Biomechanical Outcomes of Bridge-enhanced Anterior Cruciate Ligament Repair Are Influenced by Sex in a Preclinical Model
Biomechanical Outcomes of Bridge-enhanced Anterior Cruciate Ligament Repair Are Influenced by Sex in a Preclinical Model
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DOI：
10.1007/s11999-015-4226-9
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发表时间：
2015-08-01
影响因子：
4.2
通讯作者：
Murray, Martha M.
中科院分区：
文献类型：
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作者：
Kiapour, Ata M.;Fleming, Braden C.;Murray, Martha M.
尽管性别在前交叉韧带(ACL)损伤风险中的作用已得到证实，但其对前交叉韧带手术结果的影响仍存在争议。这在开发治疗创伤的新外科技术时尤其关键，因为关于这些手术在不同性别中的反应数据有限。其中一种方法是桥接增强型前交叉韧带修复，即用饱和了自体血液的生物活性支架增强前交叉韧带的一期缝合修复。我们询问(1)性别是否影响桥接增强前交叉韧带修复的生物力学结果；以及(2)用于修复撕裂的前交叉韧带的缝线类型(可吸收或不可吸收)是否可以在大型动物临床前模型中最小化愈合15周后潜在的性别差异。17头(8雄9母)约克郡猪(美国马萨诸塞州哈德利帕森农场)接受了双侧前交叉韧带横切，并接受了一侧可吸收缝线(n=17)和另一侧不可吸收缝线(n=17)的桥式增强前交叉韧带修复。接受可吸收缝合的腿在每只动物中被随机分配。在愈合15周后，测量每个膝关节的前交叉韧带结构特性和AP膝关节松弛程度。可吸收缝线组女性前交叉韧带线硬度较低(女性11N/mm[范围8~42]；男性31N/mm[范围12~56]；差异20N/mm[95%可信区间4~36]；p=0.032)，前交叉韧带产量(女性121N[范围56~316]；男性224N[范围55~538]；差异103N[95%CI，6~200]；P=0.078)，最大负荷(女性，128N[范围，63-332]；男性，241N[范围，82-538]；差异，114N[95%可信区间，15-212]；p=0.052)。接受可吸收缝线治疗的女性膝骨线硬度较低(可吸收，11N/mm[范围，8-42]；不可吸收，25N/mm[范围，8-]；差异，14[95%CI，2-26]N；p=0.054)，前交叉韧带屈光度(可吸收，121N[范围，56-316]；不可吸收，230N[范围，149-573]；差异，109N[95%CI，56-162]；p=0.002)和最大载荷(可吸收，128N[范围，63-332])；不可吸收，235N[范围，151-593]；差异，107N[95%CI，51-163]；p=0.002)，以及30A度时更大的AP膝关节松弛(可吸收，9 mm[范围，5-12]；不可吸收，7 mm[范围，2-13]；差异，2 mm[95%CI，1-4]；p=0.034)。当使用非可吸收缝线修复时，女性和男性膝关节的生物力学结果相似(p>；0.10)。当使用可吸收缝线进行修复时，女性的生物力学结果明显比男性差。然而，不可吸收缝线的使用改善了男性和女性之间的这些差异。目前的研究结果强调了性别在相关大型动物模型中桥式增强前交叉韧带修复的生物力学结果中的关键作用。使用临床前模型和伴随的人类患者临床研究，更好地了解导致这些观察结果的机制，可能允许进一步开发针对性别的手术和康复策略，潜在地改善女性的结果。
Despite the well-established role of sex on the anterior cruciate ligament (ACL) injury risk, its effects on ACL surgical outcomes remain controversial. This is particularly critical when developing novel surgical techniques to treat the injury because there are limited data existing on how these procedures will respond in each sex. One such approach is bridge-enhanced ACL repair, in which primary suture repair of the ACL is augmented with a bioactive scaffold saturated with autologous blood. It has shown comparable biomechanical outcomes to ACL reconstruction in preclinical models.We asked (1) whether sex affects the biomechanical outcomes of bridge-enhanced ACL repair; and (2) if suture type (absorbable or nonabsorbable), used to repair the torn ACL, can minimize the potential sex discrepancies in outcomes after 15 weeks of healing in a large animal preclinical model.Seventeen (eight males, nine females) Yorkshire pigs (Parson's Farms, Hadley, MA, USA) underwent bilateral ACL transection and received bridge-enhanced ACL repair with an absorbable suture (n = 17) on one side and with a nonabsorbable suture (n = 17) on the other side. The leg receiving the absorbable suture was randomized within each animal. ACL structural properties and AP knee laxity for each knee were measured after 15 weeks of healing. Mixed linear models were used to compare the biomechanical outcomes between sexes and suture groups.When treated with absorbable suture, females had a lower ACL linear stiffness (females, 11 N/mm [range, 8-42]; males, 31 N/mm [range, 12-56]; difference, 20 N/mm [95% confidence interval {CI}, 4-36]; p = 0.032), ACL yield (females, 121 N [range, 56-316]; males, 224 N [range, 55-538]; difference, 103 N [95% CI, 6-200]; p = 0.078), and maximum load (females, 128 N [range, 63-332]; males, 241 N [range, 82-538]; difference, 114 N [95% CI, 15-212]; p = 0.052) than males after 15 weeks of healing. Female knees treated with absorbable suture had a lower linear stiffness (absorbable, 11 N/mm [range, 8-42]; nonabsorbable, 25 N/mm [range, 8-64]; difference, 14 [95% CI, 2-26] N; p = 0.054), ACL yield (absorbable, 121 N [range, 56-316]; nonabsorbable, 230 N [range, 149-573]; difference, 109 N [95% CI, 56-162]; p = 0.002), and maximum load (absorbable, 128 N [range, 63-332]; nonabsorbable, 235 N [range, 151-593]; difference, 107 N [95% CI, 51-163]; p = 0.002) along with greater AP knee laxity at 30A degrees (absorbable, 9 mm [range, 5-12]; nonabsorbable, 7 mm [range, 2-13]; difference, 2 mm [95% CI, 1-4]; p = 0.034) than females treated with nonabsorbable suture. When repaired using nonabsorbable suture, the biomechanical outcomes were similar between female and male knees (p > 0.10).Females had significantly worse biomechanical outcomes than males when the repairs were performed using absorbable sutures. However, the use of nonabsorbable sutures ameliorated these differences between males and females.The current findings highlight the critical role of sex on the biomechanical outcomes of bridge-enhanced ACL repair in a relevant large animal model. Better understanding of the mechanisms responsible for these observations using preclinical models and concomitant clinical studies in human patients may allow for additional development of sex-specific surgical and rehabilitative strategies with potentially improved outcomes in women.