BIOMECHANIC STUDY OF GRAFT BONE TUNNEL MODEL IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING INTRATUNNEL ALLOGENIC BONE MARROW MESENCHYMAL STEM CELLS (BM-MSCs) AND VASCULAR ENDOTHELIAL GROWTH FACTOR (VEGF)
Downloads
Successful anterior cruciate ligament (ACL) reconstruction using tendon graft requires good and rapid integration between the tendon graft and the bone tunnel. The strength of the tendon-bone tunnel graft in the initial phase is very important to facilitate aggressive rehabilitation and as early as possible to support rapid recovery to normal activities. The objective of this study was to determine ultimate tension strength (UTS) on the femoral tendon-bone tunnel graft model after reconstruction of anterior cruciate ligament (ACL) by administering allogenic bone marrow mesenchymal stemcells (BM-MSCs) and vascular endothelial growth factor (VEGF) intratunnel in experimental animals. The design of this research was Post-Test Only Control Group Design using 24 rabbits divided into treatment and control group. Biomechanical evaluation was done at week 3 and 6. Evaluation at week 3 found ultimate tension strength of treatment group significantly higher than control (p <0,05). In the 6th week evaluation, Ultimate tension strength was found that the treatment group significantly higher than the control group (p <0.05). Ultimate tension strength at week 3 did not differ significantly with week 6 (p> 0.05). Intravenous administration of BM-MSCs and VEGF on ACL reconstruction increased ultimate tension strength in graft-bone tunnel significantly since week 3. The study of Ferdiansis et al using BM-MSCs and VEGF intraarticular, only showed a significant increase in ultimate tension strength in graft-bone tunnel since week 6. Comparison of this method indicates acceleration in incorporation of tendon graft with bone tunnel on intratunnel method better thaninvitro intraarticular method.
Keywords : Anterior cruciate ligament, allogenic bone marrow mesenchymal stem cells, vascular endothelial growth factor and biomechanic study.
Alpert, J.M., Brush-Joseph, C.A., Bach, J. & Bernard, R., 2008. Patellar Tendon Autograft for Anterior Cruciate Ligament Reconstructiom. In Surgical Techniques of The Shoulder, Elbow, and The Knee in Sports Medicine.Philadelphia, PA, USA: Elseviers Saunders.
Amiel, D., Frank, C. & Harwood, F., 1984. Tendons and ligaments: a morphological and biochemical comparison. J Orthop Res, 1, pp.257– 65.
Anderson, A.F., Dome, D.C. & Gautam, S., 2001. Correlation of anthropometric measurements, strength, anterior cruciate ligament size, and intercondylar notch characteristics to sex differences in anterior cruciate ligament tears. Am J Sports Med, (29), pp.58–63.
Bach, J.M., Hull, M.L. & Patterson, H.A., 1997. Direct measurement of strain in the posterolateral bundle of the anterior cruciate ligament. J.Biomech, 30(3), pp.281-83.
Baxter, F.R. & Bach, J.S., 2010. Augmentation of Bone Tunnel Healing in Anterior Cruciate Ligament Grafts: Application of Calcium Phosphates and Other Materials. Journal of Tissue Engineering.
Chandler, J.W. & Creighton, R.A., 2008. Patellar Tendon Allograft for Anterior Cruciate Ligament Reconstruction. In Surgical Techniques of TheShoulders, Elbow, and Knee in Sport Medicine. Philadelphia, PA, USA: Elseviers Saunders.
Colombet, P., Robinson, J. & Christel, P.l., 2006. Morphology of anterior cruciate ligament attachments for anatomic reconstruction: a cadaveric dissection and radiographic study. Arthroscopy, 22, pp.984–92.
Da Silva, E.M. & Albano, M.B., 2013. Knee Ligament Injuries: Biomechanics Comparative Study of Two Suture Technique in Tendon Analysis. Rev Bras Ortop, 48(1), pp.80-86.
Deehan, D.J. & Cawston, T.E., 2005. The Biology of Integration of Anterior Cruciate Ligament. British Editorial Society of Bone and Joint Surgery, 87(8), pp.889-95.
Dong, Y. et al., 2012. Enhancement of Tendon-Bone Healing for Anterior Cruciate Ligament (ACL) Reconstruction Using Bone Marrow- Derived Mesenchymal Stem Cells Infected with BMP-2. International Journal ofMolecular Sciences, 13, pp.13605-20.
