Effect of Demineralized Bone Matrix, Bone Marrow Mesenchymal Stromal Cells, and Platelet-Rich Plasma on Bone Tunnel Healing After Anterior Cruciate Ligament Reconstruction: A Comparative Micro-Computed Tomography Study in a Tendon Allograft Sheep Model.

BACKGROUND

The effect of demineralized bone matrix (DBM), bone marrow-derived mesenchymal stromal cells (BMSCs), and platelet-rich plasma (PRP) on bone tunnel healing in anterior cruciate ligament reconstruction (ACLR) has not been comparatively assessed.

HYPOTHESIS

These orthobiologics would reduce tunnel widening, and the effects on tunnel diameter would be correlated with tunnel wall sclerosis.

STUDY DESIGN

Controlled laboratory study.

METHODS

A total of 20 sheep underwent unilateral ACLR using tendon allograft and outside-in interference screw fixation. The animals were randomized into 4 groups (n = 5 per group): Group 1 received 4mL of DBM paste, group 2 received 10 million BMSCs in fibrin sealant, group 3 received 12 mL of activated leukocyte-poor platelet-rich plasma, and group 4 (control) received no treatment. The sheep were euthanized after 12 weeks, and micro-computed tomography scans were performed. The femoral and tibial tunnels were divided into thirds (aperture, midportion, and exit), and the trabecular bone structure, bone mineral density (BMD), and tunnel diameter were measured. Tunnel sclerosis was defined by a higher bone volume in a 250-µm volume of interest compared with a 4-mm volume of interest surrounding the tunnel.

RESULTS

Compared with the controls, the DBM group had a significantly higher bone volume fraction (bone volume/total volume [BV/TV]) (52.7% vs 31.8%;

CONCLUSION

Only DBM led to a significant increase in bone volume, which was seen in the femoral tunnel aperture and midportion. No treatment significantly reduced bone tunnel widening. Tunnel sclerosis in the femoral tunnel midportion was correlated significantly with tunnel widening.

CLINICAL RELEVANCE

DBM might have potential clinical use to enhance healing in the femoral tunnel after ACLR.

Informations de copyright

© The Author(s) 2021.

Déclaration de conflit d'intérêts

One or more of the authors has declared the following potential conflict of interest or source of funding: The PRP aspects of the study were funded by a research donation from the Biotechnology Institute and Sovereign Medical Ltd, received by A.T.H., N.H., and G.B. A.T.H. received funding from a Royal Free Charity Project Grant. S.R. has received research support from OREF, Toulmin Foundation, and Angiocrine Biosciences; consulting fees from Advance Medical and Flexion Therapeutic; nonconsulting fees from Smith & Nephew; honoraria from Fidia Pharma; and royalties from Zimmer Biomet; has stock/stock options in Ortho RTI; and is a paid associate editor for The American Journal of Sports Medicine. F.H. has received royalties and consulting/speaking fees from Smith & Nephew, Stryker, MatOrtho, and Corin. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.