Structure and Function of the Healing Medial Collateral Ligament in a Goat Model

Scheffler, Sven; Clineff, Theodore D.; Papageorgiou, Christos D.; Debski, Richard E.; Ma, C B; Woo, Savio L‐Y.

doi:10.1114/1.1349701

Cited by 42 publications

(38 citation statements)

References 18 publications

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“…While prior work has shown that storage at À208C has no detrimental effect on the mechanical properties of ligaments, 57 it is important to note that the experimental and intact knees were treated differently.…”

Section: Discussionmentioning

confidence: 99%

Collagen‐platelet rich plasma hydrogel enhances primary repair of the porcine anterior cruciate ligament

Murray¹,

Spindler²,

Abreu³

et al. 2006

Journal Orthopaedic Research

293

272

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ABSTRACT:The anterior cruciate ligament (ACL) fails to heal after suture repair. One hypothesis for this failure is the premature loss of the fibrin clot, or provisional scaffolding, between the two ligament ends in the joint environment. To test this hypothesis, a substitute provisional scaffold of collagen-platelet rich plasma (PRP) hydrogel was used to fill the ACL wound site at the time of suture repair and the structural properties of the healing ACLs evaluated 4 weeks after surgery. Bilateral ACL transections were performed in five 30-kg Yorkshire pigs and treated with suture repair. In each animal, one of the repairs was augmented with placement of a collagen-PRP hydrogel at the ACL transection site, while the contralateral knee had suture repair alone. In addition, six control knees with intact ACLs from three additional animals were used as a control group. No postoperative immobilization was used. After 4 weeks the animals underwent in vivo magnetic resonance imaging to assess the size of the healing ACL, followed by biomechanical testing to determine tensile properties. The supplementation of suture repair with a collagen-PRP hydrogel resulted in significant improvements in load at yield, maximum load, and linear stiffness at 4 weeks. We conclude that use of a stabilized provisional scaffold, such as a collagen-PRP hydrogel, to supplement primary repair of the ACL can result in improved biomechanical properties at an early time point. Further studies to determine the long-term effect of primary repair enhancement are needed. ß

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Section: Discussionmentioning

confidence: 99%

Collagen‐platelet rich plasma hydrogel enhances primary repair of the porcine anterior cruciate ligament

Murray¹,

Spindler²,

Abreu³

et al. 2006

Journal Orthopaedic Research

293

272

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“…As one of the rare examples, the experimental work by Abramowitch et al [87] on healing medial collateral ligaments (MCL) in goat knees provides excellent data to validate the HTR model. In their experiments, the MCL is surgically sectioned, and the free ends of the ligament are realigned but not sutured, leaving a gap of about 0.5 cm between the free ends [87,88]. The wound is then closed, and the animals are allowed to recover for six weeks, after which they are humanely euthanized and their knees are prepared for testing.…”

Section: Healing Ligamentmentioning

confidence: 99%

A homeostatic-driven turnover remodelling constitutive model for healing in soft tissues

Comellas

Gasser

Bellomo

et al. 2016

J. R. Soc. Interface.

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Remodelling of soft biological tissue is characterized by interacting biochemical and biomechanical events, which change the tissue's microstructure, and, consequently, its macroscopic mechanical properties. Remodelling is a well-defined stage of the healing process, and aims at recovering or repairing the injured extracellular matrix. Like other physiological processes, remodelling is thought to be driven by homeostasis, i.e. it tends to re-establish the properties of the uninjured tissue. However, homeostasis may never be reached, such that remodelling may also appear as a continuous pathological transformation of diseased tissues during aneurysm expansion, for example. A simple constitutive model for soft biological tissues that regards remodelling as homeostatic-driven turnover is developed. Specifically, the recoverable effective tissue damage, whose rate is the sum of a mechanical damage rate and a healing rate, serves as a scalar internal thermodynamic variable. In order to integrate the biochemical and biomechanical aspects of remodelling, the healing rate is, on the one hand, driven by mechanical stimuli, but, on the other hand, subjected to simple metabolic constraints. The proposed model is formulated in accordance with continuum damage mechanics within an open-system thermodynamics framework. The numerical implementation in an in-house finite-element code is described, particularized for Ogden hyperelasticity. Numerical examples illustrate the basic constitutive characteristics of the model and demonstrate its potential in representing aspects of remodelling of soft tissues. Simulation results are verified for their plausibility, but also validated against reported experimental data.

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“…More specifically, ACL and MCL structures tend to heal at varying rates comparatively, and the quality of remodeled tissue overall among different animal species remains inferior to that of normal ligaments [53,54,56,60,63,68,[79][80][81][82][83]. In fact, studies of healing ligaments have consistently shown that certain ligaments do not heal independently following rupture, and those that do heal, do so with characteristically inferior compositional properties compared with normal tissue [64,74,84,85].…”

Section: Remodeled Ligaments -Not Nearly As Good As Newmentioning

confidence: 99%

Ligament Injury and Healing: A Review of Current Clinical Diagnostics and Therapeutics

Hauser¹

2013

TOREHJ

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Ligament injuries are among the most common causes of musculoskeletal joint pain and disability encountered in primary practice today. Ligament injures create disruptions in the balance between joint mobility and joint stability, causing abnormal force transmission through the joint, which results in damage to other structures in and around the joint. The long-term consequence of nonhealed ligament injury is osteoarthritis, the most common joint disorder in the world today.Ligaments heal through a distinct sequence of cellular events that take place in three consecutive stages: an acute inflammatory phase, a proliferative or regenerative phase, and a tissue remodeling phase. The process can take months to resolve itself, and despite advances in therapeutics, many ligaments do not regain their normal tensile strength.Various diagnostic procedures have been used to determine and assess ligament injury. Traditionally, MRI and X-rays have been the most utilized techniques; however, because ligaments do not show up clearly with these devices, there have been many false positives and negatives reported due to inconclusive or inaccurate readings. Newer technologies, such as ultrasound and digital motion X-ray, are able to provide a more detailed image of a ligament's structure and function.Numerous strategies have been employed over the years attempting to improve ligament healing after injury or surgery. One of the most important of these is based on the understanding that monitoring early resumption of activity can stimulate repair and restoration of function and that prolonging rest may actually delay recovery and adversely affect the tissue's response to repair. Likewise, there is a shift away from the use of steroid injections and nonsteroidal antiinflammatory medications. Although these compounds have been shown effective in decreasing the inflammation and pain of ligament injuries for up to six to eight weeks, their use has been shown to inhibit the histological, biochemical, and biomechanical properties of ligament healing. For this reason their use is cautioned against in athletes who have ligament injuries. Such products are no longer recommended for chronic soft tissue injuries or for acute ligament injuries, except for the shortest possible time, if at all.Regenerative medicine techniques, such as prolotherapy, have been shown, in both case series and clinical studies, to resolve ligament injuries of the spine and peripheral joints. More research and additional studies are needed to better assess ligament injuries and healing properties.

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Structure and Function of the Healing Medial Collateral Ligament in a Goat Model

Cited by 42 publications

References 18 publications

Collagen‐platelet rich plasma hydrogel enhances primary repair of the porcine anterior cruciate ligament

Collagen‐platelet rich plasma hydrogel enhances primary repair of the porcine anterior cruciate ligament

A homeostatic-driven turnover remodelling constitutive model for healing in soft tissues

Ligament Injury and Healing: A Review of Current Clinical Diagnostics and Therapeutics

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