Biological and Biomechanical Evaluation of the Ligament Advanced Reinforcement System (LARS AC) in a Sheep Model of Anterior Cruciate Ligament Replacement: A 3-Month and 12-Month Study
Biological and Biomechanical Evaluation of the Ligament Advanced Reinforcement System (LARS AC) in a Sheep Model of Anterior Cruciate Ligament Replacement: A 3-Month and 12-Month Study
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DOI：
10.1016/j.arthro.2013.02.025
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发表时间：
2013-06-01
影响因子：
4.7
通讯作者：
Migonney, Veronique
中科院分区：
文献类型：
--
作者：
Viateau, Veronique;Manassero, Mathieu;Migonney, Veronique
目的：本研究旨在评估高级韧带加强系统（LARS）人工韧带（LARS AC; LARS，Arc sur Tille，France）内的组织长入，并研究前交叉韧带（ACL）置换术绵羊模型中重建膝关节的生物力学特征。研究方法：25只雌性绵羊接受左侧ACL近端三分之一切除术，并使用44股聚对苯二甲酸乙二醇酯韧带（平均极限拉伸失效载荷，2，500 N）进行关节内关节稳定。手术后3个月或12个月处死动物。对取出的膝关节进行组织学（n = 10）或力学试验，包括松弛试验和拉伸失效载荷试验（n = 15）。结果如下：仅在与宿主组织接触的韧带部分（天然韧带和骨隧道）中观察到人工韧带内血管化良好的组织向内生长。在40%的膝关节置换术后观察到韧带磨损。在两个时间点，手术膝关节的极限拉伸失效载荷均低于对侧完整膝关节（3个月时为144 +/- 69 N，12个月时为260 +/- 126 N，分别为1，241 +/- 270 N和1，218 +/- 189 N）（P <0.01）。在人工韧带完整的标本中，术后3个月所有标本和术后12个月一半标本均因从骨隧道滑脱而发生失效。结论：本研究提供的证据表明，LARS AC具有令人满意的生物整合性，但如果考虑均匀的组织长入，则不适用于ACL置换术。尽管植入后1年内临床表现良好，但在绵羊模型中，没有一种重建方法接近正常ACL的力学性能。在绵羊模型中，40%的病例中观察到人工韧带部分撕裂，导致极限拉伸强度显著降低。
Purpose: The purposes of this study were to assess tissue ingrowth within the Ligament Advanced Reinforcement System (LARS) artificial ligament (LARS AC; LARS, Arc sur Tille, France) and to study the biomechanical characteristics of the reconstructed knees in a sheep model of anterior cruciate ligament (ACL) replacement. Methods: Twenty-five female sheep underwent excision of the proximal third of the left ACL and intra-articular joint stabilization with a 44-strand polyethylene terephthalate ligament (mean ultimate tensile failure load, 2,500 N). Animals were killed either 3 or 12 months after surgery. Explanted knees were processed for histology (n = 10) or mechanical tests including tests of laxity and loading to failure in tension (n = 15). Results: Well-vascularized tissue ingrowth within the artificial ligament was only observed in the portions of the ligament in contact with the host's tissues (native ligament and bone tunnels). Ligament wear was observed in 40% of explanted knees. The ultimate tensile failure loads of the operated knees at both time points were inferior to those of the contralateral, intact knees (144 +/- 69 N at 3 months and 260 +/- 126 N at 12 months versus 1,241 +/- 270 N and 1,218 +/- 189 N, respectively) (P < .01). In specimens with intact artificial ligaments, failure occurred by slippage from the bone tunnels in all specimens explanted 3 months postoperatively and in half of the specimens explanted 12 months postoperatively. Conclusions: This study provides evidence that the LARS AC has a satisfactory biointegration but that it is not suitable for ACL replacement if uniform tissue ingrowth is contemplated. Despite good clinical performance up to 1 year after implantation, none of the reconstructions approached the mechanical performance of the normal ACL in the ovine model. Partial tearing of the artificial ligament, which led to a significant decrease in ultimate tensile strength, was observed in 40% of cases in the ovine model.