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BioMed Research International 2021The Ross procedure has long been seen as an optimal operation for a select few. The detractors of it highlight the issue of an additional harvesting of the pulmonary... (Review)
Review
The Ross procedure has long been seen as an optimal operation for a select few. The detractors of it highlight the issue of an additional harvesting of the pulmonary artery, subjecting the native PA to systemic pressures and the need for reintervention as reasons to avoid it. However, the PA is a living tissue and capable of adapting and remodeling to growth. We therefore review the current evidence available to discuss the indications, contraindications, harvesting techniques, and modifications in a state-of-the-art narrative review of the PA as an aortic conduit. Due to the lack of substantial well-designed randomized controlled trials (RCTs), we also highlight the areas of need to reiterate the importance of the Ross procedure as part of the surgical armamentarium.
Topics: Aortic Valve; Aortic Valve Disease; Autografts; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Pulmonary Artery; Transplantation, Autologous
PubMed: 33937396
DOI: 10.1155/2021/5547342 -
Journal of Orthopaedic Surgery (Hong... 2020The aim of the study was to evaluate whether or not there was any incompatibility between two-strand hamstring tendons taken from the same knee and the ATFL and it was...
PURPOSE
The aim of the study was to evaluate whether or not there was any incompatibility between two-strand hamstring tendons taken from the same knee and the ATFL and it was the determination of suitable footprint points in the fibula and talus for anatomical ATFL reconstruction.
METHODS
16 fresh frozen cadaver specimens were dissected to gracilis and semitendinosus tendons and the anterior talofibular ligament. The origins, insertions, distances from osseous landmarks of fibular talus of ATFL were determined. The diameters of gracilis, semitendinosus and ATFL were calculated. There was a moderate correlation between body height and the distance between the distal of inferior lateral malleolus and the fibular adhesion site of ATFL (r: 36.5 p: 0.036). There was a weak correlation between body height and the distance between the apex of the lateral talar process and the talus adhesion site of ATFL in a single bundle (r: 28.4 p: 0.002). There was no correlation between the distance from proximal and distal adhesion side of ATFL and body height in the double bundle (p: 0.241).
RESULTS
There was no significant relationship between ATFL diameter and gracilis, semitendinosus and both hamstring in women. A significant relationship at 80.5% was determined between the ATFL and the gracilis diameter in man. A significant relationship at 92.6% was determined between the ATFL and the semitendinosus diameter in man.
CONCLUSION
It was determined that there is not compatibility between the gracilis tendons, the semitendinosus tendon and ATFL in women. It should be supported by biomechanical and clinical studies whether this incompatibility has a clinical effect or not.
Topics: Aged; Aged, 80 and over; Ankle Joint; Autografts; Biomechanical Phenomena; Cadaver; Female; Hamstring Muscles; Hamstring Tendons; Humans; Lateral Ligament, Ankle; Male; Middle Aged; Orthopedic Procedures; Plastic Surgery Procedures; Transplantation, Autologous
PubMed: 33272074
DOI: 10.1177/2309499020974830 -
The American Journal of Sports Medicine Aug 2021Although graft choice may be limited in the revision setting based on previously used grafts, most surgeons believe that graft choice for anterior cruciate ligament...
BACKGROUND
Although graft choice may be limited in the revision setting based on previously used grafts, most surgeons believe that graft choice for anterior cruciate ligament (ACL) reconstruction is an important factor related to outcome.
HYPOTHESIS
In the ACL revision setting, there would be no difference between autograft and allograft in rerupture rate and patient-reported outcomes (PROs) at 6-year follow-up.
STUDY DESIGN
Cohort study; Level of evidence, 2.
METHODS
Patients who had revision surgery were identified and prospectively enrolled in this cohort study by 83 surgeons over 52 sites. Data collected included baseline characteristics, surgical technique and pathology, and a series of validated PRO measures. Patients were followed up at 6 years and asked to complete the identical set of PRO instruments. Incidence of additional surgery and reoperation because of graft failure were also recorded. Multivariable regression models were used to determine the predictors (risk factors) of PROs, graft rerupture, and reoperation at 6 years after revision surgery.
