Can suture repair of ACL transection restore normal anteroposterior laxity of the knee? An ex vivo study. J Orthop Res

Department of Orthopaedics, Warren Alpert Medical School of Brown University, CORO West, 1 Hoppin Street, Providence, Rhode Island 02903, USA.
Journal of Orthopaedic Research (Impact Factor: 2.99). 11/2008; 26(11):1500-5. DOI: 10.1002/jor.20690
Source: PubMed


Recent work has suggested the transected anterior cruciate ligament (ACL) can heal and support reasonable loads if repaired with sutures and a bioactive scaffold; however, use of a traditional suture configuration results in knees with increased anterior-posterior (AP) laxity. The objective was to determine whether one of five different suture repair constructs when performed at two different joint positions would restore normal AP knee laxity. AP laxity of the porcine knee at 60 degrees of flexion was evaluated for five suture repair techniques. Femoral fixation for all repair techniques utilized a suture anchor. Primary repair was to either the tibial stump, one of three bony locations in the ACL footprint, or a hybrid bony fixation. All five repairs were tied with the knee in first 30 degrees and then 60 degrees of flexion for a total of 10 repair constructs. Suture repair to bony fixation points within the anterior half of the normal ACL footprint resulted in knee laxity values within 0.5 mm of the ACL-intact joint when the sutures were tied with the knee at 60 degrees flexion. Suture repair to the tibial stump, or with the knee at 30 degrees of flexion, did not restore normal AP laxity of the knee. Three specific suture repair techniques for the transected porcine ACL restored the normal AP laxity of the knee at the time of surgery. Additional studies defining the changes in laxity with cyclic loading and in vivo healing are indicated.

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    Ultrasonics Symposium, 2005 IEEE; 10/2005
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    ABSTRACT: In this study, we hypothesize that supplementation of suture repair of the anterior cruciate ligament (ACL) with platelet-rich plasma (PRP) will improve the biomechanics of the repair. Six 30-kg pigs underwent bilateral suture repair of the ACL. One side was treated with suture repair alone, while the contralateral side was treated with suture repair augmented with PRP. After 14 weeks in vivo, anterior-posterior (AP) knee laxity and the tensile properties of the repaired ligament were measured. The addition of PRP to the suture repairs did not improve AP knee laxity at 30 degrees (p = 0.73) or 60 degrees (p = 0.65). It also did not improve the maximum tensile load (p = 0.64) or linear stiffness (p = 0.42) of the ACL repairs after 14 weeks in vivo. The model had 80% power to detect a 30% improvement of biomechanical properties with PRP; thus, we are confident that a clinically meaningful effect as a result of adding PRP is unlikely. Use of PRP alone to supplement suture repair of the ACL is ineffective in this animal model.
    Journal of Orthopaedic Research 05/2009; 27(5):639-45. DOI:10.1002/jor.20796 · 2.99 Impact Factor
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    ABSTRACT: Background: The outcome of anterior cruciate ligament (ACL) reconstruction is variable, and many patients have increased joint laxity postoperatively.Hypothesis: Placement of a collagen-platelet composite (CPC) around the graft at the time of ACL reconstruction decreases postoperative knee laxity and improves the structural properties of the graft compared with standard ACL reconstruction. Study Design: Controlled laboratory study.Methods: Thirteen immature pigs underwent unilateral ACL reconstruction with a bone—patellar tendon—bone allograft. In 6 pigs, a standard allograft was used to reconstruct the ACL. In 7 pigs, a CPC was placed around the allograft. After 15 weeks of healing, the animals were euthanized, and the anterior-posterior (AP) knee laxity and structural properties of the graft were measured. Qualitative histology of the grafts was also performed.Results: The AP laxity values of the reconstructed knees, normalized to the contralateral control, were significantly reduced by 28% and 57% at 60° and 90° of knee flexion, respectively, with the addition of CPC (P < .001). Significant improvements in the graft structural properties were also found; the normalized yield (P = .044) and maximum failure loads (P = .025) of the CPC group were 60% higher than the standard ACL-reconstructed group. Although cellular and vessel infiltration were observed in the grafts of both groups, regions of necrosis were present only in the standard ACL-reconstructed group.Conclusion: These data demonstrate that the application of CPC at the time of ACL reconstruction improves the structural properties of the graft and reduces early AP knee laxity in the porcine model after 15 weeks of healing.Clinical Relevance: Application of a CPC to an ACL graft at the time of surgery decreased knee laxity and increased the structural properties of the graft after 15 weeks of healing.
    The American Journal of Sports Medicine 07/2009; 37(8):1554-1563. DOI:10.1177/0363546509332257 · 4.36 Impact Factor
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