This content will become publicly available on February 13, 2024
- Award ID(s):
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- Date Published:
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- Transactions of the annual meeting of the Orthopaedic Research Society
- Medium: X
- Sponsoring Org:
- National Science Foundation
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INTRODUCTION: Quadriceps tendon autografts have experienced a rapid rise in popularity for anterior cruciate ligament (ACL) reconstruction due to advantages in graft sizing and potential improvement in biomechanics. While there is a growing body of literature on use of quadriceps tendon grafts, deeper investigation into the biomechanical properties of stitch techniques in this construct has been limited. The purpose of this study was to evaluate the performance of a novel suture needle against different conventional suture needles by comparing the biomechanical properties of two commonly used stitch methods, a whip stitch, and a locking stitch in quadriceps tendon. It was hypothesized that the new device would be capable of creating both whip stitches and locking stitches that are biomechanically equivalent to similar stitch techniques performed with conventional needle products. METHODS: This was a controlled biomechanical study. A total of 24 matched pair cadaveric knees were dissected and a total of 48 quadriceps tendons were harvested and tested. All tendon grafts were standardized to the same size. Samples were then randomized into the following groups, keeping the matched pairs together: (Group 1, n=16) consisted of Company W’s novel two-part suture needle design, (Group 2, n=16) consisted of Company A suture, and (Group 3, n=16) consisted of Company B suture. For each group, the matched pairs were categorized into subgroups to be instrumented with either a whip stitch or a locking stitch. Two fellowship-trained surgeons performed all stitching, where they each instrumented 8 tendon grafts per group. For instrumentation, the grafts were clamped to a preparation stand in accordance with the manufacturer’s recommendations for passing each suture needle. A skin marker was used to identify and mark five evenly spaced points, 0.5 cm apart, as a guide to create a 5-stitch series. For Group 1, the whip stitch as well as the locking whip stitch were performed with a novel 2-part needle. For Group 2, the whip stitch was performed with loop suture needle and the locking stitch was krackow with a curved needle. Similarly, for Group 3, the whip stitch was performed with loop suture needle and the locking stitch was krackow with a curved needle (Figure 1). Cyclical testing was performed using a servohydraulic testing machine (MTS Bionix) equipped with a 5kN load cell. A standardized length of tendon, 7 cm, was coupled to the MTS actuator by passing it through a cryoclamp cooled by dry ice to a temperature of -5°C (Figure 2). All testing samples were then pre-conditioned to normalize viscoelastic effects and testing variability through application of cyclical loading to 25-100 N for three cycles. The samples were then held at 89 N for 15 minutes. Thereafter, the samples were loaded to 50-200 N for 500 cycles at 1 Hz. If samples survived, they were ramped to failure at 20 mm/min. Displacement and force data was collected throughout testing. Metrics of interest were total elongation (mm), stiffness (N/mm), ultimate failure load (N) and failure mode. Data are presented as averages plus/minus standard deviation. A one-way analysis of variance (ANOVA) with a Tukey pairwise comparison post hoc analysis was used to evaluate differences between the various stitching methods. Statistical significance was set at P = .05. RESULTS SECTION: For the whip stitch methods, the total elongation was found to be equivalent across all methods (W: 36 ± 10 mm; A: 32 ± 18 mm; B: 33 ± 8 mm). The stiffness of Company A (103 ± 11 N/mm) method was significantly larger than Company W (64 ± 8 N/mm; p=.001), whereas stiffness of whip stitch by Company W was equivalent to Company B (80 ± 32 N/mm). The ultimate failure load was equivalent across all whip stitch methods (W: 379 ± 31 mm; A: 412 ± 103 mm; B: 438 ± 63 mm). For the locking stitch method, the total elongation (W: 26 ± 10 mm; A: 14 ± 2 mm; B: 29 ± 5 mm), stiffness (W: 75 ± 11 N/mm; A: 104 ± 23 N/mm; B: 79 ± 10 N/mm) and ultimate load (W: 343 ± 22 