Bioengineering Labs, Department of Orthopaedics, Rhode Island Hospital, Coro West, Suite 404, 1 Hoppin Street, Providence, RI 02903, USA.
Am J Sports Med. 2013 Aug;41(8):1762-70. doi: 10.1177/0363546513483446. Epub 2013 Jul 15.
Although anterior cruciate ligament (ACL) reconstruction is the treatment gold standard for ACL injury, it does not reduce the risk of posttraumatic osteoarthritis. Therefore, new treatments that minimize this postoperative complication are of interest. Bioenhanced ACL repair, in which a bioactive scaffold is used to stimulate healing of an ACL transection, has shown considerable promise in short-term studies. The long-term results of this technique and the effects of the bioenhancement on the articular cartilage have not been previously evaluated in a large animal model.
(1) The structural (tensile) properties of the porcine ACL at 6 and 12 months after injury are similar when treated with bioenhanced ACL repair, bioenhanced ACL reconstruction, or conventional ACL reconstruction, and all treatments yield results superior to untreated ACL transection. (2) After 1 year, macroscopic cartilage damage following bioenhanced ACL repair is similar to that in bioenhanced ACL reconstruction and less than in conventional ACL reconstruction and untreated ACL transection.
Controlled laboratory study.
A total of 64 Yucatan mini-pigs underwent ACL transection and randomization to 4 experimental groups: no treatment, conventional ACL reconstruction, bioenhanced ACL reconstruction using a bioactive scaffold, and bioenhanced ACL repair using a bioactive scaffold. The biomechanical properties of the ligament or graft were examined and macroscopic assessments of the cartilage surfaces were performed after 6 and 12 months of healing.
The structural properties (ie, linear stiffness, yield, and maximum loads) of the ligament after bioenhanced ACL repair were not significantly different from those in bioenhanced ACL reconstruction or conventional ACL reconstruction but were significantly greater than those in untreated ACL transection after 12 months of healing. Macroscopic cartilage damage after bioenhanced ACL repair was significantly less than that in untreated ACL transection and bioenhanced ACL reconstruction, and there was a strong trend (P = .068) for less macroscopic cartilage damage than in conventional ACL reconstruction in the porcine model at 12 months.
Bioenhanced ACL repair produces a ligament that is biomechanically similar to an ACL graft and provides chondroprotection to the joint after ACL surgery.
Bioenhanced ACL repair may provide a new, less invasive treatment option that reduces cartilage damage following joint injury.
尽管前交叉韧带（ACL）重建术是 ACL 损伤的治疗金标准，但它不能降低创伤后骨关节炎的风险。因此，人们对最小化这种术后并发症的新治疗方法很感兴趣。生物增强 ACL 修复术，即在 ACL 横断处使用生物活性支架来刺激愈合，在短期研究中显示出很大的前景。在大型动物模型中，尚未对该技术的长期结果以及生物增强对关节软骨的影响进行评估。
（1）生物增强 ACL 修复、生物增强 ACL 重建或常规 ACL 重建治疗后，猪 ACL 的结构（拉伸）特性在 6 个月和 12 个月时相似，所有治疗方法的结果均优于未经治疗的 ACL 横断。（2）1 年后，生物增强 ACL 修复后的宏观软骨损伤与生物增强 ACL 重建相似，小于常规 ACL 重建和未经治疗的 ACL 横断。
对照实验室研究。
共有 64 只尤卡坦迷你猪进行 ACL 横断，并随机分为 4 个实验组：不治疗、常规 ACL 重建、使用生物活性支架的生物增强 ACL 重建和使用生物活性支架的生物增强 ACL 修复。在愈合 6 个月和 12 个月后，检查韧带或移植物的生物力学特性，并对软骨表面进行宏观评估。
生物增强 ACL 修复后的韧带结构特性（即线性刚度、屈服和最大载荷）与生物增强 ACL 重建或常规 ACL 重建无显著差异，但在愈合 12 个月后明显大于未经治疗的 ACL 横断。生物增强 ACL 修复后的宏观软骨损伤明显小于未经治疗的 ACL 横断和生物增强 ACL 重建，并且在猪模型中，与常规 ACL 重建相比，在 12 个月时，宏观软骨损伤明显减少（P =.068），具有强烈的趋势。
生物增强 ACL 修复产生的韧带在生物力学上与 ACL 移植物相似，并在 ACL 手术后为关节提供软骨保护。
生物增强 ACL 修复术可能提供一种新的、侵入性较小的治疗选择，可减少关节损伤后的软骨损伤。
