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J Knee Surg 2019; 32(11): 1094-1101
DOI: 10.1055/s-0038-1675599
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Effect of Remnant Preservation on Tibial Tunnel Enlargement in Anterior Cruciate Ligament Reconstruction with Polyethylene Terephthalate Artificial Ligament in a Large Animal Model

Jiangyu Cai
1   Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic China
,
Fang Wan
1   Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic China
,
Chengchong Ai
1   Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic China
,
Wenhe Jin
1   Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic China
,
Dandan Sheng
1   Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic China
,
Xingwang Liu
1   Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic China
,
Siheng Wang
1   Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic China
,
Yunlong Zhi
1   Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic China
,
Jun Chen
1   Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic China
,
Shiyi Chen
1   Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic China
› Author Affiliations
Funding This work was supported by the National Key R&D Program of China (2016YFC1100300, 2017YFC0840100 and 2017YFC0840106), the National Natural Science Foundation of China (No. 81572108 and 81772339), the Key Clinical Medicine Center of Shanghai (2017ZZ01006), the Sanming Project of Medicine in Shenzhen (SZSM20161207), the Shanghai RisingStar Project (18QB1400500), the Introduction Project of Clinical Medicine Expert Team for Suzhou (SZYJTD201714), CAS Key Laboratory of Nano-Bio Interface (No: 17NBI01) and State Key Laboratory of Molecular Engineering of Polymers (No: K2018-17).
Further Information

Publication History

04 August 2018

29 September 2018

Publication Date:
26 November 2018 (online)

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Abstract

An enlarged bone tunnel may affect the graft–bone integration and pose a problem for revision anterior cruciate ligament (ACL) surgery. The purpose of this study was to evaluate the effect of remnant preservation on tibial tunnel enlargement in ACL reconstruction with polyethylene terephthalate (PET) artificial ligament. Twenty-four skeletally mature male beagles underwent ACL reconstruction with PET artificial ligament for both knees. One knee was reconstructed with remnant preservation using sleeve technique (remnant group), while the contralateral was reconstructed without remnant preservation (control group). The animals were sacrificed at 1 day, 6 weeks, and 12 weeks after surgery for further evaluation including macroscopic observation, microcomputed tomography (micro-CT), histological assessment, and biomechanical testing. The remnant group had better synovial coverage than the control group at 6 and 12 weeks after surgery. The micro-CT analysis showed the tibial tunnel area (TTA) of the remnant group was significantly smaller and the bone volume/total volume fraction (BV/TV) value was higher than those of the control group at 6 and 12 weeks. Moreover, TTA and BV/TV at each time point were divided into three groups according to the different grade of synovial coverage. Significant association was observed between the synovial coverage degree and the TTA and BV/TV values. The histological assessment revealed that the interface width between the graft and host bone in the remnant group was smaller than that in the control group in the tibial tunnels at 6 and 12 weeks. Moreover, the remnant group had better failure load and stiffness than the control group at 12 weeks. The remnant preservation using sleeve technique could effectively promote the synovial coverage of the graft, decrease the risk of tibial tunnel enlargement by sealing the bone tunnel entrance, and enhance the biological environment for graft–bone healing after ACL reconstruction using PET artificial ligament. This technique provides a potential solution for bone tunnel enlargement following artificial ligament surgery for the acute ACL rupture in the clinical practice.

Keywords

remnant preservation - bone tunnel enlargement - anterior cruciate ligament - polyethylene terephthalate - artificial ligament

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