RESULTS
A total of 1234 patients including 716 (58%) men were enrolled. A total of 325 (26%) underwent revision using a bone-patellar tendon-bone (BTB) autograft; 251 (20%), soft tissue autograft; 289 (23%), BTB allograft; 302 (25%), soft tissue allograft; and 67 (5%), other graft. Questionnaires and telephone follow-up for subsequent surgery information were obtained for 809 (66%) patients, while telephone follow-up was only obtained for an additional 128 patients for the total follow-up on 949 (77%) patients. Graft choice was a significant predictor of 6-year Marx Activity Rating Scale scores ( = .024). Specifically, patients who received a BTB autograft for revision reconstruction had higher activity levels than did patients who received a BTB allograft (odds ratio [OR], 1.92; 95% CI, 1.25-2.94). Graft rerupture was reported in 5.8% (55/949) of patients by their 6-year follow-up: 3.5% (16/455) of patients with autografts and 8.4% (37/441) of patients with allografts. Use of a BTB autograft for revision resulted in patients being 4.2 times less likely to sustain a subsequent graft rupture than if a BTB allograft were utilized ( = .011; 95% CI, 1.56-11.27). No significant differences were found in graft rerupture rates between BTB autograft and soft tissue autografts ( = .87) or between BTB autografts and soft tissue allografts ( = .36). Use of an autograft was found to be a significant predictor of having fewer reoperations within 6 years compared with using an allograft ( = .010; OR, 0.56; 95% CI, 0.36-0.87).
CONCLUSION
BTB and soft tissue autografts had a decreased risk in graft rerupture compared with BTB allografts. BTB autografts were associated with higher activity level than were BTB allografts at 6 years after revision reconstruction. Surgeons and patients should consider this information when choosing a graft for revision ACL reconstruction.
Topics: Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Autografts; Bone-Patellar Tendon-Bone Grafting; Cohort Studies; Humans; Male; Reoperation; Transplantation, Autologous
PubMed: 34260326
DOI: 10.1177/03635465211027170 -
Knee Surgery, Sports Traumatology,... Aug 2023The purpose of this study was to evaluate the patient-reported outcomes, graft failure, quadriceps rupture and sports preference after arthroscopic ACL reconstruction in...
PURPOSE
The purpose of this study was to evaluate the patient-reported outcomes, graft failure, quadriceps rupture and sports preference after arthroscopic ACL reconstruction in patients older than 50 years who underwent arthroscopic ACL reconstruction with a quadriceps tendon (QT) autograft.
METHODS
Between 2010 and 2020, prospectively collected data were obtained from an institutional database. Patients older than 50 years with primary arthroscopic ACL reconstruction and a minimum of 2 years of follow-up were included. Patients undergoing a revision ACL reconstruction or undergoing a primary ACL reconstruction using a graft other than a QT autograft, and patients with a contralateral knee injury or osteoarthritis (Ahlbäck stage 2 or higher) were excluded. A minimally invasive technique was used for QT autograft harvesting. Patients were evaluated for pre-injury and 2-year follow-up Lysholm knee score, Tegner activity level, Visual Analog Scale (VAS) for pain, graft failure, quadriceps tendon rupture, and return to sport.
RESULTS
A total of 57 patients were included in the study. The mean age of the cohort was 54.9 ± 5.2 (range 50-75). Of the 57 reconstructions, 16 (28%) were isolated ACL reconstructions, while 41 (72%) were complex reconstructions (concomitant meniscus, cartilage and/or collateral ligament injuries). At the 2-year follow-up Lysholm knee score, Tegner activity level and VAS for pain improved to pre-injury level and no significant difference was noted between pre-injury and 2-year follow-up functional scores (n.s.). No case of graft failure or quadriceps tendon rupture was reported. No significant difference was noted in the pre-injury and postoperative sports preference (n.s.) and all patients return to their desired sports activity.
CONCLUSION
Arthroscopic ACL reconstruction by using QT autograft in highly active older patients provides satisfactory patient-reported functional outcomes and allows recovery of the pre-injury level of activity. QT autograft is a good graft option in patients older than 50 years.
LEVEL OF EVIDENCE
Level IV.
Topics: Humans; Middle Aged; Autografts; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Transplantation, Autologous; Tendons
PubMed: 36917246
DOI: 10.1007/s00167-023-07367-2 -
Orthopaedics & Traumatology, Surgery &... Dec 2021Most of the studies on ulna fractures assess the treatment of fractures accompanied by other tissue injuries; thus, the number of studies focused directly on isolated...
Using autograft in the surgical treatment of isolated distal ulna fractures with open reduction internal fixation improves short-term clinical outcomes: 11 years of experience.
BACKGROUND
Most of the studies on ulna fractures assess the treatment of fractures accompanied by other tissue injuries; thus, the number of studies focused directly on isolated distal ulna fractures are very few. In this study, it was aimed to evaluate the short-term results of open reduction internal fixation (ORIF) and autograft+ORIF approaches in the treatment of isolated distal ulna fractures.
