<i>In vivo</i> study of posterior cruciate ligament reconstruction augmented by a novel elastic internal tension-relieving augmentation tape in Diannan miniature pigs_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SHI Zhengliang , RUAN Zhaohui , YANG Hongmai , LI Kaiquan , YUAN Ping , TANG Wenting ,  LI Yanlin

Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China;

Corresponding?author：

LI Yanlin, Email: liyanlin@kmmu.edu.cn

Keywords：

Novel elastic internal tension-relieving augmentation tape; posterior cruciate ligament; internal tension-relieving technique; tendon-bone healing; ligamentization; biocompatibility; biosafty; pig

DOI：

10.7507/1002-1892.202604110

Video：

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Objective To explore the biosafety of a novel elastic internal tension-relieving augmentation tape (hereinafter referred to as “novel tension-relieving tape”) for posterior cruciate ligament (PCL) reconstruction and its regulatory effects on graft healing and tendon-bone integration via a Diannan miniature pig PCL reconstruction model. Methods Eighteen female Diannan miniature pigs aged 6-8 months were randomly assigned to tension-relieving group and non-tension-relieving group, with 9 pigs per group. One hind limb of each pig was randomly selected as the experimental limb for PCL reconstruction (n=9): autologous tendon combined with the novel tension-relieving tape was applied in tension-relieving group, while only autologous tendon was used in non-tension-relieving group; the contralateral hind limb was served as self-normal control. Postoperative general conditions of animals were observed, and complete blood count (CBC) tests were performed. Knee joint specimens were harvested at 3, 6, and 12 months postoperatively for gross observation and Marburger Arthroscopy Score (MAS) evaluation. Toluidine blue staining, safranin O-fast green staining, hematoxylin-eosin (HE) staining, collagen type Ⅰ/Ⅲ immunohistochemistry staining, and Sirius red staining were conducted to assess tendon-bone interface healing. HE staining of liver, lung, spleen, and the tissues around tendon-bone implantation area were performed to evaluate the biosafety of the material. Results All animals survived to the experimental endpoint. The indicators of CBC tests of both groups before operation and at different time points after operation, including white blood cell counting, hemoglobin, platelet counting, and neutrophil percentage, remained within normal physiological ranges, with no significant intergroup differences (P>0.05). No difference was found in histological scores of liver, lung, and spleen between groups (P>0.05). No giant cell aggregation, chronic inflammatory granuloma, or tissue erosion and degradation was observed in soft tissues around the implantation area, which indicated that the novel tension-relieving tape exhibited favorable biocompatibility without systemic or local toxic reactions. At 3 and 6 months postoperatively, the tension-relieving group obtained superior MAS score, tendon-bone healing score, nuclear morphological score, collagen type Ⅰ immunohistochemical score, and collagen volume fraction (P<0.05) as well as more regularly arranged elastic fibers compared with non-tension-relieving group, whereas no intergroup difference was detected in collagen type Ⅲ immunohistochemical score (P>0.05). At 12 months postoperatively, the degree of graft ligamentization and tendon-bone interface integration were comparable between the two groups, and no significant intergroup difference was observed in all above indicators (P>0.05). Conclusion The novel tension-relieving tape possesses reliable biosafety. It can effectively accelerate early graft collagen remodeling and tendon-bone interface healing after PCL reconstruction, and improve early knee joint stability.

Citation： SHI Zhengliang, RUAN Zhaohui, YANG Hongmai, LI Kaiquan, YUAN Ping, TANG Wenting, LI Yanlin. In vivo study of posterior cruciate ligament reconstruction augmented by a novel elastic internal tension-relieving augmentation tape in Diannan miniature pigs. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(8): 1258-1270. doi: 10.7507/1002-1892.202604110 Copy

