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Orthopaedic Surgery May 2024All-inside and standard techniques with 4-strand hamstrings graft have been widely used in anterior cruciate ligament (ACL) reconstruction. However, the graft diameter... (Comparative Study)
Comparative Study
OBJECTIVE
All-inside and standard techniques with 4-strand hamstrings graft have been widely used in anterior cruciate ligament (ACL) reconstruction. However, the graft diameter of less than 8 mm will significantly increase the rate of surgical failure, and the 6-strand graft can solve this problem. The purpose of this study is to compare all-inside ACL reconstruction using suspensory cortical button fixation on both tibia and femur with standard ACL reconstruction using suspensory femoral fixation and a bioabsorbable tibial interference screw with a 6-strand hamstring tendon autograft in postoperative clinical outcomes.
METHODS
From January 2020 to December 2020, 48 patients performed ACL reconstruction were divided into the all-side group and the standard group according to the different surgical techniques. Magnetic resonance imaging (MRI) and subjective function scores was used to assess clinical outcomes at least 24 months following ACL reconstruction. MRI was used to measure the value of bone tunnel widening in articular and middle portions. Subjective function scores included the Lysholm knee score, the International Knee Documentation Committee (IKDC) score, the Knee Society Score (KSS) for pain and function, and KT-1000. The t-test was used assuming the distribution of the patients which follows the normal distribution and we used non-parametric tests if these two conditions were not satisfied.
RESULTS
At the final follow-up, there were 22 patients in the all-inside group and 24 patients in the standard group. No significant differences were found with respect to femoral tunnel widening and subjective function scores. However, a significant increase in tibial tunnel widening was found in the middle portion of the standard group (2.25 ± 0.74) compared to the all-inside group (0.76 ± 0.24) (p < 0.01) and also in the articular portion of the standard group (2.07 ± 0.77) compared to the all-inside group (1.52 ± 0.54) (p = 0.02). In addition, the value of the KT-1000 was 1.81 ± 0.45 for the all-inside group and 2.12 ± 0.44 in the standard group (p = 0.016).
CONCLUSION
The objective stability of the knee was relatively better in the all-inside group than in the standard group. And tunnel widening after ACL reconstruction was significantly greater in the standard technique when compared to the all-inside technique on the tibia side.
Topics: Humans; Anterior Cruciate Ligament Reconstruction; Male; Adult; Female; Hamstring Tendons; Young Adult; Autografts; Retrospective Studies; Transplantation, Autologous; Magnetic Resonance Imaging; Adolescent
PubMed: 38506183
DOI: 10.1111/os.13982 -
Orthopadie (Heidelberg, Germany) May 2024The use of allografts and autografts has been met with mixed views on whether allografts are a suitable alternative to autografts.
Peracetic acid sterilized tendon and ligament allografts for knee reconstruction : For anterior cruciate ligament (ACL), posterior cruciate ligament (PCL) and complex knee surgery.
BACKGROUND
The use of allografts and autografts has been met with mixed views on whether allografts are a suitable alternative to autografts.
QUESTION
We aimed to investigate if chemically sterilized allografts show similar rerupture rates to those reported in the literature for allografts and autografts in anterior (ACL) and posterior cruciate ligaments (PCL) and complex knee surgery.
MATERIALS AND METHODS
Retrospective data on knee reconstructions performed between 2011 and 2015 with tendon/ligamnet allografts sterilized with peracetic acid were collected in the form of a questionnaire. The inclusion criteria of 2 years for each patient were met by 38 patients, representing 22 ACL reconstructions, 5 PCL reconstructions, 3 OTHER surgeries, including the Larson technique and medial patellofemoral ligament (MPFL) reconstruction and 8 COMPLEX surgeries. The main endpoints were rerupture and complication rate. Secondary endpoints included stability of the knee (Lachman test, Pivot shift test) and the range of motion.
RESULTS
The rerupture rate was 7.9% (3 grafts). Reruptures only occurred in the ACL group. No reruptures were observed in the PCL, OTHER and COMPLEX surgery groups. Stability improved significantly after surgery and the range of motion returned to values similar to that of healthy knees.
