Repair and Regeneration of the Anterior Cruciate Ligament Using Biological and Mechanical AugmentationMau, Jonquil R. (2018) Repair and Regeneration of the Anterior Cruciate Ligament Using Biological and Mechanical Augmentation. Doctoral Dissertation, University of Pittsburgh. (Unpublished)
AbstractThe anterior cruciate ligament (ACL) is the most commonly injured ligament of the knee with well over 200,000 injuries in the US annually. Surgical reconstruction is a widely used treatment option that involves replacing the ACL with a soft tissue graft. ACL reconstruction is often associated with problems such as pain and long-term follow-up studies have shown that up to 25% of patients have experienced unsatisfactory results that include prevalence of osteoarthritis. In recent years, there has been a renewed interest in regenerating the ACL as an alternative treatment option. In our research center, an innovative approach was developed using an extracellular matrix (ECM) sheet and hydrogel along with a novel metallic implant made of magnesium (Mg) designed to connect the two ends of a torn ACL. The biological augmentation provided by the ECM scaffolds has been shown to incite and accelerate new tissue growth. The mechanical augmentation provided by the Mg ring can restore stability to the knee immediately post-operatively and load the healing ligament throughout the healing process preventing disuse atrophy of the insertion sites. Additionally, the repair construct can be resorbed by the body as the healing tissue begins to bear load. The objective of this research was to continue the development of ECM + Mg ring repair. First, single crystal Mg was coated using micro-arc oxidation to engineer a degradation rate appropriate for the ACL healing application and the corrosion, coating, and surface properties of this novel material-coating combination were characterized. Then, a long-term study of ECM + Mg ring repair of a surgically transected ACL in a goat model was performed to examine if the advantages persist up to 26 weeks. The joint stability, ligament function and structural properties of the femur-ACL-tibia complex were measured. Finally, the Mg ring was redesigned for the human ACL and evaluated using finite element analysis and in human cadaveric knees. This dissertation research has found exciting results that a goat ACL can heal successfully with a combined biological and mechanical augmentation approach and suggests further study of ACL healing in humans. In the end, such an approach could lead to an alternative treatment for ACL injuries. Share
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