Effect of autologous fibrin clot on tendon-bone healing after anterior cruciate ligament reconstruction_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Penghe ¹ , DAI Zhipeng ² , ZHAO Jiajun ² , ZHANG Zhen ² ,  HUANG Suizhu ²

1. Department of Joint Surgery, the Second Affiliated Hospital of Luohe Medical College, Luohe Henan, 462300, P.R.China;
2. Department of Joint Surgery, People’s Hospital of Henan Province, Zhengzhou Henan, 450000, P.R.China;

Corresponding?author：

HUANG Suizhu, Email: 15037120735@163.com

Keywords：

Anterior cruciate ligament; ligament reconstruction; autologous fibrin clot; tendon-bone healing

DOI：

10.7507/1002-1892.201701089

Video：

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ObjectiveTo observe the effect and significance of autologous fibrin clot on tendon-bone healing after anterior cruciate ligament (ACL) reconstruction.MethodsBetween October 2014 and January 2016, 34 patients (34 knees) with ACL injury were enrolled in the study. During ACL reconstruction, autologous fibrin clot was used in 17 cases (trial group) and was not used in 17 cases (control group). The anterior drawer test, Lachman test, and axial displa-cement test were positive in 2 groups before operation. There was no significant difference in gender, age, causes of injury, injury side, disease cause, and preoperative knee joint activity, Lysholm score, and American Hospital for Special Surgery (HSS) score between 2 groups (P>0.05), with comparable. The results of anterior drawer test, Lachman test, and axial displacement test were recorded and compared between 2 groups after operation. The knee joint activity, Lysholm score, and HSS score were used to evaluate the knee function recovery at 6, 24, and 48 weeks after operation; the graft signal intensity, graft signal to noise ratio, bone tunnel expansion, and graft tendon-bone node T2 value were measured.ResultsAll patients were followed up 48 weeks. Surgical incision healed at stage I. No joint infection and joint adhesion occurred. The drawer test, Lachman test, and axial shift test were negative in 2 groups. At 6, 24, and 48 weeks after operation, the Lysholm score of trial group was significantly higher than that of control group (P<0.05); there was no significant difference in knee joint activity between 2 groups (P>0.05). The HSS score of trial group was significantly higher than that of control group at 24 and 48 weeks (P<0.05), but no significant difference was found at 6 weeks (P>0.05). MRI measu-rement showed that there was significant difference in graft signal intensity, bone tunnel expansion, and graft signal to noise ratio between 2 groups at 6, 24, and 48 weeks after operation (P<0.05). There was no significant difference in graft tendon-bone node T2 value between 2 groups (P>0.05) at 48 weeks after operation, but difference was significant at 6 and 24 weeks (P<0.05).ConclusionAutologous fibrin clot can effectively enhance graft revascularization, and accelerate the process of tendon-bone healing after ACL reconstruction.

Citation： LIU Penghe, DAI Zhipeng, ZHAO Jiajun, ZHANG Zhen, HUANG Suizhu. Effect of autologous fibrin clot on tendon-bone healing after anterior cruciate ligament reconstruction. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(7): 799-804. doi: 10.7507/1002-1892.201701089 Copy