CONCLUSIONS
Tendon allografts sterilized with peracetic acid show promising low rerupture rates and good clinical scores and the results are comparable to the literature on autografts and other allografts.
Topics: Humans; Male; Female; Retrospective Studies; Adult; Tendons; Middle Aged; Sterilization; Allografts; Peracetic Acid; Anterior Cruciate Ligament Reconstruction; Posterior Cruciate Ligament Reconstruction; Posterior Cruciate Ligament; Transplantation, Homologous
PubMed: 38498205
DOI: 10.1007/s00132-024-04486-7 -
Bio-design and Manufacturing 2024Autograft or metal implants are routinely used in skeletal repair. However, they fail to provide long-term clinical resolution, necessitating a functional biomimetic...
UNLABELLED
Autograft or metal implants are routinely used in skeletal repair. However, they fail to provide long-term clinical resolution, necessitating a functional biomimetic tissue engineering alternative. The use of native human bone tissue for synthesizing a biomimetic material ink for three-dimensional (3D) bioprinting of skeletal tissue is an attractive strategy for tissue regeneration. Thus, human bone extracellular matrix (bone-ECM) offers an exciting potential for the development of an appropriate microenvironment for human bone marrow stromal cells (HBMSCs) to proliferate and differentiate along the osteogenic lineage. In this study, we engineered a novel material ink (LAB) by blending human bone-ECM (B) with nanoclay (L, Laponite) and alginate (A) polymers using extrusion-based deposition. The inclusion of the nanofiller and polymeric material increased the rheology, printability, and drug retention properties and, critically, the preservation of HBMSCs viability upon printing. The composite of human bone-ECM-based 3D constructs containing vascular endothelial growth factor (VEGF) enhanced vascularization after implantation in an ex vivo chick chorioallantoic membrane (CAM) model. The inclusion of bone morphogenetic protein-2 (BMP-2) with the HBMSCs further enhanced vascularization and mineralization after only seven days. This study demonstrates the synergistic combination of nanoclay with biomimetic materials (alginate and bone-ECM) to support the formation of osteogenic tissue both in vitro and ex vivo and offers a promising novel 3D bioprinting approach to personalized skeletal tissue repair.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s42242-023-00265-z.
PubMed: 38497056
DOI: 10.1007/s42242-023-00265-z -
Cureus Feb 2024Burn injuries, a major global health concern, result in an estimated 180,000 fatalities annually. Despite tremendous progress in treatment methods over the years, the... (Review)
Review
Burn injuries, a major global health concern, result in an estimated 180,000 fatalities annually. Despite tremendous progress in treatment methods over the years, the morbidity and mortality associated with burns remain significant. Autologous skin grafting, particularly split-thickness skin grafting (STSG), has been a cornerstone in burn reconstruction, and it has facilitated survival and functional recovery for total body surface area (TBSA) significantly. However, the requirement for primary closure at the donor site due to the constraints of full-thickness donor harvesting continues to pose challenges. The introduction of dermal regenerative templates (DRT) in the late 1970s marked a substantial step forward in tissue engineering, addressing the inadequacy of dermal replacement with STSGs. This systematic review aimed to compare the outcomes of different graft types - bioengineered, autografts, allografts, and xenografts - in burn reconstruction over the last 24 years. The review focused on the pros and cons of each graft type, offering clinical insights grounded in experience and evidence. The approach involved a systematic review of studies published in English from January 2000 to January 2024, covering randomized controlled trials (RCTs), cohort studies, case-control studies, and case series. The participants comprised individuals of all ages who underwent burn reconstruction with skin grafts, specifically split-thickness grafts, full-thickness grafts, composite grafts, and epidermal grafts (autografts, allografts, and xenografts) and bioengineered grafts. The primary outcomes were functional and cosmetic results, patient satisfaction, graft survival, and complications. The risk of bias was evaluated using the Cochrane risk-of-bias tool for randomized trials version 2 (RoB 2), the Newcastle-Ottawa Scale (NOS) for non-randomized studies, and the Canada Institute for Health Economics (IHE) quality appraisal tool for case series. Our initial search yielded a total of 1,995 articles, out of which 10 studies were selected for final analysis. Among the four clinical trials assessed, 75% showed a high risk of bias. The studies reviewed involved various graft types, with six studies (60%) concentrating on allografts, three (30%) on autografts, and one (10%) on bioengineered skin grafts. The outcomes were varied, underlining the intricate nature of burn wound management. Our evaluation revealed promising results for autologous-engineered skin substitutes and allografts but also highlighted methodological disparities among the studies included. The dominance of observational studies and the diversity of outcome measures present obstacles to direct comparisons. Future research should address these limitations, employing well-structured RCTs, standardized outcome measures, and exploring long-term outcomes and patient-specific factors. The rapidly evolving field of regenerative medicine offers great potential for novel grafting methods. This systematic review provides valuable insights into the diverse outcomes of burn reconstruction using different graft types. Autologous-engineered skin substitutes and allografts seem to hold significant promise, suggesting a possible shift in grafting techniques. However, methodological inconsistencies and the lack of high-quality evidence underscore the necessity for further research to fine-tune burn care approaches.
