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A hybrid graft of silk-based artificial ligament and TCP/PEEK anchorage for ACL reconstruction
A novel concept of silk based artificial ligament with TCP/PEEK anchor for ACL reconstruction is proposed and developed in this study. A series of in vitro and in vivo experiments were performed to evaluate and verify the concept from biomechanical and biological point of view.
There are a number of choices available to the orthopaedic surgeon for ACL reconstruction. Among all the choices, the patellar tendon bone-tendon-bone (BTB) graft has been the "gold standard" graft choice for ACL reconstructions. Except donor site morbidity, it has consistently demonstrated excellent surgical outcomes with a 90-95% success rate in terms of returning to pre-injury level of sports.
The idea of this study is to find an alternative solution for ACL regeneration, which will have similar properties and functions with patellar BTB graft, and will avoid donor site morbidity. Thus, a novel concept of silk based artificial ligament with TCP/PEEK anchor for ACL reconstruction (shown in figure) is proposed and developed in this study.
Sericin extracted silk fibers, because of advantageous biological properties and robust biomechanical strength, were adopted to fabricate the main part of artificial ACL. The anchor contains tricalcium phosphate (TCP) part, and polyether ether ketone (PEEK) part. The TCP part, because of perfect osteoinductive bioactivities, was used to provide biological attachment of artificial ligament to native bone, and result in a long-term stability. However, the porous TCP is very fragile and cannot 'hold' the ligament firmly in the early stage. A PEEK anchor was used in this study to provide adequate mechanical fixation in the beginning, and result in a good initial stability. A detailed _in vitro_ biomechanical tests were performed to evaluate and optimize the design. The optimized geometry of artificial ACL with similar mechanical properties of human ACL’s was found. An _in vivo_ experiment has been done in porcines. The ACL reconstructions were performed on left knee with artificial ACL fabricated in this study. Further evaluation and improvement of this artificial ACL will be done, and finally, it will provide a promising alternative choice for ACL reconstruction in the near future.
There are a number of choices available to the orthopaedic surgeon for ACL reconstruction. Among all the choices, the patellar tendon bone-tendon-bone (BTB) graft has been the "gold standard" graft choice for ACL reconstructions. Except donor site morbidity, it has consistently demonstrated excellent surgical outcomes with a 90-95% success rate in terms of returning to pre-injury level of sports.
The idea of this study is to find an alternative solution for ACL regeneration, which will have similar properties and functions with patellar BTB graft, and will avoid donor site morbidity. Thus, a novel concept of silk based artificial ligament with TCP/PEEK anchor for ACL reconstruction (shown in figure) is proposed and developed in this study.
Sericin extracted silk fibers, because of advantageous biological properties and robust biomechanical strength, were adopted to fabricate the main part of artificial ACL. The anchor contains tricalcium phosphate (TCP) part, and polyether ether ketone (PEEK) part. The TCP part, because of perfect osteoinductive bioactivities, was used to provide biological attachment of artificial ligament to native bone, and result in a long-term stability. However, the porous TCP is very fragile and cannot 'hold' the ligament firmly in the early stage. A PEEK anchor was used in this study to provide adequate mechanical fixation in the beginning, and result in a good initial stability. A detailed _in vitro_ biomechanical tests were performed to evaluate and optimize the design. The optimized geometry of artificial ACL with similar mechanical properties of human ACL’s was found. An _in vivo_ experiment has been done in porcines. The ACL reconstructions were performed on left knee with artificial ACL fabricated in this study. Further evaluation and improvement of this artificial ACL will be done, and finally, it will provide a promising alternative choice for ACL reconstruction in the near future.
The final goal of this study is, after further improvement of this developed artificial ligament, it will provide a promising alternative choice for ACL reconstruction in the near future.
There are four concrete goals for this project:
Goal 1: To develop and fabricate a silk based scaffold for ACL reconstruction, which will have similar mechanical properties with human ACL’s.
Goal 2: To develop and fabricate a TCP/PEEK based anchor for fixing silk scaffold into bone tunnel. To develop the combination methods of silk scaffold and TCP/PEEK anchor.
Goal 3: To develop possible surgical procedures and insertion tools, and to optimize the design of the scaffold, based on in vitro biomechanical tests and pilot animal study.
Goal 4: To test this novel ACL scaffold with animal experiment. To make systematic and detailed evaluation of this scaffold. To make further improvement of this scaffold.
The final goal of this study is, after further improvement of this developed artificial ligament, it will provide a promising alternative choice for ACL reconstruction in the near future.
There are four concrete goals for this project:
Goal 1: To develop and fabricate a silk based scaffold for ACL reconstruction, which will have similar mechanical properties with human ACL’s.
Goal 2: To develop and fabricate a TCP/PEEK based anchor for fixing silk scaffold into bone tunnel. To develop the combination methods of silk scaffold and TCP/PEEK anchor.
Goal 3: To develop possible surgical procedures and insertion tools, and to optimize the design of the scaffold, based on in vitro biomechanical tests and pilot animal study.
Goal 4: To test this novel ACL scaffold with animal experiment. To make systematic and detailed evaluation of this scaffold. To make further improvement of this scaffold.
Contact:
Dr. Xiang Li, xiang.li@zurimed.com
ETH Zürich / Professorship Jess Snedeker
More information can be found at:
http://www.zurimed.com/