Download PDF
J Knee Surg 2019; 32(11): 1094-1101
DOI: 10.1055/s-0038-1675599
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Effect of Remnant Preservation on Tibial Tunnel Enlargement in Anterior Cruciate Ligament Reconstruction with Polyethylene Terephthalate Artificial Ligament in a Large Animal Model

Jiangyu Cai
1   Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic China
,
Fang Wan
1   Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic China
,
Chengchong Ai
1   Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic China
,
Wenhe Jin
1   Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic China
,
Dandan Sheng
1   Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic China
,
Xingwang Liu
1   Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic China
,
Siheng Wang
1   Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic China
,
Yunlong Zhi
1   Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic China
,
Jun Chen
1   Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic China
,
Shiyi Chen
1   Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic China
› Author Affiliations Funding This work was supported by the National Key R&D Program of China (2016YFC1100300, 2017YFC0840100 and 2017YFC0840106), the National Natural Science Foundation of China (No. 81572108 and 81772339), the Key Clinical Medicine Center of Shanghai (2017ZZ01006), the Sanming Project of Medicine in Shenzhen (SZSM20161207), the Shanghai RisingStar Project (18QB1400500), the Introduction Project of Clinical Medicine Expert Team for Suzhou (SZYJTD201714), CAS Key Laboratory of Nano-Bio Interface (No: 17NBI01) and State Key Laboratory of Molecular Engineering of Polymers (No: K2018-17).
Further Information

Publication History

04 August 2018

29 September 2018

Publication Date:
26 November 2018 (online)

    Permissions and Reprints

Abstract

An enlarged bone tunnel may affect the graft–bone integration and pose a problem for revision anterior cruciate ligament (ACL) surgery. The purpose of this study was to evaluate the effect of remnant preservation on tibial tunnel enlargement in ACL reconstruction with polyethylene terephthalate (PET) artificial ligament. Twenty-four skeletally mature male beagles underwent ACL reconstruction with PET artificial ligament for both knees. One knee was reconstructed with remnant preservation using sleeve technique (remnant group), while the contralateral was reconstructed without remnant preservation (control group). The animals were sacrificed at 1 day, 6 weeks, and 12 weeks after surgery for further evaluation including macroscopic observation, microcomputed tomography (micro-CT), histological assessment, and biomechanical testing. The remnant group had better synovial coverage than the control group at 6 and 12 weeks after surgery. The micro-CT analysis showed the tibial tunnel area (TTA) of the remnant group was significantly smaller and the bone volume/total volume fraction (BV/TV) value was higher than those of the control group at 6 and 12 weeks. Moreover, TTA and BV/TV at each time point were divided into three groups according to the different grade of synovial coverage. Significant association was observed between the synovial coverage degree and the TTA and BV/TV values. The histological assessment revealed that the interface width between the graft and host bone in the remnant group was smaller than that in the control group in the tibial tunnels at 6 and 12 weeks. Moreover, the remnant group had better failure load and stiffness than the control group at 12 weeks. The remnant preservation using sleeve technique could effectively promote the synovial coverage of the graft, decrease the risk of tibial tunnel enlargement by sealing the bone tunnel entrance, and enhance the biological environment for graft–bone healing after ACL reconstruction using PET artificial ligament. This technique provides a potential solution for bone tunnel enlargement following artificial ligament surgery for the acute ACL rupture in the clinical practice.

Keywords

remnant preservation - bone tunnel enlargement - anterior cruciate ligament - polyethylene terephthalate - artificial ligament

Supplementary Material

 

