Effect of Dynamic Changes in Anterior Cruciate Ligament In Situ Graft Force on the Biological Healing Response of the Graft-Tunnel Interface
Background: Anterior cruciate ligament (ACL) grafts that are placed for reconstruction are subject to complex forces. Current “anatomic” ACL reconstruction techniques may result in greater in situ graft forces. The biological effect of changing magnitudes of ACL graft force on graft-tunnel osseointe...
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| Veröffentlicht in: | The American journal of sports medicine 2018-03, Vol.46 (4), p.915-923 |
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| creator | Ma, Richard Schär, Michael Chen, Tina Sisto, Marco Nguyen, Joseph Voigt, Clifford Deng, Xiang-Hua Rodeo, Scott A. |
| description | Background:
Anterior cruciate ligament (ACL) grafts that are placed for reconstruction are subject to complex forces. Current “anatomic” ACL reconstruction techniques may result in greater in situ graft forces. The biological effect of changing magnitudes of ACL graft force on graft-tunnel osseointegration is not well understood.
Purpose:
The research objective is to determine how mechanical force on the ACL graft during knee motion affects tendon healing in the tunnel.
Study Design:
Controlled laboratory study.
Methods:
Male rats (N = 120) underwent unilateral ACL reconstruction with a soft tissue flexor tendon autograft. ACL graft force was modulated by different femoral tunnel positions at the time of surgery to create different graft force patterns with knee motion. External fixators were used to eliminate graft load during cage activity. A custom knee flexion device was used to deliver graft load through controlled daily knee motion. Graft-tunnel healing was then assessed via biomechanical, micro–computed tomography, and histological analyses.
Results:
ACL graft-tunnel healing was sensitive to dynamic changes in graft forces with postoperative knee motion. High ACL graft force with joint motion resulted in early inferior ACL graft load to failure as compared with knees that had low-force ACL grafts and joint motion and knees that were immobilized (mean ± SD: 5.50 ± 2.30 N vs 9.91 ± 3.54 N [P = .013] and 10.90 ± 2.8 N [P = .001], respectively). Greater femoral bone volume fraction was seen in immobilized knees and knees with low-force ACL grafts when compared with high-force ACL grafts at 3 and 6 weeks.
Conclusion:
The authors were able to demonstrate that ACL graft-tunnel incorporation is sensitive to dynamic changes in ACL graft force with joint motion. Early high forces on the ACL graft appear to impair graft-tunnel osseointegration.
Clinical Relevance:
Current “anatomic” techniques of ACL reconstruction may result in greater graft excursion and force with knee motion. Our results suggest that the postoperative rehabilitation regimen may need to be modified during the early phase of healing to protect the reconstruction. |
| doi_str_mv | 10.1177/0363546517745624 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1984753624</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_0363546517745624</sage_id><sourcerecordid>2015041675</sourcerecordid><originalsourceid>FETCH-LOGICAL-c431t-dbab9a4e5c7b80b4848917bfa7dad32bfbeecae27e0011f4d768b7dc9d9696e23</originalsourceid><addsrcrecordid>eNp1kU-P1SAUxYnROG-e7l0ZEjduqtBCKcvxOf-Sl5jouG6AXjpMWngCXcx3mA8t9Y1jMokrSO7vnMPlIPSOkk-UCvGZNG3DWcvLnfG2Zi_QhnJeV03T8pdos46rdX6CTlO6I4RQ0Xav0Ukta9kRITfo4dxaMBkHi7_eezU7g3e3yo-QsPP4zGeILkS8i4txKgPeu1HN4DO-9viHywu-jMpmfBGiARw8zreAv7gwhdEZNeErUJPzI_4O6RB8gjVnRf6oqpvFe5iKVUmxysAb9MqqKcHbx3OLfl6c3-yuqv23y-vd2b4yrKG5GrTSUjHgRuiOaNaxTlKhrRKDGppaWw1gFNQCysLUsqEsrcVg5CBb2ULdbNHHo-8hhl8LpNzPLhmYJuUhLKmnsmOCN-VDC_rhGXoXlujL6_qaUE4YbQu5ReRImRhSimD7Q3Szivc9Jf3aVP-8qSJ5_2i86BmGJ8HfagpQHYGkRviX-l_D3432m5o</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2015041675</pqid></control><display><type>article</type><title>Effect of Dynamic Changes in Anterior Cruciate Ligament In Situ Graft Force on the Biological Healing Response of the Graft-Tunnel Interface</title><source>SAGE Complete A-Z List</source><source>MEDLINE</source><source>Alma/SFX Local Collection</source><creator>Ma, Richard ; Schär, Michael ; Chen, Tina ; Sisto, Marco ; Nguyen, Joseph ; Voigt, Clifford ; Deng, Xiang-Hua ; Rodeo, Scott A.</creator><creatorcontrib>Ma, Richard ; Schär, Michael ; Chen, Tina ; Sisto, Marco ; Nguyen, Joseph ; Voigt, Clifford ; Deng, Xiang-Hua ; Rodeo, Scott A.</creatorcontrib><description>Background:
Anterior cruciate ligament (ACL) grafts that are placed for reconstruction are subject to complex forces. Current “anatomic” ACL reconstruction techniques may result in greater in situ graft forces. The biological effect of changing magnitudes of ACL graft force on graft-tunnel osseointegration is not well understood.
