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First published on March 30, 2007, doi:10.1177/0363546507300057
This version was published on June 1, 2007
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The American Journal of Sports Medicine 35:962-971 (2007)
© 2007 American Orthopaedic Society for Sports Medicine

An Analysis of Soft Tissue Allograft Anterior Cruciate Ligament Reconstruction in a Rabbit Model

A Short-Term Study of the Use of Mesenchymal Stem Cells to Enhance Tendon Osteointegration

Michael Y. H. Soon, MBBS, MRCSEd, MMed (Orth)*, Afizah Hassan{dagger}, James H. P. Hui, MBBS, FRCS, FAMS{dagger},{ddagger}, James C. H. Goh, PhD{dagger} and E. H. Lee, MD, FRCS(Edin), FAMS{dagger}

From the * Department of Orthopaedic Surgery, Alexandra Hospital, Singapore, and the {dagger} Department of Orthopaedic Surgery, National University Hospital, National University of Singapore, Singapore

{ddagger} Address correspondence to James H. P. Hui, MBBS, FRCS, FAMS, National University Hospital, Level 3, 5 Lower Kent Ridge Road, Singapore 119074 (e-mail: doshuij{at}nus.edu.sg).

Background: Soft tissue allografts are essential for revision and multiple ligament surgeries in the knee, where donor-site morbidity is an issue. However, the use of allografts is associated with a higher failure rate of osteointegration. Mesenchymal stem cells (MSCs) are investigated as potential agents to enhance bone tunnel and tendon healing.

Purpose: This study was conducted to analyze the effect of coating allografts with MSCs on the quality and rate of osteointe-gration at the allograft tendon and bone interface, and the biomechanical properties of these enhanced anterior cruciate ligament (ACL) grafts compared with controls.

Study Design: Descriptive laboratory study.

Methods: Bilateral ACL reconstructions using Achilles tendon allografts were performed in 36 rabbits. On 1 limb, the graft was coated with autogenous MSCs in a fibrin glue carrier, while the contralateral limb served as a control with no MSCs. The reconstructions were assessed histologically and biomechanically at 2, 4, and 8 weeks.

Results: At 8 weeks, histologic analysis of the controls revealed the development of mature scar tissue resembling Sharpey fibers spanning the tendon-bone interface. In contrast, the MSC-enhanced reconstructions showed a mature zone of fibrocartilage blending from bone to the allograft, strongly resembling a normal ACL insertion. On biomechanical testing, the MSC-enhanced grafts had significantly higher load-to-failure rates than controls. However, the stiffness and Young’s modulus were lower in the treatment group.

Conclusions: The application of MSCs at the allograft tendon-bone interface during ACL reconstruction results in the development of an intervening zone of fibrocartilage. The use of MSCs to enhance allograft osteointegration is a novel method offering the potential of more physiologic and earlier healing, although further investigation must be conducted to improve the biomechanical strength.

Clinical Relevance: Mesenchymal stem cells can improve the biologic properties of soft tissue allograft healing. Combined with the decrease in donor-site morbidity, allografts are a viable choice for the sports medicine surgeon.

Key Words: mesenchymal stem cells • allograft • ACL reconstruction






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