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

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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.	陈康, 朱伟民, 陆伟, 等. 关节镜下前交叉韧带单束和双束个体化解剖重建临床疗效对比研究. 中华骨与关节外科杂志, 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, 吕伟, 时剑辉, 等. 关节镜下自体骨膜包裹 6 股腘绳肌腱移植前交叉韧带重建的中期疗效评价. 中国现代药应用, 2016, 10(17): 114-116.
4.	区永亮, 黄华扬, 李凭跃, 等. 骨道内移植物更合理分布的单隧道单束前交叉韧带重建的中期疗效观察. 中国骨与关节外科, 2014, 7(1): 27-30.
5.	程鹏飞, 柴益民. 界面螺钉在前十字韧带修复中的应用进展. 中华骨科杂志, 2016, 36(12): 810-816.
6.	周平, 赵其纯, 尚希福, 等. rhBMP-2 联合 rhVEGF165 对兔前交叉韧带重建后腱-骨愈合的影响. 安徽医科大学学报, 2013, 48 (5): 458-462.
7.	王辉, 王万明. 前交叉韧带重建术后腱骨愈合影响因素研究进展. 实用医学杂志, 2014, 30(14): 2343-2345.
8.	陈平, 曲戎梅, 韩忠宇, 等. 人脂肪源干细胞促进前交叉韧带重建后腱骨界面愈合的实验研究. 中国临床解剖学杂志, 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, 刘玉杰, 李志超, 等. 体外冲击波促进兔 ACL 重建后腱骨愈合的实验研究. 中国矫形外科杂志, 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.	季锋, 许华. 富血小板血浆用于软组织炎症及损伤治疗的研究进展. 中国疼痛医学杂志, 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, 刘玉杰. 交叉韧带重建术后腱骨愈合相关研究进展. 军医进修学院学报, 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. 陈康, 朱伟民, 陆伟, 等. 关节镜下前交叉韧带单束和双束个体化解剖重建临床疗效对比研究. 中华骨与关节外科杂志, 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, 吕伟, 时剑辉, 等. 关节镜下自体骨膜包裹 6 股腘绳肌腱移植前交叉韧带重建的中期疗效评价. 中国现代药应用, 2016, 10(17): 114-116.
4. 区永亮, 黄华扬, 李凭跃, 等. 骨道内移植物更合理分布的单隧道单束前交叉韧带重建的中期疗效观察. 中国骨与关节外科, 2014, 7(1): 27-30.
5. 程鹏飞, 柴益民. 界面螺钉在前十字韧带修复中的应用进展. 中华骨科杂志, 2016, 36(12): 810-816.
6. 周平, 赵其纯, 尚希福, 等. rhBMP-2 联合 rhVEGF165 对兔前交叉韧带重建后腱-骨愈合的影响. 安徽医科大学学报, 2013, 48 (5): 458-462.
7. 王辉, 王万明. 前交叉韧带重建术后腱骨愈合影响因素研究进展. 实用医学杂志, 2014, 30(14): 2343-2345.
8. 陈平, 曲戎梅, 韩忠宇, 等. 人脂肪源干细胞促进前交叉韧带重建后腱骨界面愈合的实验研究. 中国临床解剖学杂志, 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, 刘玉杰, 李志超, 等. 体外冲击波促进兔 ACL 重建后腱骨愈合的实验研究. 中国矫形外科杂志, 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. 季锋, 许华. 富血小板血浆用于软组织炎症及损伤治疗的研究进展. 中国疼痛医学杂志, 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, 刘玉杰. 交叉韧带重建术后腱骨愈合相关研究进展. 军医进修学院学报, 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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