

“…There are other case studies on bone grafts in sheep that deserve special attention [20-23]. Furthermore, a clinical study on the use of mesenchymal cells expanded in vitro and associated with a synthetic implant was performed in four patients with segmental defects [24].…”

Section: Discussionmentioning

confidence: 99%

The effect of bone allografts combined with bone marrow stromal cells on the healing of segmental bone defects in a sheep model

et al. 2014

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“…Si bien la resistencia de los autoinjertos habituales es superior a la del LCA nativo, los isquiotibiales multifascículo se adaptan mejor a las técnicas bitúnel, hay series que muestran menos fracasos que con el tendón rotuliano 43,44 y menos secuela de dolor donante (11,8%), siempre que sean de un calibre >8 mm y polifasciculadas, 45,46 con el inconveniente de su integración más lenta e incompleta en los túneles. 47 En nuestro estudio, el calibre de la plastia fue de 8,5 mm en la técnica monotúnel transtibial y de 9,2 mm en la técnica bitúnel anatómica, debido a la tendencia a "polifascicular" el injerto siempre limitado e inconstante, 48 resulta suficiente confeccionar plastias de 6 cm de longitud. El empleo de tendón rotuliano en plastias anatómicas obliga a confeccionar pastillas óseas pequeñas para su adaptación femoral, con mayor dificultad de fijación y con los inconvenientes conocidos de dolor anterior en el 14-47% de los pacientes, 49 por lo que las plastias tendinosas autólogas van sustituyendo al HTH mayoritario en las técnicas monotúnel, 50,51 y otras opciones, como el tendón cuadricipital con pastilla ósea 52 o los aloinjertos, son secundarias debido a su peor manejo y resultados.…”

Section: Materiales Y Métodosunclassified

Ligamentoplastia del ligamento cruzado anterior monotúnel transtibial y bitúnel anatómica: estudio comparativo. [Anterior cruciate ligamentoplasty transtibial single tunnel and anatomical double tunnel: a comparative study]

Anchuela

Sieger

Martínez

et al. 2019

Rev. Asoc. Arg. Ort. y Traumatol

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Objetivo: Comparar dos series de pacientes sometidos a ligamentoplastia con tendones isquiotibiales autólogos mediante las dos técnicas quirúrgicas preferentes: monotúnel transtibial y bitúnel anatómica, utilizando idénticas fijaciones óseas, y establecerconclusiones funcionalesMateriales y Métodos: Estudio retrospectivo de dos series de 30 pacientes, con un seguimiento superior a un año, sometidos a ligamentoplastia del ligamento cruzado anterior con tendones isquiotibiales mediante técnicas monotúnel transtibial y bitúnel con tunelización retrógrada, utilizando fijación elástica cortical en fémur y fijación tibial mediante tornillo retrógrado. Se los evaluó con la escala del IKDC, y las pruebas de Lachman, de resalte (pivot-shift) y del salto monopodal, valorando la reincorporación a la actividad previa habitual y deportiva, y examen radiológico de la evolución de los túneles óseos.Resultados: La técnica bitúnel anatómica logra resultados significativamente mejores (p <0,05) en la evaluación subjetiva de la escala del IKDC, en las pruebas de resalte, del salto y en la recuperación de la actividad deportiva previa a la lesión, sin diferencias en la prueba de Lachman. No hubo casos de osteólisis en los túneles óseos, en ninguna de las dos series.Conclusiones:La técnica de ligamentoplastia bitúnel anatómica es mejor valorada y más eficaz que la técnica monotúnel transtibial, fundamentalmente en pacientes con actividad deportiva exigente, ya que en aquellos sin actividades de impacto, los resultados son satisfactorios de igual forma. Con el atornillado retrógrado tibial no hubo osteólisis significativa en el túnel tibial. AbstractObjective: Comparison of two series of patients operated on ligamentoplasty with autologous hamstring tendons by the two preferred surgical techniques: transtibial monotunnel and anatomic bitunnel, using identical bone fixations; and establishment of functional conclusions.Material and method: Retrospective study of two series of 30 patients followed up more than one year, undergoing anterior cruciate ligamentoplasty with hamstring tendons performing transtibial montunnel and bitunnel techniques with retrograde tunneling, using the cortical elastic fixation in femur and a tibial fixation by retrograde screw, evaluating the patients by IKDC scale, Lachman, pivot and monopodal jump tests, valuating the reincorporation to the previous habitual and sports activity, and performing radiological examination of the evolution of the bone tunnels. Results: the anatomical bitunnel technique presents significantly (p <0.05) better results in the evaluation of the IKDC scale, in the pivot and in the jump test and in the recovery of sports activity prior to injury, with no differences in the Lachman test. There were no cases of osteolysis in the bone tunnels in none of the two series. Conclusions: The anatomical bitunnel ligamentoplasty technique is better valued by the patient and more efficient than the transtibial monotunnel technique, fundamentally in patients with demanding sports activity, since in patients without impact activities, the results are satisfactory in the same way. With tibial retrograde screwing, there was no significant osteolysis in the tibial tunnel.

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The influence of femoral tunnel length on graft rupture after anterior cruciate ligament reconstruction

et al. 2017

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BackgroundFor ACL reconstruction, the minimum length of the femoral tunnel and the flexor tendon graft length needed within the tunnel for proper integration have not been defined. The aim of this study was to assess whether a short tunnel is a risk factor for poor prognosis and re-rupture by comparing the outcomes of patients with short femoral tunnels to those of patients with longer tunnels.Materials and methodsA retrospective observational study of 80 patients who underwent ACL reconstruction using flexor tendons via the medial transportal or transtibial technique was performed. Patients were categorized according to the amount of graft within the tunnel: ≤1.5 versus >1.5 cm; ≤2 versus >2 cm; ≤2.5 versus >2.5 cm; and ≤1.5 versus >2.5 cm. Patients were evaluated 2 years after surgery by performing a physical examination (Lachman, pivot shift and anterior drawer tests), using a KT1000 arthrometer, calculating objective and subjective International Knee Documentation Committee scores, conducting the Lysholm score, and recording re-ruptures.ResultsOf the 80 operated patients, nine were lost to follow-up. Comparative assessment of the patients with different amounts of graft within the tunnel indicated no significant differences in the evaluated outcomes, except for positive Lachman test results, which were more frequent in patients with tunnels with ≤2 cm of graft than in those with tunnels with >2 cm of graft.ConclusionThe amount of graft within the femoral tunnel does not appear to be a risk factor for clinical instability of the knee or re-rupture of the graft. Level of evidence: case series, level IV. Level of evidenceCase series, level IV.

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Integración tendinosa de plastias autólogas en túneles de diferente calibre. Estudio experimental en ovejas

Cited by 3 publications

References 138 publications

The effect of bone allografts combined with bone marrow stromal cells on the healing of segmental bone defects in a sheep model

The effect of bone allografts combined with bone marrow stromal cells on the healing of segmental bone defects in a sheep model

Ligamentoplastia del ligamento cruzado anterior monotúnel transtibial y bitúnel anatómica: estudio comparativo. [Anterior cruciate ligamentoplasty transtibial single tunnel and anatomical double tunnel: a comparative study]

The influence of femoral tunnel length on graft rupture after anterior cruciate ligament reconstruction

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