Hexter Adam T, Karali Aikaterina, Kao Alex, Tozzi Gianluca, Heidari Nima, Petrie Aviva, Boyd Ashleigh, Kalaskar Deepak M, Pendegrass Catherine, Rodeo Scott, Haddad Fares, Blunn Gordon
Division of Surgery and Interventional Science, University College London, London, UK.
Zeiss Global Centre, School of Mechanical and Design Engineering, University of Portsmouth, Portsmouth, UK.
Orthop J Sports Med. 2021 Sep 21;9(9):23259671211034166. doi: 10.1177/23259671211034166. eCollection 2021 Sep.
The effect of demineralized bone matrix (DBM), bone marrow-derived mesenchymal stromal cells (BMSCs), and platelet-rich plasma (PRP) on bone tunnel healing in anterior cruciate ligament reconstruction (ACLR) has not been comparatively assessed.
These orthobiologics would reduce tunnel widening, and the effects on tunnel diameter would be correlated with tunnel wall sclerosis.
Controlled laboratory study.
A total of 20 sheep underwent unilateral ACLR using tendon allograft and outside-in interference screw fixation. The animals were randomized into 4 groups (n = 5 per group): Group 1 received 4mL of DBM paste, group 2 received 10 million BMSCs in fibrin sealant, group 3 received 12 mL of activated leukocyte-poor platelet-rich plasma, and group 4 (control) received no treatment. The sheep were euthanized after 12 weeks, and micro-computed tomography scans were performed. The femoral and tibial tunnels were divided into thirds (aperture, midportion, and exit), and the trabecular bone structure, bone mineral density (BMD), and tunnel diameter were measured. Tunnel sclerosis was defined by a higher bone volume in a 250-µm volume of interest compared with a 4-mm volume of interest surrounding the tunnel.
Compared with the controls, the DBM group had a significantly higher bone volume fraction (bone volume/total volume [BV/TV]) (52.7% vs 31.8%; = .020) and BMD (0.55 vs 0.47 g/cm; = .008) at the femoral aperture and significantly higher BV/TV at femoral midportion (44.2% vs 32.9%; = .038). There were no significant differences between the PRP and BMSC groups versus controls in terms of trabecular bone analysis or BMD. In the controls, widening at the femoral tunnel aperture was significantly greater than at the midportion (46.7 vs 41.7 mm; = .034). Sclerosis of the tunnel was common and most often seen at the femoral aperture. In the midportion of the femoral tunnel, BV/TV ( = 0.52; = .019) and trabecular number ( = 0.50; = .024) were positively correlated with tunnel widening.
Only DBM led to a significant increase in bone volume, which was seen in the femoral tunnel aperture and midportion. No treatment significantly reduced bone tunnel widening. Tunnel sclerosis in the femoral tunnel midportion was correlated significantly with tunnel widening.
DBM might have potential clinical use to enhance healing in the femoral tunnel after ACLR.
脱矿骨基质（DBM）、骨髓间充质干细胞（BMSCs）和富血小板血浆（PRP）在前交叉韧带重建（ACLR）中对骨隧道愈合的影响尚未得到比较评估。
这些骨科生物材料将减少隧道增宽，并且对隧道直径的影响将与隧道壁硬化相关。
对照实验室研究。
总共20只绵羊接受了同种异体肌腱移植和由外向内干涉螺钉固定的单侧ACLR。将动物随机分为4组（每组n = 5）：第1组接受4mL DBM糊剂，第2组接受纤维蛋白密封剂中含有的1000万个BMSCs，第3组接受12mL活化少白细胞富血小板血浆，第4组（对照组）不接受治疗。12周后对绵羊实施安乐死，并进行微型计算机断层扫描。将股骨和胫骨隧道分为三段（开口处、中部和出口处），并测量小梁骨结构、骨矿物质密度（BMD）和隧道直径。隧道硬化的定义为：与围绕隧道的4mm感兴趣体积相比，在250μm感兴趣体积中有更高的骨体积。
与对照组相比，DBM组在股骨开口处的骨体积分数（骨体积/总体积[BV/TV]）显著更高（52.7%对31.8%；P = 0.020）和BMD显著更高（0.55对0.47g/cm；P = 0.008），在股骨中部的BV/TV也显著更高（44.2%对32.9%；P = 0.038）。PRP组和BMSC组与对照组相比，在小梁骨分析或BMD方面没有显著差异。在对照组中，股骨隧道开口处的增宽显著大于中部（46.7对41.7mm；P = 0.034）。隧道硬化很常见，最常出现在股骨开口处。在股骨隧道中部，BV/TV（P = 0.52；P = 0.019）和小梁数量（P = 0.50；P = 0.024）与隧道增宽呈正相关。
只有DBM导致骨体积显著增加，这在股骨隧道开口处和中部可见。未治疗显著减少了骨隧道增宽。股骨隧道中部的隧道硬化与隧道增宽显著相关。
DBM可能在ACLR后增强股骨隧道愈合方面具有潜在的临床应用价值。