  • References

  • 1 Ahmad CS, Gardner TR, Groh M, Arnouk J, Levine WN. Mechanical properties of soft tissue femoral fixation devices for anterior cruciate ligament reconstruction. Am J Sports Med 2004; 32 (03) 635-640
    CrossrefPubMedSearch in Google Scholar
  • 2 Batty LM, Norsworthy CJ, Lash NJ, Wasiak J, Richmond AK, Feller JA. Synthetic devices for reconstructive surgery of the cruciate ligaments: a systematic review. Arthroscopy 2015; 31 (05) 957-968
    CrossrefPubMedSearch in Google Scholar
  • 3 Chang SK, Egami DK, Shaieb MD, Kan DM, Richardson AB. Anterior cruciate ligament reconstruction: allograft versus autograft. Arthroscopy 2003; 19 (05) 453-462
    CrossrefPubMedSearch in Google Scholar
  • 4 Noh JH, Yi SR, Song SJ, Kim SW, Kim W. Comparison between hamstring autograft and free tendon Achilles allograft: minimum 2-year follow-up after anterior cruciate ligament reconstruction using EndoButton and Intrafix. Knee Surg Sports Traumatol Arthrosc 2011; 19 (05) 816-822
    CrossrefPubMedSearch in Google Scholar
  • 5 Fukubayashi T, Ikeda K. Follow-up study of Gore-Tex artificial ligament--special emphasis on tunnel osteolysis. J Long Term Eff Med Implants 2000; 10 (04) 267-277
    PubMedSearch in Google Scholar
  • 6 Chen T, Zhang P, Chen J, Hua Y, Chen S. Long-term outcomes of anterior cruciate ligament reconstruction using either synthetics with remnant preservation or hamstring autografts: a 10-year longitudinal study. Am J Sports Med 2017; 45 (12) 2739-2750
    CrossrefPubMedSearch in Google Scholar
  • 7 Getelman MH, Friedman MJ. Revision anterior cruciate ligament reconstruction surgery. J Am Acad Orthop Surg 1999; 7 (03) 189-198
    CrossrefPubMedSearch in Google Scholar
  • 8 Wen CY, Qin L, Lee KM, Wong MW, Chan KM. Influence of bone adaptation on tendon-to-bone healing in bone tunnel after anterior cruciate ligament reconstruction in a rabbit model. J Orthop Res 2009; 27 (11) 1447-1456
    CrossrefPubMedSearch in Google Scholar
  • 9 Iorio R, Vadalà A, Di Vavo I. , et al. Tunnel enlargement after anterior cruciate ligament reconstruction in patients with post-operative septic arthritis. Knee Surg Sports Traumatol Arthrosc 2008; 16 (10) 921-927
    CrossrefPubMedSearch in Google Scholar
  • 10 Berg EE, Pollard ME, Kang Q. Interarticular bone tunnel healing. Arthroscopy 2001; 17 (02) 189-195
    CrossrefPubMedSearch in Google Scholar
  • 11 Hayward AL, Deehan DJ, Aspden RM, Sutherland AG. Analysis of sequential cytokine release after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2011; 19 (10) 1709-1715
    CrossrefPubMedSearch in Google Scholar
  • 12 Zhang Q, Zhang S, Cao X, Liu L, Liu Y, Li R. The effect of remnant preservation on tibial tunnel enlargement in ACL reconstruction with hamstring autograft: a prospective randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2014; 22 (01) 166-173
    CrossrefPubMedSearch in Google Scholar
  • 13 Sun L, Zhou X, Wu B, Tian M. Inhibitory effect of synovial fluid on tendon-to-bone healing: an experimental study in rabbits. Arthroscopy 2012; 28 (09) 1297-1305
    CrossrefPubMedSearch in Google Scholar
  • 14 Demirag B, Sarisozen B, Ozer O, Kaplan T, Ozturk C. Enhancement of tendon-bone healing of anterior cruciate ligament grafts by blockage of matrix metalloproteinases. J Bone Joint Surg Am 2005; 87 (11) 2401-2410
    PubMedSearch in Google Scholar
  • 15 Gulotta LV, Kovacevic D, Ying L, Ehteshami JR, Montgomery S, Rodeo SA. Augmentation of tendon-to-bone healing with a magnesium-based bone adhesive. Am J Sports Med 2008; 36 (07) 1290-1297
    CrossrefPubMedSearch in Google Scholar
  • 16 Wen CY, Qin L, Lee KM, Chan KM. The use of brushite calcium phosphate cement for enhancement of bone-tendon integration in an anterior cruciate ligament reconstruction rabbit model. J Biomed Mater Res B Appl Biomater 2009; 89 (02) 466-474
    PubMedSearch in Google Scholar
  • 17 Tanaka Y, Shino K, Horibe S. , et al. Triple-bundle ACL grafts evaluated by second-look arthroscopy. Knee Surg Sports Traumatol Arthrosc 2012; 20 (01) 95-101
    CrossrefPubMedSearch in Google Scholar
  • 18 Li H, Chen S. Biomedical coatings on polyethylene terephthalate artificial ligaments. J Biomed Mater Res A 2015; 103 (02) 839-845
    CrossrefPubMedSearch in Google Scholar
  • 19 Takahashi T, Kondo E, Yasuda K. , et al. Effects of remnant tissue preservation on the tendon graft in anterior cruciate ligament reconstruction: a biomechanical and histological study. Am J Sports Med 2016; 44 (07) 1708-1716
    CrossrefPubMedSearch in Google Scholar
  • 20 Li H, Chen C, Ge Y, Chen S. Spray-painted human fibronectin coating as an effective strategy to enhance graft ligamentization of a polyethylene terephthalate artificial ligament. Biotechnol Lett 2014; 36 (05) 1079-1088
    CrossrefPubMedSearch in Google Scholar
  • 21 Sun L, Wu B, Tian M, Liu B, Luo Y. Comparison of graft healing in anterior cruciate ligament reconstruction with and without a preserved remnant in rabbits. Knee 2013; 20 (06) 537-544
    CrossrefPubMedSearch in Google Scholar
  • 22 Li H, Chen J, Chen S. Remnant repair-enhanced polyethylene terepthalate artificial ligament graft ligamentization. Int J Sports Med 2015; 36 (12) 1015-1020
    Thieme ConnectPubMedSearch in Google Scholar
  • 23 Huang J, Liu H, Chen F. , et al. Characteristics of bone tunnel changes after anterior cruciate ligament reconstruction using Ligament Advanced Reinforcement System artificial ligament. Chin Med J (Engl) 2012; 125 (22) 3961-3965
    PubMedSearch in Google Scholar
  • 24 Wu B, Zhao Z, Li S, Sun L. Preservation of remnant attachment improves graft healing in a rabbit model of anterior cruciate ligament reconstruction. Arthroscopy 2013; 29 (08) 1362-1371
    CrossrefPubMedSearch in Google Scholar
  • 25 Lee BI, Min KD, Choi HS, Kim JB, Kim ST. Arthroscopic anterior cruciate ligament reconstruction with the tibial-remnant preserving technique using a hamstring graft. Arthroscopy 2006; 22 (03) 340.e1-340.e7
    PubMedSearch in Google Scholar
  • 26 Zhang L, Jiang K, Chai H, Zhou M, Bai J. A comparative animal study of tendon grafts healing after remnant-preserving versus conventional anterior cruciate ligament reconstruction. Med Sci Monit 2016; 22: 3426-3437
    CrossrefPubMedSearch in Google Scholar
  • 27 Song GY, Zhang J, Li X, Chen XZ, Li Y, Feng H. Acute anterior cruciate ligament reconstruction with an augmented remnant repair: a comparative macroscopic and biomechanical study in an animal model. Arthroscopy 2014; 30 (03) 344-351
    CrossrefPubMedSearch in Google Scholar