Duthon, V.B., Barea, C. & Abrassart, S., 2006. Anatomy of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc, 14, pp.204–13.
Feng, L., Jia, H. & Yu, C., 2007. ACL reconstruction in a rabbit model using irradiated Achilles allograft seeded with mesenchymal stem cells or PDGF-B gene- transfected mesenchymal stem cells. Knee Surgery Sport Traumatololgy Arthroscopy, Knee Surgery Sport Traumatololgy Arthroscopy, p.1219027.
Ferdiansis, e.a., 2014. Effect of intraarticular Bone Marrow Mesenchimal Stem Cells and Vascular Endothelial Growth Factor on Graft-Tunnel Integration after ACL Reconstruction., 2014. National Indonesian Orthopaedic Congress.
Freeman, A., 2001. How the Knees Move. Current Orthopaedics, 15, pp.444 - 450.
Fukubayashi, T., Torzilli, P.A., Sherman, M.F. & Warren, R.F., 1982. An in vitro biomechanical evaluation of anterior- posterior motion of the knee. Tibial displacement, rotation, and torque. J. Bone Joint Surg Am., 64(258-264), pp.258-64.
Gotter, D. & Schmidt-Wiethoff, 2007. Biomechanics of the Anterior Cruciate Ligament and Implications for Surgical Reconstruction. In Strategies Trauma Limb Reconstr. pp.1-12.
Griffin, M.D., Ritter, T. & Mahon, B.P., 2010. Immunological Aspects of Allogeneic Mesenchymal Stem Cells Therapies. Human gene therapy, 21, pp.1641-55.
Harner, C.D., Baek, G.H. & Vogrin, T.M., 1999. Quantitative analysis of anterior cruciate ligament insertions. Arthroscopy, 15, pp.741–49.
Hays, P. et al., 2008. The Role of Macrophages in Early Healing of a Tendon Graft in a Bone Tunnel. Journal Bone Joint Surgery America, 90-A(3), pp.565-75.
HW, O., JC, G. & EH, L., 2004. Use of bone marrow stromal cells for tendon graft- to-bone healing: histological and immunohistochemical studies in a rabbit model. Am J Sports Med, 32, pp.321-27.
Jones, C.D. & Grimshaw, P.N., 2011. The Biomechanics of the Anterior Cruciate Ligament and Its Reconstruction. In Theoretical Biomechanics. pp.361– 381.
Ju, Y.J. et al., 2006. Effects of Local Administration of Vascular Endothelial Growth Factor on Properties of the in Situ Frozen- Thawed Anterior Cruciate Ligament in Rabbits. The American Journal of Sports Medicine, 34(1), pp.84-89.
Kanaya, A. et al., 2007. Intra-articular Injection of Mesenchymal Stromal Cells in Partially Torn Anterior Cruciate Ligaments in a Rat Model. Arthroscopy:The Journal of Arthroscopic and Related Surgery, 23(6), pp.610-17.
Kanazawa, T., Soejima, T. & Tabuchi, K., 2012. Histological analysis on the tendon-to-bone healing utilizing bone marrow-derived MSCs in ACL reconstruction model without a bone tunnel. In ORS 2012 Annual Meeting., 2012.
Kaplan, L.D. & Fu, F., 2004. Clinical Applications of Orthopedic Tissue Engineering: Liganlents and Tendons. In A.C. VM Goldberg, ed. OrthopedicTissue Engineering Basic Science and Practice. New York, USA: Marcel DekkerInc.
Kohno, T. et al., 2007. Immunohistochemical demonstration of growth factors at the tendon- bone interface in anterior cruciate ligament reconstruction using a rabbit model. J. Orthop. Sci., 12, pp.67-73.
Krosshaug, T. & Slauterbeck, J.R., 2006. Biomechanical Analysis od Anterior Cruciate Ligament Injury Menchanisms: Three-Dimensional Motion Reconstruction from Video Sequences. Scandinavian Journal of Medicine and Science in Sports.
Lane, J.G., Kaufman, K., Rangger, C. & Daniel, D.M., 1994. The anterior cruciate ligament in controlling axial rotation. An evaluation of its effect. Am. J.Sports Med., 22(2), pp.289-93.
L'Insalata, J.C., Klatt, B. & Fu, F.H., 1997. Tunnel expansion following anterior cruciate ligament reconstruction: A comparison of hamstring and patellar tendon autograft. Knee Surg Sports Traumatol Arthrosc, 5, pp.234-38.