1.	陳康, 朱偉民, 陸偉, 等. 關節鏡下前交叉韌帶單束和雙束個體化解剖重建臨床療效對比研究. 中華骨與關節外科雜志, 2016, 9(6): 484-488.
2.	Petersen W, Laprell H. Insertion of autologous tendon grafts to the bone: a histological and immunohistochemical study of hamstring and patellar tendon grafts. Knee Surg Sports Traumatol Arthrosc, 2000, 8(1): 26-31.
3.	崔巍, 呂偉, 時劍輝, 等. 關節鏡下自體骨膜包裹 6 股腘繩肌腱移植前交叉韌帶重建的中期療效評價. 中國現代藥應用, 2016, 10(17): 114-116.
4.	區永亮, 黃華揚, 李憑躍, 等. 骨道內移植物更合理分布的單隧道單束前交叉韌帶重建的中期療效觀察. 中國骨與關節外科, 2014, 7(1): 27-30.
5.	程鵬飛, 柴益民. 界面螺釘在前十字韌帶修復中的應用進展. 中華骨科雜志, 2016, 36(12): 810-816.
6.	周平, 趙其純, 尚希福, 等. rhBMP-2 聯合 rhVEGF165 對兔前交叉韌帶重建后腱-骨愈合的影響. 安徽醫科大學學報, 2013, 48 (5): 458-462.
7.	王輝, 王萬明. 前交叉韌帶重建術后腱骨愈合影響因素研究進展. 實用醫學雜志, 2014, 30(14): 2343-2345.
8.	陳平, 曲戎梅, 韓忠宇, 等. 人脂肪源干細胞促進前交叉韌帶重建后腱骨界面愈合的實驗研究. 中國臨床解剖學雜志, 2016, 34(6): 643-646.
9.	Yamazaki S, Yasuda K, Tomita F, et al. The effect of transforming growth factor-betal on intraosseous healing of flexor tendon autograft replacement of anterior cruciate ligament in dogs. Arthroscopy, 2005, 21(9): 1034-1041.
10.	Chen CH, Chen WJ, Shih CH, et al. 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(3): 290-296.
11.	Huangfu X, Zhao J. Tendon-bone healing enhancement using injectable tricalcium phosphate in a dog anterior cruciate ligament reconstruction model. Arthroscopy, 2007, 23(5): 455-462.
12.	石斌, 劉玉杰, 李志超, 等. 體外沖擊波促進兔 ACL 重建后腱骨愈合的實驗研究. 中國矯形外科雜志, 2008, 16(4): 292-295.
13.	Martinek V, Latterman C, Usas A, et al. Enhancement of tendon-bone integration of anterior cruciate ligament grafts with bone morphogenetic protein-2 gene transfer: a histological and biomechanical study. J Bone Joint Surg (Am), 2002, 84-A(7): 1123-1131.
14.	MishraAK, Skrepnik NV, Edwards SG, et al. Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients. Am J Sports Med, 2014, 42(2): 463-471.
15.	季鋒, 許華. 富血小板血漿用于軟組織炎癥及損傷治療的研究進展. 中國疼痛醫學雜志, 2017, 23(2): 135-138.
16.	Opera WE, Karp JM, Hosseini MM, et al. Effect of platelet releasate on bone cell migration and recruitment in vitro. J Craniofac Surg, 2003, 14(3): 292-300.
17.	Hotz G. Alevolar ridge augmentation with hydroxylapatite using fibrin sealant for fixation. Part I: An experimental study. Int J Oral Maxillofac Surg, 1991, 20(4): 204-207.
18.	van Trommel MF, Simonian PT, Potter HG, et al. Arthroscopic meniscal repairwith fibrin clot of complete radial tears of the lateral meniscus in the avascular zone. Arthroscopy, 1998, 14(4): 360-365.
19.	何蔚, 劉玉杰. 交叉韌帶重建術后腱骨愈合相關研究進展. 軍醫進修學院學報, 2010, 31(10): 978-980.
20.	Gao F, Zhang ZJ, Tang W, et al. A preliminary research of T2 and T2 star relaxtion times mapping for assessment of articular cartilage in the knee. J Clin Radiology, 2013, 32(9): 1305-1309.

