Changes in the Cross-Sectional Profile of Treated Anterior Cruciate Ligament Within 2 Years After Surgery.

Autor:	Menghini D; Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Kaushal SG; Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Flannery SW; Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Ecklund K; Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Murray MM; Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Fleming BC; Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Kiapour AM; Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Proffen B; Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Sant N; Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Portilla G; Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Sanborn R; Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Freiberger C; Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Henderson R; Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Barnett S; Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Yen YM; Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Kramer DE; Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Micheli LJ; Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Jazyk:	angličtina
Zdroj:	Orthopaedic journal of sports medicine [Orthop J Sports Med] 2022 Oct 14; Vol. 10 (10), pp. 23259671221127326. Date of Electronic Publication: 2022 Oct 14 (Print Publication: 2022).
DOI:	10.1177/23259671221127326
Abstrakt:	Background: The cross-sectional area (CSA) of the anterior cruciate ligament (ACL) and reconstructed graft has direct implications on its strength and knee function. Little is known regarding how the CSA changes along the ligament length and how those changes vary between treated and native ligaments over time. Hypothesis: It was hypothesized that (1) the CSA of reconstructed ACLs and restored ACLs via bridge-enhanced ACL restoration (BEAR) is heterogeneous along the length. (2) Differences in CSA between treated and native ACLs decrease over time. (3) CSA of the surgically treated ACLs is correlated significantly with body size (ie, height, weight, body mass index) and knee size (ie, bicondylar and notch width). Study Design: Cohort study; Level of evidence, 2. Methods: Magnetic resonance imaging scans of treated and contralateral knees of 98 patients (n = 33 ACL reconstruction, 65 BEAR) at 6, 12, and 24 months post-operation were used to measure the ligament CSA at 1% increments along the ACL length (tibial insertion, 0%; femoral insertion, 100%). Statistical parametric mapping was used to evaluate the differences in CSA between 6 and 24 months. Correlations between body and knee size and treated ligament CSA along its length were also assessed. Results: Hamstring autografts had larger CSAs than native ACLs at all time points ( P < .001), with region of difference decreasing from proximal 95% of length (6 months) to proximal 77% of length (24 months). Restored ACLs had larger CSAs than native ACLs at 6 and 12 months, with larger than native CSA only along a small midsubstance region at 24 months ( P < .001). Graft CSA was correlated significantly with weight (6 and 12 months), bicondylar width (all time points), and notch width (24 months). Restored ACL CSA was significantly correlated with bicondylar width (6 months) and notch width (6 and 12 months). Conclusion: Surgically treated ACLs remodel continuously within the first 2 years after surgery, leading to ligaments/grafts with heterogeneous CSAs along the length, similar to the native ACL. While reconstructed ACLs remained significantly larger, the restored ACL had a CSA profile comparable with that of the contralateral native ACL. In addition to size and morphology differences, there were fundamental differences in factors contributing to CSA profile between the ACL reconstruction and BEAR procedures. Registration: NCT02664545 (ClinicalTrials.gov identifier). Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: this study received funding support from the Translational Research Program at Boston Children’s Hospital, the Children’s Hospital Orthopaedic Surgery Foundation, the Children’s Hospital Sports Medicine Foundation, the Football Players Health Study at Harvard University, and the National Institutes of Health and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grants R01-AR065462 and R01-AR056834). M.M.M. is a founder, paid consultant, and equity holder in Miach Orthopaedics, which was formed to work on upscaling production of the BEAR scaffold. M.M.M. maintained a conflict-of-interest management plan that was approved by Boston Children’s Hospital and Harvard Medical School during the conduct of the trial, with oversight by both conflict-of-interest committees and the institutional review board of Boston Children’s Hospital, as well as the US Food and Drug Administration. B.C.F. is an assistant editor for The American Journal of Sports Medicine and the spouse of M.M.M., with the inherently same conflicts. A.M.K. is a paid consultant for Miach Orthopaedics and maintained a conflict-of-interest management plan that was approved by Boston Children’s Hospital and Harvard Medical School during the conduct of the trial, with oversight by both conflict-of-interest committees and the institutional review board of Boston Children’s Hospital. For the BEAR Trial Team, D.E.K., L.J.M., and Y.-M.Y. all have disclosures as listed in the American Academy of Orthopaedic Surgeons database, none of which is related to this current project or technology. These include educational payments from Kairos Surgical (D.E.K., Y.-M.Y.). L.J.M. also has received hospitality payments from various companies. B.P. has manufactured the scaffolds used in the trials at Boston Children’s Hospital and is a paid consultant and equity holder in Miach Orthopaedics at this time, as he assists with transfer of the manufacturing process to the contract manufacturing organization that Miach has engaged to do the manufacturing. N.S. has manufactured scaffolds used in the trials at Boston Children’s Hospital and is a paid consultant for Miach Orthopaedics. B.P. and N.S. maintain a conflict-of-interest management plan that was approved by Boston Children’s Hospital and Harvard Medical School during the conduct of the trial, with oversight by both conflict-of-interest committees and the institutional review board of Boston Children’s Hospital. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. (© The Author(s) 2022.)
Databáze:	MEDLINE
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