1.	Yoon KH, Lee JH, Kim SG, et al. Effect of posterior tibial slopes on graft survival rates at 10 years after primary single-bundle posterior cruciate ligament reconstruction[J]. Am J Sports Med, 2023, 51(5): 1194-1201.
2.	Brown JS, Mogianos K, Roemer FW, et al. Clinical, patient-reported, radiographic and magnetic resonance imaging findings 11 years after acute posterior cruciate ligament injury treated non-surgically[J/OL]. BMC Musculoskelet Disord, 2023, 24(1): 365. doi: 10.1186/s12891-023-06480-0.
3.	Chandrasekaran S, Ma D, Scarvell JM, et al. A review of the anatomical, biomechanical and kinematic findings of posterior cruciate ligament injury with respect to non-operative management[J]. Knee, 2012, 19(6): 738-745.
4.	Temperato J, Rucinski K, Cook IL, et al. Outcomes after anatomic double-bundle posterior cruciate ligament reconstructions using transtibial and tibial Inlay techniques[J]. J Knee Surg, 2024, 37(3): 183-192.
5.	LaPrade CM, Civitarese DM, Rasmussen MT. Emerging updates on the posterior cruciate ligament: a review of the current literature[J]. Am J Sports Med, 2015, 43(12): 3077-3092.
6.	趙正呂, 李彥林, 王旭, 等. 后交叉韌帶重建移植物的特點與選擇[J]. 中國組織工程研究, 2022, 26(10): 1615-1619.
7.	Marumo K, Saito M, Yamagishi T, et al. The “ligamentization” process in human anterior cruciate ligament reconstruction with autogenous patellar and hamstring tendons: a biochemical study[J]. Am J Sports Med, 2005, 33(8): 1166-1173.
8.	Taketomi S. Editorial Commentary: Tunnel widening after anterior cruciate ligament reconstruction may increase laxity and complicate revision[J]. Arthroscopy, 2021, 37(8): 2564-2566.
9.	Kew ME, Cavanaugh JT, Elnemer WG, et al. Return to play after posterior cruciate ligament injuries[J]. Curr Rev Musculoskelet Med, 2022, 15(6): 606-615.
10.	Trasolini NA, Hatch GF, Wright D, et al. Posterior cruciate ligament reconstruction with internal brace augmentation reduces posterior tibial translation under cyclic loading[J]. Orthopedics, 2021, 44(4): 235-240.
11.	Levy BA, Piepenbrink M, Stuart MJ, et al. Posterior cruciate ligament reconstruction with independent suture tape reinforcement: an in vitro biomechanical full construct study[J/OL]. Orthop J Sports Med, 2021, 9(2): 2325967120981875. doi: 10.1177/2325967120981875.
12.	Bora M, Deshmukh P. Clinical and patient-reported functional outcome of semitendinosus autograft anterior cruciate ligament reconstruction with FiberTape^? Internal Brace^TM all-inside technique: a prospective study[J/OL]. Cureus, 2023, 15(9): e44700. doi: 10.7759/cureus.44700.
13.	Daniel AV, Wijdicks CA, Smith PA. Reduced incidence of revision anterior cruciate ligament reconstruction with internal brace augmentation[J/OL]. Orthop J Sports Med, 2023, 11(7): 23259671231188652. doi: 10.1177/23259671231178026.
14.	Maginnis C, Root C, Schiavo JH, et al. Analysis of graft types augmented with an internal brace for acl reconstruction: a systematic review[J]. Am J Sports Med, 2024, 52(1): 100-110.
15.	Mohan R, Kwaees TA, Thomas T, et al. Cohort study of short-term outcomes after ACL-reconstruction using autograft with internal brace reinforcement versus isolated autograft demonstrating no significant difference[J]. J Orthop, 2023, 43: 115-120.
16.	馬勇, 崔國慶, 敖英芳, 等. 后內束減張經脛骨骨道雙束重建后交叉韌帶[J]. 中國運動醫學雜志, 2012, 31(11): 957-961.
17.	Yu Y, Yang X, He C, et al. The Chinese knotting technique assists anatomical anterior cruciate ligament reconstruction for aggressive rehabilitation[J]. Medicine (Baltimore), 2022, 101(35): e30107. doi: 10.1097/MD.0000000000030107.
18.	Jin T, Li Y, Yang G, et al. Comparison of rapid rehabilitation after anterior cruciate ligament reconstruction with tensioning technique and traditional rehabilitation[J/OL]. Dis Markers, 2022, 2022: 6779207. doi: 10.1155/2022/6779207.
19.	余洋, 趙正呂, 謝冰, 等. 關節鏡下內減張技術輔助解剖單束重建后交叉韌帶結合快速康復治療后交叉韌帶斷裂的臨床療效[J]. 中華創傷雜志, 2023, 39(7): 593-602.
20.	Gao H, Sun L, Yu C, et al. Anterior cruciate ligament repair augmented with a polyethylene terephthalate band supports biomechanical stability during the early healing phase in a rabbit model[J]. Am J Sports Med, 2025, 53(6): 1347-1358.
21.	熊波涵, 盧曉君, 薛文強, 等. 內減張技術輔助前交叉韌帶重建對滇南小耳豬關節軟骨的保護作用[J]. 中國組織工程研究, 2024, 28(14): 2221-2226.