N; A: 369 ± 30 N; B: 438 ± 63 N) were found to be equivalent across all methods. The failure mode for all groups is in Table 1. The common mode of failure across study groups and stitch configuration was suture breakage. However, the whip stitch from Company A and Company B had varied failure modes. DISCUSSION: Products from the three manufacturers were found to produce biomechanically equivalent whip stitches and locking stitches with respect to elongation and ultimate failure load. The only significant difference observed was that the whip stitch created with Company A’s product had a higher stiffness than Company W’s product, which could have been due to differences in the suture material. In this cadaveric quadriceps tendon model, it was shown that when using Company W’s novel two-part suture needle, users were capable of creating whip stitches and locking stitches that achieved equivalent biomechanical performance compared to similar stitch techniques performed with conventional needle products. A failure mode limited solely to suture breakage for methods completed with Company W’s needle product suggest a reliable suture construct with limited tissue damage. SIGNIFICANCE/CLINICAL RELEVANCE: Having a suture needle device with the versatility to easily perform different stitching constructs may provide surgeons an advantage needed to improve clinical outcomes. The data presented illustrates a strong new suture technique that has equivalent performance when compared to conventional needle devices and has promising applications in graft preparation for ligament and tendon reconstruction.more » « less
null (Ed.)Abstract Background The pia arachnoid complex (PAC) is a cerebrospinal fluid-filled tissue conglomerate that surrounds the brain and spinal cord. Pia mater adheres directly to the surface of the brain while the arachnoid mater adheres to the deep surface of the dura mater. Collagen fibers, known as subarachnoid trabeculae (SAT) fibers, and microvascular structure lie intermediately to the pia and arachnoid meninges. Due to its structural role, alterations to the biomechanical properties of the PAC may change surface stress loading in traumatic brain injury (TBI) caused by sub-concussive hits. The aim of this study was to quantify the mechanical and morphological properties of ovine PAC. Methods Ovine brain samples (n = 10) were removed from the skull and tissue was harvested within 30 min post-mortem. To access the PAC, ovine skulls were split medially from the occipital region down the nasal bone on the superior and inferior aspects of the skull. A template was used to remove arachnoid samples from the left and right sides of the frontal and occipital regions of the brain. 10 ex-vivo samples were tested with uniaxial tension at 2 mm s −1 , average strain rate of 0.59 s −1 , until failure at < 5 h post extraction. The force and displacement data were acquired at 100 Hz. PAC tissue collagen fiber microstructure was characterized using second-harmonic generation (SHG) imaging on a subset of n = 4 stained tissue samples. To differentiate transverse blood vessels from SAT by visualization of cell nuclei and endothelial cells, samples were stained with DAPI and anti-von Willebrand Factor, respectively. The Mooney-Rivlin model for average stress–strain curve fit was used to model PAC material properties. Results The elastic modulus, ultimate stress, and ultimate strain were found to be 7.7 ± 3.0, 2.7 ± 0.76 MPa, and 0.60 ± 0.13, respectively. No statistical significance was found across brain dissection locations in terms of biomechanical properties. SHG images were post-processed to obtain average SAT fiber intersection density, concentration, porosity, tortuosity, segment length, orientation, radial counts, and diameter as 0.23, 26.14, 73.86%, 1.07 ± 0.28, 17.33 ± 15.25 µm, 84.66 ± 49.18°, 8.15%, 3.46 ± 1.62 µm, respectively. Conclusion For the sizes, strain, and strain rates tested, our results suggest that ovine PAC mechanical behavior is isotropic, and that the Mooney-Rivlin model is an appropriate curve-fitting constitutive equation for obtaining material parameters of PAC tissues.more » « less
The objective of this study was to test the hypothesis that a compression‐resistant bone graft augmented with recombinant human morphogenetic protein‐2 (rhBMP‐2) will promote lateral ridge augmentation without the use of protective mesh in a canine model.
