Enhancement of Polyethylene Terephthalate Artificial Ligament Graft Osseointegration using a Periosteum Patch in a Goat Model

Abstract

The purpose of this study is to investigate whether a periosteum patch could enhance polyethylene terephthalate (PET) artificial ligament graft osseointegration in a bone tunnel. 12 female goats underwent ACL reconstruction with a PET artificial ligament graft in the right knees. Right knees in 6 goats were reconstructed with periosteum patch-enveloped PET grafts (Periosteum group) in the tibia bone tunnel, whereas the other 6 goats had no periosteum patch and served as the Control group. All the goats were sacrificed at 12 months after surgery. 3 tibial-graft complex samples in each group were harvested consecutively for microcomputed tomography (micro-CT) scan, magnetic resonance imaging (MRI) scan and histological evaluation. The other 3 tibial-graft complex samples in each group were harvested for biomechanical testing. The mean pull-out load of the Periosteum group (208±25 N) at 12 months was significantly higher than that of the Control group (107±13 N) (p=0.0044). According to the micro-CT scan, more new bone formation was observed at the graft-bone interface in the Periosteum group compared with the Control group. Furthermore, MRI showed that the Periosteum group appeared to have a better graft osseointegration within the bone tunnel compared with the Control group. Histologically, application of a periosteum patch induced more new bone and Sharpey’s fiber formation between the graft and bone tunnel compared with the controls. The study has shown that periosteum enveloping of the PET artificial ligament has a positive effect in the induction of artificial ligament osseointegration within the bone tunnel.

Key words

polyethylene terepthalate - periosteum - osseointegration - artificial ligament - ACL