HYPOTHESIS
Using autograft in the surgical treatment of isolated distal ulna fractures with open reduction internal fixation improves short-term clinical outcomes.
PATIENTS AND METHODS
The records of isolated distal ulna fractures (distal one-third) operated at the Maltepe University Hospital Orthopedics and Traumatology Clinic between January 2009 and December 2019 were retrospectively reviewed. The cases were divided into two groups according to surgical approach, ORIF (n=40) or autograft+ORIF (n=34).
RESULTS
The mean age was 41.55±12.42 years. 52.7% of the cases were female, 67.6% of the fractures were right-sided, and 37.8% of the traumas causing the fracture were high-energy trauma. There was no significant difference between the ORIF and autograft+ORIF groups in terms of age, gender, side and severity of trauma (p>0.05). It was found that pseudoarthrosis development was significantly more prevalent in the ORIF group (25%) compared to the autograft+ORIF group (5.9%) (p=0.026). The median (1st quartile-3rd quartile) time to union was 16 (14-17) weeks in the ORIF group, and 9.5 (8.5-12) weeks in the autograft+ORIF group. Compared to ORIF, the time to union was significantly shorter with the autograft+ORIF procedure (p<0.001). At both the 3rd and 12th month follow-up examinations, the autograft+ORIF group was found to have significantly higher MAYO score and grip strength, and lower DASH score, compared to the ORIF group.
DISCUSSION
When an autograft is used in addition to ORIF in the surgical treatment of isolated distal ulna fractures, the bone heals faster, pseudoarthrosis develops less frequently, and short-term (3rd and 12th months) functional results are better.
LEVEL OF EVIDENCE
III; therapeutic study.
Topics: Adult; Autografts; Bone Plates; Female; Fracture Fixation, Internal; Humans; Middle Aged; Open Fracture Reduction; Radius Fractures; Retrospective Studies; Treatment Outcome; Ulna Fractures
PubMed: 34583013
DOI: 10.1016/j.otsr.2021.103082 -
Journal of Orthopaedic Surgery and... Aug 2021The aim of anterior cruciate ligament reconstruction (ACLR) is to restore the function of the knee joint, protect the cartilage, and reduce the occurrence of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The aim of anterior cruciate ligament reconstruction (ACLR) is to restore the function of the knee joint, protect the cartilage, and reduce the occurrence of osteoarthritis. However, due to the structural limitations of the human body, it is not possible to perform ACLR with conventional sutures. To restore normal functioning of the anterior cruciate ligament (ACL), a new ligament must be reconstructed in the position of the previous ACL.
OBJECTIVE
To compare autografts and synthetic grafts in terms of postoperative knee stability and function SEARCH METHODS: The protocol for this study was registered with PROSPERO (CRD42021243451). Two reviewers independently searched the PubMed, Embase, and the Cochrane Library databases from database inception though February 10, 2021. The following search method was used: ((Autograft) OR (Autologous) OR (Autotransplant)) OR Artificial Ligament AND (Anterior Cruciate Ligament Injury [MeSH Terms]) AND (Randomized controlled trial [MeSH Terms]). Methodological quality was assessed by the Cochrane risk of bias tool.
SELECTION CRITERIA
We only included randomized controlled trials (level I) that compared autograft and synthetic graft interventions in participants with ACL injury. We included trials that evaluated ACLR using at least one outcome (Lachman test, pivot shift test, IKDC grades, or complications).
RESULTS
A total of 748 studies were identified in the initial literature search, and seven studies that examined only bone-patellar tendon-bone (BPTB) grafts compared with artificial grafts met the predetermined inclusion criteria. The results showed that BPTB grafts were associated with significantly better pivot shift test and Lachman test results and better IKDC grades and lower complication rates than synthetic grafts.
CONCLUSIONS
This review indicates that for adults, BPTB grafts perform more favorably than synthetic grafts in ACLR in terms of knee stability, function, and complication. More research is needed to compare autologous tendons and allogeneic tendons with artificial ligaments, especially in elderly individuals.
LEVEL OF EVIDENCE
Level I, systematic review and meta-analysis.
Topics: Adult; Aged; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Autografts; Humans; Knee Joint; Patellar Ligament; Tendons; Transplantation, Autologous
PubMed: 34348750
DOI: 10.1186/s13018-021-02624-x -
Journal of Vascular Surgery. Venous and... May 2020This study evaluated swine and bovine pulmonary visceral pleura (PVP) as a vascular patch. Venous patches are frequently used in surgery for repair or reconstruction of...
