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Knee Surgery, Sports Traumatology, Arthroscopy

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01-08-2017 | Knee

Collagen application reduces complication rates of mid-substance ACL tears treated with dynamic intraligamentary stabilization

Authors: Dimitrios S. Evangelopoulos, Sandro Kohl, Stefan Schwienbacher, Benjamin Gantenbein, Aristomenis Exadaktylos, Sufian S. Ahmad

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 8/2017

Abstract

Purpose

Dynamic intraligamentary stabilization was recently proposed as an option for the treatment of acute ACL ruptures. The aim of this study was to investigate the feasibility of the procedure in mid-substance ACL ruptures and examine whether the additional application of a bilayer collagen I/III membrane would provide for a superior outcome.

Methods

The study group consisted of patients presenting with a mid-substance ACL rupture undergoing dynamic intraligamentary stabilization using the Ligamys™ device along with application of a collagen I/III membrane to the surface of the ACL (group A, n = 23). The control group comprised a matched series of patients presenting with a mid-substance ACL rupture also treated by dynamic intraligamentary stabilization Ligamys™ repair, however, without additional collagen application (group B, n = 33). Patients were evaluated preoperatively and at 24-month follow-up for stability as well as Tegner and Lysholm scores. Knee laxity was measured as a difference in anterior translation (ΔAP) and pivot shift. Any events occurring during the follow-up period of 24 months were documented. Logistic regression of complications was performed, and adjustment undertaken where necessary.

Results

A high total complication rate of 78.8 % was noted in group B, compared to group A (8.7 %) (p = 0.002). The addition of a collagen membrane was the only independent prognostic factor associated with reduced complications (OR 8.0, CI 2.0–32.2, p = 0.003, for collagen-free treatment). In group B, 6 patients suffered a re-rupture with subsequent instability requiring secondary hamstring reconstruction surgery, and 11 developed extension loss requiring arthroscopic debridement, whilst in group A, 2 patients required arthroscopic debridement for loss of exension, with no further encountered complication. Median Lysholm score was significantly higher in group A compared to group B (median 100 range 93–100 vs median 95 range 60–100, p = 0.03) at final follow-up.

Conclusions

A high complication rate following ACL Ligamys™ repair of mid-substance ruptures was noted. Application of a collagen membrane to the surface of the ACL resulted in a reduced incidence of extension deficit and re-ruptures. The results indicate that solitary ACL Ligamys™ repair does not present an appropriate treatment modality for mid-substance ACL ruptures. Collage application proved to provide healing benefits with superior clinical outcome after ACL repair.

Level of evidence

Case control study, Level III.

Ahmad SS, Evangelopoulos DS, Abbasian M, Roder C, Kohl S (2014) The hundred most-cited publications in orthopaedic knee research. J Bone Joint Surg Am 96(22):e190CrossRefPubMed

Cummings JF, Grood ES (2002) The progression of anterior translation after anterior cruciate ligament reconstruction in a caprine model. J Orthop Res 20(5):1003–1008CrossRefPubMed

Eggli S, Kohlhof H, Zumstein M, Henle P, Hartel M, Evangelopoulos DS, Bonel H, Kohl S (2015) Dynamic intraligamentary stabilization: novel technique for preserving the ruptured ACL. Knee Surg Sports Traumatol Arthrosc 23(4):1215–1221CrossRefPubMed

Feagin JA Jr, Curl WW (1976) Isolated tear of the anterior cruciate ligament: 5-year follow-up study. Am J Sports Med 4(3):95–100CrossRefPubMed

Fleming BC, Spindler KP, Palmer MP, Magarian EM, Murray MM (2009) Collagen–platelet composites improve the biomechanical properties of healing anterior cruciate ligament grafts in a porcine model. Am J Sports Med 37(8):1554–1563CrossRefPubMedPubMedCentral

Fruensgaard S, Kroner K, Riis J (1992) Suture of the torn anterior cruciate ligament. 5-year follow-up of 60 cases using an instrumental stability test. Acta Orthop Scand 63(3):323–325CrossRefPubMed

Gantenbein B, Gadhari N, Chan SC, Kohl S, Ahmad SS (2015) Mesenchymal stem cells and collagen patches for anterior cruciate ligament repair. World J Stem Cells 7(2):521–534CrossRefPubMedPubMedCentral

Gianotti SM, Marshall SW, Hume PA, Bunt L (2009) Incidence of anterior cruciate ligament injury and other knee ligament injuries: a national population-based study. J Sci Med Sport 12(6):622–627CrossRefPubMed

Henle P, Röder C, Perler G, Heitkemper S, Eggli S (2015) Dynamic intraligamentary stabilization (DIS) for treatment of acute anterior cruciate ligament ruptures: case series experience of the first three years. BMC Musculoskelet Disord 16(1):27CrossRefPubMedPubMedCentral

10.

Kohl S, Evangelopoulos DS, Ahmad SS, Kohlhof H, Herrmann G, Bonel H, Eggli S (2014) A novel technique, dynamic intraligamentary stabilization creates optimal conditions for primary ACL healing: a preliminary biomechanical study. Knee 21(2):477–480CrossRefPubMed

11.

Kohl S, Evangelopoulos DS, Kohlhof H, Hartel M, Bonel H, Henle P, von Rechenberg B, Eggli S (2013) Anterior crucial ligament rupture: self-healing through dynamic intraligamentary stabilization technique. Knee Surg Sports Traumatol Arthrosc 21(3):599–605CrossRefPubMed

12.

