Soft-tissue graft fixation in anterior cruciate ligament reconstruction

Robbe, Rudy; Paletta, George A.

doi:10.1053/j.otsm.2004.07.010

Cited by 9 publications

(7 citation statements)

References 47 publications

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“…Bone-patellar tendon‐bone autografts present one treatment option but can often induce complications such as knee stiffness, patellofemoral pain and donor site morbidity, symptomatic to the graft’s harvest ( Peterson et al, 2001 ). An alternative treatment choice is reconstruction of the ACL using semitendinosus or gracilis tendon autograft, which has increased in use with significant improvements in fixation methods ( Aga et al, 2013; Kousa et al, 2003a, 2003b; Robbe and Paletta, 2004; Samuelsson et al, 2013 ). However, these grafts also suffer complications of donor site morbidity and nerve damage during the harvesting procedure remains a possibility.…”

Section: Introductionmentioning

confidence: 99%

A biomechanical characterisation of acellular porcine super flexor tendons for use in anterior cruciate ligament replacement: Investigation into the effects of fat reduction and bioburden reduction bioprocesses

Herbert

Jones

Ingham

et al. 2015

Journal of Biomechanics

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The decellularisation of xenogenic and allogeneic biological grafts offers a promising solution to replacement of the anterior cruciate ligament (ACL). The purpose of this investigation was to determine the biomechanical effects of additional fat reduction and bioburden reduction steps in the decellularisation of porcine super flexor tendon (pSFT). Study 1 investigated the use of acetone or chloroform–methanol as a fat reduction agent. The most effective of these was then carried forward into Study 2, which investigated the use of antibiotics or peracetic acid (PAA) as a bioburden reduction agent. Stress relaxation data was analysed using a Maxwell–Wiechert viscoelastic model and, in addition to classical material properties, the tangent modulus of the toe-region was determined from strength testing data. In both studies, the majority of decellularised groups demonstrated no statistical differences for material properties such as tensile strength and Young’s modulus compared to native controls. Different trends were observed for many of the viscoelastic parameters, but also for the tangent modulus in the toe-region indicating a change in performance at low strains. The most severe deviations from the profile of the native tangent modulus were found to occur in Study 2 when PAA was used for bioburden reduction. Classic material properties (E, UTS etc.) are often used to compare the characteristics of native and decellularised tissues, however they may not highlight changes occurring in the tissues at low strains. In this study, this represented the physiological strains encountered by substitute acellular ACL grafts. Acetone was chosen as the fat reduction step whereas, antibiotics was preferable over PAA as a bioburden reduction step.

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Section: Introductionmentioning

confidence: 99%

A biomechanical characterisation of acellular porcine super flexor tendons for use in anterior cruciate ligament replacement: Investigation into the effects of fat reduction and bioburden reduction bioprocesses

Herbert

Jones

Ingham

et al. 2015

Journal of Biomechanics

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“…In our study, we used suspensory fixation of the hamstring tendon graft: endobutton at the exit of the femoral tunnel and mini-disc at the exit of the tibial tunnel. Fixation methods commonly used in ACLR could be included in two types [28]: (1) fixation at a distance such as TransFix and EndoButton;…”

Section: Discussionmentioning

confidence: 99%

Double-bundle Anatomic Anterior Cruciate Ligament Reconstruction Using Hamstring-bone Graft: a Long-term Follow Up