PubMed: 38496152
DOI: 10.7759/cureus.54277 -
Medicine Mar 2024Bone ring (BR) grafts have been introduced to reconstruct alveolar ridge defects with simultaneous implant placement, but its clinical effectiveness remains...
BACKGROUND
Bone ring (BR) grafts have been introduced to reconstruct alveolar ridge defects with simultaneous implant placement, but its clinical effectiveness remains undetermined. This systematic review aimed to comprehensively investigate BR grafts in diverse scenarios of ridge defect with simultaneous or staged implant placement.
METHODS
Electronic retrieval of MEDLINE, Embase, Cochrane Library(CENTRAL), Web of Science, Scopus, and citation search until August 3, 2023, was used to identify relevant clinical articles that utilized BR grafts for ridge defect reconstruction. The quality of evidence in the studies reviewed was assessed with the Joanna Briggs Institute Critical Appraisal tool. The protocol was registered in Prospective Register of Systematic Reviews (CRD42023453943).
RESULTS
Fourteen studies with 251 BRs were identified, of which 8 studies were for alveolar ridge augmentation, 4 studies were for extraction socket augmentation, and 2 studies were for sinus floor elevation. Reported sources of BRs included autografts, allografts, and xenografts. The follow-up period ranged from 4 months to 4.7 years. Regarding the primary outcomes, the utilization of BR grafts demonstrated favorable bone gain along with acceptable graft absorption and marginal bone loss. Regarding the secondary outcomes, satisfactory bone mineral density and implant stability were confirmed, accompanied by a recorded incidence of postoperative complications (20 cases) and an implant failure rate of 5.58%.
CONCLUSIONS
BR grafting with simultaneous or staged implant insertion is an effective approach for reconstructing alveolar ridge deficiencies. The BR grafts demonstrate favorable bone remodeling and osteointegration with the alveolar bone and implant; however, its success may be compromised by complications. Future studies should further investigate the clinical efficacy of BR grafting comparing to other bone augmentation techniques in diverse scenarios.
Topics: Humans; Sinus Floor Augmentation; Systematic Reviews as Topic; Alveolar Process; Alveolar Ridge Augmentation; Bone Transplantation; Dental Implantation, Endosseous
PubMed: 38489729
DOI: 10.1097/MD.0000000000037471 -
Scientific Reports Mar 2024Posterior tibial translation (PTT) after double-bundle posterior cruciate ligament (PCL) reconstruction has sometimes occurred. Purpose of this study is to identify the...