Kösters C, Herbort M, Schliemann B, Raschke M, Lenschow S (2015) Dynamische intraligamentäre Stabilisierung des vorderen Kreuzbandes. Der Unfallchirurg 118(4):364–371CrossRefPubMed

13.

Magarian EM, Fleming BC, Harrison SL, Mastrangelo AN, Badger GJ, Murray MM (2010) Delay of 2 or 6 weeks adversely affects the functional outcome of augmented primary repair of the porcine anterior cruciate ligament. Am J Sports Med 38(12):2528–2534CrossRefPubMedPubMedCentral

14.

Marshall JL, Warren RF, Wickiewicz TL, Reider B (1979) The anterior cruciate ligament: a technique of repair and reconstruction. Clin Orthop Relat Res 143:97–106

15.

Mascarenhas R, MacDonald PB (2008) Anterior cruciate ligament reconstruction: a look at prosthetics—past, present and possible future. Mcgill J Med 11(1):29–37PubMedPubMedCentral

16.

Mastrangelo AN, Vavken P, Fleming BC, Harrison SL, Murray MM (2011) Reduced platelet concentration does not harm PRP effectiveness for ACL repair in a porcine in vivo model. J Orthop Res 29(7):1002–1007CrossRefPubMedPubMedCentral

17.

Matsubara H, Okazaki K, Tashiro Y, Toyoda K, Uemura M, Hashizume M, Iwamoto Y (2013) Intercondylar roof impingement after anatomic double-bundle anterior cruciate ligament reconstruction in patients with knee hyperextension. Am J Sports Med 41(12):2819–2827CrossRefPubMed

18.

Mayr HO, Stohr A (2014) Arthroscopic treatment of arthrofibrosis after ACL reconstruction. Local and generalized arthrofibrosis. Oper Orthop Traumatol 26(1):7–18. doi:10.1007/s00064-013-0264-1 CrossRefPubMed

19.

Mochizuki T, Fujishiro H, Nimura A, Mahakkanukrauh P, Yasuda K, Muneta T, Akita K (2014) Anatomic and histologic analysis of the mid-substance and fan-like extension fibres of the anterior cruciate ligament during knee motion, with special reference to the femoral attachment. Knee Surg Sports Traumatol Arthrosc 22(2):336–344CrossRefPubMed

20.

Murray MM (2009) Current status and potential of primary ACL repair. Clin Sports Med 28(1):51–61CrossRefPubMedPubMedCentral

21.

Murray MM, Magarian E, Zurakowski D, Fleming BC (2010) Bone-to-bone fixation enhances functional healing of the porcine anterior cruciate ligament using a collagen–platelet composite. Arthroscopy 26(9 Suppl):S49–S57CrossRefPubMedPubMedCentral

22.

Murray MM, Martin SD, Martin TL, Spector M (2000) Histological changes in the human anterior cruciate ligament after rupture. J Bone Joint Surg Am 82-a(10):1387–1397CrossRefPubMed

23.

Murray MM, Spindler KP, Abreu E, Muller JA, Nedder A, Kelly M, Frino J, Zurakowski D, Valenza M, Snyder BD, Connolly SA (2007) Collagen–platelet rich plasma hydrogel enhances primary repair of the porcine anterior cruciate ligament. J Orthop Res 25(1):81–91CrossRefPubMed

24.

Odensten M, Lysholm J, Gillquist J (1984) Suture of fresh ruptures of the anterior cruciate ligament. A 5-year follow-up. Acta Orthop Scand 55(3):270–272CrossRefPubMed

25.

Park JH, Jeong WK, Lee JH, Cho JJ, Lee DH (2015) Postural stability in patients with anterior cruciate ligament tears with and without medial meniscus tears. Knee Surg Sports Traumatol Arthrosc 23(1):240–245CrossRefPubMed

26.

Robertson GA, Coleman SG, Keating JF (2011) The surgical treatment of knee stiffness following anterior cruciate ligament reconstruction. Scott Med J 56(3):156–160CrossRefPubMed

27.

Rosenbaum PR, Rubin DB (1983) The central role of the propensity score in observational studies for causal effects. Biometrika 70(1):41–55CrossRef

28.

Schindler OS (2012) Surgery for anterior cruciate ligament deficiency: a historical perspective. Knee Surg Sports Traumatol Arthrosc 20(1):5–47CrossRefPubMed

29.

Shelburne KB, Pandy MG, Torry MR (2004) Comparison of shear forces and ligament loading in the healthy and ACL-deficient knee during gait. J Biomech 37(3):313–319CrossRefPubMed

30.

Sommerlath K, Lysholm J, Gillquist J (1991) The long-term course after treatment of acute anterior cruciate ligament ruptures. A 9 to 16 year followup. Am J Sports Med 19(2):156–162CrossRefPubMed

31.

Spindler KP, Clark SW, Nanney LB, Davidson JM (1996) Expression of collagen and matrix metalloproteinases in ruptured human anterior cruciate ligament: an in situ hybridization study. J Orthop Res 14(6):857–861CrossRefPubMed

32.

Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49

33.

Vavken P, Murray MM (2010) Translational studies in anterior cruciate ligament repair. Tissue Eng Part B Rev 16(1):5–11CrossRefPubMed

Title: Collagen application reduces complication rates of mid-substance ACL tears treated with dynamic intraligamentary stabilization
Authors: Dimitrios S. Evangelopoulos
Sandro Kohl
Stefan Schwienbacher
Benjamin Gantenbein
Aristomenis Exadaktylos
Sufian S. Ahmad
Publication date: 01-08-2017
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 8/2017
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-015-3838-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Collagen application reduces complication rates of mid-substance ACL tears treated with dynamic intraligamentary stabilization

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

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