Advertisement

Histologic, Biomechanical, and Biological Evaluation of Fan-Folded Iliotibial Band Allografts for Anterior Cruciate Ligament Reconstruction

  • Gaëtan J.-R. Delcroix
    Correspondence
    Address correspondence to Gaëtan J-R. Delcroix, Ph.D., University of Miami Tissue Bank, Life Science Park, Second Floor, 1951 NW 7th Ave, Miami, FL 33136, U.S.A.
    Affiliations
    University of Miami Tissue Bank, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A

    Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A

    Geriatric Research, Education, and Clinical Center and Research Service, Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida, U.S.A
    Search for articles by this author
  • David N. Kaimrajh
    Affiliations
    Max Biedermann Institute for Biomechanics, Miami Beach, Florida, U.S.A
    Search for articles by this author
  • Dinah Baria
    Affiliations
    University of Miami Tissue Bank, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A
    Search for articles by this author
  • Sonya Cooper
    Affiliations
    Biomet, Warsaw, Indiana, U.S.A
    Search for articles by this author
  • Teresita Reiner
    Affiliations
    Geriatric Research, Education, and Clinical Center and Research Service, Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida, U.S.A
    Search for articles by this author
  • Loren Latta
    Affiliations
    Department of Orthopaedics, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A

    Max Biedermann Institute for Biomechanics, Miami Beach, Florida, U.S.A
    Search for articles by this author
  • Gianluca D’Ippolito
    Affiliations
    University of Miami Tissue Bank, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A

    Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A

    Department of Orthopaedics, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A

    Geriatric Research, Education, and Clinical Center and Research Service, Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida, U.S.A
    Search for articles by this author
  • Paul C. Schiller
    Affiliations
    University of Miami Tissue Bank, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A

    Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A

    Department of Orthopaedics, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A

    Department of Biochemistry & Molecular Biology, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A

    Geriatric Research, Education, and Clinical Center and Research Service, Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida, U.S.A
    Search for articles by this author
  • H. Thomas Temple
    Affiliations
    University of Miami Tissue Bank, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A

    Department of Orthopaedics, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A
    Search for articles by this author
Published:January 30, 2013DOI:https://doi.org/10.1016/j.arthro.2012.11.007

      Purpose

      The purpose of this study was to thoroughly characterize the fan-folded iliotibial band (FITB) allograft and compare it with anterior tibialis tendons (ATs) and native anterior cruciate ligaments (ACLs) to determine whether it measures up to those tissues.

      Methods

      We compared the histologic structure, tensile strength to failure, creep, and stress-relaxation properties of FITBs with those of ATs and ACLs. In vitro cytotoxicity and biocompatibility of FITBs were also compared with ATs.

      Results

      No structural difference was observed between the tissues studied. FITB ultimate tensile strength (3,459 ± 939 N) was not significantly different (P > .9999) from ultimate tensile strength of ATs (3,357 ± 111 N) and was significantly greater (P = .0005) than that of ACLs (886 ± 254 N). No significant difference (P > .9999) was observed in the increase in length resulting from creep testing between FITBs (9.5 ± 3.0 mm) and ATs (9.7 ± 4.0 mm). During stress-relaxation testing, FITBs reached 181 ± 46 N, which was not significantly different (P > .9999) from ATs (166 ± 40 N). Finally, we showed that cytotoxicity of FITBs and ATs was negligible. In vitro biocompatibility of FITBs and ATs was very good, whereas FITBs had a higher propensity to favor the attachment and infiltration of cells that proliferated for at least 4 weeks on their contact.

      Conclusions

      We found that FITBs, ACLs, and ATs shared a similar structure made of aligned collagen fibers. No significant difference was observed between FITB and AT ultimate tensile strength, creep, and stress-relaxation viscoelastic properties. Ultimate tensile strength to failure of ACLs was lower than that of FITBs and ATs, whereas ACLs were superior to both FITBs and ATs during creep and stress-relaxation testing. FITBs and ATs showed low cytotoxicity and excellent biocompatibility in vitro, with a somewhat higher propensity of FITBs to favor cell attachment and infiltration over time.

      Clinical Relevance

      This study suggests that FITBs have the potential to perform as well as ATs for ACL reconstruction.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Friedberg RP. UpToDate. “Anterior cruciate ligament injury.” October 24, 2012. Available at: www.uptodate.com. Accessed November 30, 2012.

