Idealized Anterior Cruciate Ligament Autograft Surgery and Post Traumatic Osteoarthritis
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2015-05-01
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Abstract
Traumatic joint injuries resulting in the rupture of the anterior cruciate ligament (ACL) are common in pivoting sports such as hockey, football and soccer. To prevent further joint injury, the current gold standard of treatment calls for the timely surgical reconstruction of the ruptured ACL to return stability to the injured joint. For reasons that are currently unknown, a significant number of surgically treated patients will develop post-traumatic osteoarthritis (PTOA). It is possible that the surgery itself may be a traumatic joint injury that results in the development of PTOA. Two separate animal models were designed to study both the biological and kinematic mechanisms that may contribute to the development of PTOA after ACL reconstructive surgery. An ovine model of idealized ACL reconstruction (ACL-R) was used to investigate alterations to the joint kinematics and biological responses within key joint tissues after surgery. A rabbit drill injury model was used to solely investigate the early biological changes within the knee, by limiting the impact on biomechanical aspects as much as possible. Within ACL-R joints, PTOA-like changes occur early and appear to result from predominantly biological mechanisms. Despite maintaining joint kinematics that were comparable to those of control animals, it was found that ACL-R surgery results in gross morphological PTOA-like changes at 20 weeks post-surgery. Within ACL-R joints, the initial inflammatory response appears to be early, returning to levels comparable to those of control animals by 20 weeks post- surgery, suggesting that an anti-inflammatory treatment administered early after injury may prevent PTOA-like changes from occurring. Mitigating the surgery associated inflammation in the rabbit drill injury model with a single post-surgical intraarticular (IA) injection of dexamethasone (DEX) significantly reduced PTOA- like changes at 9 weeks post-surgery. The single IA DEX injection significantly limited the inflammatory response and activation of MMP 3 within the synovium and infrapatellar fat pad at 48 hours post-surgery, resulting in cartilage that is less susceptible to structural damage due to preserved proteoglycan content in the cartilage at 9 weeks post-surgery.
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Medicine and Surgery
Citation
Heard, B. J. (2015). Idealized Anterior Cruciate Ligament Autograft Surgery and Post Traumatic Osteoarthritis (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/26414