Takashima Yoshinori, Matsumoto Tomoyuki, Nakano Naoki, Kamenaga Tomoyuki, Kuroda Yuichi, Hayashi Shinya, Matsushita Takehiko, Niikura Takahiro, Kuroda Ryosuke
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
J Orthop Res. 2023 Mar;41(3):500-510. doi: 10.1002/jor.25387. Epub 2022 Jun 7.
The purpose of this study was to determine whether the transplantation of human cells from a non-reattached injured anterior cruciate ligament (ACL) remnant could enhance tendon-bone healing. Human ACL remnant tissue was classified into two groups based on the morphologic pattern as per Crain's classification: (1) non-reattachment group (Crain Ⅳ) and (2) reattachment group (Crain Ⅰ-Ⅲ). Seventy-five 10-week-old immunodeficient rats underwent ACL reconstruction followed by intracapsular administration of one of the following: (1) ACL-derived cells from the non-reattached remnant (non-reattachment group) (n = 5), (2) ACL-derived cells from the reattached tissue (reattachment group) (n = 5), or (3) phosphate-buffered saline (PBS) only (PBS group) (n = 5). Histological (Weeks 2, 4, and 8), immunohistochemical (Week 2), radiographic (Weeks 0, 2, 4, and 8), and biomechanical (Week 8) assessments were performed. Histological evaluation showed high and early healing, induction of endochondral ossification-like integration, and mature bone ingrowth at Week 4 in the non-reattachment group. Microcomputed tomography at Week 4 showed that the tibial bone tunnels in the non-reattachment group were significantly reduced compared to those in the reattachment and PBS groups. Moreover, biomechanical testing showed that ultimate load-to-failure in the non-reattachment group tended to be larger than that in the reattachment group, though not statistically significant. The enhanced healing potential in the non-reattachment group was explained by the increase in intrinsic angiogenesis/osteogenesis. In the subacute phase, the ACL-derived cells with the non-reattached morphologic pattern showed greater and earlier tendon bone healing compared with the cells obtained from the reattached morphologic pattern.
本研究的目的是确定从不附着的损伤前交叉韧带（ACL）残端移植人细胞是否能促进腱骨愈合。根据Crain分类法，将人ACL残端组织按形态学模式分为两组：（1）不附着组（CrainⅣ）和（2）附着组（CrainⅠ-Ⅲ）。75只10周龄的免疫缺陷大鼠接受ACL重建，然后在关节囊内给予以下之一：（1）从不附着残端获取的ACL来源细胞（不附着组）（n = 5），（2）从附着组织获取的ACL来源细胞（附着组）（n = 5），或（3）仅磷酸盐缓冲盐水（PBS）（PBS组）（n = 5）。进行了组织学（第2、4和8周）、免疫组织化学（第2周）、影像学（第0、2、4和8周）和生物力学（第8周）评估。组织学评估显示，不附着组在第4周时愈合良好且较早，诱导了软骨内成骨样整合，并有成熟的骨长入。第4周的微型计算机断层扫描显示，不附着组的胫骨骨隧道与附着组和PBS组相比明显减小。此外，生物力学测试表明，不附着组的极限破坏载荷倾向于大于附着组，尽管无统计学意义。不附着组愈合潜力增强的原因是内在血管生成/骨生成增加。在亚急性期，具有不附着形态模式的ACL来源细胞与从附着形态模式获得的细胞相比，显示出更大且更早的腱骨愈合。