Purpose:
The research objective is to determine how mechanical force on the ACL graft during knee motion affects tendon healing in the tunnel.
Study Design:
Controlled laboratory study.
Methods:
Male rats (N = 120) underwent unilateral ACL reconstruction with a soft tissue flexor tendon autograft. ACL graft force was modulated by different femoral tunnel positions at the time of surgery to create different graft force patterns with knee motion. External fixators were used to eliminate graft load during cage activity. A custom knee flexion device was used to deliver graft load through controlled daily knee motion. Graft-tunnel healing was then assessed via biomechanical, micro–computed tomography, and histological analyses.
Results:
ACL graft-tunnel healing was sensitive to dynamic changes in graft forces with postoperative knee motion. High ACL graft force with joint motion resulted in early inferior ACL graft load to failure as compared with knees that had low-force ACL grafts and joint motion and knees that were immobilized (mean ± SD: 5.50 ± 2.30 N vs 9.91 ± 3.54 N [P = .013] and 10.90 ± 2.8 N [P = .001], respectively). Greater femoral bone volume fraction was seen in immobilized knees and knees with low-force ACL grafts when compared with high-force ACL grafts at 3 and 6 weeks.
Conclusion:
The authors were able to demonstrate that ACL graft-tunnel incorporation is sensitive to dynamic changes in ACL graft force with joint motion. Early high forces on the ACL graft appear to impair graft-tunnel osseointegration.
Clinical Relevance:
Current “anatomic” techniques of ACL reconstruction may result in greater graft excursion and force with knee motion. Our results suggest that the postoperative rehabilitation regimen may need to be modified during the early phase of healing to protect the reconstruction.</description><identifier>ISSN: 0363-5465</identifier><identifier>EISSN: 1552-3365</identifier><identifier>DOI: 10.1177/0363546517745624</identifier><identifier>PMID: 29298079</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Animals ; Anterior Cruciate Ligament - surgery ; Anterior Cruciate Ligament Injuries - surgery ; Anterior Cruciate Ligament Reconstruction - methods ; Biomechanical Phenomena ; External Fixators ; Femur - surgery ; Knee ; Knee Joint - surgery ; Ligaments ; Male ; Rats ; Rats, Sprague-Dawley ; Skin & tissue grafts ; Sports medicine ; Tendons - transplantation ; Transplantation, Autologous ; Transplants - surgery ; X-Ray Microtomography</subject><ispartof>The American journal of sports medicine, 2018-03, Vol.46 (4), p.915-923</ispartof><rights>2018 The Author(s)</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c431t-dbab9a4e5c7b80b4848917bfa7dad32bfbeecae27e0011f4d768b7dc9d9696e23</citedby><cites>FETCH-LOGICAL-c431t-dbab9a4e5c7b80b4848917bfa7dad32bfbeecae27e0011f4d768b7dc9d9696e23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0363546517745624$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0363546517745624$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29298079$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ma, Richard</creatorcontrib><creatorcontrib>Schär, Michael</creatorcontrib><creatorcontrib>Chen, Tina</creatorcontrib><creatorcontrib>Sisto, Marco</creatorcontrib><creatorcontrib>Nguyen, Joseph</creatorcontrib><creatorcontrib>Voigt, Clifford</creatorcontrib><creatorcontrib>Deng, Xiang-Hua</creatorcontrib><creatorcontrib>Rodeo, Scott A.</creatorcontrib><title>Effect of Dynamic Changes in Anterior Cruciate Ligament In Situ Graft Force on the Biological Healing Response of the Graft-Tunnel Interface</title><title>The American journal of sports medicine</title><addtitle>Am J Sports Med</addtitle><description>Background:
Anterior cruciate ligament (ACL) grafts that are placed for reconstruction are subject to complex forces. Current “anatomic” ACL reconstruction techniques may result in greater in situ graft forces. The biological effect of changing magnitudes of ACL graft force on graft-tunnel osseointegration is not well understood.
Purpose:
The research objective is to determine how mechanical force on the ACL graft during knee motion affects tendon healing in the tunnel.
