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J Knee Surg 2019; 32(05): 441-447
DOI: 10.1055/s-0038-1646931
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Preclinical Model to Study the Influence of Graft Force on the Healing of the Anterior Cruciate Ligament Graft

Richard Ma
1   Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
,
Mark Stasiak
2   Sports Medicine and Shoulder Service, Tissue Engineering, Regeneration, and Repair Program, Hospital for Special Surgery, New York
,
Xiang-Hua Deng
2   Sports Medicine and Shoulder Service, Tissue Engineering, Regeneration, and Repair Program, Hospital for Special Surgery, New York
,
Scott A. Rodeo
2   Sports Medicine and Shoulder Service, Tissue Engineering, Regeneration, and Repair Program, Hospital for Special Surgery, New York
› Author Affiliations
Further Information

Publication History

13 October 2017

20 March 2018

Publication Date:
04 May 2018 (online)

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Abstract

The purpose of this study is to establish a small animal anterior cruciate ligament (ACL) reconstruction research model where ACL graft force can be varied to create different graft force patterns with controlled knee motion. Cadaveric (n = 10) and in vivo (n = 10) rat knees underwent ACL resection followed by reconstruction using a soft tissue autograft. Five cadaveric and five in vivo knees received a nonisometric, high-force femoral graft tunnel position. Five cadaveric and five in vivo knees received a more isometric, low-force graft tunnel position. ACL graft force (N) was then recorded as the knee was ranged from extension to 90 degrees using a custom knee flexion device. Our results demonstrate that distinct ACL graft force patterns were generated for the high-force and low-force femoral graft tunnels. For high-force ACL grafts, ACL graft forces increased as the knee was flexed both in cadaveric and in vivo knees. At 90 degrees of knee flexion, high-force ACL grafts had significantly greater mean graft force when compared with baseline (cadaver: 7.76 ± 0.54 N at 90 degrees vs. 4.94 ± 0.14 N at 0 degree, p = 0.004; in vivo: 7.29 ± 0.42 N at 90 degrees vs. 4.74 ± 0.13 N at 0 degree, p = 0.007). In contrast, the graft forces for low-force ACL grafts did not change with knee flexion (cadaver: 4.94 ± 0.11 N at 90 degrees vs. 4.72 ± 0.14 N at 0 degree, p = 0.41; in vivo: 4.78 ± 0.26 N at 90 degrees vs. 4.77 ± 0.06 N at 0 degree, p = 1). Compared with nonisometric ACL grafts, the graft force for grafts placed in an isometric position had significantly lower ACL graft forces at 15, 30, 45, 60, 70, and 90 degrees in both cadaveric and in vivo knees. In conclusion, we have developed a novel ACL reconstruction model that can reproducibly produce two ACL graft force patterns. This model would permit further research on how ACL graft forces may affect subsequent graft healing, maturation, and function.

Keywords

anterior cruciate ligament - graft isometry - tunnel position - ACL healing

Note

Investigation was performed at the Hospital for Special Surgery.


 

