Saab Marc, Hildebrand Feng, Martel Bernard, Blanchemain Nicolas
CHU Lille, Orthopaedic and Traumatology Department, Hôpital Roger Salengro, Lille, France.
U1008 Controlled Drug Delivery Systems and Biomaterials, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Lille, University of Lille, Lille, France.
Arthroscopy. 2023 Feb;39(2):529-548.e9. doi: 10.1016/j.arthro.2022.05.011. Epub 2022 Jun 15.
To perform a systematic literature review to analyze the results of the in vivo animal models and strategies that use osteoinductive materials to enhance the tendon graft-bone interface for anterior cruciate ligament reconstruction (ACLR).
Following the Preferred Reporting Items for Systemic Reviews and Meta-Analysis guidelines, the PubMed, Embase, and Web of Science databases were searched. The inclusion criteria were studies of in vivo animal models of ACLR using a material to enhance tendon graft-bone interface healing and reporting at least the histologic results at the interface, along with radiologic and biomechanical data. Studies without control group or with another tendon-bone healing model were excluded. Methodologic quality was assessed with the Animal Research: Reporting In Vivo Experiments 1guidelines.
Twenty-seven studies met the inclusion criteria. Rabbit was the main animal model of ACLR, along with sheep and dog models. ACLR procedures varied widely between studies.. The main promising strategies and materials were wrapping the material around the graft, with a collagen scaffold loaded with an osteoinductive molecule (mostly bone morphogenetic proteins). The second strategy consisted of injecting the material at the tendon-bone interface; calcium phosphate cement or a derivative were the most used materials. Finally, using osteoinductive fixation devices was the third strategy; magnesium-based interference screws seemed to show most favorable results.
The studies retained had major methodologic flaws that limit the scope of these conclusions. However, based on histologic, biomechanical, and radiologic analyses, the most promising materials were a collagen scaffold loaded with an osteoinductive molecule and wrapped around the graft, calcium phosphate cement injected in the bone tunnel, and a magnesium-based fixation device.
In vivo animal models have identified several promising strategies and materials to optimize the tendon-bone interface after ACLR, but standardized and reproducible assessments are needed before these strategies can be adopted clinically.
进行一项系统的文献综述，以分析使用骨诱导材料增强前交叉韧带重建（ACLR）中肌腱移植物 - 骨界面的体内动物模型及策略的结果。
按照系统评价和Meta分析的首选报告项目指南，检索了PubMed、Embase和科学网数据库。纳入标准为关于使用材料增强肌腱移植物 - 骨界面愈合的ACLR体内动物模型研究，并至少报告界面处的组织学结果以及放射学和生物力学数据。排除无对照组或采用其他肌腱 - 骨愈合模型的研究。采用《动物研究：体内实验报告》指南评估方法学质量。
27项研究符合纳入标准。兔是ACLR的主要动物模型，还有绵羊和犬模型。不同研究间ACLR手术差异很大。主要有前景的策略和材料包括将材料包裹在移植物周围，使用负载骨诱导分子（大多为骨形态发生蛋白）的胶原支架。第二种策略是在肌腱 - 骨界面注射材料；磷酸钙骨水泥或其衍生物是最常用的材料。最后，使用骨诱导固定装置是第三种策略；镁基干涉螺钉似乎显示出最有利的结果。
纳入的研究存在重大方法学缺陷，限制了这些结论的适用范围。然而，基于组织学、生物力学和放射学分析，最有前景的材料是负载骨诱导分子并包裹在移植物周围的胶原支架、注入骨隧道的磷酸钙骨水泥以及镁基固定装置。
体内动物模型已确定了几种有前景的策略和材料来优化ACLR后的肌腱 - 骨界面，但在这些策略能够临床应用之前，需要进行标准化和可重复的评估。
