Solomon Ruth, Hommen Jan Pieter, Travascio Francesco
Department of Industrial and System Engineering, University of Miami, Coral Gables, FL 33146, USA.
Department of Orthopedics, Florida International University, Miami, FL 33199, USA.
Pathophysiology. 2022 Jul 26;29(3):394-404. doi: 10.3390/pathophysiology29030031.
The anterior cruciate ligament (ACL) is a commonly injured ligament in the knee. Bone tunnel widening is a known phenomenon after soft-tissue ACL reconstruction and etiology and the clinical relevance has not been fully elucidated. Osteoconductive compounds are biomaterials providing an appropriate scaffold for bone formation such as a demineralized bone matrix. Osteoinductive materials contain growth factors stimulating bone lineage cells and bone growth. A possible application of osteoinductive/osteoconductive (OIC) material is in ACL surgery. We hypothesized that OIC placed in ACL bone tunnels: (1) reduces tunnel widening, (2) improves graft maturation, and (3) reduces tunnel ganglion cyst formation. To test this hypothesis, this study evaluated the osteogenic effects of demineralized bone matrix (DBM) and platelet-rich plasma (PRP) on tunnel widening, graft maturation, and ganglion cyst formation. This was a randomized controlled clinical trial pilot study. A total of 26 patients that elected to have ACL reconstruction surgery were randomized between the OIC and control group. Measurements of tunnel expansion and graft-tunnel incorporation were conducted via the quantitative image analysis of MRI scans performed at six months after surgery for both groups. No patients had adverse post-operative reactions or infections. The use of OIC significantly reduced tunnel widening (p < 0.05) and improved graft maturation (p < 0.05). Patients treated with OIC had a significantly lower prevalence of ganglion cyst compared to the control group (p < 0.05). The use of OIC has measurable effects on the reduction of tunnel widening, improved graft maturation, and decreased size of ganglion cyst after ACL reconstruction. This study explored the utilization of biologics to minimize bone tunnel widening in ACL reconstruction surgery.
前交叉韧带（ACL）是膝关节中常见的受损韧带。在软组织ACL重建术后，骨隧道扩大是一种已知现象，其病因及临床相关性尚未完全阐明。骨传导性化合物是为骨形成提供合适支架的生物材料，如脱矿骨基质。骨诱导材料含有刺激骨系细胞和骨生长的生长因子。骨诱导/骨传导（OIC）材料在ACL手术中可能有应用。我们假设将OIC置于ACL骨隧道中：（1）可减少隧道扩大；（2）可促进移植物成熟；（3）可减少隧道腱鞘囊肿形成。为验证这一假设，本研究评估了脱矿骨基质（DBM）和富血小板血浆（PRP）对隧道扩大、移植物成熟及腱鞘囊肿形成的成骨作用。这是一项随机对照临床试验试点研究。共有26例选择进行ACL重建手术的患者被随机分为OIC组和对照组。通过对两组术后6个月进行的MRI扫描进行定量图像分析，测量隧道扩张和移植物与隧道的融合情况。所有患者均无术后不良反应或感染。使用OIC可显著减少隧道扩大（p<0.05）并促进移植物成熟（p<0.05）。与对照组相比，接受OIC治疗的患者腱鞘囊肿患病率显著更低（p<0.05）。使用OIC对ACL重建术后减少隧道扩大、促进移植物成熟及减小腱鞘囊肿大小具有可测量的效果。本研究探索了利用生物制剂来最小化ACL重建手术中骨隧道扩大的方法。
