Inokuchi Takao, Matsumoto Tomoyuki, Takayama Koji, Nakano Naoki, Zhang Shurong, Araki Daisuke, Matsushita Takehiko, Kuroda Ryosuke
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Am J Sports Med. 2017 May;45(6):1359-1369. doi: 10.1177/0363546517689871. Epub 2017 Mar 10.
BACKGROUND: Vascular CD34+ cells in anterior cruciate ligament (ACL) tissue have the potential for high proliferation and multilineage differentiation that can accelerate tendon-bone healing. While patient characteristics, such as age, can affect tendon-bone healing, the influence of elapsed time after injury on the healing process is unclear. HYPOTHESIS: Cells obtained during the early phase after injury will exhibit a greater tendon-bone healing potential compared with chronic phase counterparts when applied to an immunodeficient rat model of ACL reconstruction. STUDY DESIGN: Controlled laboratory study. METHODS: Adult human ACL-ruptured tissue was harvested from patients undergoing arthroscopic primary ACL reconstruction and classified into 2 groups based on the time elapsed between injury and surgery: (1) early group (≤3 months from injury) and (2) chronic group (>3 months from injury). In addition, 76 ten-week-old female immunodeficient rats underwent ACL reconstruction, followed by intracapsular administration of one of the following: (1) ACL-derived cells from the early group (n = 5), (2) ACL-derived cells from the chronic group (n = 5), or (3) phosphate-buffered saline (PBS) only (n = 5). During the 8 weeks after surgery, histological (weeks 2, 4, 8), immunohistochemical (week 2), radiographic (weeks 0, 2, 4, 8), and biomechanical (week 8) analyses were performed to evaluate tendon-bone healing. RESULTS: In the early group, the histological evaluation showed early healing, induction of endochondral ossification-like integration, and mature bone ingrowth. Micro-computed tomography showed that the tibial bone tunnels at week 4 and week 8 were significantly reduced in the early group compared with those in the chronic group and PBS group ( P < .05). Moreover, biomechanical tensile strength was significantly greater in the early group than in the other groups ( P < .05). An accelerated healing potential in the early group was further demonstrated by the enhancement of intrinsic angiogenesis/osteogenesis and human-derived vasculogenesis/osteogenesis. CONCLUSION: Compared with human ACL-derived cells obtained during the chronic phase, cells obtained during the early phase after injury have a greater tendon-bone healing potential when used in an immunodeficient rat model of ACL reconstruction. CLINICAL RELEVANCE: During ACL reconstruction surgery, transplanting ACL remnant tissue in the early phase after injury could accelerate and enhance tendon-bone healing.
背景:前交叉韧带(ACL)组织中的血管CD34+细胞具有高增殖和多向分化潜能,可加速腱骨愈合。虽然患者特征(如年龄)会影响腱骨愈合,但损伤后时间对愈合过程的影响尚不清楚。 假设:当应用于免疫缺陷大鼠ACL重建模型时,与慢性期细胞相比,损伤后早期获得的细胞将表现出更大的腱骨愈合潜能。 研究设计:对照实验室研究。 方法:从接受关节镜下初次ACL重建的患者中获取成人ACL断裂组织,并根据损伤与手术之间的时间分为两组:(1)早期组(损伤后≤3个月)和(2)慢性组(损伤后>3个月)。此外,76只10周龄雌性免疫缺陷大鼠接受ACL重建,然后囊内给予以下之一:(1)早期组的ACL来源细胞(n = 5),(2)慢性组的ACL来源细胞(n = 5),或(3)仅磷酸盐缓冲盐水(PBS)(n = 5)。在术后8周内,进行组织学(第2、4、8周)、免疫组织化学(第2周)、影像学(第0、2、4、8周)和生物力学(第8周)分析以评估腱骨愈合。 结果:在早期组中,组织学评估显示早期愈合、诱导软骨内成骨样整合和成熟骨长入。微计算机断层扫描显示,与慢性组和PBS组相比,早期组在第4周和第8周时胫骨骨隧道明显减小(P <.05)。此外,早期组的生物力学拉伸强度明显高于其他组(P <.05)。早期组中固有血管生成/骨生成和人源性血管生成/骨生成的增强进一步证明了其加速愈合的潜能。 结论:与慢性期获得的人ACL来源细胞相比,损伤后早期获得的细胞在免疫缺陷大鼠ACL重建模型中使用时具有更大的腱骨愈合潜能。 临床意义:在ACL重建手术中,损伤后早期移植ACL残余组织可加速和增强腱骨愈合。
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