22.	Li Y, Liu JC, Wu J, et al. Biomechanical study of posterior cruciate ligament tibial arrest avulsion fracture fixation with triple tibial channel net sutures[J/OL]. Sci Rep, 2023, 13(1): 22980. doi: 10.1038/s41598-023-50479-5.
23.	熊波涵, 王國梁, 余洋, 等. 內減張技術輔助前交叉韌帶重建促進滇南小耳豬跟腱移植物韌帶化[J]. 中國組織工程研究, 2025, 29(4): 713-720.
24.	Wang M, Wang Y, Li H, et al. Single-bundle posterior cruciate ligament reconstruction using autologous hamstrings with mesh and suture tape augmentation with transtibial tubercle fixation[J/OL]. Arthrosc Tech, 2025, 14(12): 103911. doi: 10.1016/j.eats.2025.103911.
25.	Rodarte RRP, Guimar?es JAM, Duarte BT, et al. Analysis of the mechanical behavior of the posterior cruciate ligament in a porcine model[J/OL]. Acta Ortop Bras, 2022, 30(4): e236261. doi: 10.1590/1413-785220223004e236261.
26.	Xiong B, Yu Y, Xie B, et al. Clinical efficacy and kinematic analysis of Chinese knotting technique-assisted posterior cruciate ligament reconstruction: A retrospective analysis[J/OL]. Medicine (Baltimore), 2024, 103(17): e37840. doi: 10.1097/MD.0000000000037840.
27.	熊波涵. 滇南小耳豬自體跟腱與趾長伸肌腱移植重建前交叉韌帶的對比研究[D]. 昆明: 昆明醫科大學, 2024.
28.	Wu Y, Shao Y, Xie D, et al. Effect of secretory leucocyte protease inhibitor on early tendon-to-bone healing after anterior cruciate ligament reconstruction in a rat model[J]. Bone Joint Res, 2022, 11(7): 503-512.
29.	Machova Urdzikova L, Sedlacek R, Suchy T, et al. Human multipotent mesenchymal stem cells improve healing after collagenase tendon injury in the rat[J/OL]. Biomed Eng Online, 2014, 13: 42. doi: 10.1186/1475-925X-13-42.
30.	López De Padilla CM, Coenen MJ, et al. Picrosirius red staining: revisiting its application to the qualitative and quantitative assessment of collagen type Ⅰ and type Ⅲ in tendon[J]. J Histochem Cytochem, 2021, 69(10): 633-643.
31.	Yin B, Zhao P, Chen J, et al. Decreased lateral posterior tibial slope and medial tibial depth are underlying anatomic risk factors for posterior cruciate ligament injury: a case-control study[J/OL]. BMC Musculoskelet Disord, 2022, 23(1): 689. doi: 10.1186/s12891-022-05653-7.
32.	Xu C, Luo Y, Cai Z, et al. Magnesium ions attenuate tendon graft fibrosis during its ligamentization after ACL reconstruction through modulation of fibroblast to myofibroblast trans-differentiation by promoting PGE2 secretion[J]. Bioact Mater, 2025, 52: 474-491.
33.	Wen Y, Huang W, Li M, et al. Combining an internal tension relieving technique with anterior cruciate ligament reconstruction (ACLR) reduces graft failure rate and improves functional outcomes: a systematic review and meta-analysis[J/OL]. J Orthop Surg Res, 2025, 20(1): 19. doi: 10.1186/s13018-025-05451-6.
34.	Nguyen DM, Murawski CD, Fu FH, et al. Stress shielding of ligaments using nonabsorbable suture augmentation may influence the biology of ligament healing[J]. J Hand Surg (Am), 2022, 47(3): 275-278.
35.	Rupp MC, Winkler PW, Willinger L, et al. Editorial Commentary: Early outcomes of suture tape augmentation in quadriceps tendon autograft anterior cruciate ligament reconstruction are promising but require long-term proof[J]. Arthroscopy, 2025, 41(1): 106-109.
36.	Liu CH, Chiu CH, Chang SS, et al. Clinical and functional outcomes of isolated posterior cruciate ligament reconstruction in patients over the age of 40 years[J/OL]. BMC Musculoskelet Disord, 2022, 23(1): 210. doi: 10.1186/s12891-022-05151-w.
37.	Yao S, Fu BS, Yung PS. Graft healing after anterior cruciate ligament reconstruction (ACLR)[J]. Asia Pac J Sports Med Arthrosc Rehabil Technol, 2021, 25: 8-15.
38.	Jiang L, Lu J, Chen Y, et al. Mesenchymal stem cells: An efficient cell therapy for tendon repair (Review)[J/OL]. Int J Mol Med, 2023, 52(2): 70. doi: 10.3892/ijmm.2023.5273.
39.	Xu Z, Xu W, Zhang T, et al. Mechanisms of tendon-bone interface healing: biomechanics, cell mechanics, and tissue engineering approaches[J/OL]. J Orthop Surg Res, 2024, 19(1): 817. doi: 10.1186/s13018-024-05304-8.
40.	Shen S, Lin Y, Sun J, et al. A new tissue engineering strategy to promote tendon-bone healing: regulation of osteogenic and chondrogenic differentiation of tendon-derived stem cells[J]. Orthop Surg, 2024, 16(10): 2311-2325.