  • References

  • 1 Bedi A, Kovacevic D, Fox AJ. , et al. Effect of early and delayed mechanical loading on tendon-to-bone healing after anterior cruciate ligament reconstruction. J Bone Joint Surg Am 2010; 92 (14) 2387-2401
    CrossrefPubMedGoogle Scholar
  • 2 Brophy RH, Kovacevic D, Imhauser CW. , et al. Effect of short-duration low-magnitude cyclic loading versus immobilization on tendon-bone healing after ACL reconstruction in a rat model. J Bone Joint Surg Am 2011; 93 (04) 381-393
    CrossrefPubMedGoogle Scholar
  • 3 Rodeo SA, Kawamura S, Kim HJ. , et al. Tendon healing in a bone tunnel differs at the tunnel entrance versus the tunnel exit: an effect of graft-tunnel motion?. Am J Sports Med 2006; 34 (11) 1790-1800
    CrossrefPubMedGoogle Scholar
  • 4 Thomopoulos S, Williams GR, Soslowsky LJ. Tendon to bone healing: differences in biomechanical, structural, and compositional properties due to a range of activity levels. J Biomech Eng 2003; 125 (01) 106-113
    CrossrefPubMedGoogle Scholar
  • 5 Thomopoulos S, Zampiakis E, Das R, Silva MJ, Gelberman RH. The effect of muscle loading on flexor tendon-to-bone healing in a canine model. J Orthop Res 2008; 26 (12) 1611-1617
    CrossrefPubMedGoogle Scholar
  • 6 Thornton GM, Shao X, Chung M. , et al. Changes in mechanical loading lead to tendon specific alterations in MMP and TIMP expression: influence of stress deprivation and intermittent cyclic hydrostatic compression on rat supraspinatus and Achilles tendons. Br J Sports Med 2010; 44 (10) 698-703
    CrossrefPubMedGoogle Scholar
  • 7 Murray PJ, Alexander JW, Gold JE, Icenogle KD, Noble PC, Lowe WR. Anatomic double-bundle anterior cruciate ligament reconstruction: kinematics and knee flexion angle-graft tension relation. Arthroscopy 2010; 26 (02) 202-213
    CrossrefPubMedGoogle Scholar
  • 8 Wang JH, Kato Y, Ingham SJ. , et al. Measurement of the end-to-end distances between the femoral and tibial insertion sites of the anterior cruciate ligament during knee flexion and with rotational torque. Arthroscopy 2012; 28 (10) 1524-1532
    CrossrefPubMedGoogle Scholar
  • 9 Lubowitz JH. Anatomic ACL reconstruction produces greater graft length change during knee range-of-motion than transtibial technique. Knee Surg Sports Traumatol Arthrosc 2014; 22 (05) 1190-1195
    CrossrefPubMedGoogle Scholar
  • 10 Bedi A, Maak T, Musahl V. , et al. Effect of tibial tunnel position on stability of the knee after anterior cruciate ligament reconstruction: is the tibial tunnel position most important?. Am J Sports Med 2011; 39 (02) 366-373
    CrossrefPubMedGoogle Scholar
  • 11 Musahl V, Voos JE, O'Loughlin PF. , et al. Comparing stability of different single- and double-bundle anterior cruciate ligament reconstruction techniques: a cadaveric study using navigation. Arthroscopy 2010; 26 (9, Suppl): S41-S48
    CrossrefPubMedGoogle Scholar
  • 12 Yagi M, Wong EK, Kanamori A, Debski RE, Fu FH, Woo SL. Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction. Am J Sports Med 2002; 30 (05) 660-666
    CrossrefPubMedGoogle Scholar
  • 13 Kato Y, Ingham SJ, Kramer S, Smolinski P, Saito A, Fu FH. Effect of tunnel position for anatomic single-bundle ACL reconstruction on knee biomechanics in a porcine model. Knee Surg Sports Traumatol Arthrosc 2010; 18 (01) 2-10
    CrossrefPubMedGoogle Scholar
  • 14 Rahr-Wagner L, Thillemann TM, Pedersen AB, Lind MC. Increased risk of revision after anteromedial compared with transtibial drilling of the femoral tunnel during primary anterior cruciate ligament reconstruction: results from the Danish Knee Ligament Reconstruction Register. Arthroscopy 2013; 29 (01) 98-105
    CrossrefPubMedGoogle Scholar
  • 15 Desai N, Andernord D, Sundemo D. , et al. Revision surgery in anterior cruciate ligament reconstruction: a cohort study of 17,682 patients from the Swedish National Knee Ligament Register. Knee Surg Sports Traumatol Arthrosc 2017; 25 (05) 1542-1554
    CrossrefPubMedGoogle Scholar
  • 16 Ma R, Ju X, Deng XH, Rodeo SA. A novel small animal model of differential anterior cruciate ligament reconstruction graft strain. J Knee Surg 2015; 28 (06) 489-495
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Penner DA, Daniel DM, Wood P, Mishra D. An in vitro study of anterior cruciate ligament graft placement and isometry. Am J Sports Med 1988; 16 (03) 238-243
    CrossrefPubMedGoogle Scholar
  • 18 Stasiak ME, Wiznia D, Alzoobaee S. , et al. A novel device to apply controlled flexion and extension to the rat knee following anterior cruciate ligament reconstruction. J Biomech Eng 2012; 134 (04) 041008
    CrossrefPubMedGoogle Scholar
  • 19 Rodeo SA, Voigt C, Ma R. , et al. Use of a new model allowing controlled uniaxial loading to evaluate tendon healing in a bone tunnel. J Orthop Res 2016; 34 (05) 852-859
    CrossrefPubMedGoogle Scholar
  • 20 Zong JC, Ma R, Wang H. , et al. The effect of graft pretensioning on bone tunnel diameter and bone formation after anterior cruciate ligament reconstruction in a rat model: evaluation with micro-computed tomography. Am J Sports Med 2017; 45 (06) 1349-1358
    CrossrefPubMedGoogle Scholar
  • 21 Carbone A, Carballo C, Ma R. , et al. Indian hedgehog signaling and the role of graft tension in tendon-to-bone healing: Evaluation in a rat ACL reconstruction model. J Orthop Res 2016; 34 (04) 641-649
    CrossrefPubMedGoogle Scholar
  • 22 Brophy RH, Kovacevic D, Imhauser CW. , et al. Effect of short-duration low-magnitude cyclic loading versus immobilization on tendon-bone healing after ACL reconstruction in a rat model. J Bone Joint Surg Am 2011; 93 (04) 381-393
    CrossrefPubMedGoogle Scholar
  • 23 Nomura M, Sakitani N, Iwasawa H. , et al. Thinning of articular cartilage after joint unloading or immobilization. An experimental investigation of the pathogenesis in mice. Osteoarthritis Cartilage 2017; 25 (05) 727-736
    CrossrefPubMedGoogle Scholar
  • 24 Xu L, Li Z, Lei L. , et al. Spatial and temporal changes of subchondral bone proceed to articular cartilage degeneration in rats subjected to knee immobilization. Microsc Res Tech 2016; 79 (03) 209-218
    CrossrefPubMedGoogle Scholar
  • 25 Mutsuzaki H, Nakajima H, Wadano Y, Furuhata S, Sakane M. Influence of knee immobilization on chondrocyte apoptosis and histological features of the anterior cruciate ligament insertion and articular cartilage in rabbits. Int J Mol Sci 2017; 18 (02) E253
    CrossrefPubMedGoogle Scholar
  • 26 Musahl V, Plakseychuk A, VanScyoc A. , et al. Varying femoral tunnels between the anatomical footprint and isometric positions: effect on kinematics of the anterior cruciate ligament-reconstructed knee. Am J Sports Med 2005; 33 (05) 712-718
    CrossrefPubMedGoogle Scholar
  • 27 Mae T, Shino K, Matsumoto N, Maeda A, Nakata K, Yoneda M. Graft tension during active knee extension exercise in anatomic double bundle anterior cruciate ligament reconstruction. Arthroscopy 2010; 26 (02) 214-222
    CrossrefPubMedGoogle Scholar
  • 28 Iio K, Tsuda E, Tsukada H. , et al. Characteristics of elongated and ruptured anterior cruciate ligament grafts: an analysis of 21 consecutive revision cases. Asia Pac J Sports Med Arthrosc Rehabil Technol 2017; 8: 1-7
    PubMedGoogle Scholar