1. 陳康, 朱偉民, 陸偉, 等. 關節鏡下前交叉韌帶單束和雙束個體化解剖重建臨床療效對比研究. 中華骨與關節外科雜志, 2016, 9(6): 484-488.
2. Petersen W, Laprell H. Insertion of autologous tendon grafts to the bone: a histological and immunohistochemical study of hamstring and patellar tendon grafts. Knee Surg Sports Traumatol Arthrosc, 2000, 8(1): 26-31.
3. 崔巍, 呂偉, 時劍輝, 等. 關節鏡下自體骨膜包裹 6 股腘繩肌腱移植前交叉韌帶重建的中期療效評價. 中國現代藥應用, 2016, 10(17): 114-116.
4. 區永亮, 黃華揚, 李憑躍, 等. 骨道內移植物更合理分布的單隧道單束前交叉韌帶重建的中期療效觀察. 中國骨與關節外科, 2014, 7(1): 27-30.
5. 程鵬飛, 柴益民. 界面螺釘在前十字韌帶修復中的應用進展. 中華骨科雜志, 2016, 36(12): 810-816.
6. 周平, 趙其純, 尚希福, 等. rhBMP-2 聯合 rhVEGF165 對兔前交叉韌帶重建后腱-骨愈合的影響. 安徽醫科大學學報, 2013, 48 (5): 458-462.
7. 王輝, 王萬明. 前交叉韌帶重建術后腱骨愈合影響因素研究進展. 實用醫學雜志, 2014, 30(14): 2343-2345.
8. 陳平, 曲戎梅, 韓忠宇, 等. 人脂肪源干細胞促進前交叉韌帶重建后腱骨界面愈合的實驗研究. 中國臨床解剖學雜志, 2016, 34(6): 643-646.
9. Yamazaki S, Yasuda K, Tomita F, et al. The effect of transforming growth factor-betal on intraosseous healing of flexor tendon autograft replacement of anterior cruciate ligament in dogs. Arthroscopy, 2005, 21(9): 1034-1041.
10. Chen CH, Chen WJ, Shih CH, et al. 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(3): 290-296.
11. Huangfu X, Zhao J. Tendon-bone healing enhancement using injectable tricalcium phosphate in a dog anterior cruciate ligament reconstruction model. Arthroscopy, 2007, 23(5): 455-462.
12. 石斌, 劉玉杰, 李志超, 等. 體外沖擊波促進兔 ACL 重建后腱骨愈合的實驗研究. 中國矯形外科雜志, 2008, 16(4): 292-295.
13. Martinek V, Latterman C, Usas A, et al. Enhancement of tendon-bone integration of anterior cruciate ligament grafts with bone morphogenetic protein-2 gene transfer: a histological and biomechanical study. J Bone Joint Surg (Am), 2002, 84-A(7): 1123-1131.
14. MishraAK, Skrepnik NV, Edwards SG, et al. Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients. Am J Sports Med, 2014, 42(2): 463-471.
15. 季鋒, 許華. 富血小板血漿用于軟組織炎癥及損傷治療的研究進展. 中國疼痛醫學雜志, 2017, 23(2): 135-138.
16. Opera WE, Karp JM, Hosseini MM, et al. Effect of platelet releasate on bone cell migration and recruitment in vitro. J Craniofac Surg, 2003, 14(3): 292-300.
17. Hotz G. Alevolar ridge augmentation with hydroxylapatite using fibrin sealant for fixation. Part I: An experimental study. Int J Oral Maxillofac Surg, 1991, 20(4): 204-207.
18. van Trommel MF, Simonian PT, Potter HG, et al. Arthroscopic meniscal repairwith fibrin clot of complete radial tears of the lateral meniscus in the avascular zone. Arthroscopy, 1998, 14(4): 360-365.
19. 何蔚, 劉玉杰. 交叉韌帶重建術后腱骨愈合相關研究進展. 軍醫進修學院學報, 2010, 31(10): 978-980.
20. Gao F, Zhang ZJ, Tang W, et al. A preliminary research of T2 and T2 star relaxtion times mapping for assessment of articular cartilage in the knee. J Clin Radiology, 2013, 32(9): 1305-1309.

Chinese Journal of Reparative and Reconstructive Surgery

Effect of autologous fibrin clot on tendon-bone healing after anterior cruciate ligament reconstruction

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