Study Design:
Controlled laboratory study.
Methods:
Male rats (N = 120) underwent unilateral ACL reconstruction with a soft tissue flexor tendon autograft. ACL graft force was modulated by different femoral tunnel positions at the time of surgery to create different graft force patterns with knee motion. External fixators were used to eliminate graft load during cage activity. A custom knee flexion device was used to deliver graft load through controlled daily knee motion. Graft-tunnel healing was then assessed via biomechanical, micro–computed tomography, and histological analyses.
Results:
ACL graft-tunnel healing was sensitive to dynamic changes in graft forces with postoperative knee motion. High ACL graft force with joint motion resulted in early inferior ACL graft load to failure as compared with knees that had low-force ACL grafts and joint motion and knees that were immobilized (mean ± SD: 5.50 ± 2.30 N vs 9.91 ± 3.54 N [P = .013] and 10.90 ± 2.8 N [P = .001], respectively). Greater femoral bone volume fraction was seen in immobilized knees and knees with low-force ACL grafts when compared with high-force ACL grafts at 3 and 6 weeks.
Conclusion:
The authors were able to demonstrate that ACL graft-tunnel incorporation is sensitive to dynamic changes in ACL graft force with joint motion. Early high forces on the ACL graft appear to impair graft-tunnel osseointegration.
Clinical Relevance:
Current “anatomic” techniques of ACL reconstruction may result in greater graft excursion and force with knee motion. Our results suggest that the postoperative rehabilitation regimen may need to be modified during the early phase of healing to protect the reconstruction.</description><subject>Animals</subject><subject>Anterior Cruciate Ligament - surgery</subject><subject>Anterior Cruciate Ligament Injuries - surgery</subject><subject>Anterior Cruciate Ligament Reconstruction - methods</subject><subject>Biomechanical Phenomena</subject><subject>External Fixators</subject><subject>Femur - surgery</subject><subject>Knee</subject><subject>Knee Joint - surgery</subject><subject>Ligaments</subject><subject>Male</subject><subject>Rats</subject><subject>Rats, Sprague-Dawley</subject><subject>Skin & tissue grafts</subject><subject>Sports medicine</subject><subject>Tendons - transplantation</subject><subject>Transplantation, Autologous</subject><subject>Transplants - surgery</subject><subject>X-Ray Microtomography</subject><issn>0363-5465</issn><issn>1552-3365</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU-P1SAUxYnROG-e7l0ZEjduqtBCKcvxOf-Sl5jouG6AXjpMWngCXcx3mA8t9Y1jMokrSO7vnMPlIPSOkk-UCvGZNG3DWcvLnfG2Zi_QhnJeV03T8pdos46rdX6CTlO6I4RQ0Xav0Ukta9kRITfo4dxaMBkHi7_eezU7g3e3yo-QsPP4zGeILkS8i4txKgPeu1HN4DO-9viHywu-jMpmfBGiARw8zreAv7gwhdEZNeErUJPzI_4O6RB8gjVnRf6oqpvFe5iKVUmxysAb9MqqKcHbx3OLfl6c3-yuqv23y-vd2b4yrKG5GrTSUjHgRuiOaNaxTlKhrRKDGppaWw1gFNQCysLUsqEsrcVg5CBb2ULdbNHHo-8hhl8LpNzPLhmYJuUhLKmnsmOCN-VDC_rhGXoXlujL6_qaUE4YbQu5ReRImRhSimD7Q3Szivc9Jf3aVP-8qSJ5_2i86BmGJ8HfagpQHYGkRviX-l_D3432m5o</recordid><startdate>20180301</startdate><enddate>20180301</enddate><creator>Ma, Richard</creator><creator>Schär, Michael</creator><creator>Chen, Tina</creator><creator>Sisto, Marco</creator><creator>Nguyen, Joseph</creator><creator>Voigt, Clifford</creator><creator>Deng, Xiang-Hua</creator><creator>Rodeo, Scott A.</creator><general>SAGE Publications</general><general>Sage Publications Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>20180301</creationdate><title>Effect of Dynamic Changes in Anterior Cruciate Ligament In Situ Graft Force on the Biological Healing Response of the Graft-Tunnel Interface</title><author>Ma, Richard ; Schär, Michael ; Chen, Tina ; Sisto, Marco ; Nguyen, Joseph ; Voigt, Clifford ; Deng, Xiang-Hua ; Rodeo, Scott A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c431t-dbab9a4e5c7b80b4848917bfa7dad32bfbeecae27e0011f4d768b7dc9d9696e23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Animals</topic><topic>Anterior Cruciate Ligament - surgery</topic><topic>Anterior Cruciate Ligament Injuries - surgery</topic><topic>Anterior Cruciate Ligament Reconstruction - methods</topic><topic>Biomechanical Phenomena</topic><topic>External Fixators</topic><topic>Femur - surgery</topic><topic>Knee</topic><topic>Knee Joint - surgery</topic><topic>Ligaments</topic><topic>Male</topic><topic>Rats</topic><topic>Rats, Sprague-Dawley</topic><topic>Skin & tissue grafts</topic><topic>Sports medicine</topic><topic>Tendons - transplantation</topic><topic>Transplantation, Autologous</topic><topic>Transplants - surgery</topic><topic>X-Ray Microtomography</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ma, Richard</creatorcontrib><creatorcontrib>Schär, Michael</creatorcontrib><creatorcontrib>Chen, Tina</creatorcontrib><creatorcontrib>Sisto, Marco</creatorcontrib><creatorcontrib>Nguyen, Joseph</creatorcontrib><creatorcontrib>Voigt, Clifford</creatorcontrib><creatorcontrib>Deng, Xiang-Hua</creatorcontrib><creatorcontrib>Rodeo, Scott A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of sports medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ma, Richard</au><au>Schär, Michael</au><au>Chen, Tina</au><au>Sisto, Marco</au><au>Nguyen, Joseph</au><au>Voigt, Clifford</au><au>Deng, Xiang-Hua</au><au>Rodeo, Scott A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of Dynamic Changes in Anterior Cruciate Ligament In Situ Graft Force on the Biological Healing Response of the Graft-Tunnel Interface</atitle><jtitle>The American journal of sports medicine</jtitle><addtitle>Am J Sports Med</addtitle><date>2018-03-01</date><risdate>2018</risdate><volume>46</volume><issue>4</issue><spage>915</spage><epage>923</epage><pages>915-923</pages><issn>0363-5465</issn><eissn>1552-3365</eissn><abstract>Background:
Anterior cruciate ligament (ACL) grafts that are placed for reconstruction are subject to complex forces. Current “anatomic” ACL reconstruction techniques may result in greater in situ graft forces. The biological effect of changing magnitudes of ACL graft force on graft-tunnel osseointegration is not well understood.
Purpose:
The research objective is to determine how mechanical force on the ACL graft during knee motion affects tendon healing in the tunnel.
Study Design:
Controlled laboratory study.
Methods:
Male rats (N = 120) underwent unilateral ACL reconstruction with a soft tissue flexor tendon autograft. ACL graft force was modulated by different femoral tunnel positions at the time of surgery to create different graft force patterns with knee motion. External fixators were used to eliminate graft load during cage activity. A custom knee flexion device was used to deliver graft load through controlled daily knee motion. Graft-tunnel healing was then assessed via biomechanical, micro–computed tomography, and histological analyses.
Results:
ACL graft-tunnel healing was sensitive to dynamic changes in graft forces with postoperative knee motion. High ACL graft force with joint motion resulted in early inferior ACL graft load to failure as compared with knees that had low-force ACL grafts and joint motion and knees that were immobilized (mean ± SD: 5.50 ± 2.30 N vs 9.91 ± 3.54 N [P = .013] and 10.90 ± 2.8 N [P = .001], respectively). Greater femoral bone volume fraction was seen in immobilized knees and knees with low-force ACL grafts when compared with high-force ACL grafts at 3 and 6 weeks.
Conclusion:
The authors were able to demonstrate that ACL graft-tunnel incorporation is sensitive to dynamic changes in ACL graft force with joint motion. Early high forces on the ACL graft appear to impair graft-tunnel osseointegration.
Clinical Relevance:
Current “anatomic” techniques of ACL reconstruction may result in greater graft excursion and force with knee motion. Our results suggest that the postoperative rehabilitation regimen may need to be modified during the early phase of healing to protect the reconstruction.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>29298079</pmid><doi>10.1177/0363546517745624</doi><tpages>9</tpages></addata></record> |
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| ispartof | The American journal of sports medicine, 2018-03, Vol.46 (4), p.915-923 |
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| language | eng |
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| source | SAGE Complete A-Z List; MEDLINE; Alma/SFX Local Collection |
| subjects | Animals Anterior Cruciate Ligament - surgery Anterior Cruciate Ligament Injuries - surgery Anterior Cruciate Ligament Reconstruction - methods Biomechanical Phenomena External Fixators Femur - surgery Knee Knee Joint - surgery Ligaments Male Rats Rats, Sprague-Dawley Skin & tissue grafts Sports medicine Tendons - transplantation Transplantation, Autologous Transplants - surgery X-Ray Microtomography |
| title | Effect of Dynamic Changes in Anterior Cruciate Ligament In Situ Graft Force on the Biological Healing Response of the Graft-Tunnel Interface |
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