Posterior tibial translation (PTT) after double-bundle posterior cruciate ligament (PCL) reconstruction has sometimes occurred. Purpose of this study is to identify the risk factors for postoperative PTT after double-bundle PCL reconstruction with a hamstring autograft. Comparing the results of bilateral gravity sag view (GSV) at 12 months after surgery, over 5-mm PTT was defined as 'failure' in this study. Of 26 isolated PCL reconstruction cases, over 5-mm PTT was seen in 7 cases (group F: 9.57 ± 1.28 mm), and 19 cases had less than 5 mm (group G: 2.84 ± 1.29 mm). Age, sex, body mass index (BMI), preoperative GSV, posterior slope angle of the tibia, anterolateral bundle (ALB) and posteromedial bundle (PMB) graft diameters, and tibial tunnel diameter were evaluated. The two groups were compared with the 2 × 2 chi-squared test, the Mann Whitney U-test, and Spearman's rank correlation coefficient. Multivariate logistic regression analysis was also performed to determine the risk factor. Statistical significance was indicated as p < 0.01 for correlation with postoperative PTT, and as p < 0.05 for all other comparisons. Mean age (group G 31.8 ± 12.5 vs group F 34.9 ± 15.9 years), sex (male/female: 15/4 vs 3/4), BMI (25.6 ± 4.6 vs 24.9 ± 3.9 kg/m), preoperative GSV (11.3 ± 2.2 vs 11.6 ± 2.9 mm), PMB diameter (5.37 ± 0.33 vs 5.36 ± 0.48 mm), and tibial tunnel diameter (9.32 ± 0.58 vs 9.29 ± 0.49 mm) showed no significant differences. ALB diameter was significantly greater in group G (7.0 ± 0.5 mm) than in group F (6.5 ± 0.29 mm; p = 0.022). There was also a significant difference in posterior tibial slope angle (group G 9.19 ± 1.94 vs group F 6.54 ± 1.45, p = 0.004). On Spearman rank correlation coefficient analysis, ALB diameter GSV (correlation coefficient: - 0.561, p = 0.003) and posterior tibial slope angle (correlation coefficient: - 0.533, p = 0.005) showed a significant correlation with postoperative PTT. Multivariate logistic regression analysis showed that ALB diameter (OR 19.028; 95% CI 1.082-334.6; p = 0.044) and posterior slope angle of tibia (OR 3.081; 95% CI 1.109-8.556; p = 0.031) were independently associated with postoperative PTT, respectively. In double-bundle PCL reconstruction with hamstring, smaller ALB graft diameter and lower (flatted) tibial slope angle were considered risk factors for postoperative PTT.
Topics: Humans; Male; Female; Young Adult; Adult; Middle Aged; Posterior Cruciate Ligament; Knee Joint; Autografts; Tibia; Knee Injuries; Sprains and Strains; Joint Instability; Risk Factors
PubMed: 38486115
DOI: 10.1038/s41598-024-56953-y -
Frontiers in Bioengineering and... 2024Peripheral nerve injury (PNI) is a common clinical problem, which due to poor recovery often leads to limb dysfunction and sensory abnormalities in patients.... (Review)
Review
Peripheral nerve injury (PNI) is a common clinical problem, which due to poor recovery often leads to limb dysfunction and sensory abnormalities in patients. Tissue-engineered nerve guidance conduits (NGCs) that are designed and fabricated from different materials are the potential alternative to nerve autografts. However, translation of these NGCs from lab to commercial scale has not been well achieved. Complete functional recovery with the aid of NGCs in PNI becomes a topic of general interest in tissue engineering and regeneration medicine. Electrical stimulation (ES) has been widely used for many years as an effective physical method to promote nerve repair in both pre-clinical and clinical settings. Similarly, ES of conductive and electroactive materials with a broad range of electrical properties has been shown to facilitate the guidance of axons and enhance the regeneration. Graphene and its derivatives possess unique physicochemical and biological properties, which make them a promising outlook for the development of synthetic scaffolds or NGCs for PNI repair, especially in combination with ES. Considering the discussion regarding ES for the treatment of PNI must continue into further detail, herein, we focus on the role of ES in PNI repair and the molecular mechanism behind the ES therapy for PNI, providing a summary of recent advances in context of graphene-based scaffolds (GBSs) in combination with ES. Future perspectives and some challenges faced in developing GBSs are also highlighted with the aim of promoting their clinical applications.
