Search

This study was undertaken to evaluate the placement of fibrin clot and cultured autologous marrow cells in surgically created, full-thickness, meniscal lesions in the avascular zone in 32 female Spanish goats. The menisci were repaired with two vertically oriented sutures (N = 8), exogenous fibrin clot was placed into the meniscal defect before placement of the two sutures (N = 8), fibrin clot plus cultured adherent bone marrow cells were placed in the defect (N = 8), or the meniscal lesions were left unrepaired (N = 8). On gross and manual inspection, meniscal lesions showed some degree of healing in all animals except for the eight unrepaired lesions. All the experimental specimens had decreased tensile strength compared with the contralateral control medial menisci. Ultimate load to failure, energy absorbed to failure, and stiffness were less than 40% of the controls for all groups. Histologic sections demonstrated focal cellular areas consisting of giant cells and macrophages in the repair sites. Our observations failed to demonstrate a statistically significant enhancement of healing with the use of exogenous fibrin clot compared with vertically oriented sutures alone. The addition of cultured adherent autologous bone marrow-derived cells in conjunction with the fibrin clot did not enhance the meniscal healing. [ABSTRACT FROM AUTHOR]

A matrix of demineralized cortical bone was used to reconstruct the anterior cruciate ligament in the goat model. This graft underwent considerable site-specific remodeling and transformation from a Haversian system at time zero into a ligament-like structure at 1 year. This transformation included new bone formation filling the osseous tunnels and replacing the demineralized matrix, development of a ligament-like transition zone within the graft, and ligamentous collagen orientation with crimp in the intraarticular portion of the graft. One year after surgery, the mean anterior-posterior translation in the reconstructed stifle joints at 30 N of tibial loading was 2.1 +/- 0.4 mm (+/- SEM). The mean ultimate force to failure for the reconstructed ligament at 1 year was 474 +/- 146 N compared with the time-zero (initial) strength of the matrix of 73 +/- 9 N. The cellular repopulation of the graft had no associated inflammatory cells. The potential clinical significance of these findings includes 1) replacement of a collagen matrix with bone within the osseous tunnels, 2) establishment of a more physiologic fibrocartilage transition at the graft insertion site, 3) the time-zero structural properties of a collagen matrix increasing to more desired values with biologic remodeling, and 4) a sterile biologic allograft with essentially no long-term inflammatory response. [ABSTRACT FROM AUTHOR]

Seventy-five patients undergoing arthroscopically-assisted anterior cruciate ligament reconstruction by the same surgeon were divided into three random subgroups. All of the anterior cruciate ligament reconstructions used the middle third of the ipsilateral patellar tendon autograft. Patients undergoing meniscal repair, extraarticular procedures, or repair of other ligaments were excluded. The 75 patients were divided into subgroups to assess the benefits or disadvantages of early active motion (25 patients), continuous passive motion (25 patients), and a combination of both (25 patients) during the first 30 days after surgery. All patients were evaluated at specific intervals for 6 months after surgery. Data recorded included drain output, medication usage, tourniquet time, leg involved, hospital stay length, KT-1000 testing (before surgery in the anesthetized patient, after the procedure was completed, and 2 and 6 months after surgery), and range of motion. Radiographs and the International Knee Evaluation Form were also used to evaluate the results. No statistically significant differences were found between the three groups. Side-to-side anterior-posterior differences, stability, and restoration of full range of motion were similar in each subgroup at each evaluated interval. In this prospective study of motion, started immediately after anterior cruciate ligament reconstruction, passive and active methods were shown to have identical results. A supervised active and passive motion program during the 1st month had the same results as either one used individually. [ABSTRACT FROM AUTHOR]