7Which Graft Leo P – Hamstrings Merv C – Patella tendon Americans AllograftKoreans Quads TendonFooty show says Synthetic Graft????????
8Media LARS option: Fisher aims for fast return David Rodan back on training track two weeks after knee surgeryMiracle op to melt down surgeons' phonesRodan surgery to become the normCovell's career on knife's edgeMoltzen plays it safe
9WHICH GRAFT WOULD YOU HAVE? AutograftAllograftSynthetic
30History Artificial Grafts 1918 silk sutures – failed 3 monthsFirst graft Proplast made of polytetrafluoroethylene (PTFE)Results with this system yielded an average time to breakage of just over 1 year.
31Classification of Synthetic Grafts Ligament Augmentation Devices(polypropylene, polyester)initial strength until revascularisation,stress shielding of autogenous tissue and prevented adequate strength.Total Prostheticspermanent replacement with no revascularisation.Excellent short-term results, long-term efficacy results were poor due to wear and ensuing rupture of the prosthesis.
32CARBON FIBRE PROSTHETICS Began late 70scarbon wear particlescoated with collagen and absorbable polymersGood Early resultslonger term - unacceptable stretching and complete rupture as major complications.
33DACRON tightly woven polyester strips. Early results were good however by 4 years about 50% had failed due to stretching of the graft.
34LEEDS-KEIO ARTIFICIAL LIGAMENT a polyester meshintended as a scaffold for soft tissue ingrowthGood early results.a large number of long-term graft ruptures despite excellent early results
35KENNEDY LIGAMENT AUGMENTATION DEVICE (LAD) – 1980 Ligament Augmentation Device (LAD) in 1980.Idea - protect the autogenous tissue graft earlyProblem - Stress shielding resulted.Later - effusion and synovitis.
36LIGAMENT ADVANCED REINFORCEMENT SYSTEM (LARS) ARTIFICIAL LIGAMENT polyethylene terephthalate (PET).intra-articular segmentTwistPET Encourage ingrowthwear resistance of 22 million of cycles = 10 years of straining use.
37Literature on LARS One case synovitis reported short term. Short term results in a handful of papers are good.Fast recovery and return to sport/activity.risk of rupture remain and must be addressed through long-term follow-up studies.
41Longest Follow-up LARS ACL Reconstruction Using Artificial Ligament: Five Years Follow UpS.I.O.T. 2007; 33(suppl.1) : G. Cerulli et at patients older than 40 - Lars® artificial ligaments at a five-years follow-up with very good results.
42Dr Nicolas Duval using LARS since 1993 Best results are in early ACL repair augmented by LARSIn older patients (more than 50) I use the LARS in any condition because of the low morbidity and easy rehab.
43Why is rehab “Faster” No Donor site Morbidity Graft not going to weaken early.
44LARS IndicationsSportsmen who have acute injury require fast recovery for particular target time AND prepared to take the risks possible long term failure.Older patients with less demands however functional instability and want less involved rehab.
46The future – Scaffolds and Growth Factors with Repair. tissue engineering techniquesGrafts that regenerate a mechanically robust and natural ACLcell-specific growth factors that influencing the maturation and healing response of ligament tissue will also be available.
76CARTILAGE LESIONSBottom Line – at present no technique has clinically shown to be superior than another.
77Emerging Options for Treatment Articular Cartilage Injury in the Athlete Very controversial!!!Treatment articular cartilage injuries is a therapeutic challenge.Cartilage not good at repairing due to avascular surroundings and unique matrix organisation
85Cell based repair techniques MACICartilage taken – grown in lab and then reinserted.
86Stem Cells“The Regenexx™ procedure as an alternative to traditional knee surgery is non-invasive, resulting in faster healing and less recovery time. Read more about our knee surgery alternative, or fill out our form below to find out right now if you are a candidate.”Banking Stem Cells
87Mesenchymal Stem Cells MSC found in bone marrow, skeletal muscle, synovial membrane, adipose tissue and umbilical cord blood.
88Problems MSC Selection Cell Delivery to site 3D Scaffold ideal (synthetic or polymer)Synthetic issues retention and degradationBiological – disease transmission, immunological reaction, precision.
89Tissue Engineered Construct - TEC Synovial tissue cultured with ascorbic acid – sheet collagen produced3D tissue is produced with cartilage cells interwoven in extracellular matrixCulture in medium with growth factors known to stimulate cartilage and type II collagenMore Fibrous than HyalineTesting with different GF and gene modification with viruses.
95Meniscus Replacement Partial menisectomy Replacement with a Collagen Meniscal Implant (CMI) is an option.CMI is approved in Europe for medial meniscus.CMI is a collagen-based implant that acts as a scaffold for tissue infiltration.They are like a sponge made from bovine achilles tendons, GAGs are added, they are deg\hydrated and orietated in a mold then chemically crosslinked with formaldehyde.
96Meniscus replacement - Allograft Problems are availability, logistics, costs, and varying results
97Future - Stem Cell Therapy Goats – MSC injected into knees that where OA due to ACL deficiency,A new meniscus like regenerative type tissue formed
98CONCLUSIONLots of exciting advances happening in sports knee injuries.Many advances are still some way off clinical application.Balance of biology, synthetics, growth factors and gene manipulation.Watch this space!