Gan

Martin

et al. 2021

Preprint

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Purpose We modified the hamstring tendon graft into the hamstring-bone composite graft in double-bundle anterior cruciate ligament reconstruction for anterior cruciate ligament (ACL) injuries. Here, we evaluated the technique's effectiveness by investigating the clinical results in restoring the stability and function of the knee joint. Methods We reviewed 42 patients who underwent anterior cruciate ligament reconstruction (ACLR) with the hamstring-bone graft for ACL injuries from January 2013 to April 2015, with an average follow-up of 66.6 months. The objective evaluations (KT-1000, Lachman test and pivot-shift test) and the subjective evaluations (International Knee Documentation Committee (IKDC) scores, Lysholm scores, and Tegner scores) were performed preoperatively and postoperatively. Results Forty-one of 42 patients were negative in the Lachman test and forty of 42 patients were negative in the pivot-shift test after the operation at the final follow-up time. The IKDC, Lysholm, and Tegner scores improved significantly from 56.24±9.28 to 85.33±3.37, from 62.00±11.09 to 90.43±3.71，and from 2.3±0.87 to 6.5±0.67 at the final follow-up. Conclusion Double-bundle anatomic ACLR with a hamstring-bone composite graft can restore the anteroposterior and rotational stability for ACL injuries. The modified technique can provide excellent clinical outcomes with a long-term follow-up.

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“…Commonly used fixation methods could be divided into two types: (1) fixation at the joint surface with interference screw and (2) fixation at a distance such as staples, screws with washers, TransFix and EndoButton. 35 Weiler et al demonstrated that fixation at the joint surface using interference fit fixation might neutralize tendon graft-tunnel motions, and thus promoted the development of a direct type of ligament insertion at the joint surface. 36 However, in this systematic review, cartilage-like tissue at tendon graft-bone interface was only reported in limited cases though interference screw was used for graft fixation.…”

Section: Discussionmentioning

confidence: 99%

“…This technique may allow the ingrowth of blood vessels along the entire length of the tendon graft. 35 In this study, 37 cases were included for analysis. Unexpectedly, there were 10 cases failed to integrate tendon graft with the surrounding bone and suspensory type of fixation was used in these failure cases.…”

Section: Discussionmentioning

confidence: 99%

Tendon Healing in Bone Tunnel after Human Anterior Cruciate Ligament Reconstruction: A Systematic Review of Histological Results

et al. 2018

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Most studies concerning to tendon healing and incorporation into bone are mainly based on animal studies due to the invasive nature of the biopsy procedure. The evidence considering tendon graft healing to bone in humans is limited in several case series or case reports, and therefore, it is difficult to understand the healing process. A computerized search using relevant search terms was performed in the PubMed, EMBASE, Scopus, and Cochrane Library databases, as well as a manual search of reference lists. Searches were limited to studies that investigated tendon graft healing to bone by histologic examination after anterior cruciate ligament (ACL) reconstruction with hamstring. Ten studies were determined to be eligible for this systematic review. Thirty-seven cases were extracted from the included studies. Most studies showed that a fibrovascular interface would form at the tendon-bone interface at the early stage and a fibrous indirect interface with Sharpey-like fibers would be expected at the later stage. Cartilage-like tissue at tendon graft-bone interface was reported in three studies. Tendon graft failed to integrate with the surrounding bone in 10 of the 37 cases. Unexpectedly, suspensory type of fixation was used for the above failure cases. An indirect type of insertion with Sharpey-like fibers at tendon-bone interface could be expected after ACL reconstruction with hamstring. Regional cartilage-like tissue may form at tendon-bone interface occasionally. The underlying tendon-to-bone healing process is far from understood in the human hamstring ACL reconstruction. Further human studies are highly needed to understand tendon graft healing in bone tunnel after hamstring ACL reconstruction.

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Soft-tissue graft fixation in anterior cruciate ligament reconstruction

Cited by 9 publications

References 47 publications

A biomechanical characterisation of acellular porcine super flexor tendons for use in anterior cruciate ligament replacement: Investigation into the effects of fat reduction and bioburden reduction bioprocesses

A biomechanical characterisation of acellular porcine super flexor tendons for use in anterior cruciate ligament replacement: Investigation into the effects of fat reduction and bioburden reduction bioprocesses

Double-bundle Anatomic Anterior Cruciate Ligament Reconstruction Using Hamstring-bone Graft: a Long-term Follow Up

Tendon Healing in Bone Tunnel after Human Anterior Cruciate Ligament Reconstruction: A Systematic Review of Histological Results

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