title: Anterior cruciate ligament deficiency leads to early instability of scaffold for cartilage regeneration: a controlled laboratory ex-vivo study.
abstract: OBJECTIVE
  The affect of anterior cruciate ligament (ACL) integrity on the early postoperative stability of a collagen type-I gel scaffold was investigated. The value of fibrin glue for graft fixation in ACL deficient porcine knees over a simulated early postoperative period was also studied.
  
  
  METHODS
  Full-thickness articular cartilage defects (11 × 6 mm) were created on the medial femoral condyle of 80 porcine knees. The ACL was left intact or completely transected in each of 40 knees. Gel plugs were tested in each group: press-fitting only in 20 specimens and press-fitting plus fibrin glue in 20 specimens. Each knee underwent 2,000 cycles in a validated ex-vivo continuous passive motion model.
  
  
  RESULTS
  Press-fit-only fixation grafts in knee specimens with an intact ACL showed significantly superior stability than that in ACL deficient knees (p = 0.01). In ACL deficient knees, grafts fixed with press-fitting plus fibrin glue showed significantly superior stability than those using press-fit only fixation (p = 0.01). Press-fitting plus fibrin glue fixation showed no significant differences in worn surface area between knee specimens with intact and deficient ACL.
  
  
  CONCLUSIONS
  ACL deficiency led to early scaffold instability in an ex-vivo porcine knee model. Fibrin glue in ACL deficient knees led to additional graft stability. These findings indicated that cartilage regenerative techniques may give optimum results in ACL intact knees.
authors.affiliation: Department of Orthopaedics and Rheumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany. efet@med.uni-marburg.de
authors.forename: Turgay
authors.initials: T
authors.lastname: Efe
authors.forename: Alexander
authors.initials: A
authors.lastname: Füglein
authors.forename: Alan
authors.initials: A
authors.lastname: Getgood
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Heyse
authors.forename: Susanne
authors.initials: S
authors.lastname: Fuchs-Winkelmann
authors.forename: Thilo
authors.initials: T
authors.lastname: Patzer
authors.forename: Bilal F
authors.initials: BF
authors.lastname: El-Zayat
authors.forename: Stefan
authors.initials: S
authors.lastname: Lakemeier
authors.forename: Markus D
authors.initials: MD
authors.lastname: Schofer
mesh_terms: D000818:Animals; D016118:Anterior Cruciate Ligament / Q000502:physiology / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D004195:Disease Models, Animal; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage; D048091:Guided Tissue Regeneration / Q000379:methods*; D066298:In Vitro Techniques; D007593:Joint Instability / Q000601:surgery; D015588:Observer Variation; D015203:Reproducibility of Results; D012421:Rupture; D013264:Stifle / Q000293:injuries / Q000502:physiology / Q000601:surgery*; D013314:Stress, Mechanical; D013552:Swine; D054457:Tissue Scaffolds; D016474:Weight-Bearing
chemical_list: D015718:Fibrin Tissue Adhesive