Materials & Methods
Compression‐resistant (CR) bone grafts were evaluated in a canine model of lateral ridge augmentation. Bilateral, right trapezoidal prism‐shaped defects (13–14 mm long × 8–9 mm wide × 3–4 mm deep at the base) in 13 hounds (two defects per hound) were treated with one of four groups: (i) absorbable collagen sponge + 400 μg rhBMP‐2/ml (ACS, clinical control) protected by titanium mesh, (ii) CR without rhBMP‐2 (CR, negative control), (iii) CR + 200 μg rhBMP‐2 (CR‐L), or (iv) CR + 400 μg rhBMP‐2 (CR‐H). All animals were euthanized after 16 weeks. Ridge height and width and new bone formation were assessed by μCT, histology, and histomorphometry. The release kinetics of rhBMP‐2 from CR bone grafts in vitro and in vivo in a femoral condyle defect model in rabbits was also evaluated.
All four bone grafts promoted new bone formation (11–31.6 volume%) in the lateral ridge defects. For CR grafts, ridge height and width increased in a dose‐responsive manner with increasing rhBMP‐2 concentration. Ridge height and width measured for CR‐H without the use of protective mesh was comparable to that measured for ACS with a protective mesh.
At the same dose of rhBMP‐2, an injectable, compression‐resistant bone graft resulted in a comparable volume of new bone formation with the clinical control (ACS). These findings highlight the potential of compression‐resistant bone grafts without the use of protective mesh for lateral ridge augmentation.
Allograft is the current gold standard for treating critical-sized bone defects. However, allograft healing is usually compromised partially due to poor host-mediated vascularization. In the efforts towards developing new methods to enhance allograft healing, a non-terminal technique for monitoring the vascularization is needed in pre-clinical mouse models. In this study, we developed a non-invasive instrument based on spatial frequency domain imaging (SFDI) for longitudinal monitoring of the mouse femoral graft healing. SFDI technique provided total hemoglobin concentration (THC) and oxygen saturation (StO2) of the graft and the surrounding soft tissues. SFDI measurements were performed from 1 day before to 44 days after graft transplantation. Autograft, another type of bone graft with higher vascularization potential was also measured as a comparison to allograft. For both grafts, the overall temporal changes of the measured THC agreed with the physiological expectations of vascularization timeline during bone healing. A significantly greater increase in THC was observed in the autograft group compared to the allograft group, which agreed with the expectation that allografts have more compromised vascularization.
Background For 50 years, static cold storage (SCS) has been the gold standard for solid organ preservation in transplantation. Although logistically convenient, this preservation method presents important constraints in terms of duration and cold ischemia-induced lesions. We aimed to develop a machine perfusion (MP) protocol for recovery of vascularized composite allografts (VCA) after static cold preservation and determine its effects in a rat limb transplantation model.
Methods Partial hindlimbs were procured from Lewis rats and subjected to SCS in Histidine-Tryptophan-Ketoglutarate solution for 0, 12, 18, 24, and 48 hours. They were then either transplanted (Txp), subjected to subnormothermic machine perfusion (SNMP) for 3 hours with a modified Steen solution, or to SNMP + Txp. Perfusion parameters were assessed for blood gas and electrolytes measurement, and flow rate and arterial pressures were monitored continuously. Histology was assessed at the end of perfusion. For select SCS durations, graft survival and clinical outcomes after transplantation were compared between groups at 21 days.
Results Transplantation of limbs preserved for 0, 12, 18, and 24-hour SCS resulted in similar survival rates at postoperative day 21. Grafts cold-stored for 48 hours presented delayed graft failure (p = 0.0032). SNMP of limbs after 12-hour SCS recovered the vascular resistance, potassium, and lactate levels to values similar to limbs that were not subjected to SCS. However, 18-hour SCS grafts developed significant edema during SNMP recovery. Transplantation of grafts that had undergone a mixed preservation method (12-hour SCS + SNMP + Txp) resulted in better clinical outcomes based on skin clinical scores at day 21 post-transplantation when compared to the SCS + Txp group (p = 0.01613).
Conclusion To date, VCA MP is still limited to animal models and no protocols are yet developed for graft recovery. Our study suggests that ex vivo SNMP could help increase the preservation duration and limit cold ischemia-induced injury in VCA transplantation.