        • Fu F.
        • Christel P.
        • Miller M.D.
        • et al.
        Graft selection for anterior cruciate ligament reconstruction.
        Instr Course Lect. 2009; 58: 337-354
        • Rice R.S.
        • Waterman B.R.
        • Lubowitz J.H.
        Allograft versus autograft decision for anterior cruciate ligament reconstruction: An expected-value decision analysis evaluating hypothetical patients.
        Arthroscopy. 2012; 28: 539-547
        • Strickland S.M.
        • MacGillivray J.D.
        • Warren R.F.
        Anterior cruciate ligament reconstruction with allograft tendons.
        Orthop Clin North Am. 2003; 34: 41-47
        • Carey J.L.
        • Dunn W.R.
        • Dahm D.L.
        • et al.
        A systematic review of anterior cruciate ligament reconstruction with autograft compared with allograft.
        J Bone Joint Surg Am. 2009; 91: 2242-2250
        • Barrett G.R.
        • Luber K.
        • Replogle W.H.
        • et al.
        Allograft anterior cruciate ligament reconstruction in the young, active patient: Tegner activity level and failure rate.
        Arthroscopy. 2010; 26: 1593-1601
        • Haut Donahue T.L.
        • Stephen M.H.
        • Maury L.
        • et al.
        A biological evaluation of anterior and posterior tibialis tendons as suitable single-loop anterior cruciate ligament grafts.
        Arthroscopy. 2002; 18: 589-597
        • Chan D.B.
        • Temple H.T.
        • Latta L.L.
        • et al.
        A biomechanical comparison of fan-folded, single-looped fascia lata with other graft tissues as a suitable substitute for anterior cruciate ligament reconstruction.
        Arthroscopy. 2010; 26: 1641-1647
        • McKee J.
        Autograft or allograft for ACL reconstruction?.
        AAOS Now. 2012; 6 (cover story)
        • Pattee G.A.
        • Friedman J.
        The history of intra-articular anterior cruciate ligament reconstruction.
        Oper Tech Orthop. 1992; 2: 44-46
        • Noyes F.R.
        • Barber S.D.
        • Mangine R.E.
        Bone-patellar ligament-bone and fascia lata allografts for reconstruction of the anterior cruciate ligament.
        J Bone Joint Surg Am. 1990; 72: 1125-1136
        • Shino K.
        • Kimura T.
        • Hirose H.
        • et al.
        Reconstruction of the anterior cruciate ligament by allogenic tendon graft. An operation for chronic ligamentous insufficiency.
        J Bone Joint Surg Br. 1986; 68: 739-746
        • Shino K.
        • Inoue M.
        • Horibe S.
        • et al.
        Reconstruction of the anterior cruciate ligament using allogenic tendon. Long-term followup.
        Am J Sports Med. 1990; 18: 457-465
        • D’Ippolito G.
        • Diabira S.
        • Howard G.A.
        • et al.
        Marrow-isolated adult multilineage inducible (MIAMI) cells, a unique population of post-natal young and old human cells human cells with extensive expansion and differentiation potential.
        J Cell Sci. 2004; 117: 2971-2981
        • Yates E.W.
        • Rupani A.
        • Foley G.T.
        • et al.
        Ligament tissue engineering and its potential role in anterior cruciate ligament reconstruction.
        Stem Cells Int. 2012; 2012: 438125
        • Claes S.
        • Verdonk P.
        • Forsyth R.
        • et al.
        The “ligamentization” process in anterior cruciate ligament reconstruction: What happens to the human graft? A systematic review of the literature.
        Am J Sports Med. 2011; 39: 2476-2483
        • Noyes F.R.
        • Grood E.S.
        The strength of anterior cruciate ligament in humans and Rhesus monkeys.
        J Bone Joint Surg Am. 1976; 58: 1074-1082
        • Noyes F.R.
        • Delucas J.L.
        • Torvik P.J.
        Biomechanics of anterior cruciate ligament failure: An analysis of strain-rate sensitivity and mechanisms of failure in primates.
        J Bone Joint Surg Am. 1974; 56: 236-253
        • Haut Donahue T.L.
        • Gregersen C.
        • Hull M.L.
        • et al.
        Comparison of viscoelastic, structural and material properties of the double looped anterior cruciate ligament grafts made from bovine digital extensor and human hamstring tendons.
        J Biomech Eng. 2001; 123: 162-169
        • Delcroix G.J.
        • Curtis K.M.
        • Schiller P.C.
        • et al.
        EGF and bFGF pre-treatment enhances neural specification and the response to neuronal commitment of MIAMI cells.
        Differentiation. 2010; 80: 213-227
        • Vincent J.P.
        • Magnussen R.A.
        • Gezmez F.
        • et al.
        The anterolateral ligament of the human knee: An anatomic and histologic study.
        Knee Surg Sports Traumatol Arthrosc. 2011; 20: 147-152
        • Noyes F.R.
        • Butler D.L.
        • Grood E.S.
        • et al.
        Biomechanical analysis of human ligament grafts used in knee-ligament repairs and reconstructions.
        J Bone Joint Surg Am. 1984; 66: 344-352
        • Woo S.L.Y.
        • Hollis J.M.
        • Adams D.J.
        • et al.
        Tensile properties of the human femur-anterior cruciate ligament-tibia complex.
        Am J Sports Med. 1991; 19: 217-225
        • Malinin T.I.
        • Levitt R.L.
        • Bashore C.
        • et al.
        A study of retrieved allografts used to replace anterior cruciate ligaments.
        Arthroscopy. 2002; 18: 163-170
        • Fan H.
        • Liu H.
        • Toh S.L.
        • et al.
        Anterior cruciate ligament regeneration using mesenchymal stem cells and silk scaffold in large animal model.
        Biomaterials. 2009; 30: 4967-4977
        • Ahmad Z.
        • Wardale J.
        • Brooks R.
        • et al.
        Exploring the application of stem cells in tendon repair and regeneration.
        Arthroscopy. 2012; 28: 1018-1029
        • Lovric V.
        • Chen D.
        • Yu Y.
        • et al.
        Effects of demineralized bone matrix on tendon-bone healing in an intra-articular rodent model.
        Am J Sports Med. 2012; 40: 2365-2374
        • Nurmi J.T.
        • Kannus P.
        • Sievanen H.
        • et al.
        Interference screw fixation of soft tissue grafts in anterior cruciate ligament reconstruction: Part 2: Effect of preconditioning on graft tension during and after screw insertion.
        Am J Sports Med. 2004; 32: 418-424
        • Amis A.A.
        • Jakob R.P.
        Anterior cruciate ligament graft positioning, tensioning and twisting.
        Knee Surg Sports Traumatol Arthrosc. 1998; 6: S2-S12