OBJECTIVE
This study evaluated swine and bovine pulmonary visceral pleura (PVP) as a vascular patch. Venous patches are frequently used in surgery for repair or reconstruction of veins. Autologous patches are often limited by the number and dimension of donor tissue and can result in donor complications. Bovine pericardium is the most common heterologous patch used by vascular surgeons. Researchers, however, are continually seeking to improve heterologous and synthetic patches for improved outcome.
METHODS
The PVP was peeled from swine and bovine lungs and cross-linked with glutaraldehyde. After sterilization and rinsing, the PVP patches were implanted in the jugular vein (10 × 35 mm) of pigs and dogs. Patency was evaluated by ultrasound, and animals were euthanized at 2 and 4 months. Neoendothelium and neomedia were evaluated by histologic analysis.
RESULTS
The jugular vein patched by PVP in pigs and dogs remained patent at 2 and 4 months with no adhesions, inflammation, or aneurysm in the patches. The biomarkers of endothelial cells-factor VIII, platelet/endothelial cell adhesion molecule 1, and endothelial nitric oxide synthase-were detected in the neoendothelial cells. The expression of vascular smooth muscle cell (VSMC) α-actin was robust in the neomedia at 2 and 4 months. Neomedia composed of VSMCs developed to nearly double the thickness of adjacent jugular vein. The circumferential orientation of VSMCs in neomedia further increased in the 4-month group.
CONCLUSIONS
The cross-linked swine and bovine PVP patch has a nonthrombogenic surface that maintains patency. The PVP patch may overcome the pitfall of compliance mismatch of synthetic patches. The proliferation of vascular cells assembled in the neoendothelium and neomedia in the patches may support long-term patency.
Topics: Animals; Autografts; Bioprosthesis; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Cattle; Cross-Linking Reagents; Dogs; Fixatives; Glutaral; Heterografts; Jugular Veins; Materials Testing; Neointima; Pleura; Swine; Swine, Miniature; Time Factors; Vascular Patency; Vascular Remodeling
PubMed: 31837973
DOI: 10.1016/j.jvsv.2019.09.011 -
The Journal of Thoracic and... Feb 2021
Topics: Aortic Dissection; Aorta; Autografts; Humans
PubMed: 32948306
DOI: 10.1016/j.jtcvs.2020.08.022 -
BioMed Research International 2020. In the field of orthopaedic surgery, the use of osteogenic material in larger defects is essential. Autograft and allograft are both known methods, and autograft is...
UNLABELLED
. In the field of orthopaedic surgery, the use of osteogenic material in larger defects is essential. Autograft and allograft are both known methods, and autograft is believed to be the best choice. But autograft is associated with additional invasive procedures which can prove difficult in fragile patients and can cause local side effect after bone harvest. For feasible purposes, the use of allograft is hereby rising and comparing efficacies, and the differences between autograft and allograft are essential for the clinical outcome for the patients.
METHOD
24 female Norwegian brown rats were included, 12 normal rats and 12 induced with osteoporosis (OP). OP inducement was verified in vivo by bone volume fraction (BV/TV) at 90 days after ovariectomy (OVX). The primary surgery in each rat consisted of a 2.5 × 3 mm hole in the proximal tibia, bilaterally. Autograft and allograft were randomly allocated in the right and left tibia. After an observation of 21 days, the rats were sacrificed. Tibia samples were harvested, micro-CT scanned for bone inducement and microarchitectural properties, and then embedded for histology.
RESULTS
The OP induction was verified three months after the OVX by a reduction of 68.5% in the trabecular bone BV/TV compared to normal bone. Microarchitectural analysis and histology showed no significant differences in the bone-forming capabilities between autograft and allograft in normal or osteoporotic bone after 3 weeks.
CONCLUSION
This study did not demonstrate any difference between autograft and allograft in a normal or osteoporotic rat tibial defect model after 21 days, suggesting allograft is a good alternative to autograft.
Topics: Allografts; Animals; Autografts; Bone Density; Bone Transplantation; Bone and Bones; Female; Osteoporosis; Ovariectomy; Rats; Tibia; Transplantation, Autologous; Transplantation, Homologous; X-Ray Microtomography
PubMed: 32190690
DOI: 10.1155/2020/9358989 -
The Journal of Thoracic and... Mar 2020
Topics: Adaptation, Physiological; Autografts; Humans; Vascular Calcification
PubMed: 31630839
DOI: 10.1016/j.jtcvs.2019.09.004