1. Yoon KH, Lee JH, Kim SG, et al. Effect of posterior tibial slopes on graft survival rates at 10 years after primary single-bundle posterior cruciate ligament reconstruction[J]. Am J Sports Med, 2023, 51(5): 1194-1201.
2. Brown JS, Mogianos K, Roemer FW, et al. Clinical, patient-reported, radiographic and magnetic resonance imaging findings 11 years after acute posterior cruciate ligament injury treated non-surgically[J/OL]. BMC Musculoskelet Disord, 2023, 24(1): 365. doi: 10.1186/s12891-023-06480-0.
3. Chandrasekaran S, Ma D, Scarvell JM, et al. A review of the anatomical, biomechanical and kinematic findings of posterior cruciate ligament injury with respect to non-operative management[J]. Knee, 2012, 19(6): 738-745.
4. Temperato J, Rucinski K, Cook IL, et al. Outcomes after anatomic double-bundle posterior cruciate ligament reconstructions using transtibial and tibial Inlay techniques[J]. J Knee Surg, 2024, 37(3): 183-192.
5. LaPrade CM, Civitarese DM, Rasmussen MT. Emerging updates on the posterior cruciate ligament: a review of the current literature[J]. Am J Sports Med, 2015, 43(12): 3077-3092.
6. 趙正呂, 李彥林, 王旭, 等. 后交叉韌帶重建移植物的特點與選擇[J]. 中國組織工程研究, 2022, 26(10): 1615-1619.
7. Marumo K, Saito M, Yamagishi T, et al. The “ligamentization” process in human anterior cruciate ligament reconstruction with autogenous patellar and hamstring tendons: a biochemical study[J]. Am J Sports Med, 2005, 33(8): 1166-1173.
8. Taketomi S. Editorial Commentary: Tunnel widening after anterior cruciate ligament reconstruction may increase laxity and complicate revision[J]. Arthroscopy, 2021, 37(8): 2564-2566.
9. Kew ME, Cavanaugh JT, Elnemer WG, et al. Return to play after posterior cruciate ligament injuries[J]. Curr Rev Musculoskelet Med, 2022, 15(6): 606-615.
10. Trasolini NA, Hatch GF, Wright D, et al. Posterior cruciate ligament reconstruction with internal brace augmentation reduces posterior tibial translation under cyclic loading[J]. Orthopedics, 2021, 44(4): 235-240.
11. Levy BA, Piepenbrink M, Stuart MJ, et al. Posterior cruciate ligament reconstruction with independent suture tape reinforcement: an in vitro biomechanical full construct study[J/OL]. Orthop J Sports Med, 2021, 9(2): 2325967120981875. doi: 10.1177/2325967120981875.
12. Bora M, Deshmukh P. Clinical and patient-reported functional outcome of semitendinosus autograft anterior cruciate ligament reconstruction with FiberTape^? Internal Brace^TM all-inside technique: a prospective study[J/OL]. Cureus, 2023, 15(9): e44700. doi: 10.7759/cureus.44700.
13. Daniel AV, Wijdicks CA, Smith PA. Reduced incidence of revision anterior cruciate ligament reconstruction with internal brace augmentation[J/OL]. Orthop J Sports Med, 2023, 11(7): 23259671231188652. doi: 10.1177/23259671231178026.
14. Maginnis C, Root C, Schiavo JH, et al. Analysis of graft types augmented with an internal brace for acl reconstruction: a systematic review[J]. Am J Sports Med, 2024, 52(1): 100-110.
