Bridge-Enhanced Anterior Cruciate Ligament Repair Leads to Greater Limb Asymmetry and Less Cartilage Damage Than Untreated ACL Transection or ACL Reconstruction in the Porcine Model.
Bridge-Enhanced Anterior Cruciate Ligament Repair Leads to Greater Limb Asymmetry and Less Cartilage Damage Than Untreated ACL Transection or ACL Reconstruction in the Porcine Model.
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在猪模型中，与未经处理的ACL横断或ACL重建相比，桥接增强的前交叉韧带修复导致更大的肢体不对称性和更少的肱骨损伤。
DOI：
10.1177/0363546521989265
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Fleming BC
中科院分区：
文献类型：
--
作者：
Karamchedu NP;Murray MM;Sieker JT;Proffen BL;Portilla G;Costa MQ;Molino J;Fleming BC
猪ACL横断模型中创伤后骨关节炎（PTOA）的程度取决于该损伤的手术治疗。在之前的研究中，使用组织工程植入物进行桥接增强ACL修复的动物比ACL重建治疗的动物发生PTOA更少。在骨关节炎受试者的临床研究中发现步态改变，包括不对称负重和站立时间缩短。接受导致较少创伤后骨关节炎（即，桥增强的ACL修复）与导致更大PTOA的治疗（即，ACL重建和ACL横断）。对照实验室研究36只尤卡坦小型猪接受ACL横断，并随机分配至：1）无进一步治疗，2）ACL重建，或3）桥增强ACL修复。在术前和术后4、12、26和52周进行步态分析。在第52周人道处死后进行肉眼软骨评估。与ACL重建或ACL横断治疗相比，采用桥接增强ACL修复治疗的膝关节内侧胫骨平台的宏观损伤更少（两种比较的P-adj= 0.03）。在52周时，与ACL横断治疗的膝关节相比，采用桥接增强ACL修复治疗的膝关节在后肢最大力和脉冲载荷方面具有更大的不对称性（两种比较的P-adj<0.05）。有证据表明，与ACL重建相比，采用桥接增强ACL修复术治疗的膝关节在后肢最大力和脉冲载荷方面也具有更大的不对称性（两种比较的P-adj<0.10）。与我们的假设相反，导致最低量的宏观软骨损伤的手术治疗比其他手术组在负荷相关步态参数方面表现出更大的不对称性。这一发现表明，手术膝关节的减负荷增加可能与PTOA发展速度较慢有关。手术组在52周时发现软骨损伤较少，在步态期间继续保护肢体免受全身重量的影响。这一发现表明，保护膝关节免受最大应力可能是重要的，以尽量减少发展PTOA在ACL损伤的膝关节。
The extent of posttraumatic osteoarthritis (PTOA) in the porcine ACL transection model is dependent on the surgical treatment of that injury. In a previous study, animals treated with bridge-enhanced ACL repair using a tissue-engineered implant developed less PTOA than those treated with ACL reconstruction. Alterations in gait, including asymmetric weight bearing and shorter stance times, have been noted in clinical studies of subjects with osteoarthritis. Animals receiving a surgical treatment that results in less posttraumatic osteoarthritis (i.e., bridge-enhanced ACL repair) would exhibit fewer post-surgical gait asymmetries over a 1-year period when compared to treatments that result in greater PTOA (i.e., ACL reconstruction and ACL transection). Controlled laboratory study 36 Yucatan minipigs underwent ACL transection and were randomized to: 1) no further treatment, 2) ACL reconstruction, or 3) bridge-enhanced ACL repair. Gait analyses were performed pre-operatively, and at 4, 12, 26 and 52 weeks post-operatively. Macroscopic cartilage assessments were performed following euthanasia at 52 weeks. Knees treated with bridge-enhanced ACL repair had less macroscopic damage in the medial tibial plateau than those treated with ACL reconstruction or ACL transection (P-adj=.03 for both comparisons). The knees treated with bridge-enhanced ACL repair had greater asymmetry in hindlimb maximum force and impulse loading than the knees treated with ACL transection at 52 weeks (P-adj<.05 for both comparisons). There was evidence to show that knees treated with bridge-enhanced ACL repair also had greater asymmetry in hindlimb maximum force and impulse loading (P-adj<.10 for both comparisons) compared to ACL reconstruction. Contrary to our hypothesis, the surgical treatment resulting in the lowest amount of macroscopic cartilage damage exhibited greater asymmetry in load-related gait parameters than the other surgical groups. This finding suggests that increased off-loading of the surgical knee may be associated with a slower rate of PTOA development. Less cartilage damage at 52 weeks was found in the surgical group that continued to protect the limb from full body weight during gait. This finding suggests that protection of the knee from maximum stresses may be important in minimizing the development of PTOA in the ACL-injured knee.
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影响因子：
2.9
作者：
Proffen BL;Perrone GS;Fleming BC;Sieker JT;Kramer J;Hawes ML;Murray MM
通讯作者：
Murray MM
影响因子：
--
作者：
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2.4
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1.7
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通讯作者：
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