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Augmentation of Anterior Cruciate Ligament Reconstruction Graft Healing using Demineralised Bone Matrix, Mesenchymal Stromal Cells and Platelet-Rich Plasma

Hexter, Adam T; (2022) Augmentation of Anterior Cruciate Ligament Reconstruction Graft Healing using Demineralised Bone Matrix, Mesenchymal Stromal Cells and Platelet-Rich Plasma. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

Successful anterior cruciate ligament reconstruction (ACLR) relies on graft healing, which consists of ligamentisation and tendon-bone healing. Orthopaedic biologics (orthobiologics) can potentially enhance ACLR and the effect of demineralised bone matrix (DBM), bone marrow mesenchymal stromal cells (BMSCs) and platelet-rich plasma (PRP) have been investigated in small animal models with some positive results. These treatments have not been investigated in a translational large animal model that utilises graft fixation techniques similar to those used in humans. The aim of this thesis was to investigate the hypothesis that DBM, BMSCs and PRP will each improve graft healing in an ovine model of ACLR. The hypothesis was initially investigated by developing an ovine model for ACLR using demineralised bone. The tensile strength of ovine demineralised cortical bone (DCB) strips from femur and tibia, taken from different aged donors, was investigated, and followed by measuring the strength of DCB in a cadaveric model of ovine ACLR. DCB derived from young tibia had the greatest strength but owing to inferior tensile properties when compared with ACLR using a tendon graft, was not used in an ovine model. Instead, allogenic DBM paste was used in the in vivo ovine model to augment graft healing with an allogenic superficial digital flexor tendon. After 12 weeks in vivo ACLR augmented with either DBM paste, allogenic BMSCs and autologous PRP were compared with non-augmented controls. DBM was associated with significantly improved tendon-bone healing in the femoral tunnel, as evidenced by increase bone formation on µCT and a morphologically superior insertion on histology. No significant differences were seen with BMSCs and PRP compared with the control, except in the macroscopic appearance of the intraarticular graft at autopsy. It was concluded that, although the effect was limited to healing in the femoral tunnel, only DBM treatment significantly improved graft healing.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Augmentation of Anterior Cruciate Ligament Reconstruction Graft Healing using Demineralised Bone Matrix, Mesenchymal Stromal Cells and Platelet-Rich Plasma
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Copyright © The Author 2022. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
UCL classification: UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Ortho and MSK Science
UCL
URI: https://discovery.ucl.ac.uk/id/eprint/10144837
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