15. Mohan R, Kwaees TA, Thomas T, et al. Cohort study of short-term outcomes after ACL-reconstruction using autograft with internal brace reinforcement versus isolated autograft demonstrating no significant difference[J]. J Orthop, 2023, 43: 115-120.
16. 馬勇, 崔國慶, 敖英芳, 等. 后內束減張經脛骨骨道雙束重建后交叉韌帶[J]. 中國運動醫學雜志, 2012, 31(11): 957-961.
17. Yu Y, Yang X, He C, et al. The Chinese knotting technique assists anatomical anterior cruciate ligament reconstruction for aggressive rehabilitation[J]. Medicine (Baltimore), 2022, 101(35): e30107. doi: 10.1097/MD.0000000000030107.
18. Jin T, Li Y, Yang G, et al. Comparison of rapid rehabilitation after anterior cruciate ligament reconstruction with tensioning technique and traditional rehabilitation[J/OL]. Dis Markers, 2022, 2022: 6779207. doi: 10.1155/2022/6779207.
19. 余洋, 趙正呂, 謝冰, 等. 關節鏡下內減張技術輔助解剖單束重建后交叉韌帶結合快速康復治療后交叉韌帶斷裂的臨床療效[J]. 中華創傷雜志, 2023, 39(7): 593-602.
20. Gao H, Sun L, Yu C, et al. Anterior cruciate ligament repair augmented with a polyethylene terephthalate band supports biomechanical stability during the early healing phase in a rabbit model[J]. Am J Sports Med, 2025, 53(6): 1347-1358.
21. 熊波涵, 盧曉君, 薛文強, 等. 內減張技術輔助前交叉韌帶重建對滇南小耳豬關節軟骨的保護作用[J]. 中國組織工程研究, 2024, 28(14): 2221-2226.
22. Li Y, Liu JC, Wu J, et al. Biomechanical study of posterior cruciate ligament tibial arrest avulsion fracture fixation with triple tibial channel net sutures[J/OL]. Sci Rep, 2023, 13(1): 22980. doi: 10.1038/s41598-023-50479-5.
23. 熊波涵, 王國梁, 余洋, 等. 內減張技術輔助前交叉韌帶重建促進滇南小耳豬跟腱移植物韌帶化[J]. 中國組織工程研究, 2025, 29(4): 713-720.
24. Wang M, Wang Y, Li H, et al. Single-bundle posterior cruciate ligament reconstruction using autologous hamstrings with mesh and suture tape augmentation with transtibial tubercle fixation[J/OL]. Arthrosc Tech, 2025, 14(12): 103911. doi: 10.1016/j.eats.2025.103911.
25. Rodarte RRP, Guimar?es JAM, Duarte BT, et al. Analysis of the mechanical behavior of the posterior cruciate ligament in a porcine model[J/OL]. Acta Ortop Bras, 2022, 30(4): e236261. doi: 10.1590/1413-785220223004e236261.
26. Xiong B, Yu Y, Xie B, et al. Clinical efficacy and kinematic analysis of Chinese knotting technique-assisted posterior cruciate ligament reconstruction: A retrospective analysis[J/OL]. Medicine (Baltimore), 2024, 103(17): e37840. doi: 10.1097/MD.0000000000037840.
27. 熊波涵. 滇南小耳豬自體跟腱與趾長伸肌腱移植重建前交叉韌帶的對比研究[D]. 昆明: 昆明醫科大學, 2024.
28. Wu Y, Shao Y, Xie D, et al. Effect of secretory leucocyte protease inhibitor on early tendon-to-bone healing after anterior cruciate ligament reconstruction in a rat model[J]. Bone Joint Res, 2022, 11(7): 503-512.
29. Machova Urdzikova L, Sedlacek R, Suchy T, et al. Human multipotent mesenchymal stem cells improve healing after collagenase tendon injury in the rat[J/OL]. Biomed Eng Online, 2014, 13: 42. doi: 10.1186/1475-925X-13-42.
