Fleming Braden C, Proffen Benedikt L, Vavken Patrick, Shalvoy Matthew R, Machan Jason T, Murray Martha M
Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI, USA,
Knee Surg Sports Traumatol Arthrosc. 2015 Apr;23(4):1161-70. doi: 10.1007/s00167-014-2932-6. Epub 2014 Mar 18.
The use of an extracellular matrix scaffold (ECM) combined with platelets to enhance healing of an anterior cruciate ligament (ACL) graft ("bio-enhanced ACL reconstruction") has shown promise in animal models. However, the effects of platelet concentration on graft healing remain unknown. The objectives of this study were to determine whether increasing the platelet concentration in the ECM scaffold would (1) improve the graft biomechanical properties and (2) decrease cartilage damage after surgery.
Fifty-five adolescent minipigs were randomized to five treatment groups: untreated ACL transection (n = 10), conventional ACL reconstruction (n = 15) and bio-enhanced ACL reconstruction using 1× (n = 10), 3× (n = 10) or 5× (n = 10) platelet-rich plasma. The graft biomechanical properties, anteroposterior (AP) knee laxity, graft histology and macroscopic cartilage integrity were measured at 15 weeks.
The mean linear stiffness of the bio-enhanced ACL reconstruction procedure using the 1× preparation was significantly greater than traditional reconstruction, while the 3× and 5× preparations were not. The failure loads of all the ACL-reconstructed groups were equivalent but significantly greater than untreated ACL transection. There were no significant differences in the Ligament Maturity Index or AP laxity between reconstructed knees. Macroscopic cartilage damage was relatively minor, though significantly less when the ECM-platelet composite was used.
Only the 1× platelet concentration improved healing over traditional ACL reconstruction. Increasing the platelet concentration from 1× to 5× in the ECM scaffold did not further improve the graft mechanical properties. The use of an ECM-platelet composite decreased the amount of cartilage damage seen after ACL surgery.
在动物模型中，使用细胞外基质支架（ECM）联合血小板来促进前交叉韧带（ACL）移植物的愈合（“生物增强ACL重建”）已显示出前景。然而，血小板浓度对移植物愈合的影响仍不清楚。本研究的目的是确定在ECM支架中增加血小板浓度是否会（1）改善移植物的生物力学性能，以及（2）减少术后软骨损伤。
55只青春期小型猪被随机分为五个治疗组：未处理的ACL横断组（n = 10）、传统ACL重建组（n = 15）以及使用1倍（n = 10）、3倍（n = 10）或5倍（n = 10）富血小板血浆的生物增强ACL重建组。在15周时测量移植物的生物力学性能、膝关节前后向（AP）松弛度、移植物组织学和宏观软骨完整性。
使用1倍制剂的生物增强ACL重建手术的平均线性刚度显著大于传统重建，而3倍和5倍制剂则不然。所有ACL重建组的失效载荷相当，但显著大于未处理ACL横断组。重建膝关节之间的韧带成熟指数或AP松弛度没有显著差异。宏观软骨损伤相对较小，不过使用ECM - 血小板复合材料时损伤明显更小。
只有1倍血小板浓度比传统ACL重建能更好地促进愈合。在ECM支架中将血小板浓度从1倍增加到5倍并没有进一步改善移植物的力学性能。使用ECM - 血小板复合材料减少了ACL手术后可见的软骨损伤量。
