title: Suture augmentation following ACL injury to restore the function of the ACL, MCL, and medial meniscus in the goat stifle joint.
abstract: Functional tissue engineering (FTE) approaches have shown promise in healing an injured anterior cruciate ligament (ACL) of the knee. Nevertheless, additional mechanical augmentation is needed to maintain joint stability and appropriate loading of the joint while the ACL heals. The objective of this study was to quantitatively evaluate how mechanical augmentation using sutures restores the joint kinematics as well as the distribution of loading among the ACL, medial collateral ligament, and medial meniscus (MM) in response to externally applied loads. Eight goat stifle joints were tested on a robotic/universal force-moment sensor testing system under two loading conditions: (1) a 67N anterior tibial load (ATL) and (2) a 67N ATL with 100N axial compression. For each joint, four experimental conditions were tested at 30°, 60°, and 90° of flexion: the (1) intact and (2) ACL-deficient joint, as well as following (3) suture repair of the transected ACL, and (4) augmentation using sutures passed from the femur to the tibia. Under the 67N ATL, suture augmentation could restore the anterior tibial translation (ATT) to within 3mm of the intact joint (p>0.05), representing a 54-76% improvement over suture repair (p<0.05). With the additional axial compression, the ATT and in-situ forces of the sutures following suture augmentation remained 2-3 times closer to normal (p<0.05). Also, the in-situ forces in the MM were 58-73% lower (p<0.05). Thus, suture augmentation may be helpful in combination with FTE approaches for ACL healing by providing the needed initial joint stability while lowering the loads on the MM.
authors.affiliation: Musculoskeletal Research Center, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, 405 Center for Bioengineering, 300 Technology Drive, Pittsburgh, PA 15219, USA.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Fisher
authors.forename: Ho-Joong
authors.initials: HJ
authors.lastname: Jung
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: McMahon
authors.forename: Savio L-Y
authors.initials: SL
authors.lastname: Woo
mesh_terms: D000818:Animals; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001696:Biomechanical Phenomena; D006041:Goats; D006801:Humans; D007718:Knee Injuries / Q000473:pathology / Q000601:surgery; D017888:Medial Collateral Ligament, Knee / Q000293:injuries* / Q000601:surgery*; D008592:Menisci, Tibial / Q000601:surgery*; D008953:Models, Anatomic; D012371:Robotics; D013536:Suture Techniques; D013537:Sutures; D013977:Tibia / Q000473:pathology; D000070600:Tibial Meniscus Injuries