30. López De Padilla CM, Coenen MJ, et al. Picrosirius red staining: revisiting its application to the qualitative and quantitative assessment of collagen type Ⅰ and type Ⅲ in tendon[J]. J Histochem Cytochem, 2021, 69(10): 633-643.
31. Yin B, Zhao P, Chen J, et al. Decreased lateral posterior tibial slope and medial tibial depth are underlying anatomic risk factors for posterior cruciate ligament injury: a case-control study[J/OL]. BMC Musculoskelet Disord, 2022, 23(1): 689. doi: 10.1186/s12891-022-05653-7.
32. Xu C, Luo Y, Cai Z, et al. Magnesium ions attenuate tendon graft fibrosis during its ligamentization after ACL reconstruction through modulation of fibroblast to myofibroblast trans-differentiation by promoting PGE2 secretion[J]. Bioact Mater, 2025, 52: 474-491.
33. Wen Y, Huang W, Li M, et al. Combining an internal tension relieving technique with anterior cruciate ligament reconstruction (ACLR) reduces graft failure rate and improves functional outcomes: a systematic review and meta-analysis[J/OL]. J Orthop Surg Res, 2025, 20(1): 19. doi: 10.1186/s13018-025-05451-6.
34. Nguyen DM, Murawski CD, Fu FH, et al. Stress shielding of ligaments using nonabsorbable suture augmentation may influence the biology of ligament healing[J]. J Hand Surg (Am), 2022, 47(3): 275-278.
35. Rupp MC, Winkler PW, Willinger L, et al. Editorial Commentary: Early outcomes of suture tape augmentation in quadriceps tendon autograft anterior cruciate ligament reconstruction are promising but require long-term proof[J]. Arthroscopy, 2025, 41(1): 106-109.
36. Liu CH, Chiu CH, Chang SS, et al. Clinical and functional outcomes of isolated posterior cruciate ligament reconstruction in patients over the age of 40 years[J/OL]. BMC Musculoskelet Disord, 2022, 23(1): 210. doi: 10.1186/s12891-022-05151-w.
37. Yao S, Fu BS, Yung PS. Graft healing after anterior cruciate ligament reconstruction (ACLR)[J]. Asia Pac J Sports Med Arthrosc Rehabil Technol, 2021, 25: 8-15.
38. Jiang L, Lu J, Chen Y, et al. Mesenchymal stem cells: An efficient cell therapy for tendon repair (Review)[J/OL]. Int J Mol Med, 2023, 52(2): 70. doi: 10.3892/ijmm.2023.5273.
39. Xu Z, Xu W, Zhang T, et al. Mechanisms of tendon-bone interface healing: biomechanics, cell mechanics, and tissue engineering approaches[J/OL]. J Orthop Surg Res, 2024, 19(1): 817. doi: 10.1186/s13018-024-05304-8.
40. Shen S, Lin Y, Sun J, et al. A new tissue engineering strategy to promote tendon-bone healing: regulation of osteogenic and chondrogenic differentiation of tendon-derived stem cells[J]. Orthop Surg, 2024, 16(10): 2311-2325.

Chinese Journal of Reparative and Reconstructive Surgery

In vivo study of posterior cruciate ligament reconstruction augmented by a novel elastic internal tension-relieving augmentation tape in Diannan miniature pigs

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