• References

• 1 Chen CH, Chang CH, Su CI, Wang KC, Liu HT, Yu CM, Wong CB, Wang IC. Arthroscopic single-bundle anterior cruciate ligament reconstruction with periosteum-enveloping hamstring tendon graft: clinical outcome at 2 to 7 years. Arthroscopy 2010; 26: 907-917
• 2 Chen CH, Chen WJ, Shih CH. Enveloping of periosteum on the hamstring tendon graft in anterior cruciate ligament reconstruction. Arthroscopy 2002; 18: 27E
• 3 Chen CH, Chen WJ, Shih CH, Chou SW. Arthroscopic anterior cruciate ligament reconstruction with periosteum-enveloping hamstring tendon graft. Knee Surg Sports Traumatol Arthrosc 2004; 12: 398-405
• 4 Chen CH, Chen WJ, Shih CH, Yang CY, Liu SJ, Lin PY. Enveloping the tendon graft with periosteum to enhance tendon-bone healing in a bone tunnel: A biomechanical and histologic study in rabbits. Arthroscopy 2003; 19: 290-296
• 5 Cho S, Li H, Chen C, Jiang J, Tao H, Chen S. Cationised gelatin and hyaluronic acid coating enhances polyethylene terephthalate artificial ligament graft osseointegration in porcine bone tunnels. Int Orthop 2013; 37: 507-513
• 6 Ekdahl M, Wang JH, Ronga M, Fu FH. Graft healing in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2008; 16: 935-947
• 7 Gao K, Chen S, Wang L, Zhang W, Kang Y, Dong Q, Zhou H, Li L. Anterior cruciate ligament reconstruction with LARS artificial ligament: a multicenter study with 3- to 5-year follow-up. Arthroscopy 2010; 26: 515-523
• 8 Gulotta LV, Kovacevic D, Ying L, Ehteshami JR, Montgomery S, Rodeo SA. Augmentation of tendon-to-bone healing with a magnesium-based bone adhesive. Am J Sports Med 2008; 36: 1290-1297
• 9 Harriss DJAG. Ethical standards in sport and exercise science research: 2016 update. Int J Sports Med 2015; 36: 1121-1124
• 10 Karaoglu S, Celik C, Korkusuz P. The effects of bone marrow or periosteum on tendon-to-bone tunnel healing in a rabbit model. Knee Surg Sports Traumatol Arthrosc 2009; 17: 170-178
• 11 Kawakami H, Shino K, Hamada M, Nakata K, Nakagawa S, Nakamura N, Toritsuka Y, Yoshikawa H, Ochi T. Graft healing in a bone tunnel: bone-attached graft with screw fixation versus bone-free graft with extra-articular suture fixation. Knee Surg Sports Traumatol Arthrosc 2004; 12: 384-390
• 12 Koski JA, Ibarra C, Rodeo SA. Tissue-engineered ligament: cells, matrix, and growth factors. Orthop Clin North Am 2000; 31: 437-452
• 13 Kyung HS, Kim SY, Oh CW, Kim SJ. Tendon-to-bone tunnel healing in a rabbit model: the effect of periosteum augmentation at the tendon-to-bone interface. Knee Surg Sports Traumatol Arthrosc 2003; 11: 9-15
• 14 Legnani C, Ventura A, Terzaghi C, Borgo E, Albisetti W. Anterior cruciate ligament reconstruction with synthetic grafts. A review of literature. Int Orthop 2010; 34: 465-471
• 15 Li B, Wen Y, Wu H, Qian Q, Wu Y, Lin X. Arthroscopic single-bundle posterior cruciate ligament reconstruction: retrospective review of hamstring tendon graft versus LARS artificial ligament. Int Orthop 2009; 33: 991-996
• 16 Li H, Chen C, Zhang S, Jiang J, Tao H, Xu J, Sun J, Zhong W, Chen S. The use of layer by layer self-assembled coatings of hyaluronic acid and cationized gelatin to improve the biocompatibility of poly(ethylene terephthalate) artificial ligaments for reconstruction of the anterior cruciate ligament. Acta Biomater 2012; 8: 4007-4019
• 17 Li H, Chen S. Biomedical coatings on polyethylene terephthalate artificial ligaments. J Biomed Mater Res A 2015; 103: 839-845
• 18 Li H, Chen S, Chen J, Chang J, Xu M, Sun Y, Wu C. Mussel-Inspired Artificial Grafts for Functional Ligament Reconstruction. ACS Appl Mater Interfaces 2015; 7: 14708-14719
• 19 Li H, Chen S, Wu Y, Jiang J, Ge Y, Gao K, Zhang P, Wu L. Enhancement of the osseointegration of a polyethylene terephthalate artificial ligament graft in a bone tunnel using 58 S bioglass. Int Orthop 2012; 36: 191-197
• 20 Li H, Ge Y, Wu Y, Jiang J, Gao K, Zhang P, Wu L, Chen S. Hydroxyapatite coating enhances polyethylene terephthalate artificial ligament graft osseointegration in the bone tunnel. Int Orthop 2011; 35: 1561-1567
• 21 Li H, Ge Y, Zhang P, Wu L, Chen S. The effect of layer-by-layer chitosan-hyaluronic acid coating on graft-to-bone healing of a poly(ethylene terephthalate) artificial ligament. J Biomater Sci Polym Ed 2012; 23: 425-438
• 22 Li H, Jiang J, Wu Y, Chen S. Potential mechanisms of a periosteum patch as an effective and favourable approach to enhance tendon-bone healing in the human body. Int Orthop 2012; 36: 665-669
• 23 Shen H, Qiao G, Cao H, Jiang Y. An histological study of the influence of osteoinductive calcium phosphate ceramics on tendon healing pattern in a bone tunnel with suspensory fixation. Int Orthop 2010; 34: 917-924
• 24 Vaquette C, Viateau V, Guerard S, Anagnostou F, Manassero M, Castner DG, Migonney V. The effect of polystyrene sodium sulfonate grafting on polyethylene terephthalate artificial ligaments on in vitro mineralisation and in vivo bone tissue integration. Biomaterials 2013; 34: 7048-7063
• 25 Viateau V, Manassero M, Anagnostou F, Guerard S, Mitton D, Migonney V. Biological and biomechanical evaluation of the ligament advanced reinforcement system (LARS AC) in a sheep model of anterior cruciate ligament replacement: a 3-month and 12-month study. Arthroscopy 2013; 29: 1079-1088
• 26 Wen CY, Qin L, Lee KM, Wong MW, Chan KM. Influence of bone adaptation on tendon-to-bone healing in bone tunnel after anterior cruciate ligament reconstruction in a rabbit model. J Orthop Res 2009; 27: 1447-1456
• 27 Yang J, Jiang J, Li Y, Li H, Jing Y, Wu P, Yu D, Chen S. A new strategy to enhance artificial ligament graft osseointegration in the bone tunnel using hydroxypropylcellulose. Int Orthop 2013; 37: 515-521