Lipke, J.M., Janecki, C.J. & Nelson, C.L., 1981. The role of incompetence of the anterior cruciate and lateral ligaments in anterolateral dan anteromedial instability. A biomechanical study of cadaver knees. J Bone Joint Surg Am, 63(954-960).
Ma, C.B. et al., 2007. Bone morphogenetic proteins-signaling plays a role in tendon-to-bone healing: A study of rhBMP-2 and noggin. Am. J. Sports Med., 35, pp.597–604.
Mall, N.A., Van Thiel, G.S., Bedi, A. & Cole, B.J., 2013. Graft Selectionin Anterior Cruciate Ligament Reconstruction. [Online] Available at: http://www.rockfordortho.com/wp- content/uploads/2012/07/Graft- Selection-in- ACL- Surgery.pdf [Accessed 11 January 2015]
McCarty, L.P., 2005. Anatomy, Biology, and Biomechanics of Pattelar Tendon Autograft Anterior Cruciate Ligament Reconstruction. Techniques inOrtop.
Milano, G., Deriu, L. & Fabbriciani, C., 2008. Graft-Tunnel Healing. In C. Brown et al., eds. The Anterior Cruciate Ligament: Reconstruction and Basic Science. Philadelphia, PA, United State of America: SAUNDERS Elsevier.
Odensten, M. & Gillquist, J., 1985. Functional anatomy of the anterior cruciate ligament and a rationale for reconstruction. J Bone Joint Surg Am, 67, pp.257–62.
Oe, K., Kushida, T. & Okamoto, N., 2011. New strategies for anterior cruciate ligament partial rupture using bone marrow transplantation in rats. StemCells Development, 20, pp.671- 79.
Petersen, W. & Tillmann, B., 2002. Anatomy and function of the anterior cruciate ligament. Orthopäde, 31, pp.710–18.
Pinczewski, L., Clingeleffer, A., Otto, D. & Bonar, F., 1997. Integration of Hamstring Tendon Graft With Bone in Reconstruction of the Anterior Cruciate Ligament. Arthroscopy:The Journal of Arthroscopic and Related Surgery, 13(5), pp.641-43.
Reinert, R.B. et al., 2013. Vascular endothelial growth factor-a and islet vascularization are necessary in developing, but not adult, pancreatic islets. PubMed.gov Diabetes., 62(12), pp.4154-64.
Rodeo, S.A. et al., 1993. Tendon-healing in a bone tunnel. A biomechanical and histological study in the dog. Journal Bone Joint SurgeryAmerica, 72(12), pp.1795-803.
Sakane, M., Fox, R.J. & Woo, S.L., 1997. In situ forces in the anterior cruciate ligament and its bundles in response to anterior tibial loads. J Orthop Res, 15, pp.285–93.
Song, E.K. et al., 2004. Failure of Osteointegration of Hamstring Tendon Autograft After Anterior Cruciate Ligament Reconstruction. Arthroscopy: The Journal of Arthroscopic and Related Surgery, 20(4), pp.424-28.
Tomita, F. et al., 2001. Comparisons of intraosseous graft healing between the doubled flexor tendon graft and the bone-patellar tendon-bone graft in anterior cruciate ligament reconstruction. Arthroscopy, 17(5).
Weiler A et al., 2002. Tendon Healing in a Bone Tunnel. Part I: Biomechanical Results After Biodegradable Interference Fit Fixation in a Model of Anterior Cruciate Ligament Reconstruction in Sheep. Arthroscopy: The Journalof Arthroscopic and Related Surgery, 18(2), pp.113-23.
Weiler, A. et al., 2002. Tendon Healing in a Bone Tunnel Part II: Histologic Analysis After Biodegradable Interference Fit Fixation in a Model of Anterior Cruciate Ligament Reconstruction in Sheep. Arthroscopy: The Journal of Arthroscopic and Related Surgery, 72(12), pp.113-23.
Zelle, B.A. et al., 2005. Biological Consideration of Tendon Graft Incorporation Within the Bone Tunnel. Elsevier, Operative Technique in Orthopaedics.
