ACL Reconstruction or Repair with Suture Augmentation Allows Early Rehabilitation: Collagen Co-braid Sutures May Improve Biological Integration.

IF 4.4 1区 医学 Q1 ORTHOPEDICS
Maximilian Michael Mueller, Sebastian Rilk, Fidelius von Rehlingen-Prinz, Gregory S DiFelice
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Abstract

Suture augmentation in anterior cruciate ligament (ACL) reconstruction has the potential to combine improved long-term stability and high functional outcomes with accelerated rehabilitation, enhancing the biomechanical properties of the graft, and reducing the risk of graft failure, particularly during the critical early phases of rehabilitation. Suture augmentation, applied to either ACL reconstruction or to primary repair, introduces a "safety belt" synergistically sharing loads acting on the graft or repair. Several biomechanical studies utilizing different autologous grafts for ACL reconstruction, as well as studies on ACL repair, have demonstrated that suture augmentation enhances strength and prevent elongation of the graft or ligament. Suture augmentation can protect the graft-brace integrity under loads of 350N, and reduces cyclic displacement by up to 31% compared to conventional ACL reconstruction using bone-patellar tendon-bone allograft. Perhaps, as above, the greatest advantage of suture augmentation is allowing early rehabilitation. Assuming successful ligamentization of the graft, the graft itself should stabilize the knee joint, thereby diminishing the long-term benefit of suture augmentation. In practice, we utilize suture augmentation to support immediate postoperative mobilization and weight-bearing, enabling safe and early rehabilitation, while minimizing the risk of failure. With regard to the oft-mentioned risk of over-constraint, this is not supported by biomechanical studies or clinical experience. Recent introduction of collagen co-braid sutures for suture augmentation offer two distinct advantages: first, potentially improved biocompatibility, and second, gradual biological integration allowing suture degradation over time.

前交叉韧带重建或修复缝合增量可实现早期康复:胶原共束缝合线可改善生物整合。
前交叉韧带(ACL)重建中的缝合增量术有可能将改善长期稳定性、提高功能效果与加速康复相结合,增强移植物的生物力学特性,降低移植物失败的风险,尤其是在关键的早期康复阶段。缝合增强技术可用于前交叉韧带重建或初次修复,可引入一条 "安全带",协同分担作用于移植物或修复处的负荷。多项利用不同自体移植物进行前交叉韧带重建的生物力学研究以及有关前交叉韧带修复的研究都表明,缝合增量可增强移植物或韧带的强度并防止其伸长。与使用骨-髌腱-骨同种异体移植物的传统前交叉韧带重建术相比,缝合增量术可在 350N 负荷下保护移植物-韧带的完整性,并可将周期性位移减少 31%。也许如上所述,缝合增量的最大优势在于允许早期康复。假定移植物成功结扎,移植物本身应能稳定膝关节,从而减少缝合增量的长期益处。在实践中,我们利用缝合增量术支持术后立即活动和负重,实现安全和早期康复,同时最大限度地降低失败风险。至于人们经常提到的过度约束风险,生物力学研究和临床经验都不支持这种说法。最近推出的用于缝合增量的胶原蛋白共同辫状缝合线具有两个明显的优势:第一,潜在的生物相容性得到改善;第二,随着时间的推移,缝合线会逐渐降解,从而实现生物融合。
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来源期刊
CiteScore
9.30
自引率
17.00%
发文量
555
审稿时长
58 days
期刊介绍: Nowhere is minimally invasive surgery explained better than in Arthroscopy, the leading peer-reviewed journal in the field. Every issue enables you to put into perspective the usefulness of the various emerging arthroscopic techniques. The advantages and disadvantages of these methods -- along with their applications in various situations -- are discussed in relation to their efficiency, efficacy and cost benefit. As a special incentive, paid subscribers also receive access to the journal expanded website.
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