| Title: |
Does Manual Drilling Improve the Healing of Bone–Hamstring Tendon Grafts in Anterior Cruciate Ligament Reconstruction? A Histological and Biomechanical Study in a Rabbit Model |
| Authors: |
Tei, Matteo Maria; Placella, Giacomo; Sbaraglia, Marta; Tiribuzi, Roberto; Georgoulis, Anastasios; Cerulli, Giuliano |
| Source: |
Orthopaedic Journal of Sports Medicine ; volume 8, issue 4 ; ISSN 2325-9671 2325-9671 |
| Publisher Information: |
SAGE Publications |
| Publication Year: |
2020 |
| Description: |
Background: Heat necrosis due to motorized drilling during anterior cruciate ligament (ACL) reconstruction could be a factor in delayed healing at the bone–tendon graft interface. Hypothesis: The process of osteointegration could be enhanced using manual drilling. It reduces the invasiveness of mechanical-thermal stress normally caused by the traditional motorized drill bit. Study Design: Controlled laboratory study. Methods: ACL reconstruction using semitendinosus tendon autografts was performed in 28 skeletally mature female New Zealand white rabbits, which were randomly divided into 3 groups. In group A (n = 12), the tunnels were drilled using a motorized device; in group B (n = 12), the tunnels were drilled using a manual drill bit; and group C (n = 4) served as a control with sham surgical procedures. The healing process in the tunnels was assessed histologically at 2, 4, 8, and 12 weeks and graded according to the Tendon–Bone Tunnel Healing (TBTH) scoring system. In addition, another 25 rabbits were used for biomechanical testing. The structural properties of the femur–ACL graft–tibia complex, from animals sacrificed at 8 weeks postoperatively, were determined using uniaxial tests. Stiffness (N/mm) and ultimate load to failure (N) were determined from the resulting load-elongation curves. Results: The time course investigation showed that manual drilling (group B) had a higher TBTH score and improved mechanical behavior, reflecting better organized collagen fiber continuity at the bone–fibrous tissue interface, better integration between the graft and bone, and early mineralized chondrocyte-like tissue formation at all the time points analyzed with a maximum difference at 4 weeks (TBTH score: 5.4 [group A] vs 12.3 [group B]; P < .001). Stiffness (23.1 ± 8.2 vs 17.8 ± 6.3 N/mm, respectively) and ultimate load to failure (91.8 ± 60.4 vs 55.0 ± 18.0 N, respectively) were significantly enhanced in the specimens treated with manual drilling compared with motorized drilling ( P < .05 for both). Conclusion: ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1177/2325967120911600 |
| Availability: |
https://doi.org/10.1177/2325967120911600; https://journals.sagepub.com/doi/pdf/10.1177/2325967120911600; https://journals.sagepub.com/doi/full-xml/10.1177/2325967120911600 |
| Rights: |
https://creativecommons.org/licenses/by-nc-nd/4.0/ |
| Accession Number: |
edsbas.C2CC23CC |
| Database: |
BASE |