1. As an author you (or your employer or institution) may do the following:
- make copies (print or electronic) of the article for your own personal use, including for your own classroom teaching use;
- make copies and distribute such copies (including through e-mail) of the article to research colleagues, for the personal use by such colleagues (but not commercially or systematically, e.g. via an e-mail list or list server);
- present the article at a meeting or conference and to distribute copies of the article to the delegates attending such meeting;
- for your employer, if the article is a ‘work for hire', made within the scope of your employment, your employer may use all or part of the information in the article for other intra-company use (e.g. training);
- retain patent and trademark rights and rights to any process, procedure, or article of manufacture described in the article;
- include the article in full or in part in a thesis or dissertation (provided that this is not to be published commercially);
- use the article or any part thereof in a printed compilation of your works, such as collected writings or lecture notes (subsequent to publication of the article in the journal); and prepare other derivative works, to extend the article into book-length form, or to otherwise re-use portions or excerpts in other works, with full acknowledgement of its original publication in the journal;
- may reproduce or authorize others to reproduce the article, material extracted from the article, or derivative works for the author's personal use or for company use, provided that the source and the copyright notice are indicated, the copies are not used in any way that implies JSCRTE endorsement of a product or service of any employer, and the copies themselves are not offered for sale.
All copies, print or electronic, or other use of the paper or article must include the appropriate bibliographic citation for the article's publication in the journal.
2. Requests from third parties
Although authors are permitted to re-use all or portions of the article in other works, this does not include granting third-party requests for reprinting, republishing, or other types of re-use. Requests for all uses not included above, including the authorization of third parties to reproduce or otherwise use all or part of the article (including figures and tables), should be referred to JSCRTE by going to our website at http://e-journal.unair.ac.id/index.php/JSCRTE
3. Author Online Use
- Personal Servers. Authors and/or their employers shall have the right to post the accepted version of articles pre-print version of the article, or revised personal version of the final text of the article (to reflect changes made in the peer review and editing process) on their own personal servers or the servers of their institutions or employers without permission from JSCRTE, provided that the posted version includes a prominently displayed JSCRTE copyright notice and, when published, a full citation to the original publication, including a link to the article abstract in the journal homepage. Authors shall not post the final, published versions of their papers;
- Classroom or Internal Training Use. An author is expressly permitted to post any portion of the accepted version of his/her own articles on the author's personal web site or the servers of the author's institution or company in connection with the author's teaching, training, or work responsibilities, provided that the appropriate copyright, credit, and reuse notices appear prominently with the posted material. Examples of permitted uses are lecture materials, course packs, e-reserves, conference presentations, or in-house training courses;
- Electronic Preprints. Before submitting an article to an JSCRTE, authors frequently post their manuscripts to their own web site, their employer's site, or to another server that invites constructive comment from colleagues. Upon submission of an article to JSCRTE, an author is required to transfer copyright in the article to JSCRTE, and the author must update any previously posted version of the article with a prominently displayed JSCRTE copyright notice. Upon publication of an article by the JSCRTE, the author must replace any previously posted electronic versions of the article with either (1) the full citation to the work with a Digital Object Identifier (DOI) or link to the article abstract in JSCRTE homepage, or (2) the accepted version only (not the final, published version), including the JSCRTE copyright notice and full citation, with a link to the final, published article in journal homepage.
4. Articles in Press (AiP) service
JSCRTE may choose to publish an abstract or portions of the paper before we publish it in the journal. Please contact our Production department immediately if you do not want us to make any such prior publication for any reason, including disclosure of a patentable invention.
5. Author/Employer Rights
If you are employed and prepared the article on a subject within the scope of your employment, the copyright in the article belongs to your employer as a work-for-hire. In that case, JSCRTE assumes that when you sign this Form, you are authorized to do so by your employer and that your employer has consented to the transfer of copyright, to the representation and warranty of publication rights, and to all other terms and conditions of this Form. If such authorization and consent has not been given to you, an authorized representative of your employer should sign this Form as the Author.
6. JSCRTE Copyright Ownership
It is the formal policy of JSCRTE to own the copyrights to all copyrightable material in its technical publications and to the individual contributions contained therein, in order to protect the interests of the JSCRTE, its authors and their employers, and, at the same time, to facilitate the appropriate re-use of this material by others. JSCRTE distributes its technical publications throughout the world and does so by various means such as hard copy, microfiche, microfilm, and electronic media. It also abstracts and may translate its publications, and articles contained therein, for inclusion in various compendiums, collective works, databases and similar publications
Every accepted manuscript should be accompanied by "Copyright Transfer Agreement" prior to the article publication.