BACKGROUND:Revision anterior cruciate ligament (ACL) reconstruction often requires a two-stage approach. This study analyzes the biomechanical properties after cyclic loading of a one-stage ACL revision technique using a calcium phosphate bone cement. METHODS:Arthroscopic reconstruction of the ACL was performed in 5 matched pairs of fresh-frozen cadaveric knees separated into two groups. The control group underwent a standard reconstruction with a bone-patellar tendon-bone autograft with bioabsorbable interference screw fixation. The experimental group simulated a failed reconstruction by drilling a 12 mm hole and underwent a revision after filling it with a bioabsorbable calcium phosphate bone cement. The specimens were dissected, scanned for bone mineral density, and cyclically loaded on a mechanical testing system (preload of 250 cycles of 5-75 N at 0.5 Hz followed by 10,000 cycles of 20-150 N at 1 Hz). Intact specifmens underwent a load-to-failure protocol of 50mm/min. Ultimate load, stiffness, and modes of failure were recorded. Data was analyzed using paired t-tests. FINDINGS: All specimens completed the mechanical testing protocol. The control group had a mean maximum load of 471.33 N (SD 220.73 N) and the experimental group had 453.54 N (SD 152.36; p=0.84). There were no statistically significant differences in maximum load or stiffness. No correlation between bone mineral density (BMD) and maximum load was found. INTERPRETATION: Using calcium phosphate filler in a single-stage ACL revision is biomechanically viable. Further testing of long-term incorporation of the ACL graft in an animal model, along with human clinical trials, should be performed before there is clinical acceptance of this technique.
RCT Entities:
BACKGROUND: Revision anterior cruciate ligament (ACL) reconstruction often requires a two-stage approach. This study analyzes the biomechanical properties after cyclic loading of a one-stage ACL revision technique using a calcium phosphate bone cement. METHODS: Arthroscopic reconstruction of the ACL was performed in 5 matched pairs of fresh-frozen cadaveric knees separated into two groups. The control group underwent a standard reconstruction with a bone-patellar tendon-bone autograft with bioabsorbable interference screw fixation. The experimental group simulated a failed reconstruction by drilling a 12 mm hole and underwent a revision after filling it with a bioabsorbable calcium phosphate bone cement. The specimens were dissected, scanned for bone mineral density, and cyclically loaded on a mechanical testing system (preload of 250 cycles of 5-75 N at 0.5 Hz followed by 10,000 cycles of 20-150 N at 1 Hz). Intact specifmens underwent a load-to-failure protocol of 50mm/min. Ultimate load, stiffness, and modes of failure were recorded. Data was analyzed using paired t-tests. FINDINGS: All specimens completed the mechanical testing protocol. The control group had a mean maximum load of 471.33 N (SD 220.73 N) and the experimental group had 453.54 N (SD 152.36; p=0.84). There were no statistically significant differences in maximum load or stiffness. No correlation between bone mineral density (BMD) and maximum load was found. INTERPRETATION: Using calcium phosphate filler in a single-stage ACL revision is biomechanically viable. Further testing of long-term incorporation of the ACL graft in an animal model, along with human clinical trials, should be performed before there is clinical acceptance of this technique.
Authors: David Y Ding; Alan L Zhang; Christina R Allen; Allen F Anderson; Daniel E Cooper; Thomas M DeBerardino; Warren R Dunn; Amanda K Haas; Laura J Huston; Brett Brick A Lantz; Barton Mann; Kurt P Spindler; Michael J Stuart; Rick W Wright; John P Albright; Annunziato Ned Amendola; Jack T Andrish; Christopher C Annunziata; Robert A Arciero; Bernard R Bach; Champ L Baker; Arthur R Bartolozzi; Keith M Baumgarten; Jeffery R Bechler; Jeffrey H Berg; Geoffrey A Bernas; Stephen F Brockmeier; Robert H Brophy; Charles A Bush-Joseph; J Brad Butler; John D Campbell; James L Carey; James E Carpenter; Brian J Cole; Jonathan M Cooper; Charles L Cox; R Alexander Creighton; Diane L Dahm; Tal S David; David C Flanigan; Robert W Frederick; Theodore J Ganley; Elizabeth A Garofoli; Charles J Gatt; Steven R Gecha; James Robert Giffin; Sharon L Hame; Jo A Hannafin; Christopher D Harner; Norman Lindsay Harris; Keith S Hechtman; Elliott B Hershman; Rudolf G Hoellrich; Timothy M Hosea; David C Johnson; Timothy S Johnson; Morgan H Jones; Christopher C Kaeding; Ganesh V Kamath; Thomas E Klootwyk; Bruce A Levy; C Benjamin Ma; G Peter Maiers; Robert G Marx; Matthew J Matava; Gregory M Mathien; David R McAllister; Eric C McCarty; Robert G McCormack; Bruce S Miller; Carl W Nissen; Daniel F O'Neill; Brett D Owens; Richard D Parker; Mark L Purnell; Arun J Ramappa; Michael A Rauh; Arthur C Rettig; Jon K Sekiya; Kevin G Shea; Orrin H Sherman; James R Slauterbeck; Matthew V Smith; Jeffrey T Spang; Steven J Svoboda; Timothy N Taft; Joachim J Tenuta; Edwin M Tingstad; Armando F Vidal; Darius G Viskontas; Richard A White; James S Williams; Michelle L Wolcott; Brian R Wolf; James J York Journal: Am J Sports Med Date: 2017-05-30 Impact factor: 6.202
Authors: Viviana P Ribeiro; João B Costa; Sofia M Carneiro; Sandra Pina; Ana C A Veloso; Rui L Reis; Joaquim M Oliveira Journal: Pharmaceutics Date: 2022-03-24 Impact factor: 6.525