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Cited by 20Knee injuries and reconstruction techniquesTendon Structure and TreatmentSurgical Sutures and Adhesives

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Bioresorbable Stent in Anterior Cruciate Ligament Reconstruction

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Ficek, Krzysztof, Rajca, Jolanta, Stolarz, Mateusz, Stodolak-Zych, Ewa, Wieczorek, Jarosław, Muzalewska, Małgorzata, Wyleżoł, Marek, Wróbel, Zygmunt, Binkowski, Marcin, Błażewicz, Stanisław·2019·Polymers
DOI 10.3390/polym11121961PMC PMC6960761
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Abstract

The exact causes of failure of anterior cruciate ligament (ACL) reconstruction are still unknown. A key to successful ACL reconstruction is the prevention of bone tunnel enlargement (BTE). In this study, a new strategy to improve the outcome of ACL reconstruction was analyzed using a bioresorbable polylactide (PLA) stent as a catalyst for the healing process. The study included 24 sheep with 12 months of age. The animals were randomized to the PLA group (n = 16) and control group (n = 8), subjected to the ACL reconstruction with and without the implantation of the PLA tube, respectively. The sheep were sacrificed 6 or 12 weeks post-procedure, and their knee joints were evaluated by X-ray microcomputed tomography with a 50 μm resolution. While the analysis of tibial and femoral tunnel diameters and volumes demonstrated the presence of BTE in both groups, the enlargement was less evident in the PLA group. Also, the microstructural parameters of the bone adjacent to the tunnels tended to be better in the PLA group. This suggested that the implantation of a bioresorbable PLA tube might facilitate osteointegration of the tendon graft after the ACL reconstruction. The beneficial effects of the stent were likely associated with osteogenic and osteoconductive properties of polylactide.

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Crossref · 10.3390/polym11121961

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Figures

Figure A1 Application of force and fixed support to the femur model.
Figure A1 Application of force and fixed support to the femur model.CC BY · PubMed Central
Figure A2 Stress distribution within the femur: (a) with a stent, (b) without a stent.
Figure A2 Stress distribution within the femur: (a) with a stent, (b) without a stent.CC BY · PubMed Central
Figure A3 Stress distribution within the graft and stent.
Figure A3 Stress distribution within the graft and stent.CC BY · PubMed Central
Figure A4 Strain distribution within the femur with the stent.
Figure A4 Strain distribution within the femur with the stent.CC BY · PubMed Central
Figure A5 Strain distribution within the graft and stent.
Figure A5 Strain distribution within the graft and stent.CC BY · PubMed Central
Figure 1 Scheme of the ACL reconstruction, type of graft fixation, and the implantation of polylactide (PLA) perforated tube.
Figure 1 Scheme of the ACL reconstruction, type of graft fixation, and the implantation of polylactide (PLA) perforated tube.CC BY · PubMed Central
Figure 2 PLA perforated tube.
Figure 2 PLA perforated tube.CC BY · PubMed Central
Figure 3 The microstructure of the polymer membranes used to form implants in the form of tubes. (a) membrane cross-section, (b) membrane surface.
Figure 3 The microstructure of the polymer membranes used to form implants in the form of tubes. (a) membrane cross-section, (b) membrane surface.CC BY · PubMed Central
Figure 4 Three-dimensional visualization of the tibia. Axial cross-section—blue, sagittal cross-section—orange; (a) before reslicing, (b) after reslicing.
Figure 4 Three-dimensional visualization of the tibia. Axial cross-section—blue, sagittal cross-section—orange; (a) before reslicing, (b) after reslicing.CC BY · PubMed Central
Figure 5 Axial cross-section of the tibia; yellow—a selection of ROI (regions of interest).
Figure 5 Axial cross-section of the tibia; yellow—a selection of ROI (regions of interest).CC BY · PubMed Central
Figure 6 Division of bone tunnels for the analysis.
Figure 6 Division of bone tunnels for the analysis.CC BY · PubMed Central
Figure 7 Region of interest for the analysis of histomorphometric parameters. (a) axial cross-section with the boundary of the ROI magnified three times—yellow line, (b) visualization of the segmented bone tissue.
Figure 7 Region of interest for the analysis of histomorphometric parameters. (a) axial cross-section with the boundary of the ROI magnified three times—yellow line, (b) visualization of the segmented bone tissue.CC BY · PubMed Central
Figure 8 Three-dimensional visualization of the tibial tunnel in sagittal cross-section. (a) control at 6 weeks, (b) PLA at 6 weeks, (c) control at 12 weeks, (d) PLA at 12 weeks.
Figure 8 Three-dimensional visualization of the tibial tunnel in sagittal cross-section. (a) control at 6 weeks, (b) PLA at 6 weeks, (c) control at 12 weeks, (d) PLA at 12 weeks.CC BY · PubMed Central
Figure 9 Comparison of bone tunnel diameters in the controls and PLA group; * statistically significant difference at p < 0.05.
Figure 9 Comparison of bone tunnel diameters in the controls and PLA group; * statistically significant difference at p < 0.05.CC BY · PubMed Central
Figure 10 Comparison of bone tunnel volumes in the controls and PLA group at 6 and 12 weeks; * statistically significant difference at p < 0.05.
Figure 10 Comparison of bone tunnel volumes in the controls and PLA group at 6 and 12 weeks; * statistically significant difference at p < 0.05.CC BY · PubMed Central
Figure 11 Comparison of histomorphometric parameters.
Figure 11 Comparison of histomorphometric parameters.CC BY · PubMed Central

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Metadata

Authors
Ficek, K., Rajca, J., Stolarz, M., Stodolak-Zych, E., Wieczorek, J., Muzalewska, M., Wyleżoł, M., Wróbel, Z., Binkowski, M., & Błażewicz, S.
Affiliations
  • Department of Science, Innovation and Development, Galen-Orthopaedics, 43-150 Bierun, Poland
  • Department of Biomaterials and Composites, Faculty of Materials Science and Ceramics, AGH University of Science and Technology, 30-059 Krakow, Poland
  • University of Agriculture in Krakow (PL)
  • Silesian University of Technology (PL)
  • University of Silesia in Katowice (PL)
  • AGH University of Krakow (PL)
Corresponding author
Rajca, Jolanta
ORCID
Venue
Polymers
Publisher
MDPI AG
Published
2019-11-29
Volume
11
Issue
12
Pages
1961
ISSN
2073-4360 (ISSN-L)
DOI
10.3390/polym11121961
PMC
PMC6960761
OpenAlex
W2990697124
Cited by
20
References
1
Citations by year
2026: 1 · 2025: 2 · 2024: 4 · 2023: 2 · 2022: 3 · 2021: 7 · 2020: 1
FWCI
2.63
Type
journal article
Language
en
Open access
Licence
Locations
  • Polymers (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Knee injuries and reconstruction techniques
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Tendon Structure and Treatment
  • Health Sciences › Medicine › Surgery › Surgical Sutures and Adhesives
Keywords
anterior cruciate ligament reconstruction, biodegradable stents, polylactic acid, bone tunnel enlargement, osseointegration, sheep model, micro-computed tomography, bone microarchitecture, osteoconduction

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