PubMed: 38481574
DOI: 10.3389/fbioe.2024.1345163 -
Orthopaedic Journal of Sports Medicine Mar 2024Medial opening-wedge high tibial osteotomy (OWHTO) is a useful treatment option in patients with medial compartment osteoarthritis. Typically, the osteotomy site is...
BACKGROUND
Medial opening-wedge high tibial osteotomy (OWHTO) is a useful treatment option in patients with medial compartment osteoarthritis. Typically, the osteotomy site is filled with material such as autologous bone graft, allograft, or synthetic bone substitute. However, all these options have disadvantages.
PURPOSE/HYPOTHESIS
The purpose of this study was to describe tibial cortical autograft as an alternative to conventional graft options. It was hypothesized that the tibial rectangular cortical bone that is removed from the proximal medial cortical surface of the distal tibial fragment longitudinally could be a reliable option for recovery of the gap in the osteotomy area.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
A total of 520 patients with medial compartment osteoarthritis who underwent OWHTO between June 2009 and March 2019 were retrospectively analyzed. Patients were divided into 3 groups according to the graft material used to fill the osteotomy site: allograft in group A, iliac crest autograft in group B, and tibial autograft in group C. Bone union, evaluated by radiographs performed at 2 weeks, 4 weeks, 2 months, 3 months, 6 months, and 1 year postoperatively, was defined as occurring when at least 50% of the gap site was bridged with callus. Clinical assessment was performed using the International Knee Documentation Committee (IKDC) and Lysholm scores.
RESULTS
Included were 122 patients: 40 patients in group A, 42 patients in group B, and 40 patients in group C. The mean correction was 13.87°± 3.58° in group A, 12.33°± 3.92° in group B, and 14.10°± 2.99° in group C. The mean time for radiological bone union was 6.95 ± 1.40 months in group A, 4.48 ± 1.02 months in group B, and 5.07 ± 1.70 months in group C. Patients in all groups had similar IKDC and Lysholm scores at the final follow-up.
CONCLUSION
This is the first report of this specific procedure in the literature. All clinical and radiological findings showed that use of tibial cortical autograft was an efficient method in patients undergoing OWHTO.
PubMed: 38476161
DOI: 10.1177/23259671241233321 -
International Journal of Surgery Case... Apr 2024Chronic quadriceps tendon rupture is a relatively rare injury that can be challenging to treat. Several techniques have been described for chronic quadriceps tendon...
INTRODUCTION
Chronic quadriceps tendon rupture is a relatively rare injury that can be challenging to treat. Several techniques have been described for chronic quadriceps tendon repair, including the use of autografts, allografts, and synthetic mesh. We reported a case of 17-year-old male with chronic quadriceps tendon rupture treated using autologous semitendinosus tendon graft.
CASE PRESENTATION
A 17-year-old male presented with left knee pain since 8 months ago after he fell into a ditch. Physical examination demonstrated palpable gap on suprapatellar region. Magnetic resonance imaging demonstrated quadriceps discontinuity and hyperintensity surrounding the insertion of the quadriceps tendon. The patient underwent quadriceps tendon reconstruction using ipsilateral autologous semitendinosus graft. After 3 weeks the patient was sent for physiotherapy to regain his left knee's range of motion. At final follow up at six months, the patient was able to walk with bipedal unassisted normal gait. Active knee extension and straight leg raising was possible. Final knee range of motion was 0° to 130°.
DISCUSSION
In this case, we demonstrated a successfully treated chronic quadriceps tendon rupture using autologous semitendinosus tendon graft. For cases of chronic quadriceps tendon rupture with tissue loss, it is advisable to utilise an autologous graft for the purpose of repairing and restoring the structure and function of the quadriceps tendon.
CONCLUSION
Surgical treatment of chronic quadriceps tendon rupture is challenging and lacks evidence-based guidelines. We propose the use of ipsilateral semitendinosus tendon autograft as choice for chronic quadriceps tendon rupture in this report, as it leads to favorable outcomes postoperatively.
PubMed: 38471221
DOI: